>> De facto, the increase in omicron infections, particularly due to BA-5, has led to an improvement in protection against serious infections or death from SARS-CoV-2 in the population. The antibody prevalence through vaccination and natural infection (recovered status) is around 95%. This is shown by international seroprevalence studies and national samples alike and applies to all age groups, including children.
The basic principles of pandemic management
According to ECDC1, successful pandemic management for SARS-CoV-2 must take the following aspects into account:
1. Characteristics of SARS-CoV-2: evolution, growth rate, disease severity (intrinsic), seasonality.
2. Immunology: Immune protection against severe disease, duration of protection.
3. Social factors: Social tolerance for non-pharmaceutical interventions (NPI) and infection prevention and control (IPC) measures such as hygiene measures, social tolerance for the residual risks of Covid-19, acceptance of vaccination, health system capacity.
4. Medical-immunological and therapeutic interventions: vaccines, antiviral drugs, diagnostics.

As a result, pandemic management and the necessary change in strategy must be carried out in concrete preparation for the expected autumn/winter wave caused by increased SARS-CoV-2 infections.
Infections take the following basic requirements into account:
1. A SARS-CoV-2 vaccination with a parenteral vaccine does not reliably protect against infection and infectivity. Even repeated booster vaccinations only marginally and temporarily increase protection against infection - and increasingly less so. Vaccinated and boosted people can still transmit the virus.
2. In the vast majority of cases, a complete SARS-CoV-2 vaccination protects against severe Covid-19 progression (intensive care stay, ventilation) and death and then also for periods of more than a year, probably even decades.
3. Protection against infection and infectivity is most effective with hybrid immunization through infection and vaccination.
This protection lasts significantly longer (12 months or longer) and is also immunologically broader, meaning it works more effectively against variants than would be the case through vaccination alone. Since there will be no vaccines in the short term that induce similarly effective protection of the mucous membranes against infection, the pandemic is more likely to be ended by the virus itself. However, with the vaccines currently available, the burden of disease caused by initial infections and severe disease progression can be significantly reduced.
4. The immune status of the population is only correctly reflected by simultaneously recording and taking into account vaccination status and recovery status. The recovery status, ie the immunity after an infection, is a central component of the general immune protection of the population. Classifying unvaccinated or partially vaccinated people as a vulnerable population group per se ignores the different disease risks in the respective age groups and does not make sense without taking the recovered status into account. The neutralizing IgG antibodies in the blood are neither a correlate of “protection against serious illness” (that would be all antibodies against the virus) nor of “protection against infection” (that would be neutralizing antibodies on the mucous membranes of the respiratory tract). All antibodies against the spike protein as a correlate of a vaccination or infection as well as all antibodies against the nucleocapsid protein of the virus as a correlate of a virus infection would have to be recorded.
5. The amount of antibodies in the blood (antibody titer) does not directly correlate with the level of immunity. The quality of the antibodies is also of crucial importance, e.g. their avidity for the antigen (strength of antigen-antibody binding), their class (function) and, in relation to possible serious illnesses, the protection provided by cellular immunity. Vaccination recommendations for individuals should therefore not only be derived from the amount of antibodies.
6. Vulnerable in the sense of an increased risk of illness or death are people who
a. who have neither recovered nor been vaccinated and at the same time have certain risk factors, e.g. B. an acquired immune deficiency caused by autoantibodies against interferons, the latter with a prevalence of around 4% in people over 70 years old. Although these people respond well to vaccination, they are at risk if infected.
b. who are vaccinated but do not develop or cannot develop an adequate immune response due to immunodeficiency or therapeutic immunosuppression (e.g. transplant recipients and patients with autoimmune diseases or tumors).
c. or who react immunologically more slowly due to old age (> 80 years).
7. Diagnostic procedures to predict a serious course of the disease, e.g. B. Measurement of autoantibodies against interferons should be included in routine diagnostics.
8. Special vaccination recommendations for vulnerable people should be adapted, further developed and scientifically justified as quickly as possible, as the risk situation has fundamentally changed with the transition to endemic disease. It is the task of STIKO to analyze the consequences of the dynamically changing definition of vulnerability and the associated vaccination indications in order to formulate concrete vaccination recommendations for specific risk groups. Also future antiviral therapies that aim to prevent severe disease or death
Covid-19 must be used based on the criteria for vulnerability.
