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Uhm, wo es natürlich nicht unbedingt hingehört, aber ich kann den Kollegen dann auch kaum noch
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Ich mache Ihnen dann draußen einen Abstrich. Wir müssen gar nicht aussteigen. Also so eine Art Drive-In-Lösung. Das ist zum Beispiel total pragmatisch und gerade in einem ländlichen Bereich, wo sowieso alle mit dem Auto zum Arzt kommen, ist das ein gangbarer Weg.
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In der Stadt, da fahren die, die Patienten dann natürlich zum Teil mit öffentlichen Verkehrsmitteln und solange sie jetzt noch kein bestätigter Fall sind, gibt es da auch keinen Grund, das anders zu machen, denn man kann ja nicht aufhören, ganz normal sich zu bewegen.
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Nur weil man einen Kratzen im Hals hat. Und man will aber trotzdem sich testen lassen.
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Und da haben wir ja zum Teil eben organisierte Fahrdienste, also von der, vom ärztlichen Notdienst, den gibt's Privat- und Kassenärztlich. Und da sind zum Teil Praxen, also diese großen ärztlichen Notdienstpraxen, die da auch
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Also die auch so sagen, ah, wir haben hier noch so ein Bereich draußen, ne, da kann man also auch einfach einen Patienten
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Mal hinkommen lassen und dann kann der Diensthabende und da sind häufig dann mehrere Diensthabendeärzte da.
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Einer geht raus mit einem Mundschutz und macht draußen schnell einen Rachenabstrich. Das ist überhaupt kein Akt. Und dabei gibt es natürlich dann auch kein Virus, das zum Beispiel in der Raumluft hinterlassen wird, in der Praxis, im Wartezimmer, wo dann andere Patienten sitzen. Also diese Lösung nach draußen zu gehen, das ist etwas,
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Was ich so aus dem Kollegen-Kreis höre, was ich gut finde und auch sehr pragmatisch. Und andere Arztpraxen sagen, ah, wir haben hier einen speziellen Raum, den nutzen wir eigentlich gar nicht. Das ist die Besenkammer, da stellen wir jetzt mal drei, vier Stühle rein und machen da ein improvisiertes...
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Corona-Wartezimmer draus. Also alle diese Dinge gibt es.
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Und die kann man natürlich jetzt dann so im Detail weiter diskutieren. Wir haben hier in Berlin zum Beispiel die Situation, der niedergelassene Bereich, der ist noch nicht so
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Und wir haben hier in der Charité jetzt aber zusätzlich zu unserer Reisemedizinischen Ambulanz im Tropeninstitut ein eigenes Testzentrum eingerichtet auf dem Campus Vircho.
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Ähm, SARS-2-Virus, wo natürlich dann das medizinische Personal auch hochgradig mit Eigenschutz, also mit persönlicher Schutzausrüstung versehen ist und wo dann dieses Abstreichen der Rachenschleimhaut
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Hausärzte sind, ähm, zunächst mal Privatunternehmer mit wirtschaftlicher Eigenverantwortung und freiberuflich. Das heißt, die sind auch
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Die sind schon über die Kassenärztliche Vereinigung.
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Es ist da schon eine gewisse Freiheit und es gibt eine Heterokät.
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Und es gibt zum Teil auch eine organisierte Heterogenität. Also wir, ich sehe beispielsweise, ich bekomme hier in meine Email zum Teil Schreiben von organisierten niedergelassenen Ärzten, die argumentieren gegen im Prinzip alles, was die Gesundheitsämter im Moment vorhaben. Das ist natürlich
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Ja, inhaltlich zum Teil für mich zu verstehen. Ich verstehe, wie die Kollegen belastet sind, wie andere Patienten, die diese Erkrankung nicht haben, sondern was ganz anderes, vielleicht abgeschreckt werden und wie das massiv den Praxisbetrieb stört.
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Und wie dann auch gleichzeitig die Wahrnehmung besteht, wir sollen uns alle jetzt irgendwelche Masken kaufen, aber wir kriegen die gar nicht mehr geliefert. Was ist denn hier überhaupt los?
