Episode 51- Special Edition: How We Can Continue to Live With Uncertainty

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 have learned almost completely by myself, 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. I am simply a medical student who admires the work of Dr. Drosten and colleagues, and the clarity with which he presents concepts in his podcast, and I would like to provide unofficial translations of his podcasts so that they may be helpful to those who do not speak German. I hope this is acceptable- if not, please reach out to me on Reddit and send corrections and advice in. I apologize in advance for any errors I have made. There are some footnotes at the bottom of this translation.

Original audio: https://mediandr-a.akamaihd.net/download/podcasts/podcast4684/AU-20200716-1232-0100.mp3
Original transcript: https://www.ndr.de/nachrichten/info/coronaskript216.pdf


-----A BRIEF LOOK-----


MARTINI:Welcome to the Update: this time something new, as Christian Drosten is on a summer break. We have here today four renowned scientists to begin with. My name is Anja Martini and I am a science editor for NDR Info. Our theme is the same as usual. For nearly half a year, the coronavirus has affected our lives.
(various quotations from the podcast):
    "This is certainly a very unique situation, at first when we heard of the first cases in China, we thought that (the virus) would     never come to Germany."
    "Focusing more on the opportunities instead of the negative effects- I see great opportunity in the crisis."
    "This means that we must see to it that the language used in public discourse sends the right message to those in danger of being left behind."
    "This interdisciplinary, objective discussion- I believe this a critical factor,  this openness that even politics has demonstrated some time ago, that separates us from many, many, from most countries in the world."

MARTINI: What is the current situation like? Today, we would like to explore these from different perspectives.  For this, Dr. Birgit Spinath is here. She is the president of the German Society for Psychology. She says that we must be vigilant in order to detect signs of a change of mood(1) in our society. We also have Professor Dr. Stefan Kluge, the Director of the Department of Intensive Medicine at the University Medical Center Hamburg-Eppendorf. He says that we have gotten to know a new sickness that has brought medicine and (other) sciences closer together. In doing so, we (Germans) have fought this crisis well so far. We also have Professor Dr. Jurgen Manemann, Director of the Institute for Philosophical Research in Hannover. He thinks that we are right in the middle of the crisis and that we must learn to live with uncertainty in the long term. Lastly, we have Professor Dr. Jonas Schmidt-Chanasit. He is the leader of the Central Diagnostics Unit and Deputy Head of Virology at the Bernhard Nocht Institute for Tropical Medicine. We are right in the middle of the pandemic, he says. Up till now however, we are one of the few countries that have done well so far, which is due to the overall societal and political structures that underlie our country. Hello everyone.

OTHER GUESTS: Hello.

MARTINI: Thank you for coming here. Let’s begin with a brief recap. Germany is “back on the road” again. When you, Dr. Schmidt-Chanasit, look at this (situation), what do you see? Does this worry you?

SCHMIDT-CHANASIT:  I’m not worried. However, I have a feeling—how should I describe it? This is a Kafkaesque situation. We are somehow in the middle of the tunnel, in the middle of the pandemic, and every so often see a light at the end of the tunnel which ends up disappearing again. I believe that’s the feeling that disturbs many people as well. This feeling of danger that’s always in the air, but isn’t always obvious, there is, I believe, something psychological too—luckily we have experts with us, to whom I am very thankful for—psychologically, this is simply put a big problem, maintaining this awareness, this sensitivity, because we must live with the virus, as well as the danger, in the coming months.

MARTINI: Dr. Spinath, what do you see?

SPINATH: Yes, I’d like to add something to that. We have a situation where on the one hand, a lot of things have gone back to normal. But with other things we can still tell that things aren’t normal, and this makes it dangerous. And therefore I would like to return to this phrase, a possible "change of mood”(1). We must therefore take care not to fall for anything that offers us a false sense of security.

MARTINI: Dr. Kluge, what do you see right now in the hospitals?
Kluge: The situation has calmed down as far as patient treatment is concerned. The number of patients (in Germany) has definitely shrunk. We’re taking care of just under 300 patients in intensive care nationwide. They have a long course of disease, but there’s also the issue of hospital tests, personal tests, what happens to suspected cases and how will things proceed? And how can we handle seriously ill patients that’ll come to us in the next months? This issue is of course something that we spend hours every day on.

MARTINI: Dr. Manemann, when you look at this, what do you see from a philosophical perspective?

MANEMANN: I see that the fear of infection, of getting sick, is weakening. But the fear of change, change that is happening so subtly in our society, change that may so massively destabilize our society that it endangers our democracy. And I detect a third type of fear, most of all among young people, the fear that nothing changes, that the Corona crisis will pass without the changes that young people are waiting for, that the crisis will pass without any changes. And I also see in our society a fear of fear. We’re avoiding discussion about fear.


-----THE SECOND WAVE IS COMING-----


MARTINI: Those were our first thoughts (about the situation) from different disciplines. Now let us take a closer look. If we are to understand that we will have a second wave in the autumn, Dr. Schmidt-Chanasit, what can we expect? What are you afraid of?

SCHMIDT-CHANASIT: It’s not a matter of “if it comes” or “when it comes”. It is one among many possibilities. The question one should ask is whether we are sufficiently prepared. And these questions, of course, depend on intensive medicine, on virology and on many other disciplines. And I believe that we have done much in the last weeks, months. Many people have been working constantly to get to where we are now. You can’t be lax with this. There are still many things one can do. And the challenges, as I would like to call it, the second wave as a challenge, these challenges can come up again, and we will be confronted with critical situations, which we then must deal with.

