Episode 53- How will we do over the autumn without a lockdown?

If you are able and willing to help me with these translations, please PM me on Reddit. My schedule is going to get a lot busier in the next few weeks so any help would be appreciated.

DISCLAIMER: I am not a doctor or a healthcare practitioner, nor do I have a master's or a PhD. I am not a native German speaker either- I only know German as a foreign language, one I learned using whatever resources I could get a hand on. If my translation conflicts with that of anyone belonging to any of the groups mentioned above, please refer to theirs instead of mine. Needless to say, if an official translation, done by a scientific translator comes out, then refer to that instead of this one. I am simply a medical student who admires the work of Dr. Drosten and colleagues, and I would like to provide unofficial translations of the podcasts so that they may be helpful to those who do not speak German.For corrections, please reach out to me on Reddit and send advice in. I apologize in advance for any errors I have made. There are some footnotes at the bottom of this translation.

Original release date: August 27, 2020
Original audio: https://mediandr-a.akamaihd.net/progressive/2020/0827/AU-20200827-0953-5900.mp3
Original transcript: https://www.ndr.de/nachrichten/info/coronaskript220.pdf

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ANNOUNCER: NDR Info. The Coronavirus Update.

MARTINI: Welcome to the Podcast. Dr. Christian Drosten is still on summer break and will be back on September 1. We have therefore prepared a special episode. The topic: how will we get through the autumn and winter without a lockdown? Dr. Drosten has already talked about this topic- namely, how the infection rates, what scientists call the incidence rate, will develop.

DROSTEN: “Really during the summer break we have made clear that we are in a phase where we must make decisions. We have also said that if we do not “turn our sensors on”, there will be a rise in infections in a month, in two months we would have a problem- although we are not yet at the two month mark, we have already seen this supposed increase in infections after a month. We do not yet have a problem, but we don’t know exactly either what lies behind this increase in numbers.

MARTINI: And we will find out about this here. My name is Anja Martini and I am a scientific editor at NDR Info. These are my guests. Professor Anja Muntau, the leader of the Department of Pediatrics at the University Medical Center Hamburg-Eppendorf. Hello, Dr. Muntau.

MUNTAU: Good day, Dr. Martini.

MARTINI: According to you, finding the right balance is important. Children must be protected from the virus without compromising their access to education, social contact or appropriate ways to take care of their own health. Also here with us, via the App, is Professor Sandra Ciesek. She is the Director of the Institute for Medical Virology at the Unversity Clinic Frankfurt. Hello, Dr. Ciesek.

CIESEK: Hello.

MARTINI: She thinks that we should think about targeted test strategies for the autumn and winter so that we can protect at-risk groups. By the way, from September onwards, she will be alternating with Dr. Drosten in speaking in this podcast. And we have Professor Lothar Wieler, the President of the Robert Koch Institute in Berlin. Hello, Dr. Wieler.

WIELER: Hello everyone.

MARTINI: He is also connected to us via the app and says that if we continue to work with many scientists from different specialties, in other words in an interdisciplinary manner, we can defeat the pandemic. Also here with us: Professor Martin Kriegel. He is the leader of the Hermann Rietschel Institute at the Technical University of Berlin.

KRIEGEL: Hello Dr. Martini.

MARTINI: Currently, he says, engineers know a lot about aerosols and how they spread. Nevertheless, new concepts regarding ventilation for this situation. I am very glad to have you all here with me. Let’s start with a brief recap. We are now at the end of August and most German federal states are finished with their holidays. Slowly, we’re beginning to go into the autumn, we can see that in the weather. More precisely, it’s starting to rain, at least in Hamburg. What we are seeing is that the number of infections is slowly, but surely, rising. Dr. Ciesek, from a virological perspective, what does this mean?

CIESEK: Yes, we have seen a rise in positive tests during the last few days or weeks, and we also see that the situation in hospitals is still very peaceful. And I believe that there are many reasons that we are seeing such a rise- partly because we’re testing more people, but also because many infected young people are returning from vacations abroad. There is certainly a combination (of factors). We must therefore pay close attention in the coming weeks to whether the disease progression in these newly-infected people will be particularly severe, and how this situation will develop.

MARTINI: Dr. Wieler, a few weeks ago you said that you felt uneasy about this. Do you still feel the same way?

WIELER: Yes, of course. First of all, one must understand that this virus still exists in our country and that we are in the middle of a pandemic and that at any time new infections can occur. These are things that everyone should keep in mind. In other words, the virus is everywhere. Such a pandemic would distinguish itself in being caused by a pathogen that has certain particular biological properties. In this case, this is SARS-CoV-2, a pathogen that we understand well but not completely. But we know enough in order to fight against it and to limit its transmission. The pandemic’s host- in this case, we humans- can be infected by the virus. That means that our behavior, our day-to-day lives as people living with this virus, play an absolutely decisive role in determining how the pandemic progresses. Thus, it is very important that we keep a few rules in mind. I am therefore very happy that we have here Professor Kriegel, who knows very, very much about how infections occur in a particular way. A virus that is only, or at least chiefly transmitted via breathing- if we are able to control this transmission well, we can live much easier with the virus and with new cases. We can ensure that in our country, as few people are infected as possible.

