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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Germany should prepare for Covid wave in autumn, ministers warn

German health ministers say that tougher Covid restrictions should come back into force if a serious wave emerges in autumn.

Germany should prepare for Covid wave in autumn, ministers warn

Following a video meeting on Monday, the health ministers of Germany’s 16 states said tougher restrictions should be imposed again if they are needed. 

“The corona pandemic is not over yet – we must not be deceived by the current declining incidences,” said Saxony-Anhalt’s health minister Petra Grimm-Benne, of the Social Democrats, who currently chairs the Conference of Health Ministers (GMK).

According to the GMK, new virus variants are expected to appear in autumn and winter. Over the weekend, federal Health Minister Karl Lauterbach (SPD) also warned that the more dangerous Delta variant could return to Germany. “That is why the federal Ministry of Health should draw up a master plan to combat the corona pandemic as soon as possible and coordinate it with the states,” Grimm-Benne said.

Preparations should also include an amendment of the Infection Protection Act, ministers urged. They want to see the states given powers to react to the infection situation in autumn and winter. They called on the government to initiate the legislative process in a timely manner, and get the states actively involved.

The current Infection Protection Act expires on September 23rd this year. Germany has loosened much of its Covid restrictions in the last months, however, face masks are still compulsory on public transport as well as on planes. 

READ ALSO: Do people in Germany still have to wear Covid masks on planes?

The health ministers said that from autumn onwards, it should be possible for states to make masks compulsory indoors if the regional infection situation calls for it. Previously, wearing a Covid mask was obligatory in Germany when shopping and in restaurants and bars when not sitting at a table. 

Furthermore, the so-called 3G rule for accessing some venues and facilities – where people have to present proof of vaccination, recovery, or a negative test – should be implemented again if needed, as well as other infection protection rules, the ministers said. 

Bavaria’s health minister Klaus Holetschek, of the CSU, welcomed the ministers’ unanimous call for a revision of the Infection Protection Act. “The states must be able to take all necessary infection protection measures quickly, effectively, and with legal certainty,” he said.

North Rhine-Westphalia’s health minister Karl-Josef Laumann (CDU) warned that no one should “lull themselves into a false sense of security”.

“We must now prepare for the colder season and use the time to be able to answer important questions about the immunity of the population or the mechanisms of infection chains,” he said.

On Tuesday, Germany reported 86,253 Covid infections within the latest 24 hour period, as well as 215 Covid-related deaths. The 7-day incidence stood at 437.6 infections per 100,000 people. However, experts believe there could be twice as many infections because lots of cases go unreported. 

READ ALSO: Five things to know about the Covid pandemic in Germany right now