Here is a picture from a study from the Robert-Koch-Institute in the year 2012:
This shows a ficticous pandemic outbreak scenario in germany:
I have translated part of the study with the help of google san - Brace for wall of text:
The risk analysis "Pandemic caused by Virus Modi-SARS" was carried out under the technical leadership of the Robert Koch Institute and the participation of other federal authorities 13.
Here too, a corresponding scenario was first developed by the inter-agency working group.
The probability of occurrence of such a pandemic and the extent of the damage to be expected were then determined. The scenario describes an unusual epidemic that is based on the spread of a novel pathogen. For this, the hypothetical "Modi-SARS" pathogen, but with realistic properties, was used. A SARS-like virus was chosen against the background that the natural variant in 2003 quickly pushed very different health systems to their limits.
The past has already shown that pathogens with novel properties that trigger a serious epidemic event can suddenly appear (e.g. SARS coronavirus (CoV), H5N1 influenza virus, Chikungunya virus, HIV) .14
Using simplified assumptions for this Modi-SARS virus, the hypothetical course of a pandemic in Germany is modeled, which is both federally relevant and plausible.15
The scenario describes a worldwide spread of a hypothetical new virus from Asia, which is named Modi-SARS virus. Several people enter Germany before the authorities receive the first official warning from WHO. Among them are two infected people who, through a combination of a large number of contact persons and high infectivity, contribute strongly to the initial spread of the infection in Germany.
Although the measures provided for by the Infection Protection Act and pandemic plans are implemented quickly and effectively by the authorities and the health system, the rapid spread of the virus cannot be stopped effectively due to the short interval between two infections.
At the height of the first wave of illness after approx. 300 days, approx. 6 million people in Germany contract Modi-SARS.
The health system is facing immense challenges that cannot be overcome. Assuming that maintaining the function of vital infrastructures is given top priority and key positions remain occupied, large-scale supply failures can be avoided in the other infrastructure sectors.
After the first wave subsides, two more, weaker waves follow until a vaccine is available three years after the first diseases appear.
The special thing about this event is that, firstly, it affects the entire area of Germany and all population groups to the same extent, and secondly, it occurs over a very long period.
If such a pandemic occurred, three separate waves with immensely high casualty numbers and serious effects on different protected areas could be expected over a period of three years.
For this scenario, both the probability of occurrence to be assumed for such an epidemic and the extent of damage to be expected when it occurred were then determined using the method of risk analysis for civil protection at the federal level.
The results of the risk analysis (probability of occurrence, extent of damage, scenario) are attached to the report in Appendix 4.
1. Definition of the hazard / type of event
A pandemic is a global spread of disease.
Exceptional epidemics can have natural causes, e.g .:
x recurrence of known pathogens (measles, typhoid)
x imported cases of diseases with rare highly contagious and / or highly pathogenic pathogens (Ebola, Lassa fever)
x pandemics with variations of known pathogens (influenza pandemic)
x occurrence of new types of pathogens (serious Acute Respiratory Syndrome (SARS).
In exceptional cases, epidemics can also result from accidental or intentional release, e.g. For example:
x accidental release due to a laboratory accident (as in individual cases after the SARS pandemic or the H1N1 influenza in 1977, the so-called "Russian flu", which was probably the result of a laboratory release (Scholtissek et al., 1978; Zimmer and Burke, 2009))
x intentional release in the area of food blackmail or with a bioterroristic background (the best-known example here is the "Anthrax Letters" in the USA 2001).
The present scenario describes an unusual epidemic that is based on the spread of a novel pathogen. The scenario is based on the hypothetical pathogen "Modi-SARS", the properties of which are described in the information sheet (see Appendix) and which is very closely based on the SARS virus. The past has shown that pathogens with novel properties that trigger a serious epidemic can suddenly appear. (e.g. SARS coronavirus [CoV], H5N1 influenza virus, Chikungunya virus, HIV).
A current example of a new pathogen is a corona virus ("novel corona virus"), which is not closely related to SARS-CoV.