MARTINI: Dr. Muntau, from a pediatric perspective, how do you feel about the situation at the moment?

MUNTAU: We have a situation in which the numbers are rising and in which we must ensure safety as schools reopen. I believe that our task is now to ensure safety in education, taking care of our health and psychosocial contact between children and young people, as well as protecting ourselves against infection. I think that here there are many different players working on different ideas to deal with this. For instance, we have experts like Dr. Ciesek, Dr. Wieler and Professor Kriegel as well as political representatives. We can see that there aren’t always agreements, and that it is probably necessary to adjust to local conditions. I believe that this is a great task for us. And as Dr. Wieler said, the more we know and understand, the more specific we can be when preparing ourselves and protecting people.

MARTINI: Professor Kriegel, Dr. Wieler has said that he is glad that you are here today. What are your impressions of the situation? What do you observe when you look at what is happening?

KRIEGEL: This is mainly to do with the question of transmission. In other words, the question of airborne or virus-infected particles is coming to the fore. I must say that there is a lack of knowledge in the population and maybe also a lot of fear too. If you can imagine it, these particles are in the end all flying around in the air and we are indeed always breathing them in. This should probably be put in perspective.

MARTINI: Let us take a closer look. Dr. Wieler, please help us out. The number of cases is rising again and we hear in the news things like, “The number of new infections is as high as it was at the end of April” or whatever. What is really happening now? How high are the numbers and how concerning are they really?

WIELER:  I think that we must keep in mind three things, three aspects that we have been observing over the past month. The first is the occurrence of infections, in other words the dynamics of the infections. How many people are infected? That is, of course, the number of infections today. Around 1,500. The fewer infections, the better, that is something we all agree on. The second question is: what are the dynamics in relation to time? In which areas are there higher incidence rates, in other words the rate of infection per 100,000 people within a specific period of time. We take this period to be seven days, because that is internationally considered to be a good measure, one that lends itself very well to comparisons. This plays a role as well. This is the second aspect, the so-called severity of illness. The severity of illness varies greatly depending on which people are infected. We have known since the beginning- and currently, the figures for Germany are in agreement with this- that young people have a noticeably smaller risk of becoming seriously ill. There are however a number of cases, in young people as well, in which people have become severely ill. And there have also been young people who have died. However, the older the person is, and the more underlying illnesses they have, the greater the probability of their sickness being more severe or even of dying of the illness is. We have just recently heard from pathologists that more than 85% of those who have undergone autopsy have died of the coronavirus. This means that the sickness takes a great toll on the body, but this depends on who is infected and how old they are. And the third aspect that we must keep in mind, which has already bee mentioned, is the burden on the healthcare system. Here I would like to differentiate between the three pillars (of the healthcare system) that everyone knows about, namely, the hospital and outpatient care, in other words, my colleagues in private practice. And the pillar that has finally become clear to other people in the last few months, is the so-called public health system. There is always a balance between all these three factors that allow us to make judgements about the situation. And at this point in time, our healthcare system is not overloaded. There are a few health offices that are, again, at their limits, one must be very clear about this. Thus, the question of region is as always important. This illness is being fought on site. It is being fought in outpatient care and it is being fought in the hospitals. This is concerning patients, but the chain of infections is broken in the public healthcare system. There, outbreaks are controlled and care is taken to ensure that as much as possible, the virus does not spread any further. And we must therefore pay attention to these regional factors. If you look at the big picture, we can very well make do with 1,500 new infections, I would say. We can overall go about things well, that has already been mentioned, because at the moment the elderly aren’t as affected as younger people, who generally have better prognoses. That is very good. We make reports on the situation daily. One can see how the distribution of infections according to age is changing. This means, however, and this is an important point, one that young people, to whom I appeal to, must see- regardless of whether young people themselves fall seriously ill, they can eventually transmit the virus to other people who may suffer more from the illness and perhaps die from it. This is the point that I want to make, that we experts, who are here in this podcast today, we are concerned with certain scientific things, and seek to communicate as well as possible, which isn’t always a trivial thing. But we must of course generate knowledge too. I find it sensational, how much scientific knowledge was generated in the previous months. We must however communicate this well to the public as well and include them, because without other people we will not be able to beat the pandemic. Thus, other people’s behavior is the deciding factor. It is for me personally not so relevant whether we have 1,000 or 2,000 or maybe even 10,000 cases. Every single infected person, if they behave properly, can help ensure that this sickness does not spread. That is true regardless of the circumstances. This attentiveness, this careful behavior, the protection that the AHA rules(1) guarantee in a very high capacity, should be always present among us. That is what we have been talking about, how we can achieve this balance, how we can live our lives under these circumstances and still keep to these rules as much as possible. That is the big challenge that we have ahead of us in the autumn and winter—simply because we’ll spend more time in closed rooms and thus increase the likelihood of transmission.