MARTINI: What can you do as a virologist to confront these challenges?

SCHMIDT-CHANASIT: As a virologist I can, next to the scientific work that we do, bring about improvements in the laboratories concerning rapid diagnostics, field diagnostics, for instance availability—these are the tasks that a diagnostics virologist does and ultimately can change and improve. This includes the development of new testing procedures in order to test antibodies in order to draw conclusions about how long these antibodies can be detected for, cellular immunity and so on. Thus there are many questions concerning laboratory diagnostics, that is our ultimate role in patient care, one which we work day and night on, so that we can finally give conclusions to our colleagues in direct patient care such as Dr. Kluge, and also to our colleagues in health authorities, so that they can act more quickly and more precisely.

MARTINI: The antibodies in our bodies that appear after someone gets sick, this is a topic that can be read about quite a lot in the media. Are they there for a long time or not? If yes, what does that mean? What do we know about this?

SCHMIDT-CHANASIT: Yes, these questions, are they there for a long time or not, one must say this: with which test were (the antibodies) observed? One can see very quickly that these tests as well as the antibody levels are not comparable with each other. That is normal in such a phase. What we have here is a virus that we do not relate to the same way we do the HIV virus, which we have known for decades, which we can—so to say—very accurately quantify. We cannot do the same for (Coronavirus) antibodies, which there are international standards for. Thus, when we compare studies, this is very problematic. One study has a low detection limit, another a high detection limit. What this ultimately means, especially with respect to immunity, is still unclear. One should be very, very careful when talking about this. Every day new studies come out that are very interesting. But once again, I can only say that either immunity arises or that immunity is present for three months or that there isn’t any pre-existing immunity, if for example someone has been infected with other coronaviruses. There’s no way to make any definite conclusions. These are the first results and we must wait for further studies.


-----RAPID TESTS: DO THESE WORK?-----


MARTINI: Dr. Kluge, upon looking at virology, what do you urgently need to really prepare for these challenges?

KLUGE: I think we in Germany are very well prepared. In terms of infectious disease, virology, we in Germany are very strong. We intensive medicine doctors are well coordinated. We in hospitals are more strongly bound together than ever before and have also connected well on a national level. One can be very proud of what we have done. PCR tests are also available in greater numbers and in higher quality—this is not the case in many other countries. Of course, we’re still hoping for faster, better tests and antibodies that can reliably predict immunity. We are very satisfied with this. I believe that time is, so to say, already important, because to give an example we wanted to put a certain patient back in rehabilitation, and our colleagues said to us that they will only take patients with an up-to-date test. Yes, if I need 24 hours, because these tests are only conducted until 4 in the afternoon, then I have a problem. Thus I want a test that can ideally show whether a patient is positive or not within 60 minutes. All in all though, we are very, very satisfied.

MARTINI: Dr. Schmidt-Chanasit, is this the same for you?

SCHMIDT-CHANASIT: Yes, of course, it’s the same for me. The progress is immense. In terms of rapid tests, development is proceeding in the direction of cartridge systems, which listeners might recognize from pregnancy tests. There are many, many developers for this. That would of course be a breakthrough, especially when we think of events. We have discussed this, about theaters and so on. If we have the possibility, so to say, of ruling out an acute infection in 20 to 30 minutes, we could permit much more in many areas of life. This is where test development and ultimately our task as biologists plays a very, very decisive role. This goes for many other branches which have been just as heavily affected by the lockdown and the measures. However, just as Dr. Kluge has said, we already have the possibility of conducting tests very quickly. This is therefore a question of organization, partly also of financing, which is always being answered. Still, much has been done in the last weeks. And I hope that we can also be forward-looking, prophylactic, as we go into the autumn, that teachers, daycares, healthcare workers and those in homes for the aged can be tested more quickly and in greater numbers.

MARTINI: So are these good signs, Dr. Kluge? The right direction?

KLUGE: Absolutely. I believe that we are well prepared. One must pay attention though. We’re working in big hospitals and institutes. This should all also come to pass in clinics on the outskirts of the cities and in small hospitals in the countryside. That’s what people should pay a little attention to, when we experts from larger institutions have discussions here.

MARTINI:  That’s right. We shouldn’t let the countryside go ignored. Let’s take a look at your intensive care unit. What are you doing? Is it going back to normal? Or what are you doing to bring it back to normal?

KLUGE: We have learned that intensive care patients with coronavirus-positive pneumonia only arrive on the tenth day of their infection or later. Thus, we can easily see from the infection rates what we can expect in ten days. Right now it seems as if there will be very few infections, because we only have a few new infections in Hamburg and throughout the country. We currently still have four patients in intensive care. We really are taking care of all other ICU patients. When it comes to German intensive care we have the luxury of having so many ICU beds, in this we are the “world champions”, but not enough healthcare workers. Thus before corona a large percentage, 20% of ICU beds were closed off due to a lack of healthcare workers. That is now our main focus. However in order to be well-positioned, we must depend on whether politicians improve conditions for healthcare workers. Overall things have definitely improved, but other issues have again come up.