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Und dieses Verständnis, das da aufgebracht werden muss, also, ähm, dass ich vielleicht so zusammenfassen kann, das ist jetzt nun mal eine beginnende Pandemie und das wird sogar noch schlimmer werden. Und wenn wir nicht jetzt anfangen, einfach zu improvisieren, einfach drauf los,
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Ja, zu einem gemeinsamen Zweck, also nicht sich beklagen, nicht sagen, niemand sagt uns, wie wir es machen sollen, sondern einfach sagen, ich hab mir da was überlegt und das wird hier für mich zum Beispiel in meiner Praxis oder auch jetzt, wenn man
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Also eine normale Bevölkerung muss ja nur sich denken, naja, wie schaffe ich es, dass ich mich nicht infiziere und wenn ich mich infiziert habe, was mache ich dann?
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Aber so eine Praxis ist ja ein Wirtschaftsbetrieb. Also alles das ist eine extreme Herausforderung und dann viele niedergelassene Kollegen im Moment für sich jeweils das Rad neu. Und es ist halt schon dann irgendwann der Impuls zu sagen, ach, die Behörden müssten uns doch mal sagen, was wir jetzt machen sollen.
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Weil denn am Ende bewegt man sich sogar noch in einem Rechtsrandbereich, wo man sagt, mach ich jetzt was falsch? Mach ich mich jetzt hier irgendwie gesetzeswidrig, wenn ich Dinge mir ausdenke?
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Die will ich jetzt, am liebsten würde ich das mal mit dem Gesundheitsamt besprechen, aber da kriege ich keinen ans Telefon. Ich kann das schon verstehen, aber ich muss einfach sagen, das wird nicht zum Ziel führen.
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Ja, also da gehen auch viele Dinge nicht genug ins Detail.
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Und wir haben, und da muss ich jetzt, also ich sag da jetzt einfach mal als Virologe etwas, wo mir ein Hygieniker sagen würde, oh, das ist aber jetzt hier weit aus dem Fenster gelehnt. Aber ich sag jetzt mal,
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Behüllte Viren, dazu gehören Coronaviren und auch Influenza zum Beispiel, sind gegen Eintrocknung sehr empfindlich. Unbehüllte Viren sind nicht sehr empfindlich gegen Eintrocknung.
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Es gibt Viren, die in die Nase gehen häufig, Schnupfenviren, also Rhinoviren und Enteroviren klassischerweise.
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Das sind Viren, die machen ein Vlieschnupfen der Nase und das sind Viren, bei denen wahrscheinlich, muss man sagen, es gibt da schlechte Daten drüber, aber wahrscheinlich ist das so, dass die stärker davon leben, dass sie auf Oberflächen kleben und dann eben mit den Fingern in die Nase gebracht werden beim Nasebohren.
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Auch Influenza-Viren. Diese Viren sind weniger ein, weniger trocknungsstabil und die müssen auch mehr in den Hals als in die Nase.
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Und wir stecken uns nicht den Finger in den Hals, stecken uns den Finger an die Lippen oder in die Nase rein. Und wahrscheinlich ist das so, dass diese Viren einfach schwerpunktmäßig mehr über Tröpfcheninfektion übertragen werden, weil sie eben eingeatmet werden müssen oder zumindest müssen sie vorne an die Mundschleimhaut kommen und dann
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So mit der Zunge weitertransportiert werden. Das ist mein Denkmodell. Also mein Denkmodell ist, dass bei dieser Coronavirus-Erkrankung eigentlich die Kontaktübertragung eine geringere Rolle spielt als bei anderen Erkältungskrankheiten.
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Das ist nach meinem Bauchgefühl die größere Gefahr gegenüber der Kontaktübertragung, die aber natürlich dennoch auch zu Buche schlägt. Also das heißt jetzt nicht, man soll sich nicht die Hände waschen.
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Also ehrlich gesagt, ich glaube nicht, dass das im Moment sehr viel helfen würde, weil wir im Moment wahrscheinlich noch nicht sehr viel Virus hier in der Zirkulation haben.
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Es geht hier nur um ein paar hundert Fälle und selbst wenn es ein paar tausend Fälle sind, ist das gegenüber einer Bevölkerung von 80 Millionen einfach vernachlässigbar.