MARTINI: Exactly, we’re getting there. But, Dr. Cisek, if we take a moment to look at our society we have been very successful with the AHA rules. We have made sure to protect the elderly and those at risk. If we, however, hear something else, namely that “the virus has come back into our society”, what would it mean to say that we do not have any more chains of infection and yet there’s an outbreak here another one there? What does this mean from a virological perspective?

CIESEK: First of all I would like to say that solidarity is very much required of the young. It is very important that people behave in such a way and that the young are conscious of the fact that they can be the source of infection chains. But another important argument as to why the young should try not to become infected themselves is the risk of secondary illnesses. These illnesses can affect different organs. We still do not know how long they can last and what this means in the long term. For this reason, it is important to avoid being infected as much as possible, even if young people don’t tend to have serious acute symptoms. That is very important. If the infection appears everywhere in the population, it will be more difficult to track infection chains for public health authorities. We have seen this a few months ago, where we had among other things outbreaks in refugee homes, and in Gütersloh, where many people were infected, but the infections were limited to that area. At the moment we can see that throughout Germany, currently most of all in the region in which I live, infections are rising in the general population. That is dangerous, because that can quickly get out of control, as opposed to if they are present in a defined area, where they can more easily be followed.

MARTINI: Dr. Muntau, you are in a pediatric clinic—in other words, you see young children as well as teens and young adults. What do you see regarding the illnesses there? It was already mentioned that there is the possibility of secondary infections and that therefore even young people are advised to avoid falling ill. What do you see at the moment in the clinic?

MUNTAU: We are lucky that we have yet to see a Covid-19 patient between 0 and 18 years old. My colleagues in other pediatric clinics have only very rarely seen them. We, however, have not. But we are taking part in a study from the University of Kiel about these long-term effects. For this we are looking at a large number of adults. But we are also observing children and young people, because we must take a very long-term look at what complications exist, for instance neurological effects, effects on other organs, psychological effects. I am glad that we ourselves have not encountered such a case (of a Covid-19 patient between 0 and 18) yet.

MARTINI: If we look at the cases, as you have said, you have yet to directly encounter a single child. Why is this so? Maybe because the children haven’t been moving around so much in the last few months? What has happened?

MUNTAU: Exactly. Once there was a number of children who returned from a skiing trip to Ischgl and were infected because their parents were infected. They were without exception so lightly affected that they could be treated at home. And another thing was the lockdown, which was, with regards to the children, extremely successful. The younger the children, the fewer the public contacts they made and therefore the lower they were infected—this we have learned from (studies on) their antibodies. We have a clear stratification (of proportion of infections) by age—people from 0 to 7 make up less than one percent, six to 12 year olds make up 1.5% and people over 12 years old make up 2%. I believe this has a lot to do with the amount of contact with others children and young people had.

MARTINI: This means that the older children are, the more at risk they are of really getting ill. If we take a look at where exactly the children are at the moment, at school, this must not sit well with you, Professor. Kriegel? If you think about it, children are in schools, in closed rooms. Thus we have arguments: open the windows, close the windows, cold air temperatures, warm air temperatures. What is going on? Bad air. You are—I would say rather inelegantly, an air researcher. What goes through your mind when you think about this?

KRIEGEL: That depends on the mode of transmission. If we take a look at the two modes of transmission we do know about, namely via droplets and via aerosols, we must say that schools aren’t really the best places to be, especially if we think about how they normally are, with so many people sitting very close to each other, and where the rooms are demonstrably badly ventilated. This means that this runs contrary to the recommendations of the Robert Koch Institute, which say that people shouldn’t stay too long in poorly ventilated rooms. I cannot say anything from a medical perspective, but yes, schools and classrooms aren’t exactly appropriate areas to be in.

MARTINI: What does the Robert Koch Institute recommend, Dr. Wieler?

WIELER: There are the basic recommendations, namely the AHA rules, this basic consideration that we must keep a certain distance from each other. We are talking about a distance of 1.5 meters at the minimum. We talk about hand hygiene. This is because of the fact that, for instance, if a sick person sneezes, they can transmit viruses through their hands—which is why we require wearing of masks. These are the basic concepts we have. What Professor Kriegel is talking about is of course clear. Now we have the question, we all agree that we want to see children in schools. This is because of many reasons. For instance, the requirement for children to be educated, or for instance the mental burden on children. They need their classmates, they need to be together. But there are certain rules as well. To keep a distance of 1.5 meters in schools is not always possible. And there is the question of wearing masks in the rooms, which is being discussed at the moment. Some schools require this, others don’t. Some schools are able to have small, tight-knit learning groups. To my knowledge, this is not the same throughout Germany.

