Germany’s ‘real Covid fourth wave’ has started, says health expert

Germany is seeing an alarming rise in Covid-19 infections, with the 7-day incidence rising above 90 for the first time since May.

A sign telling customers to remember the Covid mask requirement at a restaurant in Waldkirch, Baden-Württemberg.
A sign telling customers to wear masks at a restaurant in Waldkirch, Baden-Württemberg. Photo: picture alliance/dpa | Philipp von Ditfurth

Health experts said the rising cases show the “actual fourth wave” is getting underway in Germany – and that the situation will get worse. 

For the ninth day in a row, the 7-day incidence in Germany increased. On Friday the incidence was 95.1 Covid-19 infections per 100,000 people within seven days. It’s the first time since mid-May that the incidence has risen above 90. A week ago, the 7-day incidence was 68.7.

On Friday, Germany recorded 19,572 new Covid infections within a day, and 116 Covid-related deaths.

In the past few months, Covid infections in Germany have been stagnating and decreasing at times, leaving many wondering if a serious fourth wave would emerge. But cases have been going up quickly recently.


The Robert Koch Institute (RKI) and health experts are sounding the alarm.

“Since the end of September 2021, a rising trend in the 7-day incidences has again become apparent, which became visible in almost all age groups last week,” said the RKI in its weekly report. 

“It is to be expected that the rise in case numbers will accelerate more in the further course of autumn and winter,” the RKI added. 

The chart by Our World in Data below shows the number of Covid cases per million people in Germany compared to a few other European countries. Many neighbouring countries are seeing a trend of rising cases. 

What’s going on in hospitals?

The number of Covid-19 patients admitted to clinics per 100,000 residents within seven days – the government’s most important indicator for a possible tightening of restrictions – was 2.45 on Thursday.

Although it has risen slightly, it’s far off the previous hospitalisation rate peak which reached 15.5 in December last year. 

According to the DIVI intensive care register, the number of Covid-19 patients in ICU wards stands at around 1,540 (as of Thursday). Around 850 of these patients are receiving ventilation treatment. For comparison, at the start of October there were just over 1,300 Covid-19 patients in intensive care.

Health specialists say they are concerned, particularly because of a lack of ICU nursing staff.

The German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) said that in the coming weeks “a noticeable restriction in the care of the population is to be expected”.

Currently, 22,207 intensive care beds in Germany are available, compared to 26,475 at the beginning of the year.

The past months have led to many nurses leaving the profession, and not enough new nurses being taken on, DIVI said.

“A foreseeable difficult autumn and winter wave” with many Covid-19 patients, but also patients with other respiratory infections such as Influenza, could bring intensive care units in Germany “once again to and beyond its limits”, said Stefan Kluge, Director of the Clinic for Intensive Care Medicine at the University Hospital Hamburg-Eppendorf, Tagesschau reported on Friday. 

“The real fourth wave has now begun and is continuing to pick up speed,” DIVI director Christian Karagiannidis wrote on Twitter. He added that there is still a “very close correlation between incidence and new admissions to intensive care units”.

More vaccine breakthrough infections ‘expected’

According to the RKI report, more outbreaks have again been reported in medical facilities as well as in old people’s and nursing homes.

For the first time since the May, the 7-day incidence among people over the age of 90 rose again last week to over 50 cases per 100,000 people.

Health experts acknowledged that with increasing vaccination coverage especially among the elderly, outbreaks had gone down significantly. But they still occur and also affect vaccinated people, RKI said.

In general, the RKI says that more vaccination breakthrough infections can be “expected” over time.

This is partly down to the virus spreading quickly again.

“This increases the probability of coming into contact with the virus as a fully vaccinated person,” said the RKI.

According to the RKI, severe courses of the disease are, however, very rare in vaccinated people. 

READ ALSO: Why vaccinated people in Germany are still getting Covid

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EXPLAINED: Where Covid infections are rising rapidly in Germany

Covid numbers throughout Germany are rising, with the states of Saarland, Bavaria and some regions of Hesse seeing particularly high numbers of infections. We look at recent stats, and explore what they mean.

EXPLAINED: Where Covid infections are rising rapidly in Germany

What’s the overall picture?

On Monday, Germany’s Robert Koch Institute (RKI) reported a nationwide incidence of 598.1 infections per 100,000 people within seven days – an increase of over 100 from the previous week, when the incidence was at 471.1.

According to the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), as of Sunday there were 1,468 Covid-19 patients in intensive care units throughout the country – an increase of nearly 50 percent from the previous week when 996 people were reported to be in ICUs with Covid.

But the numbers of infections and hospitalisations vary greatly throughout the country.

