What's behind the falling Covid cases in Germany?

It sounds confusing: Germany's vaccination rate is not at the level that experts and politicians are desperate to see - and yet the nationwide infection momentum is levelling off in the midst of the fourth Covid-19 wave driven by the more transmissible Delta variant. 

Since surpassing the 60 percent mark nearly a month ago, the rate of fully vaccinated people in Germany has gone up by only about three to four percent.

At the same time, the 7-day incidence of Covid infections is following a downward trend - and is once again well below the level of 70 newly registered Covid 19 cases per 100,000 residents within seven days.

READ ALSO: Doctors in Germany can continue to grant sick leave by phone

As Welt data journalist Olaf Gersemann remarked, the 7-day Covid incidence dropped to 63.1 cases per 100,000 people on Thursday, down from 65 the day before. We are now at the lowest level since August 25th. 

Die 7-Tage-#Corona-Inzidenz in ?? sinkt deutlich, von 65,0 auf 63,1.

➡️ niedrigster Wert seit dem 25. August

➡️ #Berlin und #Hessen (je 69) fallen auf unter 70

➡️ jetzt liegen nur noch #Bayern und #BadenWuerttemberg (je 81) sowie #Bremen (107) über dieser Marke pic.twitter.com/1CDa7CvV0Z

— Olaf Gersemann (@OlafGersemann) September 23, 2021

Although hospital admissions have grown considerably since the start of August, this now seems to have reached a plateau phase. 

As of Wednesday 1,500 Covid patients had been admitted to ICU wards, with 823 receiving ventilation. Around a week ago, the number of patients stood at 1,537.

So what's going on?

In many ways, things look like they are almost back to normal across Germany. People are visiting bars, comedy clubs, and theatre shows again. Streets are busy and friends are hugging each other. Restaurants and birthday parties are on the menu. People are doing karaoke. It's a development that's welcome after the months of shutdown last winter. 

Looking at why infections are falling despite people having lots of social contact is tricky, but there are possible explanations.

Despite the slowing of vaccinations, almost two thirds of the population has been jabbed which is positive. The end of the travel season could also have a major influence on the downward trend of cases. 

In its latest weekly report, the Robert Koch Institute (RKI) suspects "a decline in summer travel, a decrease in infections diagnosed during the start of school, and the widespread introduction of 2G or 3G rules (Germany's version of the Covid health pass)" as explanations for the downward trend being observed.

SPD health politician Karl Lauterbach points to the past increase in case numbers due to travellers returning home. "This development has now subsided," he told Tagesspiegel. 

"Now we are in an intermediate phase, until now the weather has been good, the infection figures overall stable. But I expect the numbers to rise again when the majority of life shifts indoors again," Lauterbach said.

People showing their vaccination certificates to enter a bar in Hamburg under the Covid health pass system in Germany. Photo: picture alliance/dpa | Daniel Reinhardt

Despite all of this, we've been hearing repeated warnings about an incoming drastic fourth wave. Is Germany actually out of the woods when it comes to Covid?

Not at all, says the Frankfurt virologist Sandra Ciesek. "The vaccination rate is unfortunately too low to assume that we do not have to fear a renewed wave with possibly many severe courses and deaths," she told the Tagesspiegel.

READ ALSO: Covid fourth wave in Germany - is it the calm before the storm?

As of Wednesday 63.6 percent of people in Germany were fully vaccinated, while 67.5 percent had been given at least one dose. 

However, this is the figure for the whole population. In the 18-59 year old age bracket, around 69 percent of people are fully vaccinated, while 84 percent of over-60s are.

German health experts want to see at least 75 percent of the 12-59-year-olds jabbed, and 90 percent of over-60s immunised to prevent another disastrous Covid wave. 

Short-term trends are not enough to predict long-term developments, stresses Ciesek, who hosts the podcast Coronavirus Update with her Berlin colleague Christian Drosten from the Charité.

Vaccination 'still most important factor'

"To continue increasing the vaccination rate is currently the most important measure for autumn," Ciesek, who heads the Institute for Medical Virology at the University Hospital Frankfurt, said.

She added that the disappointing results of Germany's recent 'vaccination action week' are not encouraging. "Nevertheless, every vaccination counts," said the virologist. Easy-to-access vaccination offers and conversations with vaccine sceptics among families and groups of friends remain important in the coming weeks.

Medical expert Lauterbach, who carries out vaccinations himself, says more education is needed rather than campaigns that don't say anything new. 

"There are the vaccination refusers and the vaccination hesitants. You reach the last group by taking away their worries," Lauterbach said. "They need to be told something new."

Mixed picture across Germany

Even though the 7-day incidence is falling, the overall outlook is varied across Germany. 

According to the RKI's weekly report, Covid infections in the eastern states rose, sometimes dramatically, during the first two weeks of September, with Saxony and Thuringia leading the way with 40 percent increases in each case. This may be related to vaccination rates, which are lower in the east than in the west.

However, the number of cases in the western states tends to be significantly higher - with the exception of Berlin (81.1) on the one hand and Schleswig-Holstein (34.5) on the other. This can be seen in the map below where most of the red and dark red areas are in the west of the country. 

Source: Robert Koch Institute

A look at the age groups affected reveals a lot.

"At the moment, the incidence is rising especially among children and adolescents," the RKI weekly report states. The RKI also writes that most hospitalised cases "continue to be transmitted in the 35- to 59-year-old age group." According to the report, this is followed by the 60- to 79-year-old age group and then the 15- to 34-year-old age group.

ANALYSIS: Where Covid rates are dropping in Germany - and why

What do we know about the people dying from Covid?

The findings are more alarming when looking at the number of fatalities. The pandemic in Germany has claimed the lives of more than 93,000 people since it began.

The number of Covid-19 deaths, while rising slowly, is going up steadily. Since mid-August, the death toll has followed an upward trend: while a 7-day average of 15 new deaths was the case month ago, the number has now risen to 57 - a nearly fourfold increase.

So are we nearing the end of the fourth wave?

We're not there yet. Lives are still being lost, people are still being infected by Covid, and may need hospital treatment especially if they are unvaccinated. 

But no-one knows exactly what will happen in the coming months.

Lauterbach said the main issue will be protecting the unvaccinated. He favours Germany moving to allow only vaccinated and recovered people to enter many indoor public spaces (the 2G option) rather than 3G which is allowing access to the vaccinated (geimpft), recovered (genesen) and those who've tested negatively against Covid (getestet). 

READ ALSO: Who will still get free tests in Germany in October?

"We would be well advised to significantly expand the 2G options," he said. "And I am sure after the Bundestag elections, more 2G options will be drawn up," he said.

The best strategy remains vaccination, experts say, even though vaccinated people can still get Covid.

"But that by no means means that vaccination is ineffective," Ciesek said. In particular, the effectiveness against severe or even fatal courses is still very high, he said. "The benefit of the vaccination is very great, even many months after the vaccination," she said.