From the disaster mode of politics to risk-stratified action
Prof. Dr. med. Harald Matthes is a senior physician in Gastroenterology, medical director and managing director of the Havelhöhe community hospital, a clinic for anthroposophic medicine in Berlin.
EK: Mr. Matthes, how have you experienced the Covid-19 events in everyday hospital life since the beginning of the pandemic and what was the specific situation on site?
Harald Matthes: The beginning of the corona pandemic was marked by the greatest uncertainty among the population as well as the doctors, so that there was a lack of consultation options in outpatient medicine and the clinics with so-called corona outpatient departments were extremely popular, but also thankful. At the same time, strong efforts were made to increase the intensive care capacities, so that we too increased up to 49 ventilation places. Fortunately, these capacities were never needed. The intensive care corona patients, however, were very complex to care for due to the difficult process with long artificial ventilation and cardiovascular failure and required a high level of expertise. In contrast, the rest of the medical process was clearly shut down, in particular the elective operations – these are operations that do not have to be performed immediately – so that the hospitals had a rather quiet spring and summer. Inpatient treatment cases with corona patients are currently increasing again.
EK: What motive did the Havelhöhe have to set up a corona ambulance?
HM: Corona initially caused too much fear in public. This can only be countered through concrete observation. Therefore, as a hospital, we have decided to become a Covid-19 focus center in Berlin in order to be able to judge from our own perspective. Without real perception, we currently see the social fear in our heads with media-controlled images as head cinema, without any comparison of reality. Politicians act abstractly and in disaster mode instead of reacting appropriately in a risk-stratified manner. Attempts are currently being made to counter a global pandemic even with small-state thinking and travel restrictions are now being imposed at the district and county level.
EK: Can you say something about tests and infection numbers? What about the error rate?
HM: The problem with molecular PCR testing is not the error rate of approx. 0.4 to max. 1% due to test errors, not even incorrect acceptance conditions, but their evaluation. A positive PCR test and its ct value (cycle threshold) says something about the viral load, little about infectivity and nothing about the clinically relevant question of the disease. At least 80% with a positive Covid-19 test have no or only very few clinical symptoms. 4-6% in Germany are more seriously ill and only 0.3-0.8% die from Covid-19 disease (figures from meta-analyzes for Germany). It is not the number of infections that is of interest, but diseases and their severity. If a lot is currently being tested, the decisive factor is how many of those tested are sick or even seriously ill. 4,000 young people who tested positive for Covid-19 are hardly a medical problem; if they were over 75 years old, it would be assessed completely differently. The risk increases with age and the risk factors heart disease, metabolic syndrome, sugar disease and other pre-existing organ damage as well as immune defects or drug immunosuppression. While mortality in children is close to 0, it increases with age and risk factors to 7-8% in those over 75 years of age. Large differences in mortality in Germany compared to other countries are due to the health system. Germany has far more intensive care beds than any other country in the world and the state-of-the-art equipment is also excellent. The highest utilization of Covid-19 patients in spring was 15%, so that capacity utilization or even overload in Germany was never seriously imminent. There are currently around 500 Covid-19 patients in the intensive care unit (10.10.2020) with 30,255 intensive care beds with a reserve capacity of a further 12,156 beds (corresponds to 1.19% occupancy).
EK: How did you treat? Are there specific anthroposophical approaches – with what success?
HM: So far there is no specific Covid-19 drug from conventional medicine. In studies, remdesivir does not lead to a significantly improved survival, but only to a mild reduction in symptoms. The initially large study, especially at university hospitals, with hydrochloroquine and azithromycin even resulted in an increase in the death rate. Therefore, anthroposophic therapy concepts with an increase in self-healing powers have become very important. Important anthroposophic medicines were iron as meteor iron or as Ferrum metallicum praep., the phosphorus, the stibium as well as the Cardiodoron® and Pneumodoron®, but also Bryonia (turnip) and Tartarus stibiatus (emetic tartar). The results were very good, as no Covid-19 patient has died in Havelhöhe, with a mortality rate of around 30% of all Covid-19 intensive care patients.
EK: Many people live in fear of further waves or a permanent condition. What’s your forecast?
HM: The evidence for Covid-19 will rise again this autumn and winter. Nevertheless, we will not come up against the capacity limits of the health system in Germany, but we will come up against the limits of the health authorities and infection tracking. It is currently crucial that we move away from disaster management under emergency legislation (epidemiological situation on a national scale) to risk management. However, this also means that not only a limit of 50 new infections per 100,000 inhabitants applies as the risk limit value or the R-value, but also clinically relevant parameters such as age distribution, sick people and the severity of the disease, as well as the utilization of hospital and intensive care capacities. In the complex risk assessment, one or two values, especially if they do not reflect the reality of the diseases, are of no value.