MARTINI: Professor Kriegel, Dr. Ciesek, let us take a look at what we are currently talking about. Dr. Ciesek, from a virological perspective, we are talking about a virus that spreads via droplets and aerosols and via  a “smear infection”(2). How can this happen?

CIESEK: The most important thing to say is that there are many ways. More and more do I read that people think that this only has to do with aerosols. I don’t think so. I think that many ways play a role. Thus, one shouldn’t always make generalizations. For this reason, we need different measures. Regarding smear infections, it has been explained, it is quite clear, that if, for instance, someone blows their nose into their hand and then touches something and then someone else touches it and then touches their mouth or some other mucus membrane, they can be infected.

MARTINI: I believe the figure is 800—we touch our face 800 times a day without thinking about it.

CIESEK: Right. The number is not so high though, and it isn’t the main factor behind SARS-CoV-2, this is what we at the moment believe. We can see that if people pay close attention to handwashing and hygiene, the number of infections can be reduced by around 16%, which to me isn’t a very small number. But this isn’t the main thing. We could then move on to droplets and aerosols, which my colleague knows more about than I do. These can be differentiated by their size, namely, how big they are. And droplets, above all from coughing and blowing one’s nose, once released fall relatively quickly onto the ground. Aerosols originate from speaking or breathing or signing and are  much, much smaller and can therefore remain for much longer periods of time in the air. All three, I believe, play a role. Anyone talking about taking care cannot neglect this.

MARTINI: We have not yet come to smear infections, Professor Kriegel, and to droples and aerosols. What exactly happens if I were to sit with you in a room, opposite you, and talk to each other without a mask? What happens?

KRIEGEL: We will produce the smallest particles. I’m talking about particles and not the term “aerosols”.

MARTINI: Small particles, then.

KRIEGEL: In the end, these are fluid particles, one could say. It is a little unclear in the general population: what really are droplets and what are aerosols? In the end they are fluid particles with different sizes. We have ourselves—and so have others using similar methods—found out that we almost exclusive produce small aerosols, namely small particles via breathing, speaking, singing and dry cough, which are almost all aerosols. There are very, very few droplets, which occur in so-called “wet speech” (spitting while talking) perhaps or in wet cough and when blowing your nose—there, these macroscopic drops really are produced. They behave differently. There are no hard limits with which one can differentiate between an aerosol and a droplet. People speak of aerosols if the particles are so small that they can float in the air. Larger particles fall to the ground—not immediately, but rather, they travel around 1.5 meters, this we have found out. These aerosols sink to the ground as well, but the speed of the air in the room is always much higher so that they, in theory, move with the air as well. The hardest thing to understand is that we think that the air isn’t moving at all. But when we stay in a room, the air moves at a very low speed. But it is enough to move the smallest aerosols through the room. And if we sit opposite each other and sit very close to each other and speak to each other, you would have around you a cloud of aerosols emitted by me and would breathe them in—not exactly all of it, but a part of it. And if they contained viruses, you would breathe them in in a very concentrated form. Droplets are always moving downwards somewhat. But this must be clear: these droplets, despite being few in number, can make contact somewhere in your mucus membranes. This is what smear infections are, for instance, if these droplets fall on the table and you wipe them away and then touch your face.

MARTINI: That means that droplets are a problem as well as aerosols. If we sit in a room and talk to each other, the whole time there will be droplets and aerosols in the air, and I would be in constant danger of being infected.

KRIEGEL: Yes, we produce a huge amount of these aerosols, even when breathing. If we breathe normally, i.e. we aren’t exerting ourselves physically, then we would be emitting around 50 particles, 50 aerosols, in the air per second. And this means that after an hour—there are 3,600 seconds in an hour, times 50, that is a lot of droplets that come into the air of the room per hours. And because these aerosols spread around the room very quickly, they would be everywhere. That means that those in this room would breathe them in.

MARTINI: You just said that if there were viruses in the aerosol, we wouldn’t know it?

KRIEGEL: Yes, this is a medical question that I get asked over and over again, which I cannot answer.

MARTINI: Maybe Dr. Ciesek?

CIESEK: This is also a topic of current research. People don’t know at all how many viral particles are needed to infect a person. We must say, we do not have a definite answer. But I think that we can find this out. We are trying to work this out in the laboratory. Technically, however, this isn’t so easy to investigate. We still do not have a lot of data.

MARTINI: Professor Kriegel, that was an important part of your research, right?

KRIEGEL: Yes, I keep asking the medical partners we work with. And the answer would be very helpful in order to make better statements regarding the stopping or transmission of aerosols within a room. It is very clear that I would need a certain viral load, or as was said, how much virus is present in an aerosol. And on the other hand, how much virus is needed to cause an infection? If I were to know both these numbers, I would have a very, very good basis to work out air capacity, or in other words the amount of air to be purified, in order to clearly minimize the risks.

