How is the GATE paper adjusted?

Divi-Gate: Scientists correct numbers - wrong again

A theses paper is hotly debated online: Ten scientists claim in it that the fear of overburdened intensive care units was unfounded during the entire pandemic. After discovering many errors in the paper, the scientists made corrections. But apparently the numbers are still wrong. What is it about the theses?

Ten scientists published a thesis on Sunday that shed light on the situation in the intensive care units in the pandemic and, among other things, assumed that the official patient numbers were manipulated. t-online took a closer look at the theses and the authors on Monday. Finally, the most important medical associations reacted to the allegations. And: The scientists have evidently dealt with their theses again. What has changed?

What is in the thesis paper?

The ten scientists make various claims about the situation in German intensive care units during the corona pandemic. One of the theses is that Germany has "considerable overcapacity in inpatient care". Compared to other EU countries, patients end up in hospital more often, even though they could actually be treated on an outpatient basis.

Another thesis is that in a European comparison Germany has the most intensive care beds in relation to the number of inhabitants. In 2020, two percent of the inpatient and four percent of the intensive care capacities were used for Covid 19 patients.

According to the thesis paper, Germany is also the leader in the number of intensive care patients: "In no country are so many infected people treated in intensive care compared to the reporting rate, and in no other country are so many hospitalized infected people treated in intensive care units." In addition, there have been fewer intensive care beds since summer 2020, although an increase in capacities would actually have been expected.

"This decrease corresponds exactly to the decrease in free beds, so that the decrease in free beds should be interpreted more as a result of a decrease in total capacity than as a result of increased utilization by Covid-19 patients," claim the authors of the paper. For this purpose, a "retroactive correction" of the figures took place.

The authors also assume that there is a lack of objective data with regard to the number of nurses. "There is no statistical evidence of a decrease in the number of active nurses," says the summary of the paper. In fact, according to data from the Federal Employment Agency, there was even an increase, but not all nursing staff met the required qualifications.

The theses also focus on funding, which, according to the authors, was paid to ensure the development of intensive capacities. "According to our research, however, these beds do not seem to exist," explained main author Matthias Schrappe in an interview with "Welt". For example, 530 million euros in investment grants to expand the intensive care capacity had been called up, but the 11,000 intensive care beds thus created never went into operation, as the authors write.

Who are the scientists?

The thesis paper was written by a total of ten scientists and doctors who have already caused a stir in the past with a total of seven thesis papers on the corona crisis. The current paper was written by:

  • Prof. Dr. med. Matthias Schrappe: The former deputy chairman of the Health Expert Council and Cologne doctor is the focus of the discussion. As early as February, he affirmed, among other things, that the pandemic could not be "sat out" by a lockdown.
  • Hedwig François-Kettner: The care manager and consultant, as well as the former chairwoman of the patient safety alliance, criticized the way politicians were dealing with the pandemic months ago and called for better protection for the elderly.
  • Dr. med. Matthias Gruhl: The doctor for public health and general medicine and former state councilor from Bremen published a thesis paper in November 2020 in which he criticized the corona policy.
  • Prof. Dr. jur. Dieter Hart: The lawyer is a professor at the Institute for Information, Health and Medical Law, University of Bremen.
  • Franz Knieps: lawyer and board member of the health insurance association of the BKK in Berlin. In mid-May he published a comment in the "Frankfurter Rundschau" in which he criticized, among other things, that Health Minister Jens Spahn had "emptied the public coffers to the core".
  • Dr. med. Andrea Knipp-Selke: The doctor, who is also presented as a science journalist, is part of a blog called the "Corona Info Platform". In contrast, no publications by her can be found in known media.
  • Prof. Dr. rer. pole. Philip Manow: The political scientist at the University of Bremen is part of the Socium Research Center on Inequality and Social Policy and has examined, among other things, the impact of the pandemic on voting behavior.
  • Prof. Dr. phil. Holger Pfaff: The Cologne medical sociologist already commented on the corona measures in November and criticized the "surveillance of society".
  • Prof. Dr. med. Klaus Püschel: The forensic doctor at the University Medical Center Hamburg-Eppendorf was actually almost retired, but was the first to autopsy corona deaths. At the beginning of the pandemic in spring 2020, he claimed that not a single person who was not previously ill had died of Covid-19 and was sharply criticized for this.
  • Prof. Dr. Gerd Glaeske: The pharmacist and health scientist is a former member of the Health Expert Council, and recently criticized the rapid approval of the corona vaccines, among other things.

Prof. Klaus Püschel: The pathologist is part of the group of authors who wrote the thesis paper on the corona situation in intensive care units. (Source: Teutopress / imago images)

Fact check: what is the truth of the theses?

The theses of the scientists are already being hotly debated online. Many intensive care physicians and nurses say the numbers are wrong and argue against the scientists' claims. Others say the thesis paper is a "slap in the face" for medical professionals.

For example, the thesis is refuted that the Divi numbers for intensive care beds have decreased since summer 2020. Schrappe explains in an interview with "Welt": "If we compare the data (since summer) with today's figures in the Divi archive, suddenly there are no longer just under 34,000 beds registered at the top, but only around 30,000. You have retrospective systematically intervened, so that 3,000 fewer beds are recorded everywhere. " That is a problem because these beds are being financed.

But already in the podcast "The Idea" from the NDR, Divi President Christian Karagiannidis had stated that it was not until October that all hospitals understood when which bed could be counted as an intensive care bed. "This sharpening has meant that the number of intensive care beds in the intensive care registry has formally dropped," he explains, "but the number we are seeing now is actually the true number of intensive care beds." Because nobody would dismantle intensive care beds voluntarily.

