EXPLAINED: What will the Covid situation look like in Germany this winter?

Endemic rather than pandemic?

One factor that makes this winter different from the previous two years is that a much higher percentage of the population has now had some form of contact with the Covid virus.

A recent study funded by the German Federal Ministry of Education and Research, for example, detected Covid antibodies in the blood of more than 95 percent of study participants.

In an interview with Bavarian Radio last week, Thomas Mertens, chairman of the Standing Commission on Vaccination (Stiko), assessed the Covid-19 situation in Germany as an "endemic viral infection".

READ ALSO: KEY POINTS: Germany’s new Covid-19 rules from October

A disease is considered endemic if it occurs permanently in a region with a relatively constant number of cases. In a pandemic, on the other hand, “an unknown pathogen encounters a human population that has no immunological experience with it”, Mertens explained.

As a large part of the German population has now developed basic immunity against Covid-19, this means that the situation in  Germany is becoming more endemic.

However, recent projections published by the Technical University (TU) in Berlin, have shown that Germany could still be hit with a new winter wave of Covid infections, even if no new dominant variant emerges.

Bremen epidemiologist Hajo Zeeb also told DPA that: "I don't assume that the current wave - which appears to be waning slightly - is already the last one this autumn/winter".

Vaccinations and medication

Since October 1st, a booster vaccination has been required in order to be considered fully vaccinated in Germany.

READ ALSO: What to know about getting a fourth Covid vaccination in Germany

There are currently several advanced vaccines available that have been adapted to the current Omicron virus variants BA.1 and BA.4/BA.5. Currently, the official recommendation from the Standing Commission on Vaccination (STIKO) stipulates that people over the age of 60 should get a further booster vaccination, as well as those over the age of 12 who have an underlying health conditions and residents and staff in nursing homes or long-term care facilities.

A steep increase in Covid cases could see Omicron vaccinations being recommended for all age groups, however.

Drug treatments for Covid patients will also be more widely promoted over the next few months and doctors' offices are now able to dispense the drug Paxlovid directly without patients having to go to the pharmacy.

New variants

As reported by The Local, experts expect new sub-variants of the Omicron BA.5 to spread rapidly in the coming weeks. The European disease control agency (ECDC) expects case numbers to increase due to the Omicron sub-variants BQ.1 and BQ.1.1. 

Which rules might come back?

Under the current Covid regulations, which came into force on October 1st and apply nationwide, mask-wearing is only mandatory on long-distance trains and for residents and staff in nursing and care homes.  

READ ALSO: Are German states poised to bring back uniform Covid measures?

Whether or not to increase restrictions is up to the states. It's likely that, in the event of rising numbers, states will broaden the mask-wearing rule, rather than reintroduce the so-called 2G and 3G rules, which set restrictions on public life based on vaccination and recovery status.

Most states have already taken measures to enforce mask-wearing on their own transport networks, though some differ on whether passengers have to wear an FFP2 mask or if a surgical mask suffices. 

Last week, Johannes Nießen, chairman of the Federal Association of Public Health Physicians, urged ministers to establish a clear measure for what constitutes a "critical" situation after which Covid measures must be tightened.  

Speaking to ARD's Morgenmagazin show, he said that it should be clear which rules will apply in both Hamburg and Munich “if the incidence reaches 500 or 1,000”.

Though some states, like Lower Saxony, have come up with their own thresholds for loosening and tightening measures, there is no clear guidance in the Infection Protection Act about what constitutes a “critical” situation. 

READ ALSO: German health minister urges states to bring back mask-wearing indoors

In mid-October, Federal Health Minister Karl Lauterbach also urged states to reintroduce the obligation to wear a mask in indoor spaces.

How will the situation look in hospitals?

Most researchers, experts and politicians no longer see the health threat posed by the virus itself as the biggest problem. What is a cause for concern, however, is the serious staffing problems in hospitals due to high infection numbers.

In Lower Saxony, for example, the incidence of weekly hospitalisations and the proportion of beds occupied by Covid patients - rather than Covid infection numbers - are the two key benchmarks for deciding which Covid measures to bring in. It could be that as the winter progresses, other states introduce such benchmarks. 

Intensive care physician and member of the German government's Corona Expert Council, Christian Karagiannidis, warned that the already precarious situation in nursing is becoming even more dramatic because so many employees are catching Covid.

Speaking to the Rheinische Post on Monday he said: "Our main problem in the health care system is currently the multiple staff shortages and the associated bed closures." 

"If the number of patients increases significantly in the winter, the system will come under extremely heavy strain. I can't imagine this happening without limiting regular care," Karagiannidis said.

Bremen epidemiologist Hajo Zeeb also said that he expects care facilities to be "under more or less permanent pressure this winter".