Germany is sick. Clinics and art practices sound the alarm. Because a certain catch-up effect can be observed due to the pandemic, mask opponents are currently happy. You see an “immune debt”. What it’s all about.

Many people in Germany are currently struggling with respiratory diseases, some have to go to the hospital. In its current weekly report, the Robert Koch Institute (RKI) estimates the number at around 9.5 million – that is above the level of previous years, even at the peak of severe flu waves. Why is that?

The answer is sometimes the term “immune debt” (English: “immunity debt”). There is no concrete definition and no uniform understanding of what is meant by it. Often, however, it is used to explain the weakening of the immune system by two years of pandemic with measures such as wearing a mask. Some, including critics of the Corona measures, but also lateral thinkers and conspiracy theorists, see their drastic rejection of state regulations confirmed.

One of the critics of this term is Colin Furness, an epidemiologist at the University of Toronto. “A word on the bullshit known as ‘immunity debt,'” he wrote on Twitter. If this view were correct, the immune system would have to function like a muscle. Muscles atrophy if we don’t use them regularly. But: “The thing is: the immune system is not a muscle.” Furness compares it more to a kind of “photo collection”. And it wouldn’t fade just because you don’t look at it.

The term “unhappy” describes Johannes Hübner, deputy clinic director and pediatric infectiologist at the Dr. from the Hauner Children’s Hospital in Munich. Even if there is a real effect behind it. Because of the failed infections, the children are now less protected from these pathogens.

Experts in the specialist magazines “Science” and “Lancet” see things similarly. They also mention the term “immunity debt”, but they don’t see it as an immune deficiency, but rather an exposure gap. To stay with the image of the photo collection: Our immune system has to see a pathogen in order to be able to get an idea of ​​it and form antibodies.

Some time after an infection, there are also the so-called memory cells, which can immediately produce suitable antibodies in the event of a new infection. They are our “immunological memory”. If we are in frequent contact with pathogens, the immunological memory constantly receives new input and updates. It also adapts to possibly modified pathogens and can therefore react more quickly to an infection. And if there are still many antibodies, we may not even notice an infection because no symptoms develop.

Due to the pandemic, we have recently been in contact with fewer pathogens. “But you can’t call that a ‘weakening’ of the immune system as a result of the measures,” explained Reinhold Förster, head of the Institute for Immunology at the Medical University of Hanover, in the “Spiegel”. “It doesn’t change anything about the fundamental and sustainable function of our body’s defenses. She just missed some specific training sessions.”

Experts see these missed training sessions as the most likely reason for the currently increased number of infections. Babies and small children are particularly affected – for them it is the first contact. After the pandemic years, this currently affects three birth cohorts.

A further aggravating factor is that the high number of infections encounters an ailing clinic system, which has been completely economized, in particular by the flat rate per case. The shortage of nursing staff is also exacerbating the situation and pushing the clinics to their limits.

Health Minister Karl Lauterbach has already promised help. The Bundestag has decided that there should be an additional 300 million euros each for children’s clinics in 2023 and 2024. A general hospital reform is to follow.