First people over 80, then people with dementia, and then people with liver diseases or HIV: The current vaccination ordinance from Federal Health Minister Jens Spahn (CDU) should provide clear guidelines on when those affected with which illness can hope for their corona vaccination.
But in reality, the calculation is likely to be much more complex: Older people in particular often suffer from not just one, but several previous illnesses.
Data from the Barmer health insurance company now shows which combinations lead to a drastically higher risk of severe or fatal courses of Covid-19.
The Barmer Institute for Health System Research (BIFG) combined the individual data for WELT.
Accordingly, a person infected with corona with hematological neoplasms (often malignant tumors) and simultaneous dementia has a 16-fold increased risk of dying from Covid disease compared to their peers of the same sex.
The likelihood of hospital treatment is 3.6 times higher.
Mental illnesses underestimated
For people with mental illness and also AIDS, the risk of corona death is at least 7.5 times as high.
In addition, their corona disease has to be treated in hospital two and a half times more often on average.
And those who suffer from dementia as well as lung metastases and liver failure at the same time have an almost 50 times higher risk of dying from corona than their peers of the same sex, according to the data.
Source: WORLD infographic
In total, Barmer has identified 66 individual pre-existing conditions that could complicate a Covid-19 course.
Trisomy increases the risk of a severe or fatal course in corona disease the most, followed by dementia and lung metastases.
But also mental illnesses, AIDS or an infection with multi-resistant germs are among the ten most critical pre-existing illnesses.
In December, the Federal Ministry of Health issued an ordinance stating which population groups should be given access to the vaccination first.
It is based on a proposal by the Standing Vaccination Commission (Stiko), the Ethics Council and the Leopoldina.
The highest priority is given to everyone over the age of 80, people in inpatient care and health facilities and people in medical facilities who are exposed to a particularly high risk, such as in intensive care units.
A second group (high priority) is followed by people over the age of 70 and with pre-existing conditions such as trisomy, dementia or people with intellectual disabilities and people who have had organ transplants.
Third (increased priority) are people with chronic kidney or liver disease, cancer, HIV or COPD.
Last week, however, the insurer's own institute suggested an optimized sequence of vaccinations based on the insured person's data.
In a report it advocates a much more detailed prioritization within the large group of people with previous illnesses.
This includes an estimated 10 to 15 million people in Germany - too many to be able to vaccinate all of them at the same time.
Source: WORLD infographic
According to the health insurance company, preferential access should be given to those people for whom patient data shows that they are more likely to become seriously ill or die of Covid-19.
"Lives can be saved and the risk of overloading the supply system can be reduced," says Christoph Straub, CEO of Barmer.
"Health insurance companies have exactly this important data."
If the previous prioritization remained, the number of deaths after 100 days of vaccination would be 73 lower than without prioritization.
The Barmer numbers read, however, much more promising: With the optimized model, a reduction by a full 90 is possible, according to the report.
Barmer expects a similar effect in the number of inpatient corona infected people, should her model be used.
After three and a half weeks, hospital admissions would decrease by 25 percent.
According to the currently applicable prioritization, this would take twice as long.
For the calculations, however, the health insurance institute assumes that 140,000 people (280,000 doses) are vaccinated every day.
Germany is far from that.
On the previous record day, last Wednesday, a total of only around 118,000 doses were administered.
With her proposal, the Barmer takes up a flaw in the previous vaccination sequence.
As a result, there was no concrete data from patients on previous illnesses and disease stages or previous therapies.
The Stiko has systematically examined numerous scientific studies into the connection between previous illnesses and the course of Covid-19.
However, some things remained unclear, emphasizes the Barmer.
For example, the extent to which older people with previous illnesses are more at risk than younger people.
Or how several diseases affect at the same time.
"Without this information, the effect of previous illnesses on the risk of a serious disease course, intensive ventilation and death can only be estimated imprecisely or not at all," says Straub.
The Stiko and the Federal Ministry of Health apparently rated some risks with previous illnesses also significantly higher than the figures from Barmer show.
The current vaccination ordinance places people in the second highest priority group after organ transplants, immediately after those over 80 and residents and employees in nursing homes.
In Barmer's list of increased corona risks, organ transplants are only in twentieth place.
In addition, people with mental illnesses are not even included in the current vaccination ordinance.
According to Barmer, those affected have an almost 2.9 times higher risk than their peers of the same sex to die of or with corona.
When asked, the Federal Ministry of Health refers to the statements made by Minister Jens Spahn (CDU).
"We're looking at what we can learn from it," he said on Friday with reference to the Barmer model.
Spahn has already asked Stiko to examine the proposals.
However, the model cannot simply be transferred like that, explains Spahn after consulting the experts.
After all, only certain data are available from the health insurance companies.