-----TRAVELLING IN THE TIME OF CORONA-----


MARTINI: Ms. Spinath, in terms of medicine, we appear to be on the right track, according to (Kluge and Schmidt-Chanasit). What do you say, how far have we come? Can we expect a change of mood?

SPINATH: When one thinks of a change of mood and looks around, then they can note that everyone’s in the mood for a vacation and are considering whether they can take this well-deserved vacation and under what circumstances, and this is of course a type of change of mood. You’ve done something together—hopefully there is that feeling, that you’ve done something together. And now one would want to relax. And that has new dangers, because this situation must also be appropriately dealt with. We have seen on TV that not everything is done carefully. And this is something new that we must learn. What happens to fun, then? What happens to relaxation under corona conditions? That’s a new situation. I would like to speak as well about this topic, there has been, especially from medical perspectives, much said about test development, and how important this is, and therefore I would like to add something from a psychological perspective, because what we are doing is trying out a sort of monitoring. We are trying to see whether the mood is shifting. To what extent are people aware of risks? In which groups is this most pronounced? And these are also tests that tell us where we are at the moment. And therefore we can say that it’s looking very good right now, at least for Germany. In this respect people are still being sensible. But from these tests one can also identify groups that we need to pay attention to. There can be a change of mood among these groups.

MARTINI:  What happened to them? Have we left these groups behind?

SPINATH: There are certainly groups that are especially negatively affected and must then ask whether this is appropriate. I’m thinking for example of young people who want to enjoy their lives. Yes, others want to do so too. But this need to do so at parties and nightclubs, is this more pronounced among young people than in other groups, and what are the arguments they can use to reach them? And there it is, the arguments. These concern empathy for especially at-risk individuals. This is how you reach out to these groups. And this is equally important, that we know how to reach out to these particular groups.

MARTINI: Dr. Manemann, when you look at this situation and what we have just talked about, the tests, clinics preparing themselves for what we in the autumn—I’m using this term, yes, Dr. Schmidt-Chanasit says that he doesn’t really like hearing it—but the second wave can come eventually. What do you say, do people still have faith in the measures politicians have implemented and in science?

MANEMANN: One must make a distinction. The question is of course, who is this “we”? “They”, then refers to the “outsiders”. The system is well set up. Our healthcare system’s capacity for intensive medicine looks good. We don’t need to worry about this. If, however, I take a look from the outside in and ask, “How are we citizens doing”, this is also a very big abstraction, “we citizens.” But if I may ask such rhetorical questions, such as how prepared we citizens are and ask, whether we still have the strength and energy to deal with something similar in a few weeks, I am very ambivalent about this.

MARTINI: Why?

MANEMANN: The point is that we don’t have very much valid data available, and in this respect—this is also important that the listeners know this—that I present from a philosophical perspective subjective impressions that I have about my environment and the public.

MARTINI: So no numbers, no facts, but perceptions.

MANEMANN: Perceptions, yes, I mean, whether these aren’t more objective than numbers, facts. However, we shouldn’t get sidetracked by this. But is important to know that first of all, we are all a little bit uncertain and whatever we say shouldn’t be taken as the final word. But the question that many people ask is: how do I find something to hold on to(2) in unstable times, when I have nothing, not even people to hold on to? I can say this from a philosophical perspective, something to hold onto in unstable times, when there isn’t anything external you can hold on to, (the answer) lies in one’s inner stability(3). That means that we must think about how we can foster stability that can help us live with this unpredictability, this uncertainty. And I worry a little bit, because before the coronavirus our society has been diagnosed as a burnout society. A burnout society means that fatigue depression, burnout is spreading. And when the “Corona society”, if I may call it so, the Corona society now tires us even more, then it threatens to become a burnout society. Then, just as the sociologist Hartmut Rosa has said, our social energy will run out. And we need this social energy in order to develop our innermost attitudes, in other words our habitus(4), for me this is the question.

MARTINI: Dr. Spinath, do we need stability?

SPINATH: Yes, we really need this. The habitus is a sociological construct. From psychology, one would rather think about the outside from the inside and say that we need a certain attitude. And that is for me for instance always important, that people approach things with this attitude: “There’s a lot under my control. I can take measures to protect myself and others.” And it’d be very dangerous if we lose this feeling of control.

MARTINI: Have we lost that feeling or is it still there? I take care to protect myself but also make sure to protect other people.

SPINATH: I believe that many people feel that they can protect themselves. What is dangerous is the fact that I do not see the consequences that I have prevented. And there is the famous saying, “there is no glory in prevention”. When I have prevented the catastrophe, I do not see how great the consequences are at all because there is no catastrophe. And this is something we must keep finding out more about, when we see how other countries have fought against the pandemic. And we can see differences, and these differences correspond to the measures taken or even when individual cases are reported, where risks are underestimated and where the corresponding consequences, which of course aren’t desirable, occur.

MARTINI: And is this therefore an explanation for the fact that the measures we have taken, such as covering our mouths and distancing, have been somewhat forgotten?

SPINATH: Certainly. Thus we can see a lifestyle that looks normal. The masks are probably the most visible sign that things aren’t normal. However we naturally underestimate what these masks do. Distancing, wearing masks, these are small things that have great effects that we are in danger of underestimating.


-----HAVE WE COMMUNICATED APPROPRIATELY?-----


MARTINI: Dr. Kluge, when we look out and you take a look at the ICU, what do you see? How do patients come to you? Are they well prepared? Do they know roughly what is going on with them when they come to your hospital and know that they might get a positive Corona test? What have you experienced?

