A Low Risk Still Isn’t Zero Risk
A Chief Physician on the Perils of Germany’s Omicron Strategy
Infectious Disease Specialist Jana Schroeder believes this summer will mark a temporary return to near normality for many, but she warns there could be more COVID waves to come this autumn and winter. She also explains why German politicians have failed our children and what an “endemic” virus really means.
Interview Conducted By Rafaela von Bredow und Veronika Hackenbroch
Der Spiegel, Hamburgo – 2/02/2022
Dr. Jana Schroeder, 40, is the chief physician of the Institute for Hospital Hygiene and Microbiology at the Mathias Spital Foundation hospital group in the western German state of North Rhine-Westphalia. Her main focus is on the treatment of children during the pandemic, and she recently published a position paper on the protection of children with a group of scientists.
DER SPIEGEL: Dr. Schroeder, the Omicron wave is growing, local public health authorities seem to have capitulated in the face of it, testing laboratories are overwhelmed and the actual current case numbers can only be estimated. Have we lost control of the pandemic in Germany?
Schroeder: We are potentially far past a tipping point. We now have a positivity rate of over 30 percent on PCR tests, which means that almost one-third of all suspected cases are actual infections. A pandemic is under control when that figure is under 5 percent. Because of the lack of PCR tests, the actual data is getting hazy. Contact tracing has also collapsed. And the World Health Organization is expecting that half of the European population will get infected in the next eight weeks – presumably here in Germany, as well.
DER SPIEGEL: How have you experienced the chaotic pandemic management?
Schroeder: As a great loss of confidence in politicians. It’s an extremely unpleasant feeling. I always thought that they would always find an at least roughly correct solution, despite the differing positions between the political parties. But I hadn’t expected a decoupling of science and political action as drastic as the one that has influenced the course of the pandemic.
DER SPIEGEL: Schools were closed for months, and children struggled. You have now called for the protection against infection and the protection of the psychological health of children to be considered as one. How would that work? Leave schools open at any price?
Schroeder: No, not at any price! This absolute commitment to in-person teaching in its current form has many downsides. School is only stabilizing when it actually provides education, if it supports and strengthens children and youth, if there is a daily structure, a stable rhythm. At the moment, school doesn’t provide that, if only because of the constant infections and cases of quarantine. It creates stress for families, substitute teachers are needed and the pressure to perform never stops. A strong pandemic dynamic creates psychosocial stress, and the longer the psychosocial stress lasts, the more it makes people psychologically and physically sick. We have just summarized this in our interdisciplinary position paper.
DER SPIEGEL: How can children be better protected?
Schroeder: There has been a guideline on this issue for a long time that can be followed. You can move to online hybrid teaching, cut class sizes in half and create small groups. Well-planned online teaching is better than a school building that is open but where in-person teaching is constantly being cancelled. Especially given that there are plans for doing – ones that I am not the only person who has been puttering around with for more than a year now. Of course, nobody needs to listen to me, but I also don’t understand how the education ministers have been able to ignore the issue for so long. Instead of insisting on mandatory in-person teaching, there should be mandatory education.
DER SPIEGEL: In the United Kingdom, experts talk of "two epidemics,” a swelling one among children and a waning one among adults. How will things continue here?
Schroeder: Here in North Rhine-Westphalia, the number of cases among school pupils has doubled in the past week. We now have 42,000 infected children; 65,000 are in quarantine. According to the Robert Koch Institute (Germany’s center for disease control), only 17 percent of those under the age of 12 have received at least their first dose of vaccine across Germany. To this day, there is no general recommendation that children in this age group be vaccinated. Everyone in school will get infected. It appears that it’s no longer possible to stop that. What is taking place right now is mass transmission among children – a development that current German Health Minister Karl Lauterbach had categorically ruled out not so long ago. I think that could be clearly communicated. If we are rejecting a lockdown because of the social costs, then we should also honestly say that we will pay the price for it through the infection of society in its entirety.
DER SPIEGEL: And what does that price look like?
Schroeder: Children can get pediatric inflammatory multisystem syndrome (PIMS), which is a serious disease. Between one in 5,000 and one in 1,000 infected children get it. More than 50 percent of children who get it wind up in intensive care. Although this has been largely preventable in previous variants through vaccination, a low risk still doesn’t equal no risk. In Germany, we have approximately 9 million children under the age of 12 …
DER SPIEGEL: … which would mean, calculated roughly, at least 2,000 children with PIMS.
Schroeder: Just for comparison: When it turned out that one out of every 100,000 people vaccinated with AstraZeneca get cerebral venous sinus thrombosis, the use of the vaccine was stopped. And then there is, of course, long COVID, which is actually a hodgepodge of different illnesses resulting from an infection with SARS-CoV-2 that also affects a low one-digit percentage of children. And in the general population, we are talking about around 15 percent, of which approximately two-thirds are women, typically younger ones.
DER SPIEGEL: Does this also apply with Omicron?
Schroeder: We don’t know yet. The gaps in knowledge are part of the problem. And PIMS doesn’t show up until after approximately eight weeks, the same amount of time we have now known about Omicron.
DER SPIEGEL: How seriously do we need to take long COVID?
Schroeder: Now, there is very worrisome evidence in studies with a small number of long COVID cases among children, of striking changes in areas of the brain. There have also been findings of impaired thinking after an infection in some adults. It is better to prevent infections from the start, or at least mitigate them through vaccination.
DER SPIEGEL: There is also good news on this point: The danger of developing long COVID symptoms appears to dramatically decrease through vaccination.