EK: All human and social life is affected by this viral threat. What perspectives does a holistic anthroposophical approach open up and what inner attitude do you adopt as the treating doctor and scientist?
HM: The Covid-19 infection is a zoonoses, i.e. an infection that has passed from animals to humans. This points to ecological damage and a reduction in diversity in nature. Factory farming with a high level of antibiotic use and over-exploitation of nature are the cause of the increasing zoo-noses in recent decades (bird flu, MERS, Ebola, etc.). Not only man is a comprehensive, multidimensional being (body, soul and spirit), but also the earth. Dignified interaction with people and nature is only possible in the deeper sense if an active spirit in people and nature is experienced and really experienced. Anthroposophic medicine and biodynamic agriculture have lived and acted according to this principle for over 100 years. Humanism, sustainability and the common good have been an ethical basis for a hundred years now. The chance to use the Covid-19-related economic investments of 1.3 trillion euros for an overdue restructuring of the economy and agriculture as well as medicine is currently being missed by politicians.
EK: COViD-19 is not only a burden for the specifically sick person, but also for society as a whole. What makes the individual and society resilient?
HM: 100 years of bacillus theory and the dominance of a pathogenic medical concept have led to the social tyranny predicted by Rudolf Steiner as early as 1909. Humans have a microbiome and virome, which are indispensable for their immunity and in terms of quantity more powerful than humans themselves (microbiome 1014 bacteria with approx. 1200 species e.g. in the intestine with only 1012 body cells) Awareness of the salutogenic potential in humans leads from the victim role towards bacteria to an awareness of life that accepts that humans must live in ecological harmony with their environment and nature.
Corona is currently polarizing society in terms of society. The « rectifiers » are increasingly irreconcilable towards the « deniers ». Corona attacks the center of the human being, breathing and cardiovascular system. The social answer must be the powers of the heart of understanding, which we apply to other people and nature. Action based on mindfulness is more necessary than ever. Appropriate handling of the pandemic in a risk-stratified manner is only possible with an understanding heart.
EK: What do you think of the hygiene and prevention measures in schools?
HM: Politicians treat schoolchildren and old people alike in disaster mode, which is completely inappropriate, since the Covid-19 disease risk in children is almost zero compared to an 8% risk of death in poly-morbid older people. This is currently already leading to incorrect supplies, so that the Covid-19 tests are mainly carried out by teachers instead of carers for the elderly. In a region as a risk area with 50 infected per 100,000, only every two thousandth smear can be positive. This prevents a risk-stratified diagnosis in the population and thus a real risk reduction for the endangered groups of people. Strategy-less testing blocks test capacities and thus prevents a differentiated approach based on risk factors. Surface disinfection in schools is reminiscent of the sins of the 1980s in hospitals, which cultivated highly resistant germs because the local microflora was destroyed. Politics in Germany is currently far from a scientifically based, socially appropriate and balanced risk stratification, especially for schools. Authoritarian emergency decree takes precedence over information, transparency and, above all, personal assumption of responsibility, taking into account the respective risk factors and reducing them appropriately. There is absolutely no thought for salutogenic and resilience-increasing measures. If there is a need for physical rather than social distancing, then in schools, especially due to the digitization push, a spiritually nourishing and warm social heart climate should be given as an active response.
Concepts for Holistic health care
“Today many believe that they are really great when they only do external factual medicine – everything that is evidence-based and scientifically proven. This often means that facts and figures are more important than, for example, quality of life. An example of this: a woman with breast cancer after her operation. Studies say that if she receives radiation afterwards, it lowers her risk of getting the tumor again by 15 percent. This therapy would be completely useless for seven patients, only one in eight would benefit from it. Even so, guidelines advise for radiation. We take a different approach and rather ask the question: What can I (still) do as a patient in my lifetime? How am I? What do I want to experience? Autonomous self-sufficiency is extremely important. Are there children to be looked after? Is my hair falling out and is that an immeasurable burden on me? Sometimes it is more important for older patients to experience the summer in the south of France than to go to chemotherapy every two weeks and maybe just live a few months longer. The patients have to decide for themselves, because they have to face the consequences. It is important to note what patients want, what their intrinsic values are, and not what a study says that doctors think is good. So we have to design their individual therapy with the patients from the general medical facts. «