This virus has been detected in six patients since summer 2012, two of whom have died. One patient was treated in Germany and could be discharged as healed. In contrast to SARS-CoV, however, this virus does not appear to be or can only be transmitted very poorly from person to person, so that the current risk assessment assumes that the risk of illness as a result of transmission from person to person is low (status November 26, 2012).
For the human population, SARS-CoV and HIV were “new”, previously unknown viruses with a high lethality that could only be reduced for HIV after years and extremely costly research.
In contrast, Chikungunya viruses and H5N1 viruses were already known; properties altered by mutations, however, led to better transferability to humans in these viruses.
SARS-CoV and H5N1 are transmitted via the respiratory tract, Chikungunya is transmitted via a vector (mosquito).
This makes these diseases more difficult to control than HIV, which is transmitted through sexual intercourse or through contact with HIV-positive blood. While HIV control in Germany and other countries in Western Europe or North America has been relatively successful, this is not the case in many other countries with less good health infrastructure - an indication of how essential control measures are in limiting the spread.
2. Description of the event
The hypothetical Modi-SARS virus is identical to the natural SARS-CoV in almost all properties.
The incubation period, i.e. the time from the transmission of the virus to a human being until the first symptoms of the disease, is usually three to five days, but can range from two to 14 days.
Almost all infected people also fall ill. The symptoms are fever and dry cough, the majority of the patients have shortness of breath, changes in the lungs visible in X-rays, chills, nausea and muscle pain. Diarrhea, headache, rash (rash), dizziness, cramps and loss of appetite may also occur.
The mortality rate1 is high at 10% of those affected, but is different in different age groups. Children and adolescents generally have easier disease courses with a lethality of around 1%, while the lethality for over 65-year-olds is 50%.
The duration of the disease also differs depending on the age of the patient; younger patients often got over the infection after just one week, while seriously ill, older patients had to be treated in the hospital for around three weeks, and treatment needs of up to 60 days were also described for the SARS-CoV.
This age-dependent course of infection with SARS-CoV was not assumed for Modi-SARS.
When modeling the numbers of sick and affected people in the scenario, we assume that all age groups are affected equally.
Other parameters that can modify the course, such as human contacts and mobility in metropolitan areas or social networks, were also not taken into account.
The transmission is mainly via droplet infection, but since the virus can remain infectious for a few days on inanimate surfaces, smear infections are also possible.
When the first symptoms appear, the infected people are contagious.
This is the only difference in the transferability between the hypothetical SARS mode and the SARS CoV - the naturally occurring pathogen can only be transmitted from person to person if a person already shows clear symptoms of the disease.
No medication is available for treatment, so treatment can only be symptomatic.
A vaccine is also not available for the first three years.
In addition to compliance with hygiene measures, protective measures in this sense can only be taken by isolating the sick or suspected of infection, and by using protective equipment such as protective masks, protective glasses and gloves.
Isolation, isolation and quarantine are only of limited effectiveness, since there is a very pronounced infectivity at the onset of symptoms (Fraser et al., 2004).
The infectious disease spreads sporadically and in clusters.
Transmission takes place in particular via household contacts and in the hospital environment, but also in public transport, at work and in leisure time.
For the modes SARS scenario, only a mutation-related change in the transferability of the virus is assumed; further possible variants, even with a multifactorial form, would be conceivable (Reichenbach, 2008) 2, but are not considered in this scenario.
2.1 Place of occurrence / spatial expansion
Where does the event happen / which area is affected by the event?
The event occurs globally (mainly Asia, North America, Europe).
The spread in Germany takes place via a trade fair city in northern Germany and a university city in southern Germany (Æ see 2.4 Duration and course).
In the initial phase of the event, a total of ten cases are registered in Germany.
Two cases are of particular importance here, since they occupy key positions for the dissemination (see 2.3 Triggering events).
The other cases concern travelers who contribute to the spread.
The distribution takes place across Germany, analogous to the population density.
This assumption reflects a theoretical, simplified model, in the case of a natural “real” outbreak, geographical differences can be expected, the complexity of which cannot be shown here.