MARTINI: If, even without these numbers, you had to give an estimate and had to say how classes in school would have to be in order to prevent putting children in danger—how much fresh air must enter a room in order to ensure that things go well for the children, and how quickly and how often?

KRIEGEL: We are now trying to do retrospective studies of past outbreaks. How was the situation regarding air quality in rooms and how many people were infected? This is a very, very unclear task. There are other methods in literature, albeit somewhat different, but which all had relatively similar results. What we can say is that a certain amount of fresh air is required per infected person. But this is at the moment very, very vague. Thus one can say that the fewer aerosols or virus-laden aerosols we have in the air, the better, and the lower the risk. I have already said, in the Robert Koch Institute letter it says, that one should avoid staying in badly ventilated rooms for long. That says both things. We should also have good air quality, a lot of air exchange in the room, and the duration that people stay there (should be adjusted accordingly). If we think about the topic of aerosols, we are always breathing them in. And the more we breathe in, the higher the risk may be.

MARTINI: So that would mean, in a class of 20, a period of 10 minutes of intense airing per hour?

KRIEGEL: Well, that would be a badly ventilated room. It has long been known that the air quality in classrooms is very bad. Before recently, this was more to do with the carbon dioxide concentration in the room, which is very different to virus-laden particles. In any case, this isn’t an indicator of how good the air quality or ventilation in the room is. If we have 45 minutes of lessons and then only start to ventilate the room during the break, then after a quarter hour, the air quality would fall back down again. We’d exceed a certain limit for good air and then this would mean that we have a badly ventilated room.


MARTINI: Dr. Muntau, you would like to say something?

MUNTAU: I have a naïve question for Professor Kriegel: it is clearly extremely important to have fresh air in closed off rooms. We hear time and time again that in airplanes, this question of air supply is so good that it is practically a negligible risk. Professor Kriegel, can this country perhaps allow it, that in situations as critical as that in schools, various ventilation devices will be experimented with in order to solve these problems? I see that generally, with windows open and so on, this really won’t work.

KRIEGEL: Yes, I think it is possible. What is rather disturbing to me about this discussion- disturbing is perhaps the wrong way to put it, maybe “what I find noteworthy” works better- is that we have known about this problem of poorly ventilated classrooms for 130 years now. Every 10, 15 years, a study comes out about how badly classrooms are ventilated. And yet when schools are renovated, again and again, no ventilation apparatuses are built. I can’t understand it at all. Even before Corona, there were so many reasons to improve this. Now people are getting anxious about this and say, “We need better air quality.” And I see a purely practical problem- you can’t equip thousands of schools with new ventilation apparatuses so quickly at all. Thus we should try to live with this situation, to live with ventilation via windows, knowing that this comes at the cost of making the room a bit colder.

MARTINI: Dr. Wieler, from the perspective of someone at the Robert Koch Institute, how can classes proceed in the autumn and winter?

WIELER: I can’t really say much about this. Maybe a few epidemiological considerations. What Dr. Kriegler has said is true. We can all hope that, as much as possible, this implementation of new ventilation measures succeeds. Better late than never. Surely, the opportunity is now to obtain the necessary measures and to take care of the technicals. Anyone who has sat in a classroom and has experienced what the air is like knows that after 45 minutes, it becomes difficult to concentrate. This is the time for these things to happen, and I hope they will. But what can one do from an epidemiological perspective? The deciding factor is whether certain defined groups are included. Thus in such a period of time, which is a very exceptional time, changed or removed a few rules. I support the idea of not having normal classes, but rather, small, tightly-knit groups with defined teachers. Of course, this doesn’t apply everywhere. One must pay attention to each individual case. Why? Because if cases start appearing among children, then the number of children and teachers who are potentially affected and must go into quarantine smaller. One must refer to epidemiological concepts in order to limit the infections and adverse effects within schools.

MARTINI: Families are a close group for children. Dr. Muntau, if we have a look at studies, as you have said, they were not easy to perform as children were at home and really didn’t go out much. Now children are going out again. They are at school. They go about their hobbies and come back to their families- to their parents, who are 35-45 years old or older. And then there are grandparents. What is happening, how dangerous is this situation?

MUNTAU: Yes, this is a question that has not yet been fully answered. What are infections like within a family? We have for a long time feared that children could pose a great risk to older generations, especially their grandparents. For now these considerations have been left out somewhat. I believe that we haven’t seen many cases where grandchildren have infected their grandparents. Now here’s the question: is that a consequence of having been careful when it comes to making contact with them? Or perhaps because children in our country are not as closely in contact with their grandparents as in other countries, such as in Italy or Spain? This remains to be answered. And regarding the potential of spreading in children—in our study, we have made an important observation. Only 20% of children who live in the same household as a confirmed patient have developed antibodies. In other words, only 20% of children have been infected by adults and therefore have the potential to further spread the virus. Regarding the situation in schools, I would like to say one more thing. I find the idea of having small, compact groups excellent. That is good for learning, good for interaction and good from an infectiological perspective. But then there is still the question of how many and in what way we are to test. I keep reading that we should test for symptoms. But I believe that especially with children, the younger they are, the less applicable symptom-based testing will be, because as we have heard many times before, many children are asymptomatic or only have mild symptoms. We can’t just wait until a child starts coughing heavily until we test them. That is the question that is being asked in many other places: do we want to test these children every week, maybe every two weeks, maybe even their caretakers as well? I would like to ask Dr. Wieler about this. At the same time, I would like to ask him: would it make sense to do pool testing(3), so that we spend less? If the results are negative, we can leave the pool, and if we find a positive, we test everyone within the “pool” afterwards.

