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"We must now prepare for the second wave".


Where the German healthcare system has weaknesses, how the university should prepare for a second Corona wave, and why the virus reinforces social and health inequalities - an interview with Kassel-based health scientist Prof. Dr. Alfons Hollederer.

Image: University of Kassel.
Prof. Dr. Alfons Hollederer.

Mr. Hollederer, stores are opening again, the first students are returning to classes. The anxious question: Will this backfire, will the Corona wave hit the hospitals after all? And in your opinion, is the German healthcare system sufficiently prepared?

It is very likely that a second wave will come. And why not? It will still take time until a vaccine is developed, tested and available. To draw a comparison with the Spanish flu around 100 years ago: There were three waves then, and only the second and third waves developed full lethality. Are our hospitals prepared for this? I am cautiously optimistic. The hospital sector, i.e. the inpatient sector of the healthcare system, is relatively well positioned in Germany. For example, we have the highest number of intensive care beds per capita in Europe. Nevertheless, it has to be said that the pandemic is ruthlessly exposing the weaknesses in healthcare systems worldwide.


So if not in the hospitals, does the German system have weaknesses in other areas?

We talk about three pillars of the healthcare system: I have just said something about the inpatient system, the hospitals. The outpatient sector is in a somewhat worse position, for example, in terms of equipment with test kits, protective clothing and respirators. You have to wonder - we are the world's leading exporters, but we don't manage to supply our healthcare personnel with enough of these items! At least this is improving. The area of outpatient and inpatient care is problematic. It is now also a question of the third pillar of the German healthcare system, the Public Health Service.


That's the public health authorities?

Exactly, at all three levels: the federal authorities such as the much-cited Robert Koch Institute, the state authorities, which are usually subordinate to the ministries of health, and, more broadly, above all the roughly 400 municipal health offices. Germany has made massive job cuts in these areas over the past 20 years. This is now taking its toll. We are currently experiencing a race against time.


In what way?

There is a saying that the three most effective measures in the Corona pandemic are: first test, second test, third test. I would add, the next three most important measures are: isolate, isolate, isolate. It is right for health departments, for example, to be beefed up now in contact tracing teams to better identify and isolate covid sufferers in the field. But this comes late in the day and more structures need to be put in place. The investment needed in health care, especially prevention and health protection, is relatively small compared to the potential consequential damage to society. If health protection functions better, the economy, the labor market and social life will also recover very quickly as a result.


For weeks, large parts of public life were frozen. What was the effect?

It has been effective, the numbers are going down. However, not as much as in Austria or in Asian countries. Countries like Taiwan or Korea were better prepared because they had learned lessons from SARS and MERS. China now largely controls the disease incidence. It was clear to all experts that a pandemic would come at some point, the question was: when? Germany could have been warned at the latest after swine flu in 2009/2010. We are now in a comparatively good position, mainly because we were able to react more quickly after the experience in Italy.


In taking their measures, the government agencies are dependent on the population's compliance. How do you increase compliance? By fines alone - 100 euros if I don't wear my mask?

Self-protection and the protection of others in the event of covid disease are very important in the pandemic. People's compliance is therefore essential, but the effect tends to be overestimated, as is the case with mouthguards. On the other hand, the influence of the circumstances tends to be underestimated.


What do you mean by that?

What rules apply in organizations? Where could infection chains start and how can they be interrupted? For example, are there enough washing facilities, disinfectants or simply enough space to keep a distance? Think of nursing homes or shared housing for refugees, where the first outbreaks are now occurring because of the confinement and conditions. Another issue is travel restrictions.


The issue will now become quite different with the opening of schools....

Yes, but our university is also affected. For the city of Kassel and the region, an institution of our size has enormous significance in the pandemic. How can the staff and students stay healthy? There are also risk groups with pre-existing conditions and disabilities among them. We already need to prepare for a second wave of Corona, and we need to buy time until a vaccine and drug therapy are available. So develop long-term solutions: What do exams look like and who takes them, how are seminars designed, are there technical solutions to prevent many people from touching the same objects? How is cutlery distributed in the cafeteria? There is a mood among the population right now that the situation is now easing. I don't see it that way.


What consequences will the pandemic have in the long term?

Every pandemic has its own time. There are, of course, the expected consequences, such as on the labor market and in the economy. Another long-term effect is often overlooked: Society will become further socially differentiated, I fear. This is because the virus affects different groups in society to different degrees. Health is unequally distributed socially. Those who live in precarious circumstances have more pre-existing conditions, fewer resources and are more susceptible to this virus as well. One particularly vulnerable group, for example, is the homeless, who often do not have health insurance, already have many health problems, and whose aid networks are now tearing. Separate aid programs would be necessary here.


Prof. Dr. habil. Alfons Hollederer has held a professorship for the theory and empirics of health care at the University of Kassel for a year. He previously worked as a medical director at the Bavarian State Office for Health and Food Safety and the State Institute for Health and Labor in North Rhine-Westphalia, among other positions.


Interview: Sebastian Mense