Experts agree: the pandemic is over – or at least close to it. So what can we expect this year? While the coronavirus has lost much of its initial terror, it is here to stay.
After three years, the time has finally come: the corona pandemic is coming to an end. Normality has long since returned in most areas of life. Nobody talks about fully booked vaccination appointments or long queues in front of test centers. At the end of December, Charité virologist Christian Drosten finally said the redeeming words: “We are experiencing the first endemic wave with Sars-CoV-2 this winter.” But what does that mean for the future? Will the last Corona measures also fall now? How often will we have to vaccinate ourselves? And what dangers does the virus still pose?
According to experts like Drosten, there is now a high level of immunity in the population due to vaccinations and recovery. In addition, the pandemic situation has changed fundamentally with the appearance of the omicron variant. “The Sars-CoV-2 virus now belongs to the large group of viruses that cause acute respiratory infections,” says intensive care physician Stefan Kluge from the University Hospital Hamburg-Eppendorf (UKE) to the Science Media Center. Omicron subtypes, such as the XBB.1.5 line, which is currently spreading, are very contagious, but do not lead to more severe disease progressions.
This is also evident in the hospitals. “Due to the now high level of immune competence in the population and the changed Sars-CoV-2 strains, I only expect a few patients with severe courses in the clinic,” says senior physician Paul Lingor from the Klinikum Rechts der Isar at the Technical University of Munich. “Fortunately, we are already treating hardly any patients with severe Covid 19 pneumonia – despite the fact that the number of infections is still relevant in some cases,” reports his colleague and infectiologist Christoph Spinner ntv.de.
Many clinics are still struggling with high occupancy rates. But that is largely due to the unusually strong wave of colds this winter. Because hospitals are reporting fewer and fewer Covid patients nationwide. According to the German Hospital Society, the number of patients who tested positive for corona fell again significantly by 25 percent compared to the previous week. And the downward trend is also continuing in the intensive care units: the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) is currently reporting 898 patients in intensive care units. For comparison: During the delta wave a year ago, there were almost 5,000 Covid patients there.
In view of these developments, many experts assume that tests, masks and isolation will be abolished nationwide in the course of 2023. “From the point of view of infection medicine, the hygiene rules were only intended from the outset as a measure to bridge the time until immune competence in the general population has increased significantly through vaccination and recovery,” says infectiologist Spinner in an interview with ntv.de. Since that is now the case, there is no longer any reason to maintain the measures, including the obligation to wear a mask.
Some federal states such as Saxony and Bavaria have already pushed ahead with the abolition of the mask requirement. Most of the others should follow by early February at the latest. At that point, the mask requirement for long-distance traffic will also fall. “The pandemic situation has stabilized,” said Federal Health Minister Karl Lauterbach. At the same time, he relies on personal responsibility. “Anyone who wants to protect themselves and others is of course still well served by wearing the mask.”
Lauterbach, on the other hand, firmly rejects a nationwide end to the obligation to isolate: “The obligation to isolate remains in place,” he said recently. But the countries have long been creating facts. In Bavaria, Schleswig-Holstein, Baden-Württemberg, Rhineland-Palatinate, Hesse and Saarland, people infected with corona no longer have to stay at home. Lower Saxony, Bremen, Mecklenburg-Western Pomerania, Thuringia and Saxony-Anhalt have at least promised an early end to the obligation to isolate.
The easing of the rules for isolation and quarantine has already had an impact on another corona measure: Anyone who wants to “test themselves” after an infection will no longer receive a free quick test in the future. The Federal Ministry of Health no longer sees a need to fund tests to end isolation from federal funds. However, medical staff who need to be tested before resuming work are still entitled to a free rapid test. “A broad test regime is no longer needed,” agrees Peter Galle, head of the Covid 19 ward at the Mainz University Hospital. “Tests actually only make sense in the case of symptoms and in vulnerable areas, for example in transplant stations in hospitals.”
Regular vaccinations will probably only remain an issue for high-risk patients. According to studies, the corona vaccination continues to provide reliable protection against serious illnesses. Andreas Radbruch from the German Rheumatism Research Center Berlin expects that “the vaccination does not have to be refreshed, as was and is the case with Sars-CoV-1.” There, after an infection, the T cells have been stable for 17 years.
And a triple vaccination plus an infection that has gone through could also protect against infection for much longer than previously thought. A new Portuguese study speaks of an immunity of up to eight months. Therefore, intensive care physician Galle considers seasonal vaccinations, such as in the case of influenza, to be sensible. Accordingly, there is more to be said for continuing to use boosters than against it. In addition, risk groups, i.e. the elderly, the sick and the immunosuppressed, should be vaccinated every six months.
Now there are people who cannot be vaccinated because of certain pre-existing conditions. But now they can protect themselves. They are recommended preventive therapy with monoclonal antibodies that neutralize the pathogens.
There are now a number of treatment options for Covid infection. Antiviral drugs such as Paxlovid can stop the virus from multiplying in the cells and thus prevent a severe course. Certain cardiovascular drugs protect blood vessels, the heart and other organs from complications caused by Covid 19 disease – for example thrombosis. Other drugs help the lungs to maintain their function during the acute infection and then to regenerate with as few consequences as possible.
“In my opinion, there are more treatment options for acute Covid 19 infection than for almost any other viral disease of the respiratory tract,” says intensive care physician Christian Karagiannidis. The unique, worldwide research achievement in the past three years is sensational. And it’s far from over. According to the US association BIO, more than 460 different drugs are currently being tested to see whether they can be helpful against Covid-19 in one way or another.
Widespread immunity, milder corona variants, fewer and fewer Covid patients, protective vaccinations and good treatment options: In general, the prospects for this year are quite good. Nevertheless, the aftermath of the pandemic will probably stay with us for a long time.
One of the biggest challenges is and remains Long Covid. According to Carmen Scheibenbogen, head of the immune deficiency outpatient clinic at the Charité in Berlin, around ten percent of those who are ill suffer from long-lasting consequences after a Covid infection. The World Health Organization (WHO) estimates that 17 million people are affected by Long Covid in Europe alone. Various studies also state that Sars-CoV-2 infections, especially without prior vaccination, leave clear traces in the immune system even after mild courses.
However, there are still many unanswered questions about the development of Long Covid as well as about the diagnosis and possible therapeutic approaches. Intensive care physician Karagiannidis therefore wants a severity score to be established for Long Covid, as is common for many internal diseases. “That would help enormously to better capture and classify the large and heterogeneous group of long-Covid cases.” Disc sheet demands that chronically ill people should be able to be referred to special outpatient clinics or practices to confirm the diagnosis and create a therapy concept. However, they have so far been underfunded and often only aligned one-sidedly and have long waiting times.
Even if the pandemic is on the retreat, Sars-CoV-2 will not simply go away with it. “A lot depends on which new virus variants develop and prevail in the medium and long term,” says infectiologist Julian Schulze zur Wiesch from the UKE. According to the doctor, new, possibly more dangerous corona variants can arise at any time. “Perhaps it will even be necessary to develop and approve further variants of the Covid-19 vaccines that are specifically directed against further variants.”
Infectiologist Spinner even considers the emergence of new variants to be very likely. But: “From a medical point of view, it is also very unlikely that a significantly more pathogenic variant will occur in the near future.”
