Public life in Germany has largely come to a halt as part of restrictions to stall the spread of coronavirus.
Experts are so far cautiously optimistic that these strict social distancing measures, which include a ban on groups of more than two people in public and the closure of various shops and restaurants, are beginning to work.
It came as reports emerged of post-lockdown plans drawn up by the government, which include ideas such as mandatory face masks, limits on public gatherings and tracing of infection chains. Restrictions are scheduled to last until April 19th.
On Friday April 3rd, Lothar Wieler, president of Germany’s public health organisation the Robert Koch Institute said: “We are seeing that the spread of the virus is getting slower… it's working.”
As of Tuesday April 7th at 9am, Germany had more than 103,300 cases and more than 1,800 people had died, according to data compiled by Johns Hopkins University. More than 36,000 people have recovered.
And there is hope: the time it takes for the number of infections to double in Germany has slowed to about eight days, signalling that the curve is starting to flatten.
But Wieler said the partial lockdown measures needed to be maintained, however, and warned that the number of infections and deaths will continue to increase.
When will Germany reach its peak of coronavirus cases?
Senior virologist Christian Drosten of the Berlin Charité previously estimated that the maximum amount of cases “will probably occur from June to August”.
Now a new study by an interdisciplinary team of scientists from the Johannes Gutenberg University of Mainz (JGU) and the University of Hamburg, has found that if the current partial lockdown measures remain in place up until April 19th, the highest point of the pandemic could occur in Germany in early June.
At this time, the wave of infections could hit their peak, meaning up to 1.5 million people (active cases – that's not including those who have recovered or died) would be infected with Covid-19 at the same time.
After that the number of new ‘active cases’ would decrease, according to the study, and approach zero in August. In September, there would then be no more new infections.
However, researchers point out that experience from past outbreaks shows that usually cases go down before a second wave of infections occur.
The model assumes that the partial lockdown put in place is completely lifted after April 19th. In reality, other forms of restrictions will be enacted across federal states with varying degrees of success.
That means in practice, the number of infections could potentially go up and down over time, depending on the success of these post-shutdown measures.
Wieler from the Robert Koch Institute has previously said it could take up to two years for much of the population – up to 60 to 70 percent by some estimates – to contract the virus and build immunity to it, at which point the epidemic would be largely under control.
Economics postdoctoral researcher Dr. Jean Roch Donsimoni, who is part of the team at the University of Mainz, told The Local that the accumulated number of cases will grow throughout, “all the way to September”.
“What we will expect to see dropping is the number of new cases every day and that will happen as we approach the peak,” he said.
A person wearing a mask in Jena where it is now mandatory in some public places. Photo: DPA
“If indeed the current policies in place continue as initially planned – that means the shutdown lasts from March 14th until April 19th – then, using our model, we predict that at the peak of the pandemic, we will see between 0.2 and 1.5 million individuals actively infected with Covid-19.
“This figure only takes into account people who are confirmed to be ill. It therefore excludes asymptomatic carriers, those who have already recovered, and those who have passed away.”
The researchers applied a mathematical model widely used in epidemiology and labour market research. As a basis for their calculations, they used figures from the Robert Koch Institute on Covid-19 in Germany.
What would happen if the measures were extended?
An extension of the 'contact ban' until mid-June would postpone both the peak of the pandemic and its end by about a month, researchers found. If this were the case, it could mean at the beginning of July, up to 1.2 million people in Germany would be confirmed to be sick at the same time.
“Public measures such as ‘contact bans’ temporarily flatten the increase in disease and prolong the duration of the epidemic,” the scientists explain in their research.
Using estimates they worked out that at the end of the current pandemic, six percent of the population in Germany, i.e. around five million people, will have coronavirus.
“Admittedly, this assumption is associated with great uncertainty,” said Professor Dr. Klaus Wälde, economist at JGU. “However, there has not been a comparable pandemic so far, so we do not have a reliable value for the long-term infection rate.”
Donsimoni said researchers did not calculate how many deaths might occur in Germany because there are too many different variables to estimate this accurately.
“We focus on the number of sick people,” he said. “Our model could report that (deaths) in theory but it’s a bit risky because there’s a myriad of other factors that can affect people, for example if they are smokers.”
What will happen after the peak?
Experts have warned that the crisis won't be over even after new cases start to drop. It means social distancing restrictions will have to remain in place in some form.
“Even if we are lucky, and we succeed in halting the progression of the disease to the point where confirmed active cases start to drop, it still won’t be over,” said Donsimoni. “The fact is, if we begin relaxing too early, there will simply be another wave of infections that will sweep through the country.
“On the other hand, if we are able to control the progression effectively, then by and large we should be able to return to some degree of normality in our lives. However, even then it won’t happen overnight, and will take some time.”
The longer the measures stay in place would mean a slower progression of the disease – and less of a burden on health services, the research found.
“The great problem is that ending those restrictions early will let the disease run its course more quickly which means it will also end sooner, but in the meantime it will wreak havoc on an overstretched healthcare system,” said Donsimoni.
“So, even though it may be uncomfortable for many to stay at home for several weeks, it will lead to better outcomes in the long run.”
Donsimoni added that extending the lockdown could significantly reduce the number of active cases between 10 and 40 percent, depending on how long it lasts and how severe the pandemic ends up being.
That's because it would slow the spread of the disease further while allowing people who are infected to recover. Once the shutdown is over, the size of the population that's susceptible to being infected would be smaller and that reduces the speed at which the disease spreads, translating into a lower peak.
“In that sense, sacrificing some social comfort for a while longer will enable us to spare our hospitals as well as to protect the most vulnerable among us,” Donsimoni said.
What would happen if Germany introduced stricter measures?
There is currently no general curfew like that imposed in Italy or Spain. Would it help the situation if Germany followed and introduced a tougher lockdown?
Not necessarily, say experts.
“At the moment the pandemic in Germany appears to be under control, with much fewer fatalities than most of our neighbours, however this is not sufficient to take a laissez-faire approach,” said Donsimoni.
“On the other hand, measures, such as the ones seen in Italy with strict controls on the movement of its citizens in public spaces, do not appear to have been more effective than those taken by the German government and its individual states. Italy is still seeing a large number of new cases being reported daily, with very little signs of slowing down.”
Donsimoni said it comes down to compliance rather than how strict policy is.
“If the government introduces a strict lockdown but people keep going to their neighbours’ homes and spending time together, then the policy is ineffective,” he said.
“If the policy is softer but individuals follow the recommendations from the government and stay at home without seeing friends, family, or colleagues, then it will be more successful. In that sense, it is up to the people to make sure this type of policy is a success. The government can only do so much.”
How will Germany's health system cope in the coming weeks and months?
It's all down to how people comply with the social distancing restrictions. But that doesn't mean the health system won't be burdened, even if people follow the measures.
“Even in our best-case scenario, our research points toward the healthcare system being greatly taxed over the next few months,” said Donsimoni. “Our most pessimistic scenario pushes this well into the summer and to unsustainable levels, which we hope we will not see.
“This means that even now we must work hard to ensure contagion is limited via distancing measures, as this is the most potent tool at our disposal, one we can all employ.
“The fact is, there is not enough room in hospitals and other healthcare service providers to handle a sudden increase in patients in the millions in a few weeks. Thus, the only way we can help is to be responsible and patient.”