miércoles, 28 de julio de 2021

miércoles, julio 28, 2021

The Delta Dilemma

Coronavirus Variant Has Some Worried about a New Autumn Wave

Germany’s political leaders want to avoid further lockdowns and school closures this fall. But they are also warning that there may be fresh outbreaks with the spread of the delta variant. It seems almost inevitable that some measures will need to be taken.

By Matthias Bartsch, Markus Becker, Jörg Blech, Jan Friedmann, Annette Großbongardt, Claus Hecking, Martin Knobbe, Timo Lehmann, Veit Medick, Gabriel Rinaldi, Cornelia Schmergal und Christoph Schult

German Health Minister Jens Spahn (left) and Lothar Wieler (right), the head of the Robert Koch Institute, Germany's center for disease control, at a press event in Berlin Foto: Hermann Bredehorst


It’s Wednesday morning in German Chancellor Angela Merkel’s offices. 

It’s already summer recess for parliament, but Merkel’s cabinet continues to hold meetings. 

The country has to be governed, after all. 

The issue at hand is the new delta variant of the coronavirus and a growing dispute among the German states. 

Some state governors are calling on the chancellor to make sure there are stricter controls on travelers returning to Germany and the debate is triggering irritation in the cabinet.

Interior Minister Horst Seehofer of the conservative Christian Social Union (CSU) noted in the meeting that airlines are already required to check the paperwork to make sure passengers have been tested. 

Besides, the states also need to do their jobs, he said, complaining that they and municipalities aren't doing enough to monitor adherence to the two-week mandatory quarantine for travelers returning from countries like Britain and Portugal, where the virus variant has become widespread.

In other words, the federal government versus the states, just as it has always been in this pandemic.

Merkel’s government has barely three months left in office, and things could have been so relaxed until then. 

There was still time for a few small projects, a few votes and then they would all go on their summer vacations. 

That, at least, is how some in Merkel’s cabinet envisioned things. 

Suddenly, though, an issue that only recently seemed to be reasonably under control is back: the fight against the coronavirus.

While many Germans are enjoying the return of old freedoms, flocking to restaurants and planning their vacations, the question is arising again over how to deal with the virus and whether the current state of near normality will have to end soon. 

It’s like a curse – the virus just won’t go away.

The delta variant, the highly contagious coronavirus mutant first discovered in India, is currently spreading in Germany and Europe. 

There is growing concern that the summer travel season, with millions of people on vacation, could reignite the pandemic. 

And the question is whether the German government is prepared. 

Or if it is misjudging the situation as it did last summer.



In the case of Portugal, where the virus has recently struck with a particular vengeance, the government has already pulled the emergency brake, unsettling many travelers. 

Since Tuesday, all travelers returning from Portugal to Germany are required to quarantine for 14 days, including those who have been fully vaccinated. 

But what if travelers begin bringing infections back with them from other countries? 

What if the vaccination pace slows down and school classes start again after the summer holidays? 

Will we then be threatened with a fourth wave?

The situation isn’t the same as it was last year, when all countries were largely unprotected against the virus and many in power in the government, including the chancellor, had no choice but to impose strict lockdown measures. 

In the time since, many Germans have been vaccinated, meaning there is reason to believe that a fourth wave would not be a disaster, even if the delta variant becomes more widespread. 

Some protection is in place, just not yet for everyone. 

This means that politicians will now have to consider more carefully the need to balance confidence vs. caution and freedom vs. restrictions than it did last year.

The concern is already considerable in a number of German states. 

Delta is an "invisible race against time,” warns Markus Söder, the governor of Bavaria and member of the CSU. 

"We must now be careful not to gamble away what we have achieved by being too lax with the delta variant," warns Manuela Schwesig, the governor of Mecklenberg-Western Pomerania.

The delta variant is hitting the government at a delicate time. 

If a big fuss is made about new dangers during the election campaign, it could cause public sentiment to plummet. But doing nothing could be even worse. 

Although Germany has made significant progress with its vaccination campaign, it is nowhere close to herd immunity. Some 55 percent of Germans have received their first dose of vaccine, and almost 40 percent have received both shots, but there are still large groups that are not immune.

And this creates a dilemma for Merkel’s government in its final months in office: It has to protect people who haven’t yet been fully vaccinated from the delta variant while at the same time not stripping people of their growing sense of freedom. 

And she needs a plan for the autumn, when all Germans in age groups that have been approved for vaccines will have had a chance to be vaccinated and there is no longer any reason to impose restrictions on vaccinated people. 

