Statement of Society of Virology on a science-based approach to the Covid-19 pandemic
19/10/2020
In recent weeks, we have seen the number of people infected with SARS-CoV-2 around the world, especially among our European neighbours, rise with near exponential momentum and continue to rise[1]. While Germany recorded a moderate incidence until recently, the renewed onset of exponential spread can now be observed here as well[2]. In Austria (133)[3] and Switzerland (230)[4] the 14-day incidence per 100,000 is already significantly higher compared to Germany (47)[5].
The renewed increase in the spread of SARS-CoV-2 infections is particularly due to private events such as family celebrations, wedding parties as well as other gatherings. Although this means that the majority of infections occur in younger age groups, who are mostly much less affected by the health consequences of COVID-19 than older people[6], we are seeing an increase in hospitalisations everywhere and a steady advance of infections into older age groups[7].
Due to the explosive infection dynamics that we are seeing in all hotspots across Europe, it is to be feared that beyond a certain threshold, control over the infection incidence will be lost even in previously uncritical regions. If this threshold is exceeded, the tracking of individual outbreaks and strict isolation measures are no longer feasible and uncontrolled spread to all parts of the population, including particularly vulnerable risk groups, can no longer be adequately prevented. It is to be expected that this would lead to a rapid overload of the health care systems, which could already be the case in Germany, for example, at well under 20,000 new infections per day, simply because of the shortage of intensive care staff[8]. Not only the treatment of COVID-19 patients, but also the entire medical care system will suffer.
We are concerned to note the renewed strength of voices advocating the natural contamination of large sections of the population with the aim of herd immunity as a strategy for combating the pandemic. For example, the signatories of the so-called Great Barrington Declaration[9] are calling for the immediate lifting of all restrictions on public and private life, including all distance rules and mandatory masking. To mitigate morbidity and mortality in vulnerable groups (the elderly, the previously ill), the Declaration proposes special protective measures for these people, up to and including quasi-isolation ("retired people living at home should have food and other essentials delivered to their homes").
We strongly oppose this strategy, although we of course recognise the enormous burden that the drastic containment measures place on the population. Health care in other areas not associated with Covid-19 is also suffering from the restrictions imposed to mitigate the pandemic[10],[11]. Nevertheless, we are convinced that the damage we face directly but also indirectly in the event of an uncontrolled contagion could exceed these burdens many times over and result in a humanitarian and economic catastrophe. We are not alone in this assessment: in a statement published in the medical journal "The Lancet" on 14 October ("John Snow Memorandum")[12], numerous international experts express the same concerns and strongly advise against pursuing the strategy of uncontrolled contamination propagated in the Great Barrington Declaration.
Uncontrolled contamination would lead to an escalating increase in fatalities, since even with strict isolation of retirees there are still other risk groups that are far too numerous, too heterogeneous and in part also undetected to be actively screened. An increased risk for a severe COVID-19 course arises, for example, with obesity, diabetes, cancer, renal insufficiency, chronic lung disease, liver disease, stroke, after transplantation [13] and, according to initial findings, also during pregnancy [14, [15], [16], [17]. A possible complication of a survived COVID-19 disease is also the so-called "long COVID" syndrome, which combines various late damages to different organs [18], [19], [20]. Whether this limits the quality of life, ability to work and also life expectancy is still unclear.
Furthermore, we do not yet reliably know how long immunity acquired through infection lasts. It is becoming increasingly clear that it is precisely the less symptomatic infections, such as those prevalent in younger people, that do not confer stable immunity[21]. The Board of Society of Virology therefore expressly supports the position of the signatories of the John Snow Memorandum and considers the pursuit of herd immunity without vaccination to be unethical as well as medically, socially and thus also economically highly risky.
We respect divergent attitudes held by individual colleagues in the media and social networks, as controversial discourse is a characteristic of both science and democracy. Nevertheless, the Executive Board of Society of Virology considers it appropriate to summarise its assessment in this statement, which, judging by numerous conversations and emails, also represents the attitude of the majority of members of our society working in virology and medicine in Germany, Austria and Switzerland.
The Board of Directors of the Society of Virology
Prof. Dr. Ralf Bartenschlager, Heidelberg University Hospital
Prof. Dr. Thomas Stamminger, University Hospital Ulm
Prof. Dr. Ulf Dittmer, University Hospital Essen
Prof. Dr. Sandra Ciesek, University Hospital Frankfurt
Prof. Dr. Klaus Überla, Erlangen University Hospital
with the participation of:
Dr Marco Binder, German Cancer Research Center Heidelberg
Prof. Dr. Melanie Brinkmann, Technische Universität Braunschweig and Helmholtz Centre for Infection Research Braunschweig
Prof. Dr. Christian Drosten, Charité, University Medicine Berlin
Prof. Dr Isabella Eckerle, University Hospital Geneva, Switzerland
Prof. Dr. Beate Sodeik, Hanover Medical School
Prof. Dr Friedemann Weber, Justus Liebig University Giessen
Sources
[1] https://www.ecdc.europa.eu/en/covid-19-pandemic
[2] https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsb...
[3] https://covid19-country-overviews.ecdc.europa.eu (as at 15.10.2020)
[4] Situation report on the epidemiological situation in Switzerland and the Principality of Liechtenstein (as of 16.10.2020; 8:00 a.m.)
[5] https://covid19-country-overviews.ecdc.europa.eu (as at 15.10.2020)
[6] https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30243-7/fulltext
[7] RKI Daily Situation Report on Coronavirus Disease-2019 (COVID.19) of 6 October 2020 and 27 October 2020.
[8] https://www.aerzteblatt.de/nachrichten/sw/Intensivmedizin?s=&p=1&n=1&nid...)
[9] https://www.sciencemediacentre.org/expert-reaction-to-barrington-declara...
[10] https://www.who.int/publications/m/item/rapid-assessment-of-service-deli...
[11] Bakouny et al. (2020) COVID-19 and Cancer: Current Challenges and Perspectives. Cancer Cell DOI: https://doi.org/10.1016/j.ccell.2020.09.018
[12] https://www.johnsnowmemo.com
[13] https://www.nature.com/articles/s41586-020-2521-4
[14] Ellington et al. (2020) Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep. 69(25):769- 75.
[15] Zambrano et al. (2020) Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 69
[16] Badr et al. (2020) Are clinical outcomes worse for pregnant women ≥ 20 weeks' gestation infected with COVID-19? A multicenter case-control study with propensity score matching. American Journal of Obstetrics and Gynecology.
[17] Collin et al. (2020) Public Health Agency of Sweden's Brief Report: Pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand. 2020;99(7):819-22.
[18] https://www.bmj.com/content/370/bmj.m2815
[19] https://www.nature.com/articles/d41586-020-02599-5
[20] https://evidence.nihr.ac.uk/themedreview/living-with-covid19/