KLUGE: Yes, I’m thinking of the times when a lot of patients came to the ICU and when we had to take emergency measures to take in patients from Italy and France because their healthcare systems were overwhelmed. Intensive care physicians have calmed down for now, but whoever wants to save lives of course doesn’t think about the psychological effects and collateral damage at first. And it was very dramatic. And we must say that other healthcare systems that were perhaps always comparable to ours, the USA’s, France’s, Italy’s, they have collapsed. And we have managed things very well. And thus I cannot understand at all why there is so much discussion over removing requirements to wear a mask and so on. We can only continue like this as long as there isn’t a vaccine. Someone has said to me, “Oh, it’s so awful, I must still wear a mask in museums” and so on. “That has been a problem for me.” I said to them, “Please be glad that you are alive, that you can go to the museum. It’s all well for you, you haven’t lost your income because of the pandemic.” You should see that as a big positive. In this respect there are of course many negatives. But sometimes there are a few unnecessary complaints in Germany.

MARTINI: Have we communicated poorly? Have we not made it clear that we have done very well in many respects? Were we bad at this?

KLUGE: I don’t really think so. Everyone knows the statistics, the death rates and the incidence rates. And everyone can see how things go in Germany, in Brazil, in the USA, and France. And I believe the government shutdown was completely appropriate for the time. We didn’t pay as much attention to the economic damage, we were saving lives. And I think that’s appropriate. And I found the politics of information very, very good. But I can see that in the clinics, we still haven’t reached the end, that’s just how it is. Therefore we should probably do even better.

MARTINI: How?

KLUGE: Yes, communicate more, really talk to people out there. To send out an email, newsletter, daily news updates, to print certain things, that just isn’t enough. Many people don’t read them. And—I have always understood this—we simply must speak about this more, amongst ourselves as well as among those in the ICUs who take care of these patients. Yesterday I was in a meeting where many questions were asked, questions that I really thought we had spoken a hundred times about. I believe this is important in such a crisis, in such a pandemic, that people really take everyone else into account. To send emails or to publish things on the Internet just doesn’t cut it.

MARTINI: Do you have the time for this?

KLUGE:  I believe we must find the time. Especially in hospitals, we must talk to workers, healthcare workers especially, and of course doctors. If we do not have these conversations, especially in  patient care right now, then we may not be able to treat the next patient well, and thus it is very important to talk to people.

MARTINI: Dr. Schmidt-Chanasit, from your experience, communication with scientists was not always very easy in the past as well. We have seen that science is a process and that there are always new discoveries. And so on and so forth. Have you felt that you have been well understood as a scientist in the last six months, or was it difficult?

SCHMIDT-CHANASIT: Yes, there are definitely times where one can say that this is (overly) shortened or distorted. But all in all people should know, I believe, which role they play in this pandemic, especially in cooperation with the media. Whether a person shares information, or whether they are a scientific arbitrator who compares other studies, or whether they already have a scientific-political agenda. And I believe that most of my colleagues belong to the first category, where communication is fine. And it is not always possible to avoid judging other studies as an arbitrator. I believe that only a few colleagues support their own political agenda or an agenda at all. But it is not easy at all to maintain and defend this position. Thus, I have perceived that this gap is growing wider. And I have believe that this is intensified by the side-effects (of the lockdown) that have kept growing stronger. We were very, very closely knit going into the lockdown. I had the feeling—and this is only my feeling—that there was great approval, everyone stuck together. And this division will only widen as the effects become clearer, even in daycares and schools. And there is what Dr. Kluge has spoken about, the problems amongst doctors caring for patients. In this respect I found what Dr. Spinath has said very interesting, that there is no glory in prevention. This I see very, very critically. I thought to myself, is that not a certain intellectual arrogance? I always had the feeling that people have a very fine feeling for what prevention can do. Otherwise not many people would allow their children to be vaccinated, had it not been clear what this can do in terms of long term protection. In this regard I have always said that the population has, I believe, a very fine sense of this. And who really wants glory? I don’t want glory. That isn’t our task, to achieve glory. We want to go through this pandemic well and to help out with this. But maybe I have understood this wrongly. Either way I have found what Dr. Spinath has explained in a certain way very interesting. Thus I believe that this discussion about what role scientists or doctors play in communication with the media very interesting. There are many different models and personalities. And I believe we can learn much from this crisis, something that people in the future should pay attention to, especially of course with regards to personification. This discussion of individual people, this is something I criticize, because this places a terrible burden on the individual, even up to death threats against them. I believe we should avoid this in the future.

MARTINI: So, to be more careful. Dr. Manemann, you have written a concept paper with colleagues from your philosophical institute called “Corona-Answers to a Cultural Challenge”(5). How scientifically mature is our society according to you? How many scientific processes do we understand?

