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Why are Covid infections in Germany rising?

After a period of stagnation, Covid infections are rising dramatically in Germany - even though much of the population is vaccinated. What's going on?

A face mask lies on the ground in Frankfurt.
A face mask lies on the ground in Frankfurt. Photo: picture alliance/dpa | Frank Rumpenhorst

Germany is seeing a rising number of Covid-19 cases, and an increase in the number of patients with coronavirus being admitted to intensive care wards.

This isn’t entirely unexpected –  experts have been warning for some time that a drastic fourth wave was imminent. They say it’s down to a number of factors.

READ ALSO: Germany’s real Covid fourth wave has started, says health expert

What’s the situation compared to last year?

Most of us don’t look back on autumn 2020 fondly.  A year ago, Chancellor Angela Merkel and the state ministers agreed on a so-called “lockdown light” as the infection figures skyrocketed. At the time the incidence had climbed above 100 cases per 100,000 people within seven days, and there were more than 18,000 daily infections. That partial lockdown went on to become progressively tougher – and lasted until around May 2021, much to everyone’s despair.

A year on and the situation is much more encouraging in some regards – for instance around 66.6 percent of the population is now fully vaccinated, whereas there was no approved Covid-19 vaccine last year.

However, Covid cases are spiking. On Saturday, the Robert Koch Institute (RKI) recorded more than 24,000 new infections and 86 deaths within 24 hours, as well as a nationwide 7-day incidence of 145.1 Covid infections per 100,000 people. On Monday November 1st, the 7-day incidence had climbed to 154.8.

The situation in intensive care units (ICU) also looks worse than last year: while 1,569 Covid patients were receiving intensive care on October 28th 2020, one year later there are around 1,808 people in ICU with Covid-19.

According to Frankfurt virologist Sandra Ciesek, the increase in new infections and the high occupancy rates in intensive care units mean that “we are even worse off compared to last year”, as she stated last Tuesday in the NDR Coronavirus-Update podcast. 

Delta variant 

One thing is clear: the current Covid-19 numbers cannot be explained by a single cause. There are several factors playing a role in the current sharp increase. Experts say one main reason – and a large difference from autumn 2020 – is the spread of the virus variants.

In particular, the far more transmissible Delta variant of Covid “is contributing to the fact that the virus is now spreading faster,” epidemiologist Hajo Zeeb from the Leibniz Institute Bremen told German news site RND.  The Delta variant was first discovered in India and has been the dominant virus variant in Germany since the end of June 2021.

“Delta spreads very effectively,” said Martin Stürmer, virologist and laboratory manager at the IMD Laboratory for Interdisciplinary Medicine and Diagnostics in Frankfurt.

Stürmer pointed out that politicians are moving towards loosening measures, rather than towards infection prevention. 

The general view from the politics world is that the German health system is no longer at risk of becoming overburdened due to the vaccination coverage. That’s why Health Minister Jens Spahn believes Germany’s Covid ‘state of emergency’ should be allowed to expire later in November. 

But Stürmer said there was too much focus on the end of the “epidemiological emergency” and about a UK-style “Freedom Day”, which he says the infection situation doesn’t allow yet.

READ ALSO: German Health Minister insists Covid emergency can end in November

Fewer measures – and concern about virus decreasing

The German government insists that there will be no more lockdowns or school closures in the pandemic. But according to some experts, that means there are not as many resources to combat the spread of the virus.

“In contrast to last year, we now have the vaccinations, but we have also lost weapons against the virus,” said Stürmer.

Last year, measures were still strongly based on the 7-day incidence – and due to the drastically rising numbers at that time, the nationwide partial lockdown came into effect on November 2nd.

AfD supporter with placard
A supporter of the far-right AfD party holds a placard calling for “No lockdowns ever again”. Both the current and future governments have promised that no further lockdowns will occur in Germany. Photo: picture alliance/dpa/dpa-Zentralbild | Jens Büttner

“The hospitalisation rate is now the central control button – but there are no nationwide limits on when new measures will be introduced again,” said Stürmer.

The RKI reported the hospitalisation incidence on Monday as 3.46 per 100,000 population, but there are large differences in the incidence between the states. Around Christmas time last year, the hospitalisation incidence reached around 15. 

