I would like to briefly comment on the current situation – although this is primarily my personal point of view. COVID 19 is no longer the dominant issue – at the moment, the energy crisis and the war in Ukraine are at the forefront of public perception – however, many of my patients are still asking questions about the progress of the pandemic and the vaccinations against COVID 19. As a doctor, one should have a clear stance on this. First of all, it’s nice and reassuring that public life has largely normalized again – and normalization is working. Of course, patients with COVID 19 are still being admitted to the hospital. But more often with the pathogen than because of COVID 19. Severe cases of COVID 19 have become rare and mostly affect unvaccinated individuals or (predominantly older) people with pre-existing internal diseases and weak immune systems, for whom any infection can pose a problem.
We can be relatively sure that the SARS-CoV2 virus will stay with us. The coronavirus will join the list of pathogens that mainly cause respiratory infections in autumn/winter, similar to the influenza (flu) virus or the RSV virus.
In contrast to the previous two years, a relatively good immunity against SARS-CoV2 has now been built up in the population through the vaccination campaign and the infections that have occurred (especially with Omicron). Personally, I am therefore not as worried about the upcoming autumn as some health politicians are. In particular, I do not share the concern about the emergence of a “killer variant”. We will not be able to prevent infections, but the initial danger of severe illness and death has been averted.
Prevention prophylaxis is also still sensible. Wearing a mask in public spaces in autumn/winter is not unwise to protect oneself in general from respiratory infections, but it should again be the responsibility of individuals. The situation is different in hospitals and health care facilities. Here, a mask requirement is still appropriate and sensible due to the vulnerable groups that are treated and cared for here. Personally, I assume that we will have to use face masks in hospitals for a very long time. On the other hand, testing (rapid test) of asymptomatic persons should be questioned.
The magic three
Regarding vaccination, “3” is the magic number here. If you are vaccinated 3 times with the (original) mRNA vaccines, you are on the safe side in the absence of risk factors. It is likely to be similar with 2x vaccination and one infection (2 + 1 = 3). The most favorable constellation is probably a triple vaccination with the (original) mRNA vaccines and an Omicron infection. In these constellations, from my point of view, a further vaccination with the (original) mRNA vaccines (also referred to as 2nd booster) is not necessary. I would also make this statement to otherwise healthy MS patients, even if they are being treated with immunotherapy (regardless of which one).
Therefore, I do not share the “enthusiasm” of the Federal Minister of Health for a general 2nd booster. I even consider it questionable from an immunological point of view. On the other hand, the recommendation of a 2nd booster for the population group of older people (> 70), especially if cardiovascular pre-existing conditions are present, makes sense and I would extend this recommendation to (older) MS patients with severe physical restrictions. Even here, a 2nd booster can’t hurt.
What can we expect from the adjusted Omicron vaccines?
So how about the new adapted Omicron vaccines? Currently, only the update vaccine against the Omicron variant BA.1 is available in Germany. It plays a minor role in the current infection situation. Therefore, I currently see no compelling need to recommend this vaccine to otherwise healthy MS patients. Personally, I would therefore wait for the availability of the update vaccine against the Omicron variant BA.5, which currently dominates the infection situation. Regardless of the presence of MS, I would recommend a booster with this vaccine to people whose basic immunization was some time ago or whose last infection was more than 6 months ago. It is likely that the COVID 19 vaccination will be similar to the flu vaccination. It is conceivable that in the next few years we will receive offers with updated vaccines in autumn. Similar to the flu vaccination, patients with autoimmune diseases like MS would also be recommended this vaccination – but on a voluntary basis.
My hope is that we as a society can relax a bit regarding the topic of Corona. Neither a categorical rejection of measures is helpful, nor an overly tense approach. However, I would like to emphasize in view of Corona deniers and vaccine opponents that the measures of our government and our health system at the beginning and during the course of the pandemic were absolutely right and have prevented a lot of suffering.
