Doctor Çelik, you are senior physician in the isolation ward for Covid-19 patients at the Darmstadt Clinic;

we talk regularly about the state of affairs.

How is the situation right now?

Sebastian Eder

Editor in the society department at FAZ.NET.

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At the moment it is still the case that we have two internal medicine wards fully occupied with normal Covid ward cases.

As of Friday, there were 26 patients in normal wards and 11 in intensive care, but it fluctuates a lot. In the middle of the week we had 40 in normal wards, and recently fewer patients were added.

The normal ward is organized in such a way that we have a multidisciplinary ward, mostly there are patients with and not because of Covid.

While this distinction doesn't quite do justice to the medical complexity, it is at least the case that in many of these cases another medical department has primary responsibility, not the internist department.

Then, for example, neurological problems are in the foreground, or a patient is cared for by a surgical team after an accident.

And then we still have our pneumology focus station.

This is where most of the patients are lying because of Covid.

What kind of patients are there?

Here the situation has changed.

In the past few weeks, about a third were unvaccinated, younger patients;

a third older people who were vaccinated but had pre-existing conditions;

and another third absolute high-risk patients such as organ transplant recipients and severely immunosuppressed.

In the past two weeks, on the other hand, we have seen many multimorbid older patients, as was to be expected in this group as well due to the increase in incidence.

Unfortunately, this also means that we are seeing more severe cases and deaths on the ward again.

But we expected that too.

Do people come to you after three or four vaccinations?

Many older people after two vaccinations are among the severe cases.

Anyone who has a severe course after three vaccinations is usually very old and often has immunosuppressive previous illnesses.

In the over-nineties, the whole system is often very fragile, so even a relatively minor infection can mean that people have to be treated in hospital.

However, the survival rate of these patients is still better compared to the previous waves.

But a fourth vaccination makes sense for older people?

You always have to be very careful about drawing conclusions about the big picture based on the experience in the hospital – even if we have already looked after more than 1,400 cases.

However, there are very good study results that show that the fourth vaccination protects high-risk patients very well from a severe course and from death.

Data from Israel show that it makes sense for people over the age of 60 to have a fourth vaccination, and it is already recommended in the USA.

The additional effect is not as great as after the 3rd vaccination, but still very good.

Do you observe many outbreaks in old people's and nursing homes?

They came back, recently also in a neurological rehabilitation facility.

Outbreak management in such facilities with many elderly at-risk patients is not easy.

That is why they are transferred to us in a very low-threshold manner, we have to do our part to ensure that there are no more outbreaks in these homes.

Unfortunately, this often-presented simplified idea that one only has to protect old people's homes and patients at risk fails again and again.

The facilities cannot really be sealed off.

Do the different variants still play a role for you, especially subtype BA.2?

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