MARTINI: Dr. Wieler?

WIELER: Yes, such considerations are being made. They are being conducted for instance in hospitals, when for instance testing inpatients. One of the first clinics that I have heard of that have done this was the University Clinic in Cologne. There are a few very good examples of this already. It certainly makes sense to do pool testing. This depends on the size of the groups, there are certain tables that tell us how many people can be put into a pool, depending on the epidemiological situation. Such considerations are definitely valid. They can only be effective, however, if schools have really thought about these concepts and for instance worked together with local health authorities or with the National Association of Statutory Health Insurance Physicians (NASHIP) in order to put these into practice. This certainly requires a lot of commitment, and here I must make an appeal: there are some schools have already done this. I think these schools should create platforms from which to share this information. That is a possibility, perhaps on the federal state level, perhaps on a national level. We can only learn from examples. There are already schools that have done so. They can exchange information. There are also other countries that already have good frameworks, for instance Finland and Denmark. We can learn from them as well. We must keep on learning about this dynamic situation. It’s not like we have any patents on these frameworks. We must continue to keep our eyes open for new solutions that may come from other countries.

MARTINI: Dr. Ciesek, do you think that would be a solution, pool testing in schools?

CIESEK: Theoretically yes, practically, certainly not. In my opinion, logistically, this is impossible. The question is: who’s going to distribute the tests among the children before classes? When are results going to come? That is not trivial at all. We have done pool testing for a long time now in Frankfurt. We are doing them as well in hospitals. That is easier because they take a shorter time there. It takes longer to obtain results when testing pools. I think that we must do things a different way when it comes to schools. We must try antigen tests. Namely, tests that function like pregnancy tests, which are feasible for children and the elderly. The morning before someone goes to school, they can do the test at home. And if it is positive, they must report it and stay at home. If it is negative, they may go to school. They are not at all as sensitive as PCR. That is a disadvantage, but this must not be so. PCR is very sensitive and can detect people that have only a very small viral load and are not infective any more at all. And above all we would like to filter out those who have the potential to infect many other people. And therefore, these antigen tests are really ideal. In Frankfurt, we are planning a study with teachers who are to perform this antigen test at home every other day. We’ll find out teachers get on with these tests. And I believe that this is the way to go, as opposed to pool testing, because logistically, the issues with the latter are not trivial at all.

MARTINI: But how far are we along with these antigen tests? Are there already enough of them?

CIESEK: There are many different companies that have created such tests. There are a number of European companies, some within Germany, that are developing them. Large diagnostics companies are developing them too. Our study in Hesse is being performed with a test that is not yet publicly available. I believe this will take a few weeks. When it will be released depends on the authorities. But I am optimistic that hopefully, it will be released soon. I only believe that this is more realistic than pool testing. If you were to ask about laboratories—it is very hard to correctly deal with the pools, to ensure that no mistakes are made. To sort through the amount of material in the laboratory—this isn’t easy at all. Thus, self tests are much better to aim towards.

MARTINI: We can currently—Dr. Ciesek, please correct me—we can currently perform about 600,000 tests per week. Dr. Wieler: 600,000 tests per week?

WIELER: More than that. Testing capacity depends on PCR, namely the method, which is of a very high quality. The capacity is actually over one million. In reality, we have conducted around 800,000 to 900,000 tests. That is of course, as Dr. Ciesek has said, the game changer. If we have high quality antigen tests, this would be a great help to us, because we would be able to conduct these tests. Many, many people are waiting for these. As far as I know, there are no antigen tests that are of a high enough quality, but we are waiting for them. That would give us much more freedom of movement, I believe, if these tests arrive.

CIESEK: What can be said about the capacity of the tests is that it is above one million. But you must remember that, for instance, if I can run 1,000 meters in four minutes, I could run at that speed for five kilometers, but certainly not 50 or 500 kilometers. That is of course a large number of tests. But in the long term there will be shortages of materials. Thus it is a problem, when you think of how many schoolchildren we have in Germany, if we were to test them all.

MARTINI: Let’s move away from the topic of schoolchildren somewhat and think about how we can improve our testing strategy in the autumn and in the winter. At the moment, we have testing centers in airports and train stations. There, many people can be tested. How will this pan out during the autumn and the winter? Test as many people as possible, Dr. Ciesek?

