The summer wave is rushing through Germany – will it be another autumn full of restrictions? Chief physician Markus Unnewehr from Hamm calls for a rethink: Many measures are more of a hindrance in everyday clinical practice and the current wave cannot be compared to previous ones.
While almost no infections were registered in the summer of 2021 and few people contracted Covid-19, Germany will be hit by a violent wave this summer. What does this mean for autumn? dr Markus Unnewehr, chief physician for pneumology and infectiology at the St. Barbara Clinic in Hamm, reports in an interview with FOCUS Online about the current challenges that Covid-19 and the measures for everyday clinical practice mean. According to his observation, the disease has changed completely – and is currently primarily endangering a very specific group of people.
FOCUS Online: Mr. Unnewehr, how has Omikron changed the importance of Covid-19 in everyday hospital life?
Markus Unnewehr: For a few months now, it has been noticed that with Omikron, the mortality rate has fallen below that of an influenza disease. Surveys on this are of course difficult, because the number of influenza deaths was ultimately only estimated. But when I evaluate the situation from my clinical experience, I come to this conclusion.
The disease has changed completely. We no longer have 60-year-old women or men with pneumonia in the clinic, or 70-year-olds who are otherwise healthy but have been in the hospital for three weeks because of Covid disease. Almost no patients still need oxygen. Today, Covid-19 is essentially an upper respiratory tract infection that can still lead to subjectively severe symptoms. But we no longer see the patients in the hospital like we had in 2020/21.
You even say that the disease should actually be renamed?
Unnewehr: Yes, because clinically and epidemiologically it is no longer comparable to what we know from the first, much worse waves. For one thing, vaccinations have helped. On the other hand, the continuous contact with the virus, i.e. the so-called “contagion”. You could measure that with antibody studies, which unfortunately were not carried out in Germany; an omission that the Corona Expert Council also criticized in its evaluation of measures. However, data from other countries, such as Great Britain, suggest that the infection is widespread.
Many patients who test positive no longer have any symptoms. This means that in everyday clinical practice, Covid-19 is often only an incidental finding. People are with us because of something completely different, but then count as Covid patients because of the findings.
Does that also mean that there are far fewer deaths?
Unnewehr: We had around 280 deaths in the first waves in the city of Hamm, for a few months it was maybe 10. The patients who still die from this disease today are almost always severely immunosuppressed, so they have a severely weakened immune system – for example For example, because they have leukemia. These people also have atypical omicron courses.
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From a clinical point of view, how do you rate the impact that vaccinations are currently having?
Unnewehr: From my observation, it has no influence on the course of an omicron disease whether someone is vaccinated or not. That was completely different in the first waves, especially at Delta. There, the seriously ill people in the intensive care unit were mostly those without vaccination protection.
What about Long Covid? The assessment of the significance of these long-term consequences differs widely.
Unnewehr: Long Covid is something that we are definitely seeing and that needs to be looked at closely. However, one must not forget: We also know from influenza and other viruses that viral diseases can still cause problems weeks or months after an infection; in the past, such complications just weren’t the focus of attention.
In an appeal to colleagues and medical associations, you described that the measures against corona in everyday hospital life would now lead to greater problems than the virus itself. What does that mean exactly?
Unnewehr: Many requirements significantly hinder everyday clinical work. Testing without cause takes time, transfers or layoffs are made more difficult, operations have to be postponed. At the same time, there are numerous staff failures, also because of the quarantine rules. All this leads to considerable organizational problems. We are still working with measures that are up to date in 2020/21 – but Covid-19 is no longer at this level.
The Ministry of Health and many politicians are calling for the mask requirement to return in autumn. In fact, the Corona Expert Council has identified the obligation to wear masks as one of the few measures whose benefits have been largely proven. However, there are more and more expert voices pointing out possible side effects of the mask requirement, most recently the General Practitioners Association in Saarland: They fear a weakening of the immune system. How do you rate that?
Unnewehr: Masks, if they are put on well, make sense. But who does that in reality? When I ride the train, I see a lot of people who don’t wear the mask properly. And an FFP2 mask has such a high airway resistance that you can hardly wear it permanently and, in my opinion, it should only be used in particularly vulnerable patients. Otherwise, people are given a false sense of security.
What we noticed in everyday clinical practice is the following: In the summer of 2021 we had an atypical accumulation of respiratory infections such as the RS virus, especially in children. We see atypical diseases at atypical times and with atypical severity. I don’t think we will be able to outwit the viruses with masks – and we may be less prepared for the next wave of influenza.
We always have to ask ourselves: What is the aim of our measures? The disease avoidance? So far, the development of the virus has always gone as expected: it has become more contagious but less dangerous. The summer wave is now rolling through and could help ‘stretch’ infections. We also have to register how other countries deal with it. Many of the measures that we still have or plan to reintroduce soon have not been common there for months. This also applies to the obligation to wear a mask. In patients who are particularly at risk or in certain situations, the mask will continue to be used – but we did that in the clinic before Corona.
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Let’s hypothetically assume that the corona tests would be stopped immediately tomorrow. Would you still notice anything of the pandemic in everyday hospital life?
Unnewehr: In the current situation, we would probably register a severe summer flu, no more and no less, but with little relevance for the hospitals. Of course we still have to monitor the situation. If, for example, we suddenly saw in September that 60-year-olds with severe symptoms ended up in our clinic again, the situation would have to be reassessed.
About the person: Dr. Markus Unnewehr (born 1975) has been chief physician for pneumology and infectiology at the St. Barbara Clinic in Hamm since 2019. He is a specialist in internal medicine, pneumology, infectiology and emergency medicine.