Scientists say that people are not as worried about rising Covid numbers and may be fatigued from previous measures. 

“The concern for personal health and that of family and relatives has noticeably decreased over the course of a year – also due to vaccinations,” said epidemiologist Zeeb.

Virologist Ciesek also spoke of a “habit effect” in the NDR podcast. People have become accustomed to the Covid figures and no longer perceive them as alarming to the same extent, she said. 

Colder weather

Experts generally agree that seasonality plays a role in the development of respiratory viruses.

When it comes to Covid, we’ve often seen spikes in the number of cases when people tend to socialise more indoors in the colder months, rather than outside.

The German government and states have 3G (entry to the vaccinated, recovered and tested people) and 2G (excluding the unvaccinated) entry rules to many public spaces in place. But there is some concern that the rules are not enforced consistently everywhere. 

Vaccination rate still too low – and declining immunity

Another reason for the rising numbers is that the vaccination rate in Germany is still too low, experts say.

RKI data shows 85.3 percent of the over 60s are fully vaccinated, and 73 percent of the 18-59-year-olds are fully jabbed. Overall, 66.7 percent of the whole population are inoculated against Covid.

Although the RKI has previously said the vaccination rate could be five percentage points higher than the official stats, Germany is still pushing for a higher take-up.

“The vaccination rate is therefore currently no reason to completely abandon infection prevention,” said Stürmer.

Furthermore, there is an increase in vaccination breakthroughs because immunity decreases over time.

“Someone who was vaccinated three quarters of a year ago and is over 70 should actually no longer be considered fully vaccinated according to current knowledge,” said Stürmer.

But vaccinations remain the best way out of the pandemic. According to Zeeb, vaccines provide proven protection, especially against severe courses of the disease. 

This is also shown by the current situation in intensive care units. Doctors say most patients are unvaccinated.

“A year ago, people with severe courses of disease had to be treated in an intensive care unit because there were no vaccines yet – and even today, it is mostly unvaccinated people who end up in hospital,” said Zeeb.

Booster take-up slow

To boost immunity, Germany has been recommending a top-up shot to all risk groups, those over 70 and people who’ve had the vector vaccines AstraZeneca and Johnson and Johnson. However, the take-up has been slow.

The government has been criticised for not launching a strong enough booster jab campaign. 

Last week Health Minister Spahn then came out and said that everyone in Germany is entitled to a Covid booster jab six months after their last shot (although people who’ve had Johnson & Johnson can get an mRNA Covid shot after four weeks.)

READ ALSO: Covid booster jabs ‘possible for all’, says Health Minister

SPD health expert Karl Lauterbach previously called on authorities to start a fresh booster-vaccine campaign. 

He said: “In view of the rising number of cases – also among the elderly – a new vaccination campaign for the use of booster vaccinations in this age group is now absolutely necessary.”

Zeeb also welcomed rapid booster vaccinations – especially for the elderly.

Holidays, neighbouring countries and regional differences

As we’ve seen in the entire course of the pandemic, there are also strong regional differences. While Thuringia currently has the highest 7-day incidence with around 307 Covid cases per 100,000 people (as of Monday), Saarland is clearly below the nationwide number with an incidence of 72.5

It’s also noticeable that the federal states with long external borders – such as Bavaria, Baden-Württemberg and Saxony – are currently recording high infection figures.

READ ALSO: Why Covid cases remain high on the German border with Austria

“A possible explanation for the partly high incidence rates in many border regions could be the higher proportion of holidaymakers and cross-border commuters for work from neighbouring countries with high incidence rates,” said Zeeb. For example, the 7-day incidence in Austria is currently around 313, in the Netherlands 256.5 – significantly higher than in Germany.

However, the regional differences are also “multifactorial events”, said Stürmer. For example, there is also a connection between the varying period of the summer holidays and the incidence.

“The different end of the summer holidays depending on the federal state certainly also had an influence on the incidence of infection,” he said. 

No more free rapid tests?

Another factor that may be contributing to the rise in cases is that the German government stopped offering free Covid-19 antigen tests to all on October 11th.

