What is it like to be underestimated?

Start of a new pandemic : The danger of the virus mutant is criminally underestimated

A new variant of the corona virus has been circulating in the south of England at least since mid-September. In the meantime, "B.1.1.7." Has spread over the entire British island and displaced more original virus variants. The Chief Medical Officers of England, Scotland, Ireland and Wales ’issued a joint statement warning that the UK healthcare system would collapse in 21 days if countermeasures are not taken.

In fact, the Boris Johnson government has now imposed a tough lockdown, which will initially apply until mid-February.

In Denmark, the mutant made up more than two percent of the sequenced samples in the 52nd calendar week. In the four previous weeks, this number had doubled: from around 0.25 percent to 0.5, 1.0 and 2.0 percent. The mutated virus is spreading rapidly - despite the lockdown measures, which have significantly reduced the Danish case numbers overall in December.

The most likely explanation for this statistical data is that the mutated virus is much more contagious, by around 50 percent according to current estimates.

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Critical mistake in the risk assessment

If the finding had been that the mutated virus was 50 percent more deadly and would cause 50 percent more long-term damage, the outcry would probably have been great. The news that the virus has become 50 percent more contagious, but at the same time probably not more aggressive, sounds less threatening.

However, this only applies from the perspective of the individual infected person. To apply it to the general population is a mistake in thinking. Because a 50 percent increased infectivity of the virus mutant means that it can lead to many more deaths and hospitalizations in the same time interval than an increased death rate, especially since the increased infectivity has an exponential effect, which does not apply to an increased death rate.

A virus that is 50 percent more deadly leads to 50 percent more deaths; a 50 percent increase in infectivity, on the other hand, easily turns a declining or stable epidemic into an exponentially growing wave of infections, which increases hospitalizations and deaths many times over.

The number of cases could double weekly

In Germany, medium-level lockdown measures were necessary in order to reduce the reproductive number R to the value of 1 and at least to stabilize the spread of the virus. However, with the same measures, the mutated virus has an R value that is well above 1 and thus causes exponential growth.

The number of cases could double weekly, which would mean tens of millions of cases of infection by the end of April. This scenario would sabotage the vaccination strategy and undo the success of the containment measures, which we bought dearly in 2020.
In other words: the mutated virus is - with some probability - a game changer. Even if there were serious doubts about this, the relevant scenario would have to be taken seriously and discussed intensively. Anything else would be negligent in terms of risk policy.

[More on the topic: Then stop a party in the open-plan office - the lockdown extension is tough, but dangerously inconsistent]

The spread of the new virus variant leads to a changed risk situation. The curves in the first of the two graphics (below) show how the daily case numbers of the original virus would develop with an R value of 0.9 (red) and 0.8 (blue). These R-values ​​require medium-level lockdown measures. In the former case there would be a halving approximately every four weeks, in the latter a halving approximately every two weeks.

Do we need tougher lockdown measures?

How do these curves change when we combine the previous virus with the new, mutated virus? This second graphic includes the (unfortunately empirically plausible) assumptions that the new virus is 50 percent more contagious and currently accounts for around one percent of all infections.

The B.1.1.7 mutant was recorded for the first time in Germany in November, is likely to have been introduced repeatedly and has very likely spread since then. Should the scenario outlined with the blue curve come true, there would be enough time to vaccinate the population - especially the vulnerable groups.

However, it requires lockdown measures, which so far have resulted in an R value of 0.8. With a scenario corresponding to the red curve, on the other hand, our health system would be completely overwhelmed. It already results from measures that previously resulted in an R value of 0.9. So there is little room for maneuver. The toughest months of the pandemic await us.

It should be noted here that more contagious viruses are often less fatal and less likely to lead to severe disease. That is true, but it doesn’t take away the horror of the red curve. Because even if the mutated virus caused significantly fewer hospitalizations, the health system would be overwhelmed with the scenario.

In addition, so far no data indicate that the hospitalization rate has decreased. On the contrary: The available data do not yet definitely rule out the hypothesis that the new virus variant leads to more severe disease courses in younger people than the conventional viruses.

A new pandemic begins with the new virus variant

This means: A new pandemic begins with the more contagious Corona mutant. What needs to be done now has been shown by the countries that are successful in pandemic strategy - such as Taiwan, South Korea, Japan, Australia or New Zealand -: If the number of cases is still low, decisive action must be taken, followed up and quarantined.

This is the only way to extinguish the spraying sparks before they become wildfire. It's the only strategy that has worked so far. In the successful states, it has minimized both health and socio-economic damage.

We must therefore do all we can to track down the new virus (through genetic sequencing) and keep its incidence to a minimum. Wherever the mutant occurs locally, it must be consistently contained as long as the small number of cases still allows it.

Follow-up and quarantine must be prioritized in the event of new infections with the mutated virus.

If it fails and hotspots form, travel bans will be inevitable, even domestically - they are the far lesser evil. This is all the more true as the vaccination is within easy reach. Because if the virus spreads, further mutations could endanger the effectiveness of the vaccination and sabotage our pandemic strategy on the last mile. To make matters worse, there is already a corona mutant in South Africa, the changes in vaccination protection are worrying.

Sluggish vaccination coverage: The US threatens to overtake Europe

Even without additional mutations, we risk losing the race against the virus because vaccination coverage is much too slow. Europe's pandemic political failure is multidimensional - poor vaccination preparation is one of them. As early as spring 2020 it became clear that we depend on an effective vaccination that is available quickly enough.

Otherwise, trying to contain the virus with drastic measures (instead of just flattening the curve, that is, slowing down the infection rate) would not have made strategic sense. Because if effective vaccinations are not available quickly enough, there is no alternative to infection.

Against this background, the strategic importance of vaccination or a fast vaccination coverage could not be overestimated. So far, Europe has acted better - at least less badly - than the USA in terms of pandemic policy. Now it seems possible that the US will vaccinate faster.

This one, perhaps most important, factor could mean that the United States as a whole will do significantly better than Europe. If the corona mutant strikes exponentially in Europe before the vaccine doses have been administered in sufficient numbers, the US / Europe difference could end up being very high.

[The authors, the economist, ethicist and risk researcher Nikil Mukerji and the philosopher, risk researcher and social entrepreneur Adriano Mannino from the Ludwig Maximilians University in Munich, discuss pandemic strategic questions in their book "Covid-19: What counts in the crisis" (Reclam) .]

Too little and too late

A sensible vaccination policy would have ensured that production capacities for all potentially successful vaccine types would have been massively expanded from spring 2020. We recommended this in this country back in April.

In advance, finding the best vaccine candidate may be like finding a needle in a haystack. But Christian Drosten is wrong when he claims that the European vaccination policy “cannot be evaluated” because of this. Because the risk strategy maxim here is: if you can't find the needle, buy the haystack!

It would have been very worthwhile even if the majority of the potential vaccines had failed and only a small group got into production. Corresponding investments should be seen as insurance premiums that protect us against possible bottlenecks in vaccine production.

They are a bargain in relation to the hundreds of thousands of deaths, the millions of long-term injuries and the trillions of economic value that are now at stake in Europe because vaccination coverage is delayed by months. During a pandemic, we simply cannot afford the risk of having to wait for production capacities after vaccines have been approved.

If the production capacities had been aggressively and diversified ramped up to hedge risks, the dangerous problem situation in which we now find ourselves would have been avoided. With enough vaccine we could vaccinate all over 65 year olds by mid-January - Israel is currently proving that a vaccination rate of one percent of the population per day is feasible.

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