Infection | Omikron: what is an easy course, when is it difficult?

Initial studies indicate that the new Corona variant Omikron tends to lead to slight gradients. But what does that mean – is there a risk of hospitalization even if the outcome is mild?

Not everyone who tests positive for the coronavirus will also get seriously ill from it. While one develops no symptoms at all, the other has to be treated in the intensive care unit or even dies. Why this is so is one of the big questions pandemic.

The Berlin virologist Christian Drosten considers milder disease courses with the new Corona variant Omikron to be “very likely”. There is more and more data on this, said Drosten. In his estimation, fewer people would have to be treated in a hospital for every 1,000 proven corona cases. The risk for unvaccinated people of having to go to a clinic after an infection is only around three quarters as high with Omikron as with Delta. Initial studies also show that Omikron may spare the lungs and leads to a mild course of Covid-19. When it comes to the effect of the corona vaccinations, the explanation comes up again and again: Although they do not reliably prevent an infection, they usually have a severe course. But how do the courses differ, when is the disease considered “mild” and when is it “severe”?

Coronavirus: stages of the WHO

The World Health Organization (WHO) created a scale for the clinical course of Covid-19 at the beginning of the 2020 pandemic. Accordingly, there are nine levels:

1. Uninfected: No clinical or virological signs of Covid infection (level 0)
2. Outpatient: An infection that either does not limit the patient’s activities at all or only slightly (level 1 to 2)
3. Hospitalized – mild course: These two levels include patients who are in the hospital but do not need oxygen therapy – but also those who have to be ventilated through a mask or nasal cannula. (Level 3 to 4)
4. Hospitalized – severe course: According to the WHO, there are three levels of severe disease: non-invasively ventilated patients or those with high-flow oxygen therapy (level 5); Patients who have to be intubated and receive mechanical ventilation (level 6) and finally patients who are artificially ventilated and receive additional organic support, for example through an artificial lung (ECMO therapy). (Level 7)
5. Death: As the last stage, the WHO finally states death from a Covid infection.

Later, in November 2021, the WHO specified these disease levels for Covid-19 again and no longer only included the treatment needs, but also symptoms in the scale. Accordingly, there is the mild, the severe and the critical course of the disease.

• Critical course: A critical course can lead to acute respiratory distress syndrome, but also to sepsis, septic shock or other complications that usually require life-prolonging measures. This also includes artificial ventilation.
• Difficult course: According to the WHO, a severe course occurs if, for example, the oxygen saturation in the blood falls below 90 percent of the room air, if there are signs of shortness of breath or other dangerous symptoms – such as the inability to eat, lethargy, unconsciousness or signs pneumonia.
• Mild course: On this scale, the WHO evaluates all the courses as mild or “non-severe” courses in which the patient does not show any of the symptoms of the severe or critical course.

In summary, both WHO scales mean that even a mild course can lead to severe symptoms or even hospitalization. Only when a patient needs help with breathing, for example, is the progression classified as more severe. However, the corona disease can become very uncomfortable for those affected even without shortness of breath and feel like a severe flu – nevertheless, it is still referred to as a mild course.

Progress stages of the Federal Center for Health Education

The Federal Center for Health Education has also created a graphic on the course of Covid-19. This does not differentiate between mild and severe course, but rather when a stay in the hospital or in the intensive care unit is necessary.

As a first stage, the Federal Central Office indicates a course without symptoms, after about 14 days such a patient is then no longer considered to be contagious. “Mild to moderate” symptoms that do not require hospitalization are loud BZgA:

• fever
• dry cough
• Exhaustion
• Changes in smell and taste
• clear feeling of illness
• Headache and body aches
• diarrhea
• sniffles

These symptoms usually last about two weeks. If the symptoms increase and there are additional breathing difficulties for two to three days, you will be hospitalized about eight to eleven days after the onset of the illness.

If the supply of oxygen becomes necessary and the patient needs artificial respiration or even the support of other body functions or organs, transfer to the intensive care unit may eventually become necessary. After 7 to 14 days in the intensive care unit, the patient is transferred to the normal ward – however, the Covid patient can also die. Such a patient is generally considered to have recovered about 7 to 14 days after being transferred to the normal ward. The entire course of the disease can thus drag on for several weeks or even months.

And this breakdown also makes it clear: Even a mild course can feel like the flu, “mild symptoms” can also mean a high fever for several days or even two weeks. The loss of smell or taste as well as headaches and body aches are also considered “mild to moderate symptoms” of Covid-19.

Symptoms according to the Robert Koch Institute

The recording of Covid-19 symptoms by the Robert Koch Institute (RKI) also shows something similar. According to this, 42 percent of all Covid patients suffer from a cough, 26 percent get a fever, 31 percent also have a cold and about one in five suffers a disorder of the sense of smell and / or taste.

“The course of the disease varies greatly in terms of symptoms and severity, from asymptomatic infections to severe pneumonia with lung failure and death. A total of 1.8 percent of all people for whom confirmed SARS-CoV-2 infections were transmitted in Germany are im Died in connection with a Covid 19 disease, “explains the RKI.