Now people have to pay a fee to take a test. The aim is to increase the pressure on people to get vaccinated. However, many people used the tests to monitor their infection status regardless of whether they were vaccinated or not. People are less likely to get a test now they have to pay for it. 

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Pandemic in Germany unlikely to end this year, says top virologist

High profile German virologist Christian Drosten believes Germany will see a severe spike in Covid infections after summer, and that the pandemic will not become endemic this year.

Pandemic in Germany unlikely to end this year, says top virologist

Drosten previously said that Germany would probably be able to declare the end of the pandemic this year.

But in an interview with Spiegel, Drosten said he had reevaluated his opinion. 

“When the Alpha variant came, it was very surprising for me. When Delta appeared I was sceptical at first, then with Omicron we had to reorient ourselves again. And since January there have already been new Omicron subtypes.

“So I would actually like to correct myself: I no longer believe that by the end of the year we will have the impression that the pandemic is over.”

READ ALSO: End is in sight for pandemic in Germany, says virologist 

Drosten also said that Germany will not see a largely Covid-free summer, which has been the case in previous years, and a further increase in infections in autumn. 

“We are actually already seeing an exponential increase in case numbers again,” Drosten said.

“The BA.5 variant (of Omicron) is simply very transmissible, and people are losing their transmission protection from the last vaccination at the same time.”

In other countries, he said, when the number of cases become high, hospitalisation and death rates also rise again. “Unfortunately, that will also be the case here,” said Drosten, but added: “Overall, however, far fewer people will become seriously ill and die than in 2021.”

Drosten said he expected many more infections from September.

“I hope that the school holidays will dampen the increase in cases somewhat. But from September, I fear we will have very high case numbers,” the head of the virology department at Berlin’s Charité hospital told Spiegel.

READ ALSO: German Health Minister lays out autumn Covid plan

Virologist Christian Drosten at a Covid press conference in 2021.

Virologist Christian Drosten at a Covid press conference in 2021. Photo: picture alliance/dpa | Kay Nietfeld

If the government does not take any action, he predicted there would be a lot of sick leave across all industries. “That will become a real problem,” he said.

Drosten said he did not expect overcrowded intensive care units in Germany.

But the new BA.5 sub-variant, which is becoming dominant in Germany, may affect people more strongly. 

“The wheel is turning more towards disease again,” said Drosten. It is not true that a virus automatically becomes more and more harmless in the course of evolution. “That makes me even more worried about the autumn,” he said.

Drosten recommends wearing masks indoors during the colder months, saying it is “the least painful” measure.

If, in addition, “up to 40 million people could be immunised or given a booster vaccination” before winter, for example by urgently calling for company vaccinations, that would “really make a difference”, Drosten said.

In the long term, he said it’s inevitable that people will become infected with coronavirus.

He said the population immunity due to vaccinations and infections will at some point be so strong that the virus will become less important. “Then we will be in an endemic state,” said Drosten. In the worst case, however, this could take “several more winters”.

However, Drosten warned against people trying to deliberately infect themselves with Covid, saying getting the infection in summer doesn’t mean people will be protected in winter. 

Drosten himself said he has not yet contracted Covid-19.

“So far, I guess I’ve just been lucky,” he said. “I rarely put myself in risky situations, but I’m not overly cautious either.”

‘Pandemic depends on behaviour’

According to the Robert Koch Institute (RKI)’s latest weekly report, more outbreaks are occurring in care homes, and the number of patients in intensive care units is slightly rising as infections go up. 

The institute said there had been a 23 percent increase in the 7-day incidence compared to the previous week. On Friday the 7-day incidence stood at 618.2 infections per 100,000 people. There were 108,190 infections within the latest 24 hour period and 90 deaths. 

“The further course of the pandemic depends not only on the occurrence of new virus variants and the uptake of vaccinations on offer, it also depends to a large extent on the behaviour of the population,” said the RKI.

According to the DIVI intensive care register, the number of Covid-19 patients in ICUs had increased to 810 on Thursday this week, from about 600 at the beginning of the month.

However, that number is still low compared to previous Covid peaks when thousands of people were in intensive care in Germany.