Schroeder: But it’s still not at zero. And there is also data that doesn’t show this, but it’s pointing in the right direction, which pleases me.
DER SPIEGEL: Many people view Omicron as harmless. Is that a misunderstanding?
Schroeder: There is less severe illness with Omicron, fewer people die from it – and that is really great. At the same time, the number of deaths in Germany at the moment is still in the triple digits. And there is a misunderstanding, I think, about the term "mild symptoms” that always comes up in this context. According to the World Health Organization, cases are considered mild as long as patients don’t have respiratory difficulties. But a patient can be sick as a dog and feel like he or she is going to die, without having a life-threatening illness.
DER SPIEGEL: What do you say to people who are now attending "Omicron parties” to infect themselves?
Schroeder: Somewhere within the notion of an Omicron infection as a kind of natural vaccination, is the hope that the pandemic will soon be over. But hope is not a strategy. You have to know that it can backfire.
DER SPIEGEL: What do you expect to happen in the hospitals in the next six to eight weeks?
Schroeder: The sheer number of infections can outweigh the less severe disease caused by the variant. And even if the number of hospitalizations were to stagnate, we would still experience a shortage of personnel, because of the many employees getting sick. It would then be difficult to provide adequate care to patients in the hospital.
DER SPIEGEL: How many Omicron patients are you expecting in the hospitals?
Schroeder: We’re not making any forecasts. Things are still going quite well here. We currently have less than 50 COVID-positive patients in our hospital, almost all of them in the normal wards. We still haven’t seen a single case of serious disease with Omicron. But the Omicron wave hasn’t really reached the older unvaccinated people yet.
DER SPIEGEL: Are we experiencing the transition to the endemic phase that people have been hoping for?
Schroeder: It is true that Omicron is likely ushering in the beginning of the endemic phase. But it must be clear that "endemic” isn’t derived from the word "end.” Charles Rosenberg, professor emeritus for the history of science at the University of Pennsylvania, has said: "Epidemics ordinarily end with a whimper, not a bang.” I think that’s very accurate. It will be a good summer, I am certain of that – through the seasonal effect and because many people will have at least temporary immunity against SARS-CoV-2. For people who aren’t at any particular risk, life will return to something like our old normality. And now we also have several effective medications at our disposal that can often prevent serious disease. But the situation could once again become more tense in the coming autumn and winter. Immunity through an Omicron infection alone, without previous vaccination, is less broad than if you first got vaccinated against Delta and then get infected with Omicron. So, it’s plausible that Delta will once again circulate next winter. Besides, Omicron probably won’t be the last variant.
DER SPIEGEL: What are you expecting?
Schroeder: That’s a very difficult question. BA.2, for example, a cousin of the Omicron variant, is now dominant in several countries, including Denmark. But this doesn’t mean that the situation will change as a result. The virus currently has very many opportunities to multiply – in infected people and in the gigantic animal reservoir. Not just minks, but cats, dogs, mice and rats can get infected with SARS-CoV-2, even hippos! And the more a virus multiplies, the greater the opportunity it has to mutate. It’s like the lottery: A person who fills out just one ticket has a much smaller chance of winning the main prize than someone who fills out millions of them.
DER SPIEGEL: If the pandemic is now slowly coming to an end, is there still a need for the compulsory vaccination that many are calling for in Germany?
Schroeder: A high vaccination rate remains important no matter what. A low vaccination rate extends the pandemic – a high one would help us to finally be one step ahead of the virus. The question is how we can reach this high rate. I would have found it much better if we had done everything possible to make compulsory vaccination unnecessary, instead of always ruling out a vaccine requirement. Other countries like Portugal have succeeded in that. Instead, we have allowed two camps to emerge – vaccine supporters on the one and the vaccine opponents on the other – and now the situation is extremely difficult.
DER SPIEGEL: A common argument against compulsory vaccination is that with Omicron, the vaccination is purely self-protection because you can still get infected.
Schroeder: I believe that is totally wrong. If even just a part of the 3 million unvaccinated people over 60 that we still have in Germany gets infected, that, of course, affects us all: Then the hospitals will once again be less able to take care of heart attack and cancer patients. If you always emphasize toleration instead of consequences, then at some point you lose the sensible people. The people who have been cautious for two years slowly begin feeling that the person who acts responsibly is the dumb one. A minority contributes to prolonging the pandemic much more than necessary – with negative consequences for us all.
DER SPIEGEL: When the worst is over, are you worried that you will be accused of having been too alarmist?
Schroeder: I think that alarmism is more of a problem of the recipient than of the messenger. I myself am pretty rationally oriented, and I like to make well-informed decisions. I see the task of science in the pandemic as that of providing solid information. But I can’t influence in individual cases what people do with the information they get from me.
DER SPIEGEL: In talk shows, where you have often been a guest, it’s not just about scientific information, but also about emphasis and intonation. Did you carefully think in advance about what balance you wanted to strike?
Schroeder: Yes, very carefully. It is very difficult to find exactly the right tone there.
DER SPIEGEL: What are you most looking forward to when summer arrives?
Schroeder: To large, spontaneous parties! We actually always have our place totally full in the summer with family, friends, our children, their friends. I totally miss that. And it’s annoying to have to worry whether the people you meet with anyone are adhering to the coronavirus rules. At the point I stop caring about that, perhaps the pandemic will finally be over for me, too.
DER SPIEGEL: Dr. Schroeder, we thank you for this interview.