A map of the spatial distribution of the number of sufferers at the peak of the first wave of infection is attached to the scenario.
When does the event happen? (Season / time of day if applicable)
The event begins in February in Asia, but is only recognized there a few weeks later in its dimension / importance.
The first identified Modi SARS case occurs in Germany in April.
This point in time forms the starting point of the present scenario.
2.3 Triggering events
Which events lead to this event? / How is the event triggered?
The pathogen comes from Southeast Asia, where the pathogen found in wild animals was transmitted to humans via markets.
Since the animals themselves do not fall ill, it was not recognizable that there was a risk of infection. Infectious chains set in motion by this zoonotic transmission could only be traced retrospectively; this did not succeed in all cases.
Domestic pets and farm animals cannot be infected by Modi-SARS and therefore do not contribute to the spread or maintenance of the infection chain.
Two of the first cases that are brought into Germany concern people who have been infected in the same Southeast Asian country.
One person flies to Germany the same evening to take care of a stand at a trade fair in a northern German city, the other person flies back to Germany a day later to resume studying in a southern German university town after a semester abroad in China.
In Germany, these two people are two of the index patients through which the infection is spread further.3
They are of particular interest because both people come into contact with an extraordinarily large number of people and thus contribute greatly to the initial spread.
There are other cases that are imported to Germany, so that a total of ten infected people are assumed to be responsible for the first wave of infection.
2.4 Duration and course
How long does the event and / or its direct impact last?
New cases can be expected until a vaccine is available. A total period of three years is assumed for the present scenario, with the assumption that a vaccine will be developed, released and available in sufficient quantities after this time. The pathogen changes over the course of the three years through mutations in such a way that people who have already had an infection become susceptible to an infection again. This results in a total of three disease waves of different intensities.
Which period after the start / occurrence of the event must be taken into account when determining the extent of the damage?
The extent of the damage is calculated as the sum for the entire period of three years.
How is the event going?
Starting from the first occurring cases in northern and southern Germany, the pandemic is spreading in waves with increasing numbers. Basically, especially in metropolitan areas, due to the high population density and the movement patterns (high mobility, use of mass transport, etc.), correspondingly higher numbers of illnesses can be expected.
It is believed that each infected person infects three people on average, and each one
takes three days for the next transmission to occur. So-called "Super Spreader"
not are not considered. Furthermore, it is believed that the population is fully susceptible to the virus. A reduction in the number of susceptible people will result from going through
infection. The number of people who can be infected decreases because the sick die or
develop temporary immunity.
The spread is also slowed down and limited due to the use of anti-epidemic Measures.
Such measures are quarantine for Contact persons of infected people or other seclusion measures such as the treatment of highly infectious patients in isolation stations with special attention to Infection protection measures.
Means of containment include school closures and Cancellation of major events. In addition to these measures which can put into force following the Infection Protection Act there are further recommendations to the personal protections, e.g. in occupationally exposed persons, such as compliance with Hygiene recommendations.
The anti-epidemic measures begin after ten patients in Germany have died from the infection. The arrangement of the measures take place in the Regions first in which cases occur; the population depends on the measures subjective feeling differently.
Generally, measures are taken between day 48 and Day 408 described as effective.
This results in the following course of events if effective anti-epidemic Measures in a population with no immunity to the virus (fully susceptible) are taken: See translated Graph …
Graph description and details:
5 The modeling of the epidemic assumes the following:
The total population is 80 million. The average latency is 3 days, the time from the onset of
Infectivity to the manifestation of symptoms 0.1 days, the length of the infectious phase is 13.1 Days, the disease duration is 13.5 days; for people who need to be hospitalized, this is Duration 19 days, the average intensive care is 13.5 days.
It will be assumed that a person is immune for 360 days after experiencing the infection with Modi-SARS, after that this person can be infected again by a mutated version of the virus. The modeling is based on population density, it includes factors such as different disease courses in different age groups or different mobility (from age groups or in certain
It is a susceptible-infected-recovered (SIR) model, it was created with Stata 12 software.