We have been promised the end of the waves several times, but always a new wave came in between. In any case, if we look at the history of pandemics, we see that the waves were never permanently of identical intensity. Even under the soon-to-be global dictates of Omikron, we may have to think of the Corona pandemic as a la-ola wave in a football stadium: At the beginning, people stand up with quickly and let the wave travel enthusiastically, then more and more people join in, but it already pushes them not so much into the standing position. In the end, the wave has caught everyone, but it is no longer a mighty wave, just a rumbling movement. Then everyone takes a seat again. Now and then there are small ripples, but the initial momentum has died down.

Can this be applied to infectious medicine? Possibly yes. Above all, we should correct our idea of what infection means. Some people think it is like the light switch. Light on - light off. Infected - not infected. Diseased - not diseased. According to the motto: You can see that the light is on. But you only see or feel an infection when it takes a symptomatic course. In retrospect, it will probably be the distinguishing mark of Corona that the virus produces a great many asymptomatic cases that do not appear as cases at all. Health offices often experience the flickering of PCR results: one is negative on Monday, positive on Wednesday, negative again on Friday. These are the grey shades of infectious diseases. Or, as they say, a few viruses have slipped through his mucous membranes.

In these times, it's probably just possible to get a few coronaviruses every now and then. The question is: How many are enough for a severe course? The answer is no longer surprising: unvaccinated people experience hospitalisation and ventilation - by mask or via machine ventilation - on a regular basis, while vaccinated people almost never do.

Many people have been misled by the options offered by vaccination, and this was also due to false hopes. A lasting sterile immunity, as with the measles vaccination, could be wished for, but it could not be programmed. On the other hand, if one reads the approval data of BioNTech or Moderna, for example, one value always stands out: the reliable prevention of severe courses of disease. That is not open to interpretation. Someone who is boosted and lies in bed with a cold, fever, night sweats and loss of appetite, as are the hallmarks of Omikron, is certainly maladjusted. But he does not have a severe course. A severe course means respiratory distress, dramatic oxygen desaturation, sepsis and a vehement storm of cytokines (messenger substances) as an excessive reaction of the immune system. Severe courses are extremely stressful for patients. Not infrequently, they even fear death because they think they are suffocating (unless they are already sedated and receiving artificial respiration).

Now, every transition from pandemic to endemic is marked by the exhaustion of the virus. What does this mean? Hasn't the virus boosted itself through Omikron? Doesn't it overfly or undermine protective barriers with particular ease? Has it not achieved a chameleonesque dimension by repainting or reconfiguring the docking sites of the spike protein? Yes, Omikron has succeeded in doing that, yet the vaccines, by preventing severe courses, are overwhelmingly safe, at least in the first few months. After all, there is a world of difference between a vaccine breakthrough with a cold and a vaccine breakthrough with intensive care.

Omikron could undoubtedly increase in severity to such an extent that the much-mentioned critical infrastructure is really at risk. But if the vaccination rate in Germany improves now, the easing of tensions that is currently dominating the Iberian Peninsula could become apparent. It is true that the infection figures there have been rising again for weeks. But even below the delay of several weeks between infection and the need for intensive care, the number of sick people in the clinics is rising only slowly. This is even more true for deaths. In Portugal, the situation is even "stable". The reason? A vaccination rate of 89 percent. A new British study says nothing else: unvaccinated people have a 60-fold increased risk of ending up in intensive care with Covid-19 compared to vaccinated people. This is the finding of the Intensive Care National Audit and Research Centre, which analyses hospital data.

Experts believe - and here they draw a parallel to South African data - that the comparatively mild Omikron courses are also related to the many months the virus has already been circulating in the population. Presumably, everyone has even had contact with the virus, unless they live in a sealed bubble. Over time, what experts call basic immunity emerges: a secure working organisation of the immune system on how to deal with a virus classified as known, distributed between antibodies and B and T cells. In fact, T cells are the most robust defence mechanism even in mutants. Like the entire immune system, they undergo constant training in dealing with a pathogen.

Omikron may also be mild because this variant of the virus is more difficult to penetrate lung cells and therefore tends to be milder. A British study has now investigated this in the laboratory. Whether the results can be transferred to real life is still unclear, say the authors. But it looks like it.

And then there is finally paxlovid, the first drug that counters post-exposure prophylaxis after an infection with an antiviral response. The registration trial has been successful, now doctors have to gain experience with the drug. There are very good signals from the scientific community for the end of the pandemic, much stronger and more robust than a year ago. There is probably no way around the fact that we will continue to hold out our arm at certain intervals. There are greater plagues.

Original text: Wolfram Goertz

Translation: Mareike Graepel