In addition, the number of stations that report staff shortages has also increased. With this, Karagiannidis also invalidates another thesis of the scientists who claim that there has been no decline in the number of nursing staff. This is also confirmed by a report in the "Frankfurter Allgemeine Zeitung" from the beginning of March 2021. According to this, more than 9,000 nurses left their jobs between the beginning of April and the end of July 2020, a decrease of 0.5 percent.

But: within twelve months from October 2019 to October 2020, hospitals finally increased the number of nursing staff by 18,500. This emerges from a special evaluation by the Federal Employment Agency, as the German Hospital Association recently announced. "Contrary to what has often been reported, the clinics did not cut staff during the pandemic, but hired significantly more. And this against the general trend on the labor market. The figures impressively show that the clinics are serious about the noticeable and sustainable increase in staff During the pandemic it became clear that care is not possible without nurses. Nursing shoulder the brunt of patient care in the hospitals and has shown great commitment during the pandemic. We will achieve our goal of bringing more care to the bedside continue to pursue great commitment, "says Dr. Gerald Gaß, CEO of the German Hospital Society (DKG).

What has now been "corrected"?

Another statement in the theses paper that was refuted was that in the first "wave" of the pandemic, only around 3,000 people had to be treated in intensive care for Covid-19. According to an anesthetist and an emergency doctor, it was maybe 3,000 at the same time, but not 3,000 in total. This is also shown by the numbers in the Divi register from spring.

After both medical associations and the media examined the thesis paper for these incorrect figures, the scientists adjusted their paper on Tuesday.

Now there is no longer talk of 3,000 intensive care patients during the entire first corona wave, but of 3,000 intensive care patients daily. The numbers have thus been revised upwards so much that they are again wrong. During the second wave, 6,000 people are said to have ended up in intensive care units every day. In the official figures of the Robert Koch Institute and the Divi, however, it can be seen that the figures are the respective peak of most Covid patients who had to be treated intensively at the same time. After all, hardly any patient spends just one day in the intensive care unit. The authors of the thesis are now exposed to a lot of ridicule online for their "correction".

How do medical associations react to the allegations?

The German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi), the Marburger Bund Bundesverband and the German Hospital Society (DKG) published a joint statement on Monday. "We strongly reject the misleading allegations of playing with fear, the manipulation of official statistics and even the allegation of treating patients in intensive care purely for financial reasons," they emphasize. "Even the claim that the hospitals wrongly collected funding for intensive care beds that were never set up is not tenable. Many of Schrappe's accusations are based on misjudgments and a lack of knowledge of the actual situation in hospitals."

The accusation that fear had been stirred up misunderstood the situation in spring 2020. In fact, in March of last year there was fear that numerous patients could no longer be adequately cared for, in particular ventilated. "The concern was justified in view of the situation in Italy, France and many other countries," confirm the experts.

"The policy has consequently decided to set up as many intensive care beds as possible. Everyone was aware that these intensive care places could not be operated across the board with highly qualified nursing staff." In fact, however, there were short courses in all federal states in which nurses were prepared for the care of ventilated patients even without intensive care training. The hospitals would have been able to operate the so-called intensive care bed emergency reserve.

"It's about the number of beds that can actually be used"

"But first of all, an intensive care bed is not just the existing bed with a ventilator. It is about the number of beds that can actually be operated, and this term is also used in the Hospital Financing Act," they explain. That means a designated space, functional equipment and material per bed space, beds, and staffing with nursing and medical specialists must be available and be able to be used.

The doctors also explain the decline in intensive care beds in the course of 2020: "There was already a decline in the number of intensive care beds in the Divi intensive care registry at the beginning of August As a result, numerous clinics have adjusted their bed reports to these personnel requirements. In addition, the emergency reserve capacities have been queried separately since then. "

The doctors also reject the accusation that they have manipulated official statistics in retrospect. "During the course of the pandemic, the Divi Intensive Care Register removed the beds in the children's intensive care units from the total number of operable beds - beds in the premature baby ward (NICU) and those for seriously ill infants (PICU). These do not play a role in the care of Covid-19 patients Role. The change in the representation of adult beds is also explicitly pointed out in all statistics. "

40 percent fewer operations than in normal years

"How far Schrappe is from the reality of care is shown by two statements alone. For example, he asks why staff had not been qualified to help out in the intensive care unit in the worst-case scenario, and says that operations should also have been postponed," they quote Experts the thesis paper. In fact, many operations have been postponed. At times, the hospitals operated 40 percent less than in normal years.

"It was never about panic or scare tactics, but always about caution. It was primarily about the care of seriously ill patients, about protecting hospitals from being overburdened and still being prepared for extremely rising patient numbers," emphasize the associations. "Evaluating this situation retrospectively with today's knowledge does not do justice to the decision-making requirements of the time."

And further: "A real slap in the face of the doctors and nurses in the hospitals is Schrappe's accusation that patients would have been placed in intensive care units without an emergency. Nurses and doctors have performed very well in the past few months under the highest stress accomplished and many lives saved ", the associations conclude their position.

What is the current situation in the intensive care units?

Currently (as of May 17, 2021), according to the Divi Intensive Care Register, around 4,000 corona patients are in intensive care. Almost 2,500 of them require invasive ventilation, which corresponds to 62 percent. In total, there were more than 105,000 corona patients in Germany in the entire corona pandemic who had to be treated in intensive care units.

Around 20,000 intensive care beds are currently occupied in Germany, 3,400 are still free. The numbers have increased slightly compared to the previous day.

Important NOTE: The information is in no way a substitute for professional advice or treatment by trained and recognized doctors. The contents of t-online cannot and must not be used to independently make diagnoses or start treatments.

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