But what will be done then about children, who still haven’t been authorized for vaccination in Germany? 

And what if even vaccinated people can contract the variant? Or has the time come to simply accept such risks?

On Monday, the chiefs of staff for Germany’s state governors held a conference call with Helge Braun, Merkel’s chief of staff. 

The question at hand was whether entry restrictions in Germany need to be further tightened given the developments in Portugal. 

For the past several weeks, a distinction has been made between high-risk, high-incidence and virus-variant areas; it's a complicated system, and travelers can sometimes lose track of what's going on. 

As can politicians.

Beer garden visitors in Berlin: Finding a balance between confidence and caution Foto: Stefan Zeitz / Xinhua / Eyevine / ddp media


Braun joined the call from his car on the road, irritating some participants. 

What followed was pure confusion. 

Participants in the call say that the state of Lower Saxony finds the current system to be coherent enough. 

But the representative from Hesse criticized the fact that the Azores and Madeira, where the number of infections is low, has not been removed from quarantine requirement for travelers returning from Portugal. 

Schleswig-Holstein is in favor of more differentiated rules; Mecklenburg-Western Pomerania wants to treat areas with high infection rates and simple risk areas equally; and Hamburg is asking how sensible it really is to force people to go into two weeks of quarantine.

Braun defended the rules in place for Portugal. 

He said you can see in Israel how quickly the delta variant spreads. 

The country has even reintroduced its requirement to wear a mask indoors. 

But Braun said he was also open to changes. 

It sounded a little like he was saying: I don’t really know either. 

In any case, nothing has been decided.

The SARS-CoV-2 virus continues to spawn new variants. 

And once it infects a person, it starts multiplying. 

Some of the variants are not exact copies – there are parts that have changed in their genetic material. 

Mutations. Some of the new variants can spread better than the old ones, that’s how nature intended it. 

First there was alpha and then delta.

And there are still many unknowns about the delta variant. 

Who is hit particularly hard? 

How high is its mortality rate? 

Is this variant more dangerous for children than others? 

None of the studies completed thus far can provide definitive answers.

     Virologist Sandra Ciesek Foto: Stefan Boness / IPON


What is known is that delta is significantly more contagious than the first virus from Wuhan. 

In no time at all, delta has spread around the world and has now been detected in around 100 countries. 

Delta is also on its way to becoming the dominant variant in Germany,” says Sandra Ciesek, director of the Institute of Medical Virology in Frankfurt. 

In just a few days, its share of new infections is expected to officially exceed the 50 percent mark.

Because so much remains unclear, an early warning system is essential, but the federal government still seems to be conspicuously passive, despite the fact that it hasn’t shied away from imposing restrictions to stop the spread of the virus in the past months.

Merkel, for her part, is strongly opposed to strict border controls between European nations. 

Interior Minister Horst Seehofer doesn’t want to see tougher rules. 

And even the rules on Portugal could be scrapped again soon, even though they were just put in place.

During a meeting of her cabinet on Wednesday, the chancellor herself commented on the measures. 

Because it is not yet scientifically certain to what extend people who have received two doses of a vaccine can also pass the delta variant on to others or contract it themselves, the two-week quarantine requirement for people returning from countries that have been designated as virus variant areas also applies to fully immunized people. 

It’s not possible to get a test after five days and end the quarantine early. 

But fully vaccinated people who remain in Germany enjoy extensive freedoms even though the delta variant is also spreading here.

This, the chancellor noted, was a "breach of logic,” and not legally justifiable in the long run. 

Essentially, it seemed, she was saying the rules made no sense.

The cabinet agreed that the rule should be overturned soon or that restrictions on vaccinated people should be introduced in other areas as well. 

It’s also possible the problem will go away on its own soon. 

If Germany itself becomes a virus variant area, it no longer makes sense to declare other countries as such.

A vaccination station in front of a bar in Berlin: Many argue that Germany needs to be doing more to convince skeptics to get vaccinated.

A vaccination station in front of a bar in Berlin: Many argue that Germany needs to be doing more to convince skeptics to get vaccinated. Foto: Sean Gallup / Getty Images


Even Health Minister Jens Spahn isn’t giving the impression that he is in any way panicking about the delta variant. 

And yet he can’t rule out the possibility there will be a fourth wave. 

Officials in his ministry are hopeful that the country is better prepared this time around. 

Germany has sufficient capacities for PCR tests and a network for rapid antigen tests is also in place. 

Public health offices, which were still sending faxes at the beginning of the pandemic, are now connected to the digital system Sormas in many states.

