Published: 1 April 2020, 14:00 | By: Ute Schönfelder
Mathias Pletz is director of the Institute for Infectious Medicine and Hospital Hygiene at the University Hospital Jena. In this interview he explains what measures are being taken to treat seriously ill COVID-19 patients, whether masks protect against infection with the coronavirus and how countries like South Korea and Taiwan have managed to keep the spread of the virus low even without a complete shutdown.
We currently (on March 30) have 119 confirmed COVID-19 cases in Jena. How many people are currently being treated in the UKJ?
In total there are six patients, four of them in a normal ward, two in intensive care. Currently there is no patient with a severe clinical course.
How is the UKJ prepared for an increasing number of corona patients? What measures have been taken?
We have prepared for a growing number of corona patients. An intensive care unit will be reserved for the treatment of corona patients alone. We have set up a complete hospital ward for triage of suspected cases, which is separated from the other wards and areas. There is a separate corona ward for confirmed cases. The team of critical care experts lead by Prof. Bauer is responsible for training doctors and nursing staff - so I think we are well prepared.
How many critical care beds for corona patients are available at the UKJ and in the state of Thuringia?
Hospitals throughout Germany report their capacities of intensive care beds to a central register. The Divi Register currently lists 281 intensive care beds in Thuringia that can be mobilized within 24 hours for COVID-19 patients. This puts Thuringia in a very good position at the moment.
How many tests for coronavirus infections can you carry out per day?
At the moment we test 200-300 samples per day, but we could test up to 1000 samples/day. Throughout Thuringia, 9000 tests are being carried out weekly. In addition to the PCR tests that are currently being used to provide information on whether an acute infection is evident, an antibody test is being established by Prof. Löffler's team (Institute for Medical Microbiology). This will indicate whether a person has formed antibodies against the virus and thus acquired at least temporary immunity. Such a test would be a great gain in terms of certainty to determine who is susceptible to the infection and who might already be immune.
When will the antibody test be available?
I expect we can start in two weeks.
To what extent has routine business at UKJ been scaled down?
Routine work has been severely limited. This is important because we still don't know how many patients with COVID-19 disease we will have to treat in the next few weeks. For example, the number of scheduled surgeries has been significantly reduced. However, this only works to a certain level: Emergency operations have to be done immediately and they will continue to be performed. For instance, patients with a tumor cannot just wait until the corona pandemic has passed. The decision on whether surgery should be performed at this point in time requires careful consideration and each case is weighed up individually.
How many inpatients do you expect will be treated in the near future?
This is really difficult to say and I cannot give you a concrete number. There are of course models that calculate and extrapolate the spread of the virus. At the University Hospital, Prof. Scherag's team (Institute of Medical Statistics, Informatics and Data Sciences) is working hard on such predictions. But in the end, we simply do not yet know how the social distancing measures will affect the further course of the pandemic. But there will very likely be an increase in the number of serious cases of illness in our country.
Are you afraid of infecting yourself? And does that affect your work as a doctor and scientist?
No, I am not afraid. But I am aware of the risk of infection, of course. The situation affects my work quite considerably. My team and I work practically around the clock and answer questions from employees, politicians, authorities, journalists, but also from the social and family environment. What is new is that we are also expanding and revising our knowledge on an almost daily basis, as new data on the pandemic is published every day. This leads to uncertainty for many people. But I also notice that being honest about admitting one's own uncertainty is very positively received by many people.
Do you see the situation today differently than before the pandemic began, when the first cases occurred in China?
Yes, I have to say that in all honesty. In January I did not expect that we would ever see COVID-19 patients in Jena. And I was not alone with this prognosis at that time. Many people assumed that this virus, like SARS or MERS before, would disappear again after a few months and remain largely confined to the region of the initial outbreak. This rapid spread of the virus around the world was not expected by many of my colleagues either.
What distinguishes SARS-CoV-2 from other viruses or why is it so dangerous, for example in comparison with seasonal influenza?
There are a number of different aspects involved. Firstly, the current corona virus SARS-CoV-2 is much easier to transmit than, for example, the related SARS virus that caused an outbreak in 2003. That virus propagated primarily in the deep lower respiratory tract, whereas the current corona virus attacks the upper respiratory tract first and can thus be transmitted very easily, even by people who themselves have no symptoms at all. The example of the first transmission in Germany at a workshop also showed that when the virus replicates in the upper airways, it can be transmitted efficiently when speaking - coughing is not necessary.
Then, of course, the fact matters that it is a new virus and that we do not have a partial basic immunization of the population as is the case with influenza, in addition to the absence of a vaccine. In the case of influenza, it is also the case that the season usually ends very quickly when summer starts. And we do not know whether this will be the case with the Coronavirus. It is possible that the virus will still be circulating in the summer, which worries me.
Can masks protect against infection?
That depends on the type of mask and the situation in which it's worn. Covering your mouth and nose in public with a fabric mask or even a scarf or cloth, as is now required in Jena, for example, is no guarantee that you won't be infected - but it certainly reduces the probability. In addition, if many people wear a mask, it also reduces the overall probability that the pathogens will be passed on. It is important, however, that we still keep as far away as possible from others, wash our hands regularly and cough or sneeze in the crook of our arms. Wearing a mask does not mean that the other measures are no longer necessary.
How long will the infection in Germany last?
It is too early to judge that. We do not yet know what part of the curve of increase we are on, and whether the measures that have been taken in Germany will lead to a flattening of the curve. Although it currently seems that the number of new infections in Germany, including in Jena, is stabilizing, the number of new infections in Germany is still rising. Personally, I think that social distancing is having an effect, but for serious forecasts it is simply too early at the moment.
How has it been possible to keep the spread of the virus relatively low in countries like South Korea and Taiwan?
In Asian countries, wearing masks in public places was already widespread before the emergence of the Coronavirus. In addition, for cultural reasons, there is a greater physical distance between strangers, and family structures may also be different from those in southern Europe. However, in my view, the decisive factor is the large number of tests that were carried out at an early stage in these countries and the consistent, very rigorous isolation of people who have been tested positive. As a result, those countries have come through the crisis relatively smoothly, even without a complete shutdown.
When do you expect available vaccines against the virus?
Intensive work is already being done on this. However, I do not expect to be able to vaccinate against SARS-CoV-2 soon. Not before next spring, I suppose. Because vaccine development is not trivial: it seems that immunopathological processes, being the misdirected or excessive reactions of the patient's immune system, are responsible for the severe course of the disease. Of course, this must not occur with a vaccination where. an infection is being feigned to the immune system. I am confident that it will be possible to solve this problem, but clinical trials will certainly take time. Hopefully, we will have drugs that help against COVID-19 more quickly.