CIESEK: As was said, we cannot test everybody. That would of course be the ideal—to test every single person every single day. That will not happen though. Thus I think that, when considering scarcity, one must consider: who is most at risk? Who is at the top in terms of triage? I think that symptomatic patients should be prioritized and tested without delay. Especially at-risk groups, the elderly, those living in homes for the aged or in healthcare facilities, they should be kept out of danger. And of course in hospitals, so that people with other illnesses can go to the hospital without fear of being infected.

MARTINI: That people feel safe—I believe that Dr. Muntau is quite interested in this, because this is a big problem for small children and those with chronic diseases. What have you observed in the last weeks and months?

MUNTAU: In our study, we have concentrated on children who are in our care, who have chronic, complex, and/or rare diseases. What we have found is that the prevalence, the frequency that children that have antibodies, is one half that in children with chronic diseases as it is in healthy children. That goes well without our observation that these children are protected by their parents in very special ways. So well protected that they even missed absolutely necessary hospital appointments for their therapy. For instance, we are taking care of children with hereditary metabolic diseases who need certain enzyme replacement therapies every few weeks—in other words, they require infusions or follow up appointments, because many of their organ systems are at great risks—some of them have stopped coming to us entirely. We are very concerned about this. And thus there is collateral damage in those who have chronic diseases and are afraid of going to the hospital, and do not get what they medically need any more. And if one looks back at the situation in hospitals over the last few months, we can see hospitals that have not received a single patient. When I spoke to my friends in pediatric private practice, they have said that similar things have happened. More trivial things such as vaccines and regular checkups have not occurred as often as they used to. Either because practices were closed or because people were afraid or because there were fewer opportunities to do so. That is not something we should let slip out of our minds.

MARTINI: That means yes, looking towards the autumn and winter, we must make sure to protect people at risk, including children, and that we must ensure that the rooms in which everyone moves are ventilated well enough. Professor Kriegel—we have, as Dr. Wieler has always said to do, worn masks. But not all is well with these masks, if my knowledge serves. Sometimes, people wear self-prepared cloths over the mouth. Or they don’t cover their noses or something. Professor Kriegel, what should a mask do in order to function properly?

KRIEGEL: A mask has two purposes, which depend on what sort of mask is in question, but I’ll talk about the masks we wear in our everyday lives. For one, they are very effective in filtering out droplets which we emit. You must imagine that drops, as I have already said, have a greater mass than aerosols. And if the air flow is hindered by the mask and then is redirected along the edge of the mask, large droplets will actually “try” to continue to move straight ahead. That is the same inertia we all feel if we drive around a corner in a car or ride in a roller coaster. The droplets end up getting stuck on the fabric. With aerosols, things are a little different, because ideally, a small part of the airflow actually goes through the material, but then over the edge of the mask and back into the air. The smallest parts, the so-called aerosols, return to the air. Still, as we have seen in our example of when we sit opposite each other without masks, you would always be exposed to my air flow, which has aerosols. With masks this wouldn’t be a problem, because the air flow would be diverted instead of flowing directly towards you. Thus, in both situations, whether with droplets or aerosols, masks make sure that we can protect other people.

MARTINI: Dr. Ciesek, this means that masks should be worn in any case throughout the autumn and winter?

CIESEK: Yes. I think that even if they cannot provide complete protection, it makes sense to do so in order to reduce the number of viruses. And there is data showing that the higher the number of viruses that one is infected with, the more severe the course of illness. What I do not like to see are these masks with holes for exhalation which some people are wearing. That is certainly not suitable at all with regards to solidarity.

MARTINI: Dr. Muntau, masks for children as well?

MUNTAU: Yes, this is difficult. We have a certain time period, five years old, which is is really decisive for these children. And I believe that regarding pedagogic frameworks in schools, this is a big setback. I am conflicted. And to add to that, there is everything Drs. Kriegel and Ciesek have said.

MARTINI: From your point of view as a pediatrician, we have already said that the problem isn’t so much with small children. Older people are more in danger. And we have 14, 15 year olds who really don’t understand this at all. How do we reach out to them?

MUNTAU: Yes, I believe that this is a question that isn’t really to be answered from a pediatric perspective, but rather from the perspective of someone with a lot of life experience. I believe that it is always good to proceed with the right information, with clear words and with explanations, to explain what is necessary and important. Sometimes you must reach out with particularly striking examples. That is not easy and so many parents avoid this in order not to burden their children and so on. But the well-being of society depends on this. I see so many young people going around in parks, on weekends, in the evening, quite a lot of the time, who don’t cover their mouths and noses. I believe that you can tell them a story of someone who didn’t make it. We have, sadly, experienced this. One of our colleagues has died a few days ago. This was a relatively young person who was infected while working with us. For parents to downplay this, thinking “I would rather not burden my children with such heavy topics,” is probably wrong. Children and young people are also mature. I believe that we can tell them why we want to be so careful. But this is something very delicate and so we must take great care here.