So far, Spahn has not wanted to make any changes to the rules for travelers returning from simple risk areas. 

The current provisions require that anyone who boards a plane to Germany has to present a valid test, proof of vaccination or evidence that they have already had COVID-19 and recovered it before they can board a plane. 

And those who enter by land can be checked by the police. 

Seehofer has announced that he plans to increase the number of controls on the borders.

It may sound easy enough, but there are many possible consequences: traffic jams on the highways and chaos at the airports. 

On Monday, four aviation associations sent an angry letter to leaders of the European Union member states complaining that the handling of vaccination certificates in the member states has been a "worrying patchwork.” 

They said that if this isn’t changed quickly, it will lead to long lines and thus new health risks. 

"The risk of chaos at Europe’s airports is real,” the letter stated. 

In this pandemic, everything seems to be interconnected.

On the one hand, Spahn’s optimism is understandable. 

From an epidemiological point of view, the situation right now is better than it has been in a long time. 

The infection rate is at rock bottom, the intensive care units are emptying out, and even if delta is considerably more contagious, that doesn’t mean that it is necessarily deadlier. 

The vaccines also appear to protect very well against serious progressions of COVID-19 caused by the delta variant. 

One study found that two doses of the BioNTech/Pfizer vaccine have a 96 percent effectiveness against the need for hospitalization.

On the other hand, though, there’s also the bad news out there. 

Like Israel. 

The country reopened its schools and restaurants in March and now the delta variant is rampant and the infection rate is rising. 

Younger people are getting hit hard by it – around half of those newly infected are schoolchildren.

Or take Australia: A country that used to be a model for COVID prevention has now become a problem child. 

The larger metropolitan areas in the country are back in lockdown. 

An outbreak of the coronavirus in Sydney has the city on tenterhooks. 

The disease is believed to have spread in a matter of seconds at a mall in the city.


Or Scotland: According to the authorities there, nearly 2,000 fans were infected there in events relating to the European Football Championship. 

They say that two-thirds of those infected were Scots who had traveled to London for games.

In view of those outbreaks, the wait-and-see attitude of the government in Berlin is causing nervousness in some states. 

Memories are still fresh of how the government miscalculated last summer when it came to travelers returning and the second wave rolling into Germany in the fall. 

Memories are also still fresh of how Spahn, as the health minister, was fully relaxed at the beginning of the pandemic, even when the virus had long already been in the country and then, suddenly, sprang into action with knee-jerk responses.

Söder, the governor of Bavaria, is concerned that a similar dynamic is taking shape this year. 

He accuses the federal government of "refusing to deal in any fundamental way with the issue” of travelers returning to the country. 

He is calling for stringent controls on buses, trains and at airports for proof of testing. 

"We have no desire whatsoever to be where we were last year when this September roles around,” says Söder.

The governors from German states where the center-left Social Democrats are in power are also growing restless. 

"We can’t make the same mistake as last year and be too careless with travelers returning from risk areas,” warns Manuela Schwesig. 

Together with Malu Dreyer and Stephan Weil, the governors of Rhineland-Palatinate and Lower Saxony, she is pushing for a double testing requirement for people returning from risk areas. 

They say that the single test that is required now is insufficient. 

Because if someone tests negative on entry, they could still test positive days later. 

Chancellor Merkel reportedly wants to consult with the states and try to find a common approach.

Ultimately, though, the question of whether delta can be controlled probably depends more on progress with the vaccination campaign than how travelers are dealt with. 

The more people who have had two doses of vaccine, the greater the protection against delta – the calculation is as simple as that.

And at the moment, the campaign is going well. Germany is receiving more supplies of vaccine right now than it ever has before. 

So far, though, the number of doses being administered has not risen accordingly. 

One of the reasons is that most people who are willing to get vaccinated will likely have done so soon. 

At that point, it will be a matter of reaching and convincing people who are skeptical or wary of the vaccination. 

But getting those people to get their jabs is the only way herd immunity can be reached. 

And that could prove to be very difficult, as seen in the United States, where the pace of vaccinations has slowed significantly.

Officials in Spahn’s ministry are also taking note of the growing surplus of vaccine doses. 

They are anticipating that there will soon be so much mRNA vaccine that the states may have trouble keeping the doses stored at -70 degrees Celsius.

They are looking for storage space now. 

The government’s stated goal is to offer every adult in the country the chance to get vaccinated this summer.

Opposition parties are nonetheless urging Spahn to do more and also launch his own vaccination campaign aimed at getting people who are skeptical to get their shots. 

The business-friendly Free Democratic Party (FDP) is calling for more mobile vaccination teams. 

