Flu season makes a comeback in Germany

For two seasons, the flu wave in Germany remained largely absent - but for the past few weeks higher-than-usual case numbers have been reported by the Robert Koch Institute (RKI).

Woman with cold
More people are getting sick in Germany this year than in the previous two years. Photo: picture alliance/dpa/dpa-tmn | Christin Klose

The flu wave began in the week ending October 30th, according to the weekly report on acute respiratory diseases which RKI released Wednesday evening.

More than 2,100 cases of influenza have been reported so far this week – and a total of around 8,330 since the start of the season in October. A particularly large number of reports came from Bavaria and North Rhine-Westphalia, according to the report. 

A total of 13 outbreaks with at least five cases were also reported, most of them at schools and Kitas.

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The report examined samples from people with acute respiratory illnesses, looking for various pathogens, such as rhinoviruses, Sars-CoV-2 (Covid-19) and influenza. 

A “flu wave” is said to have begun when influenza viruses are detected in every fifth patient sample, wrote the RKI. 

“During the last few months, significantly more incidents of influenza were submitted to the RKI than in the pre-pandemic seasons around this time,” the report continued. 

This is probably due, in part, to the recommendation since the start of the pandemic that people with respiratory symptoms should also be tested for influenza viruses, wrote the RKI.

Unusually early start

According to the RKI, the annual flu wave in the years before coronavirus usually began in January and lasted three to four months. 

In the past two seasons, however, the pandemic and the measures taken against it had a major impact on the spread of influenza viruses: in the winter of 2020 and 2021, there was no flu wave worldwide, as is typically the case, stated the RKI. 

Many people could be experiencing ‘catch-up’ effects and getting sick now. Photo: Getty Images

And between 2021 and 2022, there was no wave on the usual scale in Germany either, with reporting figures only picking up somewhat after the Easter vacations and thus very late by the RKI’s definition.

Whether there could now be a severe wave is difficult to predict, wrote the RKI. 

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However, it is “conceivable” that the population is susceptible to the pathogens to an increased extent or in an increased proportion of the population, the RKI website states. 

Other experts in Germany have said they expected there to be so-called catch-up effects. That means that those who have not had a real flu for a while could now be due again.

Who is most likely to get the flu?

Adults usually only get the flu every few years anyway, the Secretary General of the German Society for Immunology, Carsten Watzl, recently told DPA.

“What is colloquially referred to as the flu is usually just a cold,” Watzl explained. “With influenza, you can lie flat for a week.” 

He said it’s likely that more younger children than usual are without immune protection after the past two winters of low flu occurrence – when it is also likely they missed their first flu infections.

In this group, however, the illness is usually not severe, he added.

According to the RKI, the number of infections during a flu epidemic is estimated at five to 20 percent of the population, which corresponds to about four to 16 million people in Germany. 

In other words, not every infected person falls ill. “The number of deaths can vary greatly in individual flu waves, from several hundred to more than 25,000 in the 2017/18 season,” the RKI noted. 

Flu vaccines are recommended in Germany for people over 60, pregnant women, the chronically ill, retirement and nursing home residents, and people at increased occupational risk, among others.

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‘Breaking point’: Why German pediatric wards are filling to capacity

Overcrowded patient rooms, days-long stays in the ER, transfer of sick babies to hospitals more than 100 kilometers away: the current wave of respiratory syncytial virus (RSV) infections in Germany is pushing children's hospitals to their limits. 

'Breaking point': Why German pediatric wards are filling to capacity

The German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) said on Thursday that there was a “catastrophic situation” in children’s intensive care units. 

According to the physicians, a wave of respiratory syncytial virus (RSV) infections can be expected every year starting in the autumn. 

Yet this year “there are fewer and fewer pediatric hospital beds available overall” as well as a lack of nursing staff, Divi Secretary General Florian Hoffmann explained Wednesday on ZDF’s Morgenmagazin.

Because all beds were full in one case, a child was transferred from the Hannover Medical School (MHH) to Magdeburg on Friday night, a distance of around 150 kilometers. 

“My colleagues had called 21 clinics,” said Gesine Hansen, Medical Director of the MHH Clinic for Pediatric Pneumology, Allergology and Neonatology, told DPA. 

The child, who was about one-year old, had an RSV infection, which can be life-threatening, especially for babies and children with pre-existing conditions.

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‘Catching up’

Some health experts have said that hospitals are now filled to capacity because children had minimal social contact during the pandemic and are now catching up on infections.

According to the Robert Koch Institute (RKI), an estimated 5.6 severe cases of RSV respiratory illness occur worldwide per 1,000 children in the twelve months after birth. 

Within the first year of life, 50 to 70 percent would typically have experienced at least one infection with RSV, and by the end of the second year of life, nearly all children should have experienced at least one infection. 

In the wake of protective measures against Covid-19, however, many such infections had temporarily failed to materialise. 

‘Breaking point’

According to Divi, hardly any clinics had a free crib or free pediatric intensive care bed in the past few days.

“Children have to lie in the emergency room for days,” Hoffmann said.

Yet the peak of the current wave of respiratory infections in children has by no means been reached, Hoffmann said. “The situation in practices and clinics will get even worse in the coming weeks.”

“We are at the breaking point,” said Matthias Keller, head of the Children’s Hospital Dritter Orden Passau already. The rooms are often double-occupied, he said. In some cases, there were too few monitors and not enough equipment for respiratory support.

READ ALSO: Flu season makes a comeback in Germany

A child with RSV being treated at the Olgahospital in Stuttgart. Photo: picture alliance/dpa | Marijan Murat

“Some patient rooms are like bed storage areas, where you really have to crawl over the beds to get to the sick child, because the parent bed is lined up with the patient bed,” said Keller, who is also chairman of the South German Society for Pediatric and Adolescent Medicine.

This has far-reaching consequences for other young children who need treatment. When an infant who has just been resuscitated is admitted to a children’s hospital that is actually fully occupied, a three-year-old has to wait there for the third day in a row for his urgently needed heart operation.

‘Responsibility of politicians’

A wave of infections usually lasts six to eight weeks. In Bavaria, Lower Saxony and Berlin, as well as North Rhine-Westphalia, clinics are reporting a “maximally tense situation,” reported Divi on Thursday.

The Düsseldorf University Hospital, for example, is experiencing a wave of influenza among its young patients in addition to the RSV wave, which is “causing massive problems primarily for children up to elementary school age,” said University Hospital spokesman Tobias Pott.

In the Rhineland, “all beds are completely full” at times, said Jörg Dötsch, president of the German Society for Pediatric and Adolescent Medicine. An ER waiting time of six to seven hours is not uncommon, he says. 

“It is very unpleasant when children and their families have to virtually camp out in the emergency room,” says Dötsch, who is also director of the Clinic for Pediatric and Adolescent Medicine at the University Hospital in Cologne. 

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What are the solutions?

At their meeting on Thursday in Hamburg, intensive care physicians and intensive care nurses will discuss approaches to solving the crisis. 

One solution may be to temporarily bring nursing staff from adult facilities into the children’s hospitals, says Hoffmann, who is also a senior physician at Dr. von Hauner’s Children’s Hospital at the University of Munich. 

But above all, he says, many more pediatric nursing staff need to be trained. “We need to strengthen nursing,” he explained. “Only then do we have a chance.”

Others said more money needed to be invested in pediatric medicine and vaccines, even if it is less profitable.

“The fact that children’s lives are currently in danger is the responsibility of politicians,” said Jakob Maske, spokesman for the Professional Association of Pediatricians and Adolescents.

“Nowadays medicine has to be profitable – not cure diseases, but make money.”

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