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A doctor speaks about Omicron, the vaccine and Germany’s fourth wave

We spoke to a doctor working in a vaccination centre about his hopes and fears for another corona Christmas

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We spoke with a doctor about omicron, boosters and the fourth wave. Photo: IMAGO / Bihlmayerfotografie

Exberliner spoke to a doctor who works in a vaccination centre in Berlin, to ask about boosters, skeptics, and tests. They asked to remain anonymous in order not to get in trouble with their employer.

With Germany in the middle of the fourth wave, and the Omicron variant spreading, lots of people are worried, especially about seeing older relatives for Xmas. What advice would you give? 

I can’t give definitive advice since we still lack enough data regarding Omicron. For young people, it is quite clear that they needn’t worry about severe illness from Omicron even if they’ve only had two shots or were previously infected with another variant. For the elderly, say over 60, I would highly recommend getting a booster soon — preferably with Moderna, since the mRNA dosage is almost twice as much as in BioNTech.

If you are going to meet up, I would strongly advise you to get an antigen test (Schnelltest) beforehand. PCR tests are better, of course, but their availability varies. A good antigen test, in my opinion, offers more security than relying on the booster alone, especially because the Delta and Omicron variants can get past immune responses. The old advice — don’t meet up if you have fever or other symptoms of Covid — is still valid. 

Many people, including me, once thought they could stop worrying once they got two shots. How important is it to get a third? 

We are learning as the pandemic takes its toll. The elderly lose a lot of immunity after four to six months. They should get a booster as soon as possible. For young adults, the benefit of a booster is up for debate — I think we will arrive at a point where everyone will get infected with some variant of SARS CoV 2 at some points in their life. For young people with two doses of an mRNA vaccine, it is — at least at that point in the pandemic — extremely unlikely to end up on a respirator in the ICU. And this is what we need to prevent. For the elderly and immunocompromised people, it may be necessary to get regular boosters.

Lauterbach was calling for the closure of hospitals in rural areas. One of the first things he did as a minister was to implement exceptions from 2G+ rules… to be honest, I fear the worst.

People have said that vaccines are killing tons of people, Or that Moderna is getting slowly banned because it’s dangerous.

In short, no, vaccines aren’t killing people. To be fully transparent, there are deaths due to vaccination — most of them are attributed to a sinus vein thrombosis as a result of AstraZeneca vaccine. With the mRNA vaccines, there is a risk of myocarditis (heart muscle inflammation). With a weakened heart, this can cause death, but for a young and healthy individual, the usual cure is staying in bed for up to six weeks and passing the time with Netflix or books. Also, it is six times more likely to get myocarditis from a SARS CoV 2 infection than from a vaccine. Allergic reactions can also end in death, but it is more likely to die from a peanut allergy in a restaurant. If you follow doctors’ advice and wait for 15 minutes in the vaccination centre, in the case of an allergic reaction, a physician can administer life-saving adrenaline. As yet, no one has died from an allergic reaction to the vaccine in Germany.

A number of countries including Germany have stopped using Moderna for people under 30, but it is still routinely administered to the elderly. The main difference between BioNTech and Moderna is the dosage — the first and second shot with Moderna contains three times the mRNA dosage of BioNTech. For children, their young immune system means myocarditis as a side effect becomes more likely. With an old immune system, or with immunocompromised people, a higher dose is better because it provokes more response against the virus. It’s a risk vs. benefit calculation and a question of who benefits most from which vaccine.

A ton of people in Berlin are undocumented. They are worried that, if they have to show ID to get a shot, this will get them in trouble. What can they do? 

Get vaccinated. Seriously, we are not the police. Doctors are obliged to treat any information we get during medical procedures as confidential. Failure to do so would cost us our licenses. I know my colleagues, and they are overwhelmingly just happy to get people vaccinated. We don’t care whether you have a valid ID, an invalid one, or none at all. Any checks we do are to ensure that we do not give out certificates to people who are trying to make a quick buck with anti-vaxxers (who are willing to pay large sums for such documents).

At some vaccination centres, the German army is present, but they do not have any sovereign rights outside of military areas. However, if someone feels intimidated by the military presence, they should go to a pop-up vaccination centre like the one at Alexa which has no military presence. If you are under 30 or pregnant, check whether BioNTech vaccine is available at the vaccination centre. 

Why do you think there are still like 20% of adults in Berlin who are not vaccinated? What’s your experience?

There are some „Querdenker“ — people who deny the existence of Covid and think the vaccines are some kind of conspiracy. But these — according to studies and my personal impression — are a minority. 

I can only report about people I vaccinated in recent weeks. For the most part, these were people who are fighting to get by: single parents without the money for a babysitter; undocumented people who have a different job each day and can’t schedule a vaccination two weeks in the future; immigrants who were vaccinated in their home country but with a vaccine that is not recognised in the EU (like Sinovac or Sputnik) or lost the documentation; immigrants who struggle to get information about where to get vaccinated because of a language barrier. 

Then there are people who were given false information — overwhelmingly from the internet, but sometimes from physicians. This can be an elderly person whose doctor told them not to vaccinate because of a medical condition. But in 99.9% of cases, such conditions are a reason to vaccinate as soon as possible. It can be a young woman who fears infertility because of idiots on the internet spreading fake news. There is no difference in the fertility of vaccinated and unvaccinated people. With millions of vaccinated people who are now parents, we would have seen if there was a risk.

How do you think Germany’s politicians have gotten us through the pandemic so far? Are you hopeful about the new health minister, the doctor Karl Lauterbach, replacing the hapless pharma lobbyist Jens Spahn? 

Over 100.000 people have died in Germany. South Korea, which has 60 million inhabitants, has seen less than 5.000 deaths. The only way it could be worse is if we had a Covid-denier like Trump or Bolsonaro as health minister in Germany.

While Karl Lauterbach probably understands more about medicine than Jens Spahn, he still is a social democratic politician. Diagnosis-Related Groups or DRGs, which formed the basis of the commercialisation of health care in Germany, were implemented under an SPD government. In other words, Lauterbach also stands for a neoliberal healthcare system. In the past, Lauterbach has called for the closure of hospitals in rural areas. One of the first things he did as a minister was to implement exceptions from 2G+ rules for people with a booster — despite almost all experts telling him this was a bad idea. To be honest, I fear the worst.