MANEMANN: In the last few weeks I have been astonished by how much citizens have understood in the past few weeks. This is of course because information has been presented to the media. However, citizens have informed themselves as well as they could, and that is a very positive experience for me. Of course people mustn’t stop there, as the Swiss epidemiologist Marcel Salathe said: ‘In the beginning people made a small error: their statements were too simplified. And thus citizens have gone on, and he speaks about thousands of citizens who have read the studies and have discovered that things aren’t at all so simple. The situation is more complex. And this is what he is speaking about, that we should expect citizens to have scientific knowledge and to accept this complexity, and that citizens have a right to this. We should therefore proceed without question in this manner. I find it amazing how things have gone so far. There are things to be criticized but I find—I don’t want in any case to speak as a person who knows better—that this is amazing. However I would like to say something about communication here. I share many of the same opinions that Drs. Kluge and Schmidt-Chanasit have spoken of. But some things about the language used unsettle me. More specifically, the term Bewältigung(6), which if memory serves, they have both used. We must always be careful of the language we use. I mean a philosophical sensibility for language that excludes others from our discourse. And Bewältigung is a term that has a lot of exclusionary potential. In order to understand this, take a moment to think about the debate over how to handle the Nazi past, about coming to terms with the past(7)—behind this lies a mentality of willful avoidance(8). The term Bewältigung can therefore go over very badly amongst people who fight for their very existence, and could ostensibly be understood as a term that comes from the vocabulary of the privileged. That means that we must see to it that we use language in public discourse that sends the right message to those who are in danger of being left out. And that is important to me from a philosophical perspective. For example the group, I am speaking of this group, those who are mourning. And these bitter goodbyes that people have experienced from family who have died, these come with many guilt complexes and traumas. And we all must, as a society, deal with these questions and these complexes and what has happened.

MARTINI: So, language is, so to say, one of our most important instruments?

MANEMANN: Yes, this is to do with communication. As scientists we try to use language that is as neutral as possible. But neutral language is, especially during these uniquely difficult times really not neutral language, but exclusionary language. And we must take care to correct each other and to consider what language we use in order not to exclude other people.


-----DEALING WITH THE FLOOD OF INFORMATION-----


MARTINI: So we must work on some of our language. What we have seen in the crisis however is that there is much uncertainty. We have inconsistencies and we don’t really know much about the virus. Some people said we know quite a lot about Covid-19 but that has also changed. Dr. Schmidt-Chanasit, let us get back to your area of research, namely new infectious diseases. What do we really know about this coronavirus? And most importantly, which key pieces of information are missing?

SCHMIDT-CHANASIT: Yes, the most important pieces are missing so far. But let’s go back briefly to Dr. Manemann, I found what he said very good and very interesting, what I also notice, which words people use, which phrases are problematic and that people learn about these things in the pandemic as well. And the word Bewältigung, I have just used it again, I am very thankful we can have this discussion and that it happened in this broadcast. So really, very, very good. On the other hand, as far as the virus is concerned, there are fundamental questions that are as unclear as ever, even though in the beginning they seemed relatively straightforward. For instance, if someone says “Herd immunity can be reached at 70% (immune populace)”, we have to ask whether herd immunity can be reached at all. Is there immunity that, for instance, lasts throughout one’s life? And if so, is it present in 70% of people or 10% or 20%? These simplified, clear messages? I criticize those as well. Dr. Manemann said this, and so did Dr. Salathe too. I believe we can ask for this from the populace. Exactly this, which is what I am saying, the phrase “There is no glory in prevention”, which seems a little condescending. I believe we should clarify more things more specifically, as well as clear up the uncertainty and complexity of what has happened. That is therefore an example of what is of course very, very important for us, because it also affects intervention measures. Can a vaccine be developed to protect most of the population? Is this necessary at all? These are wholly decisive questions that should be aimed at a certain strategy that politics should follow. What should one therefore do now? How long can one withstand this situation? These are I believe very important questions that should be answered. Even though new findings come up every day from research, these findings don’t always mean we can better answer these questions—in fact we end up with more questions—and the whole topic looks even more complex.

MARTINI: Dr. Spinath, does this multitude of information confuse us or bring security to us?

SPINATH: Of course, one can be too well informed. Or too poorly informed. I found it very helpful to follow this advice: dedicate a certain amount of time, maybe once in the morning, once in the evening, to reading the news, and spend the rest of your time on something else. And of course, when the media doesn’t talk about anything else, we can have an erroneous picture of what else matters. One should therefore be careful with the mass of information. And at the same time we see that this lasts a long time until it has affected virtually everyone. And this means that we must have different forms of communication and that these are appropriate for their target groups. For instance, one might want technical knowledge from a virological perspective, or from a sociological perspective, and someone else might want to know whether their business can start back up again, and what they should do about it. And another group might want things explained very simply. And in this regard it is very hard to say when there is nothing else to be informed about, because now everybody has to know everything—that isn’t going to happen. And the situation is changing all the time. We have seen in the weeks of the most critical phase that we should always make sure to prepare, because something else can happen. More things can happen to us. I was able to see in the media that we were always well prepared for the next step of the lockdown. And I see in this a very important function of the media, that in my opinion was successfully put into practice.

MARTINI: Do we really need something like an authority that clearly says to us that so-and-so will happen, and this will happen next, and this will occur? Or can we continue on even if we have different information and different ways of seeing things? We say one day that the virus has a problem with warm temperatures and the next day, scientists say no, it doesn’t. Is this confusing for us?

SPINATH: Of course there can be confusing information. We are constricted by the limits of what science knows and what it can communicate—and what it has yet to find out. To make this clear, this is a big task for scientists. And for us as recipients too. But we are lucky that there are scientists who are communicating to us, and that we live in a society where we can confront responsible citizens with this ambiguity, with possible contradictions, and where we can leave the conclusions up to them. We have seen this, that this isn’t a type of lockdown where you can’t even go out the door, but where it was made clear that certain things are forbidden and certain things are up to you. And that has gone over well in our society.

