COVID-19: Is the fourth wave in Germany a warning for the rest of Europe?

With a record number of new cases of Covid-19 recorded on Wednesday, the seven-day average soaring and hospitals increasingly under pressure, the health situation in Germany is rapidly worsening. This fourth wave could prove to be the worst since the beginning of the pandemic, even though some 70 percent of the adult population has been vaccinated. The scenario risks being replicated in other European countries.

Germany has set a series of grim records on the health front in recent days. On November 10, the country recorded 39,676 new cases of Covid-19 in 24 hours, its highest tally during the pandemic. This despite a vaccination rate of nearly 67 percent of the adult population.

The seven-day average, meanwhile, continues to reach new heights. After passing the previous record of 200 new cases per 100,000 on November 8, this closely watched index has since risen to 232.1.

Risks for the unvaccinated, and for early vaccinees

The situation is also worsening in hospitals. While the number of patients admitted with severe forms of Covid-19 is not as high as a year ago, thanks to the protective effect of vaccines, "there is a clear increase," Ralf Reintjes, an epidemiologist at the University of Applied Sciences in Hamburg, told FRANCE 24.

The intensive care units are even "more overburdened than they were a year ago when there were no vaccines", reported the daily Süddeutsche Zeitung. This is due partly to a high number of resignations among nursing staff, who have been overworked since the beginning of the health crisis. In addition, more patients with other diseases are requiring care. A year ago, lockdown limited the circulation of other seasonal viruses such as influenza.

All of these factors have prompted German virologist Christian Drosten – as popular in Germany as Dr. Anthony Fauci is in the United States – to sound the alarm. On Tuesday, he deemed it likely that another 100,000 people would die if nothing were done to stop the epidemic from spirallng out of control. "And that's a conservative estimate," he added on German radio station NDR.

"It is true that with two-thirds of the adult population vaccinated, the health situation may seem surprising. But in reality, there is nothing surprising," Reintjes said.

A cocktail of particularly explosive elements explains why the fourth wave of Covid-19 in Germany appears to be, in many ways, the worst. The most obvious is "the one-third of adults who are not yet vaccinated, which represents millions of Germans, some of whom have comorbidities that make them more likely to develop severe forms of the disease," Till Koch, an infectious disease specialist at the University Hospital of Hamburg, told FRANCE 24.

In addition to the unvaccinated, there are all those who were part of the first wave of vaccinations between late 2020 and early 2021. "For them, the effects of the second dose – given more than six months ago – are starting to wear off, and they are less well protected against the virus," Reintjes said. These early vaccinees are often elderly people who are among the populations most at risk.

Moreover, the virus is no longer the same. The German health situation "confirms that the Delta variant is much more contagious than the original strain of a year ago, even in vaccinated people", Reintjes continued.

The effect of the general elections in Germany

Finally, "we have the impression that we are back to normal life with people behaving as they did before the pandemic", Koch said. This is a real boon for the coronavirus, which can circulate much more easily than a year ago, when bars and restaurants were closed and Germans were much more respectful of barrier gestures.

This relaxation can be explained, as in most of Europe, by a certain weariness regarding social distancing measures, coupled with "a false impression that, thanks to vaccines, we could turn the page on this health crisis", Reintjes said.

But there is also a particular German aspect, due to the country's "general election effect", the epidemiologist believes. During the electoral campaign before the September 26 vote, the "health crisis was not a major concern", he explained. Moreover, politicians preferred to highlight their successes in the fight against the pandemic, which meant that "communication on the health risk was poor, giving the impression that everything was going better", he said.

For the experts interviewed by FRANCE 24, the main lesson of this fourth wave in Germany is "that we have relied too much on vaccines, to the detriment of other measures to fight the virus, such as tests and movement restrictions", Reintjes said. "Faced with such a variant, close to 70 percent of the adult population vaccinated is simply too little to stop the epidemic," Koch added.

Lessons for other countries

This is enough to make other European countries with vaccination rates similar to Germany, such as France, sweat. "It is clear that what is happening here is likely to be reproduced on a European scale in the weeks to come," Koch acknowledged.

None of the contributing factors – apart from the electoral calendar – is unique to Germany. In fact, the number of cases is already starting to rise sharply in the Netherlands and in Denmark.

It is no coincidence that northern Europe has been affected first. "Like all respiratory viruses, Covid-19 is seasonal and countries in the south of the continent such as Spain and Italy are still protected by milder temperatures," Koch explained.

But a new wave is not inevitable in any part of Europe. "The advantage is that we can easily learn from what is happening in our country," Koch said. It is imperative that countries not be satisfied with a 70 percent vaccination rate, although a year ago this rate was considered the holy grail for overcoming the epidemic. "It is also essential for the authorities to make it clear that the health crisis is still with us and that we must not relax, especially during the winter period," Reintjes said.

Finally, more attention should be given to measures other than vaccination. This does not necessarily mean returning to economically painful solutions such as curfews or the closure of bars and restaurants. In the view of the two experts, measures such as large-scale free screening campaigns would make it possible to detect cases of contamination earlier and thus limit the spread of the virus.

It remains to be seen whether other countries will learn the lessons from Germany in time. France is still far from being in the same situation as its eastern neighbor, with "only" 7,000 new cases of Covid-19 per day. But that represents a 23 percent increase compared to last week. Time will tell whether President Emmanuel Macron's announcement concerning a third dose for people over 50 and the decision to require masks in schools will be enough.

This article is a translation from the original in French.