Open questions

"Everyone has the right to clear, accessible, timely and meaningful information about the nature and extent of the threat to their health".

(Esteban Beltrán, Director of Amnesty International's Spanish Section, before the Economic and Social Reconstruction Commission of the Spanish Parliament, European Union Group, 12 June 2020)

notes

25: SARS-CoV-2 Factsheet on Coronavirus-Desease-2019 [Steckbrief zur Coronavirus-Krankheit-2019 (COVID-19)], Status: 29/5/2020, https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html, last accessed 11/06/2020:
"7. incubation period and serial interval
The incubation period indicates the time from infection to the onset of the disease. It is on average (median) 5-6 days (range 1 to 14 days) (54, 137)."
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html#doc13776792bodyText7
"12. Time from onset of disease to pneumonia
In one publication (Chinese case series [n = 1,099]), this time range was four days [IQR]: 2-7 days) (23)."
"13. Time from onset to hospitalisation": 4 - 8 days.
"14. time from onset to acute respiratory distress syndrome (ARDS)": 8-9 days
"15. time from onset of illness to ICU" (intensive care unit): 5 - 10 days
"16. Time from hospitalisation to ICU
In a Chinese case series (see 13.), this time range was on average (median) one day (IQR: 0-3 days) (130)."
"22. Proportion of deceased among ICU patients".
(...) On median, deceased patients were hospitalised for nine days (49)."
(My translations.)
My calculation of the period from infection to death:
Incubation min 1 - max 14 days
Onset of illness to hospitalisation min 4 - max 8 days
Onset of illness to ICU min 5 - max 10 days
Hospitalisation to death average 9 days
Period from infection to death: MINIMUM: 14 days MAXIMUM: 31 days.

26: Tagesspiegel, 29/05/2020: "'Without the test, this would have been detected 'only a month' later, 'when the deaths would have accumulated as in Italy, Spain and Great Britain'. That's how long it takes from infection to death in intensive care, the virologist continued. 'And that's the month we - and by that I mean my lab - put in as a lead for Germany.'" (My translation.)
https://m.tagesspiegel.de/wissen/mein-labor-hat-deutschland-vorsprung-eingespielt-virologe-drosten-reklamiert-rettung-von-bis-zu-100-000-leben-fuer-sein-team/25871954.html??, last accessed 11/06/2020.

27: Robert-Koch-Institut, Estimate of the current development of the SARS-CoV-2 epidemic in Germany (Schätzung der aktuellen Entwicklung der SARS-CoV-2-Epidemie in Deutschland) – Nowcasting, Epidemiologisches Bulletin 17-2020, 23. April 2020, p. 14. https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/Ausgaben/17_20.pdf?__blob=publicationFile, last accessed 10/06/2020.
Also available in "Materials" under the title of Epidemiologisches Bulletin 17/20.

Attempt to view in perspective the health hazard posed by the COVID-19 pandemic:

Mortality in spring of 2020 in Spain and Germany compared to the general death rate in both countries

5. Open Questions

What has been the impact of the measures taken in terms of

- reduction in the incidence of death: interruption of infection chains, treatment in hospital;

- an increase in the incidence of death: panic, stress; reservation of capacity that would otherwise have been available for strokes, heart attacks, cancer and other operations; all economic, social, physical and psychological consequences.²

Is the decline of mortality in Spain after 31/03/2020 causally related to the Estado de Alarma's declaration of contact restrictions from 14/03?

This question could be answered by clarifying the average time between infection and death among those who died with COVID-19.

The period between the onset of contact restrictions and the peak of the death curve was 17 days.

According to the data published so far by the Robert Koch Institute²⁵, the time from infection to death is between 14 days and one month.

Christian Drosten also spoke of one month in a Spiegel interview, reproduced in the Tagesspiegel Berlin on 29/05/2020.²⁶

The final answer to this question is therefore left to future research.

Were the measures taken in Germany sensible, although even before the introduction of contact restrictions on 22 March 2020 ("lockdown"), according to the Robert Koch Institute, the transmission rate had fallen to below 1?²⁷

Will the virus have its own season in the future in addition to the existing flu season?

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Reinhard Wagner

notes

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