The Central Institute for Statutory Health Insurance Physicians (Zi) has put forward two new, special key figures with regard to better regional pandemic management in the Corona crisis: the country-specific load limit and the effective advance warning time. You can read here what is behind it and what these values look like for your own federal state.
Country-specific load limit for better assessment of the course of the pandemic
On May 6th, the federal and state governments agreed on what many have been wishing for back for weeks – a bit more normality and everyday life through some easing of the corona restrictions. However, what was also decided at the federal-state conference is a safety mechanism to protect the health system from being overloaded if the number of cases increases again. This intervention limit provides for the following: If more than 50 new infections per 100,000 inhabitants are reported in a district or an independent city within 7 days, corresponding restrictions must immediately come into force again there by the responsible state authorities.
Against this background, the Central Institute for Statutory Health Insurance Physician Care (Zi) has now developed two special indicators in order to be able to better and more specifically control the course of the pandemic at state level: a state-specific load limit and an effective advance warning time.
Why the reproduction number R is currently not meaningful enough
The variable that has probably been the focus of most attention for assessing the acute corona situation in Germany is the daily updated reproduction number R. It indicates how many other people a corona infected person infects on average and is therefore an indicator for the spread of the virus.
Also interesting: The most important terms related to the corona pandemic
However, Zi CEO Dr. Dominik von Stillfried in a press release. «The R value is difficult to interpret when the number of infections is low, as it reacts strongly to small changes in the number of new infections,» says von Stillfried. The Robert Koch Institute (RKI) has already reacted to this by changing the calculation method. This change provides for local «corona hotspots», i.e. isolated larger outbreaks, to be deducted.
Even the uniform intervention limit is not comprehensive enough
But even the uniformly fixed intervention limit of the federal-state conference is not comprehensive enough, according to von Stillfried. Above all, she does not take into account how much the regional medical care capacities could be used if the number of cases increases. For this reason, the Zi has now developed an extended model in order to be able to better monitor the expected spread of the Covid-19 virus on a regional basis.
The basis is two special key figures for the pandemic management of the countries: on the one hand, a country-specific load limit of the health system and, on the other hand, the warning time resulting from this with increasing case numbers until this load limit is reached. «These key figures should help to assess the urgency of further measures to contain the pandemic and to weigh them against restrictions on fundamental rights,» explains the Zi chairman.
Also interesting: Why the Corona distance rules are more important now than ever
This is how the country-specific load limit is calculated
The country-specific load limit is calculated from three factors:
- the intensive care beds available for the care of Covid-19 patients (currently 25 percent of all registered intensive care places)
- the percentage of Covid-19 patients who require intensive care (currently five percent of all reported cases)
- and the average duration of treatment of Covid-19 patients in intensive care units (ten days)
This load limit can thus also be calculated for Germany as a whole. In this way you can also clearly illustrate the difference to the uniform intervention limit. According to the register of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), 32,828 intensive care beds were available in Germany on May 7, 2020. This results in a calculated load limit for the healthcare system on this day of 16,414 daily nationwide new infections. The fixed intervention limit, on the other hand, is 5,930 new infections daily, which corresponds to only 36 percent of the actual calculated load limit.
The remaining advance warning times are also decisive
The second key figure developed refers to the Zi as the effective advance warning time. It is intended to provide information on how much time is actually left in order to avoid reaching the calculated load limit of the health care system through intervention measures in the event of an increase in new infections.
It is calculated from the difference between the state-specific load limit and the current percentage of this being exhausted by the nationwide, uniform intervention limit (e.g. in Baden-Württemberg: 42.2 percent; in Saarland: 20.2 percent). The smaller this ratio, the shorter the remaining time until the intensive care resources in the respective federal state are reached.
The calculation also takes into account the general forecast loss of time until measures take effect, assuming that the warning time will be reduced by 21 days as a result. There are large differences at country level. In some federal states, for example, the effective remaining time would be two to three weeks, in others only one to three days.
Also interesting: This is why the corona virus is so contagious even without symptoms
Country-specific load limit and warning time help to evaluate necessary interventions
«Our model consideration shows that it is necessary to consider not only the intervention limit, but also the calculated load limit and the expected time until this load limit is reached,» explains Dr. by Stillfried in the communication. This could help to adequately assess the number and type of measures needed.
«Since the competence for decisions about interventions has been transferred to the countries, and the equipment with intensive care treatment capacities varies regionally relative to the population density, it makes sense to calculate the calculated load limit by country and to compare the ratio of the uniform fixed intervention limit to the country-specific load limit is reached,” explains von Stillfried.
He also makes it clear: “In order to weigh up measures that are associated with far-reaching restrictions for the population, clear, epidemiologically based limit values are needed that give politicians a safe compass for pandemic management in order to rule out the threat of overloading the health care system , if the new infections should rise again.”
Also interesting: What would speak in favor of the Corona immunity pass – and what against it
Current load limits and warning times of the federal states at a glance
In general, according to the Zi, the federal and state governments were cautious in setting the uniform intervention limit at a comparatively low level of new infections (36% of the limit) in relation to the calculated limit. In the press release, however, this approach is considered sensible. So there is basically a reserve upwards, but this varies in size depending on the federal state. Therefore, there is still a risk that the federal states may have to impose new requirements very quickly.