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Und es ist schon richtig, dass man die Dinge im Keim ersticken will, aber dann muss man zu dem Keim auch hingehen und nicht einfach alles flachlegen. Wenn wir, wenn wir uns überlegen, dass wir hier zwei Wochen Ferien machen gegen ein Virus, das gar nicht groß, in großer Zahl jetzt in der Bevölkerung zirkuliert,
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Dann, ja, überstrapazieren wir das ganze System, sowohl ökonomisch, organisatorisch als auch psychologisch.
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Deswegen halte ich das im Moment überhaupt für keine gute Idee. Das ist nicht die Zeit dazu jetzt.
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Ich weiß nicht, was passiert, wenn vielleicht, äh, sich im nächsten Winter eine höhere Infektionszahl einstellt. Ich kann das im Moment wirklich nicht schätzen.
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Und ich will das auch nicht. Aber vielleicht braucht man irgendwann später, falls es zu einer solchen wellenförmigen Infektionsübertragung kommt in der Bevölkerung, wenn dann vielleicht viel mehr Fälle da sind.
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Vielleicht braucht man dann noch so eine Maßnahme und die sollte man sich jetzt nicht vergeben. Denn wenn man jetzt so etwas macht, dann wird man kaum den Effekt davon messen können.
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Und es wird natürlich dann irgendwann auch viel Aufregung und viel Schaden angerichtet werden. Und dann wird man das nicht nochmal machen können, wenn man es vielleicht irgendwann braucht.
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Ich glaube, dass das, was die Gesundheitsämter im Moment machen, der richtige Weg ist. Wenn ich das nicht glauben würde, dann würde ich dazu was sagen. Das traue ich mich. Ich bin jetzt nicht so, also ich bin unabhängig genug dafür. Ich glaube, dass das richtig ist. Ich glaube auch, dass es nicht mehr lange durchzuhalten.
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Also, dass man wirklich jetzt Kontakte immer für 14 Tage komplett, ja, in die Isolierung gibt, in die Heimisolierung gibt.
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Und diese Patienten sind eben doch, und das wird der Eindruck zeigen, im Wesentlichen eher mild infiziert und diese Patienten werden das zum Teil auch nicht einsehen, was das soll, solange immer zu Hause bleiben zu müssen. Gleichzeitig zeigen natürlich auch die Daten, die jetzt zunehmend publiziert werden, dass die Inkubationszeiten nicht
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14 Tage ist bei den meisten Patienten. Also es gibt solche Extremfälle, aber wir werden irgendwann natürlich mal überlegen müssen, dass wir sowieso nicht.
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Und das wäre zum Beispiel mal eine erste Maßnahme, wenn man sagen würde, das ganze System hier, das wird durch diese Isolierungsmaßnahmen überfordert, dann könnte man ja mal sagen, okay, dann machen wir ab jetzt nur noch eine Woche und nicht zwei.
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Das wäre so ein erster Schritt und genau so wird man das immer weiter mit Fortschreiten dieser Epidemie auch anpassen müssen, denn die Behörden und auch der niedergelassene Bereich müssen sonst vor dieser Herausforderung kapitulieren und das wollen wir nicht. Und auch da,
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Was ich jetzt zum Beispiel sage gerade, das sage ich Ihnen einfach hier ungeschützt in so ein Podcast rein, weil ich mir das als akademischer Professor leisten kann, sowas zu sagen und das ist natürlich richtig, was ich hier sage, aber wenn das zum Beispiel jemand vom RKI einfach so ungeschützt sagen würde,
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Vom Robert-Koch-Institut. Ja, genau, vom Robert-Koch-Institut oder von einem Gesundheitsamt. Wir haben hervorragende große Gesundheitsämter in Deutschland, die ebenso Informationen der Bevölkerung und der Niedergelassenen unterstützen und die sich sehr viele eigene Gedanken machen und wissenschaftliche Literatur lesen und auch selber wissenschaftlich tätig sind.