MARTINI: Dr. Kluge, you have lead the Department for Intensive Medicine at UKE in Hamburg since 2009. You have said that this is a new illness that has somewhat surprised you, and that we are slowly finding out that this isn’t just a pulmonary illness and so on. Is that right? This is something where we always have to relearn things, and where new things are always being discovered.

KLUGE: Yes, it took us completely by surprised and in the beginning, we underestimated it as well. And I have said, or have been criticized a bit about this, that nothing has put such a strain on our healthcare system since the Second World War. This is certainly a very unique situation. And if we can be frank, when we heard of the first cases in China, most people thought that like the other coronaviruses beforehand, this wouldn’t come to Germany. This isn’t the first, there have been six more. And therefore, we underestimated it. And then when it came to Italy and France, especially Italy, and then to Munich, we began to really pay attention. Now we must properly prepare. And we were fortunate to have time on our side. We had a timely advantage. We were well prepared. We have many intensive care beds. We are very skilled in the fields of infectious disease and intensive care, but we also had this advantage of time, we were not overtaken. And during the pandemic we were able to find out many things thanks to the abundance of post-mortem work conducted by our forensic medicine specialists. That many seriously ill patients develop thromboses, lung embolisms—this was discovered only during autopsies, that many organs are affected, such as the kidneys and heart. I want to express that these are all dead patients. We do not know how things look in healthy, asymptomatic patients. There, things aren’t so clear. But so much scientific discovery—and things are developing at an extremely explosive rate. Not I, not older colleagues, can remember such a time. It was extremely dynamic.

MARTINI: What are you learning about? What is happening?

KLUGE: Of course we are doing more research related to patient care. We have found out about thromboses, about activation of the coagulation cycle, about the involvement of multiple organs,a nd many other things to do with medication are being investigated. And this is the present situation of the discussion. We have determined that many, many patients in the ICU must be placed on artificial ventilation—70% of German ICU patients must be artificially ventilated. There has therefore been a lot of controversial discussion and differing opinions about the motto that “everyone is dying anyway.”  But we also have a lot of discussion about protective equipment. And of course the lack of protective equipment is, in the context of Germany, a big theme. We have learned that ICU patients can stay in intensive care for a long time, two, three, four weeks. And we have learned over the past weeks that there is often lasting damage. This fatigue syndrome, dyspnea, we have seen these in the previous weeks. There is therefore always something new regarding this topic.

MARTINI: Dr. Manemann, there is a lot of uncertainty that has come and with which we must go about our lives with. Can we do this? Can society do this?

MANEMANN: We must, as democratic people, as people who have democratic relationships with each other, have good prerequisites for this. Democracy can be defined as the institutional form of a public way of living with uncertainty. Thus we always have something to do with uncertainty. However, Dr. Spinath has also shown that there is also certainty. We have procedures for peace, for conflict, for compensation in our legal systems. But with this, we have a lot to do with this unthinkableness, with this uncertainty. And confronting uncertainty isn’t a wholly negative thing, but can lead people to see things anew, to leave the old behind. This means that we should always see this plurality of meanings in the term “uncertainty”.  We can’t treat this term in a purely negative way. And another thing that is important to me—you have asked this question, which we have addressed in the paper which we in the research institute have written from a cultural perspective on the Corona pandemic—is that we must learn to be ever more sensitive to the specific vulnerabilities of other people. The coronavirus is not the great equalizer that it is often made out to be. Different people suffer in different ways under different dangers. Here we must learn to recognize the specific vulnerabilities of people from the perspective of those who are vulnerable. We must also be careful with the term “at-risk groups”. “At-risk groups”—there are no homogenous at-risk groups. On the contrary, perspectives within these groups often differ, even contradict each other. And I would like to hope that we are successful at cultivating a sensitivity for these specific vulnerabilities.


-----THE SEARCH FOR MEDICATIONS AND VACCINES-----


MARTINI: Nowadays the world is dedicated to researching these unknowns, of which medication and vaccines are a part. These are, so to say, our eventual cure-alls. We hope that a vaccine will come soon. Dr. Spinath, are we not shifting the responsibility for our lives to the scientists when we pay attention, wear masks, keep distancing and so on—as say “You go do that, we’ll get the vaccine in November and we won’t have to worry anymore”?

SPINATH: Yes, indeed, it’s a bit like a patient who goes to the doctor and hopes the doctor gives them a pill to make him all better. And the doctor gives him possible suggestions like ‘Change your lifestyle”—and most patients don’t want to hear that. They say, “If that’s the solution, I’d rather live with my problem.” And this is like the hope that a vaccine will come soon and that everything will be as it was before. This is very deceptive. For one, we don’t know when a vaccine will come. We don’t know how long the antibodies last for. Of course we hope that these things will come. But we must at the same time plan for other scenarios. And I find it just as important to see to it that even without a possibility of a vaccine, we live a good life and protect ourselves and others. And maybe during this time, which for now is an unordinary time, we should think about how life should go on without a vaccine? There are many other possibilities on how to do things besides what we did before. And I find this important, to use some of this time to think about this.

MARTINI: Dr. Spinath, you say that we must pay make sure that there is no change of mood. But haven’t we already have something of the sort, because many people say that even if there was a vaccine they wouldn’t allow themselves to be vaccinated and vaccines aren’t actually that good. What do you say, do we already have this sort of change of mood?

