Doctor Çelik, we talk regularly about your work as a senior physician in the isolation ward for Covid-19 patients at the Darmstadt Clinic.

How is the situation?

Sebastian Eder

Editor in the Society department at FAZ.NET.

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As expected, we are again admitting more patients with severe courses and this week we have increased our Covid range. Before that, there was a phase in which admissions and layoffs were balanced at a low level. For us that was a little foretaste of what the work on this station could look like in the endemic phase in the future. But now you realize that the pandemic is not over yet. As expected, the patients are now much younger, the average age of our patients in August is just over 40 so far. That is a huge difference compared to an average age of over 70 in the first two waves. It is also noticeable that the social asymmetry continues to intensify; proportionally even more patients on the ward have a low socio-economic status,as far as this can be grasped in the conversation based on the living situation, living conditions, occupation and language skills. In addition to the higher risk of Covid-19 itself, these people now have a lower vaccination rate. What you can see very clearly: About 80 percent of the patients who came to us in August were not vaccinated.

Why?

In most cases, they were not anti-vaccination agents on principle.

You tend to hear things like: "Organizationally, I haven't got around to it yet";

"I'm only at home";

"I thought I was protected with a good immune system".

Many people did not have the correct information to assess the risk and benefit.

Of course, this is a selective perception of a Covid ward, which is currently mainly used by the unvaccinated with severe symptoms.

But the people I looked after here all regret that they weren't vaccinated.

This also applies to patients who previously did not believe in the virus or who opposed the vaccination.

Are conversations about it strained?

We ask about the vaccination status during the admission interview; among other things, this is important for the prognosis of how severe the disease could be. In doing so, we notice that this has become a charged question - at the latest when I ask about the reasons. Unvaccinated patients are often uncomfortable with the question. But I don't want to pillory anyone with this. It is important for us to understand why the vaccination campaign is stalling and what concerns people have about it. But nobody has to justify themselves here. The patients are with us for days or even weeks, so there needs to be a relationship of trust and no reprimand during rounds. Unfortunately, the discussion about vaccines has spread to other drugs; recently we have had to discuss with relatives of Covid suffererswhat long-term side effects a potentially life-saving acute drug could have. It is not understood that therapy is recommended whenever the benefit clearly outweighs the risk. In the event of a life-threatening course, drugs with more possible side effects are therefore used. Discussions about this are new and can limit us in treatment.

Do younger patients end up in the intensive care unit?

We treated around 30 patients in August, and there is actually a small advantage in this phase: the overall disease burden on the ward has decreased.

But that is only a dubious success because the patients are much younger.

We also have 20 to 30 year olds with severe symptoms, which was very rare before.

But yes: we have fewer patients to be transferred to the intensive care unit, we have far fewer deaths, and patients respond better to our treatment methods.

Treatment becomes easier and more rewarding.

But that depends on how many patients there will be.

We're getting on well at the moment.