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Aber dennoch ist es was anderes, wenn so jemand das sagt mit einer, einer offiziellen Konnotation oder wenn ich das hier mal so als, äh, als Professor sage. Und darum sage ich es lieber jetzt als Professor.
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Also im Moment benutzen wir die Testung zur Nachverfolgung.
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Und ich will hier nur nochmal sagen, ich finde es vollkommen richtig, das jetzt auch im Moment für 14 Tage zu machen. Wir brauchen jetzt einen einheitlichen Standard im Moment mal. Aber irgendwann werden wir das nicht mehr bewältigen können und das könnte schon in zwei Wochen soweit sein.
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Aber jetzt im Moment ist das alles in Ordnung und im Moment benutzen wir eben auch die Labordiagnostik, um uns leiten zu lassen zu einem erkannten Fall hin.
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Wir werden aber demnächst die Labordiagnostik dafür nicht mehr benutzen können, weil einfach das nicht mehr möglich ist, das alles nachzuvollziehen und dann Labordiagnostik für andere Dinge als Werkzeug benutzen.
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Ich gebe Ihnen mal ein Beispiel, wofür wir Labordiagnostik demnächst wahrscheinlich unbedingt brauchen werden. Wir haben viele medizinische Bereiche, wo Personal arbeitet und in, also stellen wir uns eine Krankenhausambulanz vor oder eine Station, ja. Und da kommt ein Patient und der hat diese
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Gerade im Anfangsstadium extrem milde Erkrankungen und der wird dann erkannt zwei Tage später durch einen Labortest als ein positiver Fall.
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Im Moment, was man da macht, ist, dass man fragt, okay, habt ihr alle persönliche Schutzausrüstung getragen? Also habt ihr alle einen Mundschutz getragen, einen Augenschutz und Handschuhe und so weiter? Und es wird sich natürlich immer rausstellen, nein, natürlich nicht. Das kann man ja nicht in der Alltagshandhabung.
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Komplett so durchhalten in einem Ambulanzbetrieb, wo auch viele andere Krankheiten gesehen und behandelt werden und wo man ja das, wo man ja normal agieren muss. Und dann stellt sich raus, okay, wir müssen jetzt diese 15 Krankenschwestern und diese drei Assistenzärzte leider für 14 Tage in Heimisolierung
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Das ist eine Katastrophe für das Krankenhaus und für die Ambulanz. Also brauchen wir pragmatische Umgangsweise mit so etwas.
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Und dazu könnte zum Beispiel gehören, dass wir Labordiagnostik benutzen, um ganz engmaschig, und damit meine ich täglich, diese Mitarbeiter nach so einem Expositionsereignis einmal mit einem kleinen Rachenabstrich zu testen in der PCR. Denn diese Labortests, die sind extrem empfindlich. Die sind so empfindlich,
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Wir brauchen dafür keinen Schnelltest, wir brauchen dafür nur den jetzigen Test, den wir eigentlich gerade im Krankenhausbereich jetzt gut zur Verfügung haben. Also es gibt hier und da natürlich noch Stellen, wo es hakt und häufig ist das dann so, dass wird dann auch in die Medien
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So durchgestochen, wie man sagt, ja. Also, ähm, dann gibt es so bisschen aufgeregte Berichte, da hat jemand zwei Tage oder drei auf seinen Test gewartet. Aber ich kann Ihnen sagen, das sind schon jetzt blöd gelaufene Einzelfälle.
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Wir, wir zimmern da gerade das Schiff zusammen, während wir schon lossegeln. Und da muss man einfach auch ein bisschen Verständnis haben, dass es Reibereien am Anfang gibt.
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Aber wir sind in Deutschland da viel besser als in vielen anderen Ländern.
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Weil wir so früh angefangen haben, unseren niedergelassenen Laborbereich
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Das, das CDC in Atlanta versucht, das zu zentralisieren und zu sagen, ihr dürft nur diesen Test benutzen, den wir hier verteilen und zwar physikalisch verteilen.
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Also die Reagenzien und, ähm, ihr dürft, ihr müsst, ähm, alle positiven Proben zu uns schicken, sonst gelten diese Fälle nicht als bestätigt und wir zählen die noch nicht. Und gleichzeitig gibt es technische Schwierigkeiten mit den Tests, die verteilt wurden und gleichzeitig kommt man mit der Bestätigungstestung gar nicht hinterher.