SPINATH: There are many different points of view and some skeptics regarding the topic of vaccinations. My hope is rather that we, for example with Corona, can see just how important it is for a society to be prepared to receive vaccinations. Not only to protect oneself but also to product others. And a vaccine can only function when almost everybody is vaccinated. And this is a big chance for this topic of vaccinations as well as other issues to be brought more to the fore.

MARTINI: Dr. Schmidt-Chanasit, the vaccine as a cure-all—what will we do if we do not develop one?

SCHMIDT-CHANASIT: Yes, again, this choice of words, this term. I have, from the beginning, criticized this very strong focus on the short-term. We are supposed continue this ascetic way of life until the super vaccine or super medicine is here. And then we can go back to normal life. That was really never realistic from the beginning, when you look at other vaccines, when they were developed, when they were made available. In this respect I believe that a bit more propriety would have been helpful to prepare for this long period of hardship, to go about and live with it. This is something that one can certainly discuss regarding the term “cure-all”. I believe that this sums it up very well: there certainly won’t be a cure-all. In any case not so fast. We could rather talk about a large selection—this, I believe, is something Dr. Kluge sees in a similar way—a large selection of medicines which we can give to certain patient groups in specific situations. This is, I believe, much more realistic, than the idea of a medicine that I can give to anyone at any time. That, I believe is far from realistic for a vaccine. There will probably be many vaccines that we can give to different patient groups. Children, the elderly, whom a vaccine can protect for a year or two. That is much more realistic. And I believe that this should’ve been communicated from the beginning, because many people have adopted an attitude of, “I must forego everything as much as I can, I must virtually shut myself in the house and wait three months and then everything will go away.” That is something that I believe has gotten a hold on many people’s minds. And if someone opens up to another perspective such as the one we have discussed, how should I go through the next months or even years with this virus? How can we plan our daily lives? I believe that would’ve been good.

MARTINI: Dr. Kluge, how does the situation with medication look?

KLUGE: Yes, this is a massive topic of discussion. In the beginning many practitioners were giving many different medications at the same time, a polypragmasy without studies. That led to a situation where nobody knew which medications were dangerous or which had any benefits among patients. First came the first medications which we too used. Then came the first studies showing that they weren’t useful. We had a massive debate over hydroxychloroquine with Mr. Trump and so on. I believe that these days there are two medications that seem to show benefits, namely Remdesivir in the early phases. But this only seems to cause a shortening of the duration of illness, not an improvement in mortality rates or chance of survival. And there is also new data for a cortisone preparation, Dexamethasone, used with patients on ventilators, in the late stages. But the problem is that these studies have not been officially published and that means that they have not been properly reviewed. They are available online, but have not been published. And we have also learned that in terms of research, a lot of things have been handled carelessly. We must therefore be careful with studies as we cannot evaluate them. We don’t have a breakthrough. I agree with my colleague, there won’t be a wonder medicine. There isn’t any for other illnesses. And therefore there will be, just as before, hard times and patients who will die. But of course it is absolutely helpful when more studies are conducted on different therapies. And a lot of studies in Germany and worldwide are being conducted on this. And therefore we hope for new knowledge and that the appropriate patient groups can benefit from these therapies too.

MARTINI: Dr. Spinath, if we don’t get a medication or a vaccine, do you believe that our society can still continue on with this marathon, this test of endurance?

SPINATH: I believe that we have come a long way and can look back at our successes and from them draw strength to go the rest of the way. I believe that this will be a marathon. We will still need strength if it becomes clear that another lockdown will be necessary. In some regions this is partially necessary. In these cases people should draw strength again. And we can do this best when we know why we are doing this. What’s the whole point? And what can I myself do for this? What can I possibly do to do things positively? And what do I personally, not just personally but also what does society have to gain from this? From this there will come many positive consequences, if we muster up this strength.

MARTINI: Dr. Kluge, if we are to be without medication or a vaccine, how do you suppose we can live with this virus? What should we do?

KLUGE: Well, we currently live with other infectious diseases, for instance malaria worldwide and severe pneumonia in Germany, and therefore, it is possible (to live with Covid-19). We all have the possibility to do this. I believe that what we want as intensive medicine specialists is that not too many patients come in at once and overwhelm the ICUs. This should happen proportionally. And that is what the discussion on herd immunity is about. To put it briefly, we know that five percent of the infected end up in the ICU. And therefore one can very accurately calculate (the number of future ICU patients) by looking at the current number of infected. We have nearly 30,000 ICU beds. Right now we have thousands of free ICU beds free, in reserve. But we must make sure that the system is not exhausted. We know as well that because of this, other operations have been delays and other cancer and emergency patients may not be able to be admitted so often into hospitals. This is the so called “medical collateral damage”. But in principle, with this severe pneumonia or lung infection, unlike with other pathogens we do not have good therapies than can handle 100% of cases well. This is then a question of how many patients.

MARTINI: Dr. Manemann, can we as a society get through this?