"That’s particularly important for socio-economically disadvantaged areas,” says Marco Buschmann, a senior official in the party.

It’s unlikely the federal government will be able to remain as casual as it has been about the coronavirus until the fall. 

The infection rate is still going down, but that could change quickly. 

Once the weather starts to cool down and people start sitting in restaurants or going to concert halls again, it’s likely the numbers will start increasing again. 

The fact that the delta variant has been proven to be more infectious than the original virus "increases the probability of transmission in places like large events, for example,” warns virologist Ciesek.

Meanwhile, the Health Ministry is currently reviewing whether the data that is currently being used to make decisions on restrictions is still the appropriate criteria. 

Is there still a corollary between the rate of intensive care occupancy and the incidence of infection? 

Andreas Gassen, head of the National Association of Statutory Health Insurance Physicians, is pushing for an addition to the incidence criteria. 

He says the infection rate alone is "unsuitable” as a sole parameter. 

"There is also a need to include hospital occupancy, age distribution of infections, intensive care occupancy, regionality and similar parameters,” he says. 

He says the data must be "swiftly collected and evaluated” so that officials can react appropriately to developments. 

He argues that blanket lockdowns are a "rather ineffective” tool.

       SPD health policy expert Karl Lauterbach Foto: Hans Christian Plambeck / laif


But Karl Lauterbach, a doctor and member of parliament with the SPD who has been a prominent expert in the pandemic, argues "it would be wrong to abandon the infection rate” as a determining factor in virus containment measures. 

"It shows us how quickly the number of cases is rising,” he says. 

But Lauterbach is also against imposing overly stringent measures if case numbers start to soar again. "

A new lockdown can’t be the way then – we would have to put up a big fight,” he says. 

He believes times have changed. 

"The willingness of the population to accept a new lockdown is simply too low.

Some state governors hold a similar view. 

"There will be a fourth wave, but the situation is different today than it was a year ago,” says Thuringia Governor Bodo Ramelow. 

He says nationwide lockdowns will be unnecessary as well as a law passed last spring that allows the federal government to impose national restrictions if infections get out of control. 

Rainer Haseloff, the governor of Saxony-Anhalt, argues that move was superfluous. 

"If the infection figures rise again in autumn, the states and local authorities will react appropriately.

Lauterbach urges those children aged 12 and over should now be vaccinated as a matter of urgency in order to reduce the delta risk among that group too." 

But the Standing Commission on Vaccination (STIKO), which is affiliated with Germany’s center for disease control, has decided not to make the recommendation for youth to get vaccinated, even though the vaccine has been approved for all children over the age of 12. 

"At the moment, there is no reason for a hasty change, even if this has been demanded at times,” says STIKO chairman Thomas Mertens. 

The expert says a "higher pathogenicity of the variant for children” has not been shown. 

As such, he argues, the vaccination of parents, grandparents and teachers should remain the priority.

Health Ministry officials are ken to get more children vaccinated in the states soon and they were unhappy with the decision made by STIKO. Spahn expects that enough vaccine will still be available for all 12- to 18-year-olds to be vaccinated by the end of August if they want to. 

Time is short. Within the government, there is concern that schools could become hotbeds for the virus in the fall. 

Would they then have to close them or return to hybrid learning with split classes?

That’s not the kind of issue politicians want to come up during the election campaign.

The federal government knows that it would be a massive failure if it isn’t able to work together to come up with a way of having schools operate at least halfway normally in the autumn. 

In some places, air purifiers are now being ordered. 

Bavaria, for example, wants to have a device installed in every classroom after the summer. 

But there hasn’t been any coordinated procurement effort.

And German Education and Research Minister Anja Karliczek of the center-right Christian Democratic Union (CDU) says she doesn’t want to guarantee that the school year will be normal because we don’t know enough about the delta variant. 

"We have to be prepared for the fact that there can always be outbreaks at individual schools after summer vacation, especially during the winter months,” she says.

 Karliczek says the aim needs to be identifying those infections quickly "so that there are, at most, short-term interruptions” to classes.

She says that hybrid education is out of the question for the fall. 

"Students across all grades should be taught together again in their classes next school year," Karliczek says, delta or no delta.

Parents might love hearing that.

But there is some bad news: No matter what happens in the coming weeks, the curse of the mutants is likely to continue. 

It’s not enough to defeat delta. 

At any time, a new variant can emerge somewhere in the world that is even more contagious.

In fact, virologists in Europe just discovered a version of the virus that could be the next to spread. 

Its name: delta plus.  

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