Some in Germany may seem surprised that, with "only" around 1,600 confirmed coronavirus infections in the country, large events are being cancelled, Chancellor Angela Merkel is speaking of the possibility of 60 to 70 percent of the German population ultimately coming down with the illness and the deputy head of the Robert Koch Institute, Germany's center for disease control, is preaching the benefits of social distancing. Among those seemingly bewildered is Berlin Mayor Michael Müller, who complained on Wednesday of other German states "pressing ahead" with measures, thus heaping "pressure" on him to cancel large events himself.
Others, though, are likely more concerned, particularly given the developments since March 1. On that day, Germany had only 129 confirmed coronavirus infections. On Wednesday, March 11, it was 1,567.
According to a report from China and the World Health Organization (WHO), the so-called R0 value in Wuhan was between 2 and 2.5. The number indicates how many other people a positive coronavirus case will infect on average. In most cases, first symptoms - primarily fever combined with a dry cough – only begin appearing five to six days after a person gets infected with the virus.
If the virus is able to spread in such an efficient manner, it is described as exponential growth. It isn't an easy concept to grasp, but consider the following example: Two people take 30 steps. Person A takes normal steps, each about a meter in length. Person B, though, has magic boots and takes exponential steps, with each step twice as long as the last: 1, 2, 4, 8, 16, and so on. How far does Person B travel in 30 steps? Several times around the globe. Person A, meanwhile, has traveled just 30 meters.
All of the measures that are now being taken are primarily aimed at – to stay with our example – taking the magic boots off the virus so that it can't quickly circle the globe and infect millions along the way.
A graphic illustration of the development in confirmed case numbers provides an idea of how quickly the virus can spread within a country. It shows the 20-day development in case numbers starting on the day that at least 100 cases have been confirmed. Please note that the graphic is logarithmic and not linear.
One thing that China, Iran and Italy all share is that the virus initially circulated widely in those countries undetected, before the outbreak was recognized as such. It is extremely likely that these countries had, or have, a large number of cases that have as yet gone undetected. The relatively high number of deaths in these countries would seem to support that theory. According to WHO, for example, South Korea and Iran each reported over 7,000 coronavirus infections on March 10. But in Iran, many more people have died: 237 in Iran compared to 54 in South Korea.
That means that these countries - indeed, all countries – are facing an even greater challenge when it comes to slowing the spread of the virus. Because the more people are infected, many of them undetected, the more difficult it will be to get ahead of the pandemic.
Different Approaches to Testing
Comparisons between countries are made all the more difficult by the fact that each country is pursuing a different approach to testing. Japan, for example, is being criticized for testing too few people, leading to a situation whereby the number of infections in the country is likely much higher than official numbers would indicate. The same is true for the U.S.
Despite all of these shortcomings, a look at the graphic makes it clear that Germany should be doing everything in its power to ensure that the curve does not spike upward as steeply as for China, Iran and Italy. Every single day counts.
Whether the virus can be stopped completely or whether it will, in fact, ultimately infect 60 to 70 percent of the population remains unclear. The WHO continues to identify containment as the top priority and to emphasize the importance of identifying each individual case and isolating them during the period during which they are infectious.
Some experts, though, believe it is likely that the virus can no longer be completely stopped. That would mean that efforts should be focused on reducing the speed with which the disease is spreading – essentially, trying to prevent the growth from being exponential. That is why countries are cancelling all events with over 1,000 participants. The Robert Koch Institute has also issued an appeal to each individual to make changes to their everyday lives by limiting their social contacts and paying more attention to hygiene.
Only these and additional measures can prevent a situation whereby each person infected with the virus passes it along to an average of 2 to 2.5 others. Only by adhering to such measures can we slow the spread. And slowing the spread is vital because the number of doctors and other health-care workers in Germany and elsewhere is not infinite, nor is the number of hospital beds. According to Germany's Federal Statistical Office, the country had around 497,000 hospital beds in 2017, with around 28,000 of those in intensive care units. Should the virus be allowed to spread rapidly, hospital personnel would almost certainly be affected, which would magnify shortages of health-care workers, a problem for all patients and not just those suffering from COVID-19.
Protecting Those Most at Risk
In China, roughly 20 percent of coronavirus infections led to symptoms serious enough that medical care became necessary. In 6 percent of the cases, the situation became critical, involving acute breathing problems, the development of a sepsis or multi-organ failures requiring intensive care. Patients with severe symptoms from the disease required between three and six weeks to recover.
Coronavirus tends to trigger serious illness in people over 50 years of age. Those over 80 are considered particularly at risk. That is also true for people already in weak health, particularly those suffering from high blood pressure, diabetes, cardiovascular disease, chronic respiratory disease and cancer. For reference: 45 percent of people in Germany are 50 or older. And 6.5 percent are at least 80, a total of 5.4 million people.
An additional goal of the measures now being put in place is that of protecting higher risk groups from infection. Virologist Christian Drosten at Berlin's Charité university hospital recommends that families should cease relying on grandparents to care for their children until at least September or October. And efforts should be made to help grandparents and elderly neighbors with their shopping so that they don't have to go to the supermarkets themselves. Employers should do what they can to allow chronically ill employees to work from home if possible.
What the above graphic does not show is the current development in China. According to WHO, there were only 20 new COVID-19 cases in the country on March 10. Wuhan, in other words, has managed to successfully stop the spread of the virus. But only after 81,000 people fell ill and 3,140 died – and with the help of drastic measures that quarantined entire cities with millions of residents.