States like Berlin and Hamburg, for example, have currently relatively low Covid incidence rates, with 351.6 and 219.0 confirmed infections per 100,000 residents respectively.

One thing to keep in mind though, is that because rapid Covid tests are no longer free for everyone, fewer positive tests are being reported to authorities. 

These are the areas which are currently being hardest hit by the autumn wave.

READ ALSO: KEY POINTS: Germany’s new Covid-19 rules from October


The Covid case volume in the southwestern state of Saarland has been far above the national average since the end of September.

On Monday, the RKI reported an incidence of 1248.5  infections per 100,000 people in seven days – more than twice as high as in Germany as a whole.

Saarland’s health minister Magnus Jung (SPD) called the rapid development of infections “worrying”  and said that the situation is tense for both the healthcare system and critical infrastructure in the region. He said that the situation in hospitals was “alarming”, as many planned operations were having to be cancelled or rescheduled due to staffing and occupancy issues. 

READ ALSO: What to know about getting a fourth Covid vaccination in Germany

As a result, the state government is currently considering all options for improving the situation – including amending the state’s Covid regulations to introduce stricter measures, such as mask-wearing in public authority buildings, the health minister said.  

The state health minister has appealed to people to wear masks indoors and to test themselves before attending events and before private meetings. 

As far as the care of Covid patients in intensive care units is concerned, the Saarbrücken Regional Association is currently in eighth place in a nationwide comparison of counties. Here, the proportion of all Covid patients requiring intensive care is 26 percent.


The Covid autumn wave is resulting in 7-day incidences of over 1,000 infections per 100,000 people in more and more Bavarian cities and counties, and is putting a strain on hospitals. On Friday morning, the RKI reported official figures above 1,000 for nine counties and the state capital Munich.

Guests celebrate in the Schützenzelt at the start of the 187th Munich Oktoberfest. Covid infections rose significantly in Munich since the start of the event. Photo: picture alliance/dpa | Felix Hörhager

On Monday, the 7-day incidence for the whole of Bavaria stood at 810.5 infections per 100,000 people – an increase of almost 25 percent within one week and the second-highest figure of all German states.

READ ALSO: Munich sees sharp rise in Covid cases after Oktoberfest

The increasing infection numbers are being felt in hospitals in Bavaria too. On Friday, the city of Munich reported an occupancy of 552 patients with Covid in regular, intensive care and transitional care units – a 47 percent increase from the previous week.


The central state of Hesse, where the city of Frankfurt is located, currently has the third highest 7-day incidence in the country – with 746.1 cases per 100,000.

The district of Vogelsbergkreis is currently experiencing particularly high numbers of Covid infections, and as of Monday had an incidence of 1,115.7.

As a result, three of the main hospitals in the district announced a ban on visitors to the hospital last week.

Hygiene and safety expert at the Eichhof hospital in the Vogelsbergkreis, Dr. Gerhard Holzberger, told a local newspaper: “There is no alternative to the measure, the situation is again clearly tense in all areas of life – but especially in the healthcare system.” 


Although the incidence in Thuringia is currently below the national average (475.8 infections per 100,000 people in seven days on Monday) the state currently has the highest number of Covid patients in intensive care in the country. 

In the district of Eisenach in Thuringia, the percentage of Covid patients in intensive care is currently at 47 percent.

What do the rising numbers mean for Germany?

In its weekly report released last Thursday, the Robert Koch Institute (RKI) pointed out that it’s difficult to interpret how dangerous Covid infections really are just by looking at the data.

READ ALSO: When – and how – people can get the new Omicron vaccine in Germany

That’s because the figures relating to Covid-positive patients in intensive care don’t make clear whether a patient is in intensive care due to a Covid infection, or if they require treatment for another illness and happen to have Covid too.

A nurse stands in the Covid isolation area of a hospital intensive care unit in Niedersachsen. Photo: picture alliance/dpa | Friso Gentsch

As for the increasing 7-day incidence of cases per 100,000 residents, many medical experts have said that, with 76.3 percent of the population now fully vaccinated, they expect most people to experience mild cases of Covid this autumn and winter.

The main concern related to rising Covid numbers, however, is that – as is currently the case in Saarland – rising infections will mean staff shortages in hospitals and other critical services.

People have to isolate for at least five days or a maximum of 10 days in Germany if they get a positive test result.

In an interview last week with the German Medical Journal, Christian Karagiannidis, president of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN), said that the mood amongst hospital staff up and down the country is currently tense.

“Staffing levels are thin,” he said. “If there are also severe absences due to Covid or other infectious diseases such as influenza, the atmosphere quickly deteriorates. The system is no longer resilient.”