Tuesday, December 21, 2021
Kekulé calls for vaccination holidays
This strategy helps against Omicron
A guest contribution by Alexander Kekulé
Christmas lockdown or just wait and see? Politics and science are debating how Germany should react to the upcoming fifth wave of the pandemic. Current data suggest that we will not get any further with the tried and tested corona measures.
The Omikron variant differs so much from its predecessors that virologists could really go into raptures. Nature has turned 59 screws to improve the Sars-CoV-2 pandemic virus compared to the original Wuhan prototype. Omikron can apparently easily infect vaccinated and convalescent people – the immune defense is tricked like a beginner in chess playing against the grandmaster. In addition, Omikron is probably more contagious than its predecessors. The newcomer serves the door opener to the cells of the human respiratory tract, the ACE2 receptor, twice as well as Delta and four times better than the common ancestor from China, with whom the pandemic began in 2019. If the preliminary results of a working group from Hong Kong are correct, the new variant can also multiply particularly effectively in the bronchi.
Despite everything, there are many indications that the infections in the Omicron wave are comparatively harmless. This is likely not due to the virus itself, but to the population’s improved immunity from vaccinations and previous infections. In South Africa, Omikron causes only a tenth of hospital admissions compared to the Delta variant, and the proportion of inpatient Covid patients requiring intensive care is significantly lower. The data from the South African health authority for infectious diseases suggest that this is mainly due to a high infection rate among those who have recovered and who have been vaccinated. In the Gauteng province, which was initially particularly affected, to which the capital Pretoria and the metropolitan region of Johannesburg belong, around 70 percent of the population have antibodies against Sars-CoV-2. Since the vaccination rate is only 30 percent, much of the immunity comes from previous infections.
It is currently evident in Denmark that countries with fewer recoveries and older populations can protect themselves against severe courses from Omikron with a high vaccination rate. The average age of the population here is 42 years, 90 percent of adults are fully vaccinated. While the number of infections doubles every two to three days, hospital admissions have only increased 6 percent since the beginning of December and the number of deaths has even decreased slightly. In the Omikron hotspot London, where confirmed infections are also increasing rapidly, there has been no significant increase in hospital admissions so far.
Previous tools are unsuitable
According to this, Omikron is also likely to lead to serious illnesses significantly less often than the Delta variant in Germany, with a vaccination rate of 81 percent of adults. All laboratory tests known to date also allow the conclusion that vaccinated and convalescent people are hardly protected from infection, but are well protected from serious illness by Omikron (according to a recent study that has not yet been assessed, this protective effect is 77 percent). Younger, otherwise healthy people who have been vaccinated and those who have recovered may even benefit from an omicron infection, because it would give them better protection against future variants of the pandemic virus. If the course of the disease is severe despite the vaccination, it almost exclusively affects people of old age or with other known risk factors. In this group, a booster vaccination has the strongest effect; it can very likely significantly reduce the rate of hospital admissions and deaths.
Germany is also starting the next phase of the pandemic from a favorable position. When the Bundestag finally decided to tighten the corona measures on November 18, the delta wave was already broken – probably due to immunity from vaccinations and infections as well as the increasing caution of the population even without state requirements. The strict measures, which were taken far too late for Delta, are proving to be a godsend in view of the fifth wave that is now imminent: While the transition to the Omikron variant in Denmark, the United Kingdom, France and the USA is falling in the middle of a rampant Delta wave , Germany has given itself a short respite.
With Omikron, however, the pandemic has entered a new phase, and the previous countermeasures are no longer suitable for combating it. Because the new variant also infects vaccinated and convalescent people and is also probably more contagious than Delta, it could only be stopped by an immediate, complete lockdown. However, this would no longer be proportionate because the risk for vaccinated and convalescent people without special risk factors and for young people – i.e. the majority of the population – is low compared to Delta.
It will therefore hardly be possible to avoid that a large part of the German population becomes infected with Omikron within a few weeks. While most people will get away with a more or less severe cold, two groups are particularly at risk: unvaccinated adults and vaccinated people at risk who have not yet received a booster. When the omicron tsunami rolls across the country, these people will face higher levels of infection pressure than ever before in the pandemic. There is therefore a risk of massive overburdening of the hospitals, especially by the age group over 60 years of age, in which three million are unvaccinated and almost half of those vaccinated have not yet received a booster.
Prioritize two weeks vaccination vacation and over 60s
A new strategy is needed to tackle the upcoming, likely final, critical phase of the pandemic. The previous tactic of keeping the infection rate low through contact reduction and third-party vaccination of all age groups and thereby relieving the health system can no longer work against Omikron. Since the majority of the population will inevitably become infected within a short period of time, there is only one recipe that is more or less promising: Protect as many unvaccinated adults as possible with first vaccinations and people at particular risk with third vaccinations from severe courses. For this, it is particularly necessary, instead of the indiscriminate booster campaigns for everyone, to specifically address people of older age and consistently prioritize them. In the age group 60 and over, it makes sense, contrary to the recommendation of the STIKO, four months after the second vaccination. It is irresponsible that massive amounts of young and healthy people can be boosted, while very old people did not get an appointment until the new year or were turned away because the six-month period had not yet passed since the second dose.
The prioritized vaccination campaign proposed here may be our last stand against the pandemic, every day counts. In order to gain additional time and resources for this, we should shut down our contacts again as best we can for two weeks after Christmas. As a concrete measure, for example, the nationwide closure of cinemas, theaters, clubs and other larger indoor events can be considered. For all other leisure events, a general test obligation must apply – maintaining the special rights for vaccinated and convalescent people (2G rule), which already contributed significantly to the increase in incidence in the delta wave, would be irresponsible in the omikron wave. In companies where home office is not possible, vaccinated employees must also be tested regularly. Private events should be limited to a maximum number of participants. Meetings in the open air are harmless as long as the minimum distance can be maintained.
Organizing a prioritized, large-scale vaccination campaign is a mammoth task for the state and its politicians. At the same time, the supply of the population with rapid tests must be ensured and the hospitals must prepare for the – unlikely – worst case. It will be equally important to convince citizens of the need for contact restrictions and to explain to them the strategic aim of the measures. This time it’s not about breaking the wave of infections or getting below a certain incidence – that would be pointless with Omikron. There is therefore no risk that the restrictions will be extended beyond the planned two weeks.
After all, the 14-day “vaccination vacation” would also be a clear signal to all previously unvaccinated adults: This is the last wake-up call, the last chance to prepare for the almost inevitable corona infection. In the worst case, a situation could arise for the first time in which there are no longer enough intensive care beds available for all Covid patients. Anyone who has not heard the bell by then surrenders themselves to the virus at that very moment.
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