9. Future vaccines should also aim to prevent infection and reduce the risk of transmission. The immunological barrier of the respiratory mucous membranes is not sufficiently influenced by current vaccines.
10. Protection of the vulnerable through focused, targeted vaccination and booster campaigns (according to STIKO recommendations) as well as hygiene measures in hospitals and care areas that adapt to a changing infection situation. A balance must be struck between infection protection on the one hand and self-determination and quality of life on the other (WHO's comprehensive health concept).
11. The vaccination requirement for healthcare workers should be lifted; it does not offer any protection against infection.
12. Ensuring the functionality of the critical infrastructure (KRITIS) and the healthcare system by eliminating disproportionate and unjustifiable, i.e. H. No longer up-to-date isolation arrangements for healthy infected people. Under the current circumstances, strict official isolation orders for healthy infected people should be critically questioned and replaced by an on-site risk assessment by hygienists. This also includes self-responsible symptom control, i.e. H. Targeted testing with qualified rapid antigen tests if symptoms occur while continuing to work while adhering to protective measures such as wearing mouth and nose protection correctly.
13. Prioritization and conservation of resources also in the test strategy: PCR tests may only be used in a targeted manner in the area of medical care structures and for diagnosing illnesses if this results in a therapeutic advantage. There is currently no longer a general indication for screening without a reason.
14. Children and young people are not a vulnerable group of people. Presumably increasing numbers of infections will affect a highly immunized age group in the fall, whose immunity is also many times more robust than that of the adult population. At the same time, the available data show that in the past the focus of numerous pandemic measures on children and young people (unfounded routine testing, mask requirements in class, restrictions on sports and leisure activities) was unable to prevent their predominantly natural immunization, but at the same time caused numerous collateral damage, The long-term consequences for this age group are currently not foreseeable or can only be assessed to a limited extent. Since this age group only carries a very low risk of a serious course of the disease, routine testing without any reason and the requirement to wear a mask in schools should be rejected without an indication. New restrictive school or daycare rules may only be justified by a foreseeable, significant burden on the healthcare system. Infection protection in schools and daycare centers must not be justified by third-party protection.
15. A representative population cohort must be established that is examined and surveyed regularly and in a timely manner.
16. Hygiene strategies (NPI) need to be adjusted. The significance of air drift needs to be better clarified and taken into account in large meeting rooms. This is also a demand of the EU.
The communication of the pandemic
A change in strategy is overdue
17. Politics must implement the above-mentioned Communicate findings transparently and initiate a clear change in strategy with a focus on protecting vulnerable groups while at the same time ensuring the functionality of critical infrastructure and the healthcare system. This includes the definitive end of contact tracing.
18. The change in strategy is already planned in the 2020 pandemic plan; the criteria have been defined. After the initial phase of containment with the aim of avoiding any infection, the phases of protection, i.e. protection against serious illness and death, and mitigation, i.e. the prevention of serious disease progression (not from infection in the long term!) with additional avoidance of disease peaks follow , which lead to overloading of the supply structures. The shift to a mitigation strategy is still overdue.
Other countries are already practicing this successfully. Great Britain, Denmark, the Netherlands and Switzerland, for example, have declared the end of the pandemic in view of the population's immunity and the mass natural infections that have occurred due to the highly infectious Omicron variants, which cause only minor illnesses.
In Germany, however, the concepts and assessments of the first phase of containment still dominate the central statements. In practice, a change in strategy has already taken place in many places. However, this is neither transparently justified nor openly communicated.
The debate about the future strategy of pandemic management requires the involvement of experts from infectiology, hygiene, practical infection control, epidemiology, data science and immunology.
The current type of non-motivating and fear-producing communication not only leads to the persistence of irrational fears of infection, depression and inadequate social withdrawal tendencies, but also reinforces an oppositional mood in parts of the population, with some aggressive rejection of any state infection protection and an increase in anti-vaccination sentiment .
The current ministerial communication on pandemic management is not only erratic, erratic and fear-producing, but also overemphasizes consequences of a Covid-19 infection that have not yet been sufficiently researched, such as dementia, brain damage and Long Covid as long-term damage. It requires a critical review with a high level of methodological competence, taking established aspects of risk communication into account. <<