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Also diese Idee, alles selbst machen zu wollen, die haben wir hier in Deutschland nie gehabt. Das Robert-Koch-Institut ist da nicht so, sagen wir mal, autoritär, sondern wir haben auch mit der, sagen wir mal, mit dem Segen des Robert-Koch-Instituts haben wir von hier aus ja ganz früh
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Diese Diagnostik einfach breit verteilt und, ähm, es ist jetzt einfach so, die Labore sind entweder schon in der Lage oder vielleicht bis Ende der Woche in der Lage, das zu machen. Es gibt wenige Labore jetzt nur noch, die das noch nicht können.
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Ja, bei denen dann die Impfung auch gestoppt wurde in der Frühphase, in einem anderen Fall wurde auch gegen SARS so etwas schon gemacht und im Tierversuch probiert und da wurde also schon vor einer klinischen Anwendung deswegen so ein Impfstoff gestoppt.
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Aber, also ich muss erstmal dazu sagen, ich bin persönlich kein Experte für Impfstoffentwicklung. Also die Vaksinologie, das ist
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Und ich denke, dass eine Impfstoffanwendung in, also eine Richtung, in die man wahrscheinlich gehen will und wird,
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Wie, wie man sagt, ähm, skalierbar ist. Also von, wo man auch nicht nur sagen kann, man macht jetzt eine schöne Laborstudie und eine wissenschaftliche Veröffentlichung und dann eine klinische Studie und noch eine wissenschaftliche Veröffentlichung, sondern man macht das mit der Intention, das für die Welt produzieren zu wollen.
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Die müssen ja alle in Zellkultur hergestellt werden. Und bei der Influenza ist das Ei, das Hühnerei als Produktionsmaschine von solchen Lebendimpfstoffen etabliert und das funktioniert.
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Und es funktioniert dann nicht mehr, wenn wir hochpathogene Influenza-Viren haben in der Produktion, denn dann stirbt der Hühnerembryo in dem Ei, wo in Wirklichkeit der Impfstoff wächst. Das sind also embryonierte Hühnereier beim Influenza. Und bei diesem Virus hier haben wir gar keinen Hinweis darauf, dass man das überhaupt im Ei machen kann.
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Und die Zellkulturproduktionsanlagen für dieses Virus jetzt aufzubauen mit Zelllinien, die zum Teil noch gar nicht ausprobiert sind,
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Das wird dauern. Das wird also deswegen sicherlich nicht der erste Impfstoff sein. Vielleicht wird das ein guter Impfstoff sein. Da bin ich mir sicher, ein Lebendimpfstoff und da gibt es verschiedene Kandidaten und man muss das unbedingt verfolgen.
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Aber die Frage stellt sich ja, was kann denn der schnellste Impfstoff sein? Und schnell bedeutet in dem Fall auch, schnell in rauen Mengen zu produzieren, sodass der auch wirklich noch zum Beispiel in einer späteren Verbreitungswelle ein Nutzen hat.
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Und das wird natürlich dann doch eine Proteinkomponente sein, ein Proteinimpfstoff, der also nicht ein abgeschwächtes, aber noch lebendes Virus ist und den man gut herstellen kann und zu dem man dann noch eine Art Juwanz dazutun wird.
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Und, äh, das Ziel wird dann sein, möglichst neutralisierende Antikörper zu erreichen.
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Ein so hoher Wert von Antikörpern sein, wir sagen Tita dazu.
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Ähm, dass das praktisch, also wir injizieren so einen Impfstoff ja dann in den Muskel, in den Oberarm zum Beispiel. Und dann soll so viel Antikörper dabei entstehen, dass das praktisch durchschwitzt in die Lunge.
