The claim

Immune debt caused the current wave of infections. We are so vulnerable because we have hardly come into contact with viruses since Corona began because of the masks. Children catch up on missing RSV infections.

Our conclusion

There is no immune debt and nothing needs to be made up for. Infections with colds, flu and RSV do not provide long-term protection because these viruses constantly mutate or the antibodies weaken over time. RSV is more dangerous for infants, so it's a good idea if children don't get infected for the first time until later.

In the last few weeks we have often heard the following arguments: During the pandemic we constantly wore masks, so our immune systems were not sufficiently trained. We are currently catching up on many of the respiratory infections. Keyword: “immune debt”. Our children are hit particularly hard: the clinics are overloaded and important medication is missing. Children who were less likely to become infected with RSV during the Corona years now have to compete for the few intensive care beds. That can only be because of the masks? No, that's too simplistic.

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Peak season of infectious diseases

At the beginning of December, the German Robert Koch Institute (RKI) reported record numbers:

The activity of acute respiratory diseases (ARE rates) in the population (GrippeWeb) increased again overall in the 48th week of 2022 compared to the previous week. The values ​​are currently even higher than in previous years at the peak of severe flu waves. In the outpatient area (Influenza Working Group), the number of doctor visits due to ARE increased nationwide in the 48th week compared to the previous week. The number of visits to the doctor is also above the range of previous years at this time and only slightly below the values ​​in the peak periods of severe flu waves.

ARE weekly report, calendar week 48 (November 28th to December 4th, 2022)

The numbers remained at this level for another week and have since fallen slightly again week 50 Around 9.0 million people currently have to deal with acute respiratory diseases. Despite the slight decline, these numbers remain significantly higher than in the same period in previous years and are still “above the level observed at the peak of the severe flu wave in 2017/18”. The ARE includes Corona, but also other pathogens such as influenza, rhino and RS viruses.

Two weeks ago, around one in four children had a new respiratory disease. The numbers have now fallen significantly again, but are still at a very high level, comparable to the autumn wave last year. The youngest patients in the 0 to 4 year age group are particularly severely affected. The main reasons for hospitalization are influenza and respiratory syncytial virus. In the very youngest (up to 1 year old), RSV is the cause in almost 60% of cases and it can quickly become dangerous. The children's clinics therefore continue to work at their limits.

The little ones in particular often suffer severely, including shortness of breath and a lack of oxygen. Even newborns with RSV infections sometimes literally crash because they can't get enough air and then have to be supplied with oxygen in hospitals. We have not seen this with corona infections in children.

Thomas Fischbach, President of the Professional Association of Pediatricians and Adolescents, to the Neue Osnabrücker Zeitung

Masks and “immune debt”

While others are considering a return to the mask requirement, pediatrician president Fischbach is against it: “The cry for masks is the usual political reflex. The mask requirement of the past two years is an important reason for the current crisis.” Further Covid protective measures such as keeping your distance and regularly disinfecting your hands also contributed to the fact that our immune system was not sufficiently trained. Other experts had already the opposite .

Where does this idea come from that the immune system might be unprepared if it is not regularly exposed to pathogens? Fischbach refers here to a position paper from a French research group from August 2021. They already used the term “immune debt” in the title, which was taken up in German as “immune debt”. “Non-pharmaceutical interventions” (measures such as wearing a mask and keeping a distance) would have helped to relieve the burden on the health system in France, but would lead to a “lack of immune stimulation”. This “immunity debt” could have negative consequences once the pandemic is back under control and measures are lifted.

“Immune guilt,” a word that sticks

Unfortunately, this term and the concept behind it have been readily picked up by many media outlets , as has the “catch-up effect” – even if many experts vehemently disagree with this. Carsten Watzl , Secretary General of the German Society for Immunology: “The immune system is not a muscle: it does not regress if it is not used or is used less.” And the President of the RKI, Lothar Wieler, recently spoke out in favor of people infected with Corona continuing to be isolated. “It is just as important that people continue to wear masks, because this also keeps the number of respiratory diseases within limits.” Others express themselves more harshly:

Hanefeld had already warned of overloads October

“The fact that we are now seeing more respiratory infections among children than last year is also due to the fact that we now have more contacts and fewer protective measures. However, one cannot conclude from this that wearing a mask is counterproductive. The experiences from last winter show that infections do not have to be a part of life,” explains immunologist Prof. Christine Falk of the DMZ . “The concern that wearing a mask, keeping your distance and ventilating will cause any damage to your immune system in the long term can be clearly answered with no.”

RSV in children: data from Denmark

Danish hospital data also speak against a catch-up effect . A lot of babies with severe cases of RSV are currently being admitted there. Last year's RSV wave failed in Denmark. Many children have never had contact with this virus, but it is not these “latecomers” who particularly often suffer from severe cases, but rather children in the first months of life. This speaks against the catch-up effect as the cause of the high number of respiratory syncytial virus cases in small children. Of course, they never wore Covid masks.

The immune system does not need to be specially trained; we are always confronted with pathogens. As we have already seen in particular Sars-Cov-2 - keyword: Long Covid - viruses can lead to long-lasting health problems. RSV infections are considered an important risk factor for the development of asthma in children , especially in infants.

CONCLUSION

There is no such thing as “immune debt.” It's also not the masks' fault that the children are now getting sick. Many antibodies against the viruses of acute respiratory diseases last a lifetime ( as with influenza ), others decrease measurably within a few months (e.g. with Covid ). You can even get the same cold “RSV reinfections are common and occur at all ages,” writes the RKI .

An infection does not (completely) protect against later infections: antibodies decrease or a new strain is now causing problems (as we know with every new flu season). This is why it is easier to become infected after a long period of time without contact with a virus. The now well-known corona protective measures also help very successfully against other infectious diseases.

Several factors are currently coming together: it is peak season for infectious diseases, protective measures have been scaled back and many have not been infected for a long time. However, the fact that it is the first RSV infection for many older children is a good thing (says Isabella Eckerle ) because the disease is more dangerous for younger children. The current problem in German clinics with the RSV wave is also a problem with the broken healthcare system, as we recently discussed .

no immune guilt - hygiene tips

Sources: RKI , BDI , frontiers , helmholtz.de , Statens Serum Institut on ArcGIS, PubMed , FAZ , Merkur , NOZ , DMZ , Die Presse , New York Times , image on YouTube, Quarks on YouTube

More on the topic: Dangerous misinformation about RSV in children

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