After almost two years of pandemic and in the face of incidences that seem to be skyrocketing, this fall more and more people are asking themselves: where is this going to lead?

Is after the wave just before the next wave?

Lucia Schmidt

Editor in the "Life" section of the Frankfurter Allgemeine Sonntagszeitung.

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It is now undisputed that the virus will no longer go away. Scientists and now many politicians call the endemic phase the goal that has therefore been proclaimed. Get out of the epidemic and into the endemic. But what does that mean exactly? Will it be the condition that the Executive Minister of Health Jens Spahn (CDU) described this week with the words: "Probably everyone will be vaccinated, recovered or died by the end of this winter"?

"If an infection is endemic, it means that it is basically spread in a regional population without major fluctuations in the spreading pattern," says Professor Hajo Zeeb from the Leibniz Institute for Prevention Research and Epidemiology in Bremen.

If you observe that “the number of infections level off at a medium or low level, but never completely come to zero, then you have an endemic situation”.

There is still a pandemic situation

For the coronavirus, this means it will remain in our society and regularly cause minor seasonal outbreaks. It will always find people who are not yet or no longer immune, such as children or people whose immunity has waned. It is important, however, that in an endemic the population, whether recovered or vaccinated, is sufficiently immunized that the number of cases no longer overloads the health system. Germany is still a long way from that. From a global perspective, there is still a pandemic situation in which the virus, unlike a regionally limited epidemic, spreads across countries and continents.

According to Zeeb, there is also no exact threshold for Germany from which one can say: "The epidemic is over, now the endemic is." could endemic. In doing so, he relies on model calculations. With the highly contagious Delta variant, they assume that around 90 percent of the population must be immune to the coronavirus through a vaccination or infection in order for the endemic phase to be reached.

“If the framework conditions remain the same as they are in Germany at the moment in the next few weeks, then the R value, i.e. the number that indicates how many people an infected person is infected, will only steadily fall below one again from mid-January 2022 and thus reduce the spread, ”says Zeeb. Zeeb does not want to commit to whether we have actually already managed to reach this endemic phase. Too many uncertain parameters are included in such a model calculation; the course of the pandemic has been too surprising in many places.

What all scientists and modelers agree on: Germany is in control of how it ultimately reaches the endemic by adjusting framework conditions and finding a political and social consensus.

If you rely on contamination, as England has been doing for weeks, you could reach your destination faster, but you have to put up with a lot of suffering and death on the way there.

If you go back into lockdown, you slow down the death rate, but also the contamination.

Is compulsory vaccination the solution?

A general compulsory vaccination that was quickly decided could lead to endemic disease very quickly with less suffering. What is also clear from the current modeling: Even if it were done quickly, a general legal obligation could not do much against the fourth wave. She will no longer help us out of this situation, "we need other means such as 2 G and significant contact reduction," says Zeeb. But, continues the epidemiologist, a general compulsory vaccination could mean that we are spared a fifth or even a sixth wave. However, as of now, such an obligation must also relate to regular refreshments. "Because it looks as if Sars-CoV-2 cannot achieve permanent vaccination protection any other way."

It remains to be seen whether reaching an endemic will really end all discussions and restrictions. It is still too unclear whether the disease Covid-19 will actually become a simple cold at some point, from which you usually get mildly ill as a child and which will no longer cause great harm in your further life. Or is Covid-19 more of a "type of flu", a disease that repeatedly claims numerous deaths, especially in risk groups, and against which one should protect oneself with vaccinations.

And despite all these uncertainties, the question still remains: Has the delta variant really reached the end of the flagpole in terms of infectivity?

If more contagious, more dangerous variants develop that even escape vaccination protection, “an endemic can quickly turn into an epidemic or even a pandemic,” says Zeeb.

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