MANEMANN: We can endure this if we do not get the fatigue I was talking about. And to develop such psychological stability, we must develop our attitudes. And I believe that we have great chances if we start by ensuring that many people take the time during the bans on contact and the shutdowns to think about their desires and to reflect which of their desires can harm others, even themselves, and whether there are other ways to satisfy their desires and even if there is anything other than satisfying wants. Satisfying my wants always starts off with myself and ends with myself. But besides wants there is, what we in philosophy but also in psychology call desire(9), which we perhaps have been more open to in this time. Desire opens me up to what is happening around me and to other people, so that I take others seriously and do not return to easily to myself, and when I do return to myself, I do so as a changed person. And these changes release a lot of energy [to act, and so on]. And I wish that for all of us, this possibility.

MARTINI: Dr. Spinath, how must we as a society prepare for a time, even a long time without a vaccine or medicines?

SPINATH: I’ve already highlighted confidence, an inner sense of control, as extremely important factors that can give us strengths. There is nothing worse than for us to think that we are at the mercy of things that we have absolutely no control over. Yes, maybe the social circles that we now interact with aren’t as big as we’re used to them being, we can’t always travel to where we want to travel, or meet people who we want to meet. But we can achieve a lot by this behavior. And what has become so clear to me is that we see that things that we have previously thought unthinkable are possible. When we see how the world has changed, we can, I believe, draw a lot of conclusions. Previously, we were very much bound by many social structures that have become somewhat looser. There are of course many opportunities hidden here. And to focus on the chances instead of the negative effects, that is a great possibility in this crisis.

MARTINI: Have you been astonished by the flexibility that we have shown? We have so quickly implemented home offices, homeschooling.

SPINATH: Absolutely, when I see this. A few months ago, when someone said to me that I would design an online semester, I said, “I am unfortunately not very proficient here. That won’t succeed.” But the semester is almost done and it was extremely successful. That is of course because the students have done so well. But really, everyone contributed to this. And this is something we can be proud of. We had fun.

MARTINI: I would like to wrap things up now. We have spoken about whether we have learned anything from the crisis, if we have taken any positives from it. I would like to begin with Dr. Kluge. Have you taken anything positive from the crisis?

KLUGE: We have learned that we can come together very well, that communication plays an extremely important role and that we are extremely capable in Germany, that we have a very good healthcare system. I would like to say that when I look at America, the USA, I would never hat thought that they would’ve had such huge problems. That frightens me. And thus we can see just how well prepared we are. And we have become very, very flexible. A few buzzwords have come up but even in the private sphere, one can easily see what is possible in such a crisis in all areas and levels.

MARTINI: Dr. Schmidt-Chanasit, when you look at this crisis, is there anything that you would say we have learned?

SCHMIDT-CHANASIT: Yes, I would like to add to what my colleague Dr. Klug said. Exactly this sort of discussion shows what distinguishes Germany, this factual, multidisciplinary discussion. I believe this has been a very decisive factor. This openness and above all, that politicians are listening. I  believe this distinguishes us from many, many, from most countries in the world. And I can only be so thankful that we in Germany can live in this social system, which in every difficult situation we must improve, which requires hard work. Overall I find this open society and open discourse, I believe this is something we shouldn’t lose going forward, and is something we should protect.

MARTINI: Dr. Manemann, is there anything that you can take from this crisis?

MANEMANN: Yes, something that a lot of people have experienced, that there is more potential in them than they thought.

MARTINI: Dr. Spinath, what have you learned?

SPINATH: Yes, I would like to tie into both of these trains of thought, namely that we can create much more than we had thought possible before with our own strength, because we didn’t have to overcome such obstacles. And the second is that we are well advised if we listen to experts that communicate clearly to us about when they will know certain things and where the borders of certainty lie. Thus we see that science has come out of this very strongly, that there is more confidence in these scientific findings, which separates us in a positive light from other countries, as we have said before.

MARTINI: Dr Spinath, Dr. Kluge, Dr. Manemann, Dr. Schmidt-Chanasit, I would like to thank you very much for this podcast and wish you all a great day. This was our Coronavirus update in a somewhat different form. Many scientists are talking about the corona crisis. You can find this podcast as always in the ARD-Audiotheque and at ndr.de/coronaupdate. And there will also be a transcript of the podcast. The next episode will be on August 6 on our site. My name is Anja Martini, and I think you for your time, goodbye.


-----NOTES----
1.	Stimmungswandel in the original German
2.	Halt in the original German
3.	Haltung in the original German, meaning something like “posture, inner stability, attitudes that shape one’s behavior”
4.	From Wikipedia, meaning “…socially ingrained habits, skills and dispositions. It is the way that individuals perceive the social world around them and react to it.”
5.	Corona-Antworten auf eine kulturelle Herausforderung, https://fiph.de/veroeffentlichungen/buecher/Corona_FIPH.pdf?m=1592484286&
6.	Meaning “to overcome, handle, to complete a difficult task”. I believe this has connotations of conquering and violence (e.g. with Gewalt, violence), but I do not know how strong a link this is, or how native Germans would perceive it. Please refer to native speakers instead of myself.
7.	Vergangenheitsbewältigung. This term in Germany carries is most often used to refer to the process of coming to terms with the Nazi period.
8.	Schlussstrichsmentalität, literally “mentality of drawing a line.” Used to refer to a situation where people simply stop talking about a very polarizing debate because they believe that no progress can be made in convincing others to come to their side or that no compromises can be made. Used especially often in debates about the Nazi period by those who believe the best solution is to simply stop talking about the problem altogether.
9.	Begehren, as opposed to Bedürfnisse, which I have translated as “wants”