Relief has spread. The international health emergency caused by Sars-CoV-2 has been over for months. What do the increase in the reported number of corona cases in Germany and conspicuous new virus variants mean?
First of all: Experts still see a very broad basic immunity from vaccinations and infections in Germany. But that doesn’t mean that you can no longer get infected. Rather, as a fundamentally healthy person, you usually don’t get so seriously ill that you have to go to a clinic or even to the intensive care unit.
According to the Robert Koch Institute (RKI), the number of corona proofs confirmed in the laboratory has been increasing for about six weeks. In the past week there were almost 4,000 cases nationwide. The level is therefore very low, but also hardly directly comparable with values from the pandemic, as testing was much more frequent. For experts it is clear that there is a high number of unreported cases.
“We hardly see any Covid patients in the intensive care units anymore, but there have been hardly any infections worth mentioning in the population in the last few months,” says intensive care doctor Christian Karagiannidis. The number of patients is not at all comparable to the peak values from the pandemic period, when up to 6,000 people infected with corona were treated at the same time. According to Karagiannidis, at the beginning of the week there were a good 100 nationwide, although not all were treated for Covid-19.
“There is no reason to panic right now, we actually made it. We are in the endemic phase,” says Carsten Watzl, Secretary General of the German Society for Immunology. “But we’re still not at the level of a cold, we’re at the level of the flu.” It could be that you will be absent for a few days with Covid-19.
The fact that corona is being talked about more frequently again is also due to further developments in the Sars-CoV-2 genome. The decisive question is whether another variant might arise that can properly trick our immune system again. “So far I haven’t seen any new variant that would give me stomach ache and urge me to be particularly vigilant,” says Watzl. The RKI also sees no evidence of a higher severity of the disease.
Above all, two new offspring of Omikron are currently in focus. The World Health Organization (WHO) initially upgraded EG.5, also known as Eris, to one of now three “virus variants of interest”. According to the WHO, because of its growth advantage and immune escape properties, EG.5 could cause more cases again and become dominant in some countries or even worldwide.
The new variant BA.2.86 is significantly more mutated. Last week, the WHO classified it as one of currently seven “variants under monitoring”. BA.2.86 shows almost 30 changes in the spike protein compared to the closest relatives, says the specialist for corona variants Richard Neher (Basel). So far only a few sequences are available, but from different countries. This indicates that it is already widespread. According to the RKI, BA.2.86 has not yet been detected in Germany.
BA.2.86 reminds some of the early days of Omikron. Omicron represented a great leap in virus evolution and spread extremely quickly worldwide. But that doesn’t have to be repeated. “Such severely mutated virus variants are reported sporadically, but they are typically isolated observations that do not spread further,” says Neher. It remains to be seen whether and how quickly BA.2.86 will spread.
Forecasts about the course of flu and corona waves are difficult. Viruses evolve. The timing and extent of their circulation are also influenced by many different parameters, as the RKI explains. However, Corona has also caused strong waves of illness, especially in autumn and winter. “Therefore, an increase in the number of cases in these times of the year can also be expected in the future,” said the RKI.
“We will continue to experience a certain ups and downs,” says the Bremen epidemiologist Hajo Zeeb. But as long as no completely different variant arises, he does not see a new pandemic situation. “But we have to remain vigilant.” As far as the intensive care units are concerned, Karagiannidis expects “individual cases to occur again and again in the coming months, especially in immunocompromised patients, but in no way comparable to the pandemic”. Rather, he expects influenza and the respiratory syncytial virus (RSV) in children to be in the foreground of events. All three respiratory pathogens could lead to staff shortages.
The Standing Vaccination Commission (Stiko) only recommends booster vaccinations for certain groups, preferably in autumn and similar to flu protection. These include people over 60, people with certain previous illnesses from the age of six months, nursing and health workers and relatives of risk patients. At least twelve months should usually have passed since the last vaccination or infection. It is no longer recommended for healthy adults under 60 and pregnant women. Stiko no longer recommends basic immunization and boosters for healthy infants, children and adolescents.
Federal Minister of Health Karl Lauterbach (SPD) recently announced on Platform X, formerly Twitter, that the adapted vaccines will probably be in practices from September 18th. According to Watzl, one can wait for the new vaccines. In the eyes of the immunologist, it would be beneficial if the EG.5 variant remained dominant, since the spike protein is very similar to that of XBB.1.5. This is the variant to which the Pfizer/Biontech vaccine, for example, was adapted.
There are still people who need protection. In addition to vaccination according to the Stiko recommendation, the RKI advises: stay at home for three to five days in the event of an acute respiratory infection, reduce contacts as much as possible, cough and sneeze into the crook of your arm and wash your hands regularly. “Particular caution is required when coming into contact with people who are at risk of a severe course of respiratory infections,” it said. In addition to booster vaccinations, masks for corona, flu and RSV waves and an early start of therapy are important for immunocompromised patients, says Karagiannidis.
Immunologist Watzl points out that Sars-CoV-2 is no longer disappearing and that infections in the current phase mean a boost in immunity for those with a healthy immune system. “If the virus were to be pushed back to a very low level for several years, then in the end there would be more serious diseases again because people had not seen the virus for years,” he says. Too much protection can therefore also be counterproductive. The risk of long-term consequences has not disappeared, long covid can also be contracted after a second corona infection. But you will get to the point where the risk is at a similar level to that of other infectious diseases.