MARTINI: Dr. Ciesek, is it important for me as a mother to keep a distance from my 14 year old daughter and my 17 year old son?

CIESEK: It would certainly make more sense to explain things to them. I have nieces and nephews of the same age who understand very well what this all means. You can really discuss things with them. And I think that rules about distancing apply to the elderly as well as adults. I can say that my daughter is six years old and also goes to school. And I must say that she has absolutely no problem with masks at all. That has become routine for her. She wears them without complaining. She forgets about distancing, I must say. When she sees her friends, she goes directly towards them. I find it harder to explain to her that she must keep a distance from her friends than to explain to her that she should wear a mask.

MARTINI: Let us wrap things up now. I’ll start with you, Dr. Muntau—what exactly must happen in order to get through the autumn and winter well?

MUNTAU: We must implement care measures. We must help people from all age groups understand these things. And we must use all the technical potential available in this country to support the most important things in our lives. That’s what I see.

MARTINI: Professor Kriegel, we have learned that improving the air in a room is from an engineering perspective something that could potentially be as effective as handwashing. What must we pay attention to? How do we go about the autumn and winter?

KRIEGEL: The risk depends on two things. Not only the air, but also, how long people stay in a certain room. And if we pay attention to both things, namely improving air quality and minimizing how long people stay in a room, that would be a great help to us. Of course, things are very different at home. But regarding the places we meet up with other people, these considerations are valid. We need well ventilated rooms and we should stay there for as short a time as possible.

MARTINI: Dr. Ciesek, what do we urgently need to know in order to move on?

CIESEK: I think that there are different aspects. We must, above all, use the knowledge we have gained in the last few months. We must improve tests and make them easier to conduct. The example I used was antigen tests. And we must make sure that vaccines are released as soon as possible, vaccines which have gone through all clinical phases in testing. I think the most important thing is to use this knowledge in order to keep the number of infections in the general population low and thus protect people at risk, but also to open schools.

MARTINI: Dr. Wieler, regarding the autumn and the winter, what must happen in order to do all of these things?

WIELER: Yes, I can only agree with everything that has been said so far. I would like, however, to mention that through the measures we have put in place early on in the year, we have reached a historically low number of infections. That means that all of these measures have very much helped to protect against infection. That is a reason to be optimistic. We know that masks really are very effective. Thus, masks and social distancing play for me a central role. And I see the same thing Dr. Ciesek does—my kids are a little older, but some younger children find it very fashionable to wear masks that look cool. I don’t see any problem with wearing masks in lessons. There are a number of perspectives on this. But this is all weighing different benefits against each other and making a decision. A problem that we have been working on since the start of March, which is an interdisciplinary problem that we have worked on with sociologists and psychologists has come right—masks are widely accepted. Wearing masks in schools—around 60% of parents prefer this. If we continue to communicate well and really explain things—there was a very nice episode in “The Show with the Mouse” (Die Sendung mit der Maus), I don’t know how many of you have seen this on the weekend, where the effectiveness of masks was very well presented. I think that this is the right way to go heading towards winter. But this will only work with a general sense of solidarity. We need everyone’s support in order to protect ourselves. We can do this with the materials we have right now. We don’t have much more at the moment. Testing must certainly be made easier so we can test more people. That would keep us safe.

MARTINI: That was a special episode of the Coronavirus Update. I must thank you all very much for having spoken with us in this episode. All the best. That was our Coronavirus Update, a special episode during the summer break. Thank you to our editorial help from Daniela Remus, Charlotte Horn, Jenny von Gagern, Nils Kinkel and of course technical help from Sabine Suhr. This podcast can be found in the ARD Audiotheque, at ndr.de/coronaupdate. Of course, there will also be a transcript of the podcast. Please enjoy reading it. My name is Anja Martini. Thank you for listening to us, see you next time—but not before we give a small shout-out to another podcast, a science podcast, Synapses (Synapsen).

HENNIG: Hello, I am Korinna Hennig. We will hear from the Coronavirus Update again on Tuesday, September 1. The pandemic is not the only topic that we at NDR Info are concerned with. There are many important and exciting fields of research which are worth talking about. In our podcast, Synapses, for instance, we talk about what can be done against the death of birds. In a single generation, over 420 million birds have been lost. I would love for you to listen to this. Synapses can be found in the ARD Audiotheque and at ndr.de/synapsen. Until next time.

NOTES
1. 	A mnemonic for three pieces of advice to reduce the spread of the Coronavirus, namely, social distancing (Abstand halten), paying attention to hygiene (auf Hygiene achten) and wearing masks (Alltagsmasken tragen)
2.	Direct contact with the body or bodily fluids such as pus of a person, or via fomites)
3.	A method of testing where multiple samples are mixed (pooled) together and tested. If a pool is negative then everyone whose samples are in the pool can be considered negative, and if a pool is positive, everyone whose samples are within the pool is tested to see who is positive.