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Ne, und in den Hals, also in diese Gewebe. Mhm. Und das, dafür gibt es gute Belege und das ist für mich erstmal so überzeugend, dass man sagt, in diese Richtung wird man wahrscheinlich arbeiten werden. Es gibt aber natürlich andere Ideen. Es gibt auch bestimmte interessante Vektor,
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Und diese, ja, Vektor-Impfstoffe, wie wir sagen, bei denen könnte man sich vorstellen, dass die Produktion eben doch in besseren Mengen klappt und dass da auch relativ früh schon eine Verfügbarkeit ist. Das heißt, wir werden
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Werden wir diese zwei großen Arbeitsrichtungen haben? Einmal die gut produzierten Rekombinanten-Proteine, so wie zum Beispiel bei einer Hepatitis-Impfung oder eben die Vektor-basierten Vaccinen, die es jetzt eher weniger als Anwendungsbeispiele gibt. Es gibt solche Beispiele zum Beispiel für eine
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Influenza-Impfung gibt es so ein Spiel. Und auch für das Ebola-Virus wurden solche Dinge entwickelt und erfolgreich eingesetzt, aber leider nur in kleinen Patientengruppen und dann jetzt gerade bei dem Ausbruch, äh, im Kongo, ähm, auch wieder als, äh, als Impfintervention erfolgreich.
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Und in diese Richtung werden wir uns bewegen müssen, aber das wird eben dauern.
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Ja, also wir werden uns weiter im Labor natürlich damit beschäftigen, jetzt zu sequenzieren und wir haben leider im Moment sehr viel Arbeit, damit den Kollegen jeweils hinterherzutelefonieren, die Fälle haben. Also wir erfahren zum Teil nur aus den Medien, wo
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Das ist relativ viel Koordination braucht. Man muss mit allen mal geredet haben und dazu fehlt einfach im Moment die Zeit.
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Ganz Italien ist seit gestern zur Sperrzone geworden und in Deutschland wird die Empfehlung von Gesundheitsminister Spahn diskutiert, Großveranstaltungen abzusagen. Außerdem haben wir in Deutschland die ersten Todesfälle zu vermelden. Das sind die letzten Meldungen in Sachen Corona seit gestern.
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Mein Name ist Anja Martini, ich bin Wissenschaftsredakteurin bei NDR Info. Jeden Tag telefonieren wir mit Professor Christian Drosten und er ist der Leiter der Virologie an der Berliner Charité, um den Podcast das Coronavirus-Update für Sie ins Netz zu stellen. Guten Tag, Herr Drosten. Guten Morgen.
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Gestern saßen Sie in der Bundespressekonferenz neben Herrn Spahn und es ging darum zu sagen, Großveranstaltungen in Deutschland könnten abgesagt werden oder nicht. Das war die Empfehlung von Herrn Spahn und darüber diskutiert jetzt.
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Ganz Deutschland könnte man fast sagen. Warum müssen es 1000 Menschen sein oder warum können es nicht 800 Menschen sein? Wenn Sie das hören, was geht dann in Ihnen vor?
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Nochmal nachgefragt, Sie als Virologe, ohne politische Zwänge, würden Sie sagen, Großveranstaltung in Deutschland bitte ab jetzt absagen.
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Trotzdem aber hören wir aus den Kommentaren, die uns die Hörer und Hörerinnen schicken, immer noch, dass ganz viele Ämter und Ärzte auch wahrscheinlich
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Ein bisschen unsicher sind oder überfordert sind und es gibt keine einheitliche Strategie, so erzählen uns die Hörer und die Hörerinnen. Zum Beispiel, wenn ein Kind aus der Schule genommen wird, wird es nun getestet oder nicht, weil es vielleicht Kontakt hatte zu einer mit Corona infizierten Person. Da scheint doch noch einiges im Argen zu liegen in Deutschland oder nicht?
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Wo wir bei Personal und Ausstattung sind, muss ich jetzt doch nochmal auf die Krankenhäuser zurückkommen.
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Der Präsident des Weltärztebundes Montgomery hat bei uns im Programm, also bei NDR Info heute früh gesagt, dass der Sparzwang der Kliniken aus den letzten Jahren uns jetzt ein bisschen auf die Füße fällt. Was können die Kliniken tun, um das jetzt auszugleichen und vor allen Dingen auch ihr Personal zu motivieren?
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Subsets and Splits
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