On April 11, the Robert Koch Institute (a German federal government agency and research institute responsible for disease control and prevention) released a fresh update on the COVID-19 situation in Germany. In the conditions of the constant media hype over the COVID-19 outbreak around the world, German’s statistics and reports on the situation remain one of the most precise and transparent and allow to get a closer look at the real scale of the declared pandemic and it impact.
Epidemiological Situation in Germany
Geographical distribution of cases
Epidemiological analyses are based on validated cases notified electronically to RKI according to the Protection Against Infection Law (Data closure: 12:00 AM daily).
Since January 2020, a total of 117,658 (+4,133) laboratory-confirmed cases of coronavirus disease 2019 (COVID-19) have been electronically reported to and validated at the RKI, including 2,544 deaths (see Table 1 and Figure 1). In addition, diagnosis is ongoing for suspected cases in several federal states. Information on confirmed cases are also available on the RKI website at https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Fallzahlen.html and https://corona.rki.de
Distribution of cases over time
COVID-19 cases were first notified in Germany in January 2020. In 44,352 cases, onset of symptoms is unknown and therefore date of reporting is shown (see Figure 2).
Demographic distribution of cases
Of reported cases, 49% are male and 51% are female. Among notified cases, 919 were children under 5 years of age, 2,311 children aged 5 to 14 years, 80,723 persons aged 15 to 59 years, 22,791 persons aged 60 to 79 years and 10,712 persons aged 80 years and older (see Figure 3). The age of 202 notified cases is unknown. The median age of cases is 50 years.
Information on symptoms is available for 90,025 of the notified cases. The most common symptoms are cough (51%), fever (42%) and rhinorrhoea (22%). Pneumonia was reported in 2,113 cases (2%). Hospitalisation was reported for 13,661 (15%) of 89,735 COVID-19 cases with information on hospitalisation available.
Approximately 57,400 persons are estimated to have recovered from their COVID-19 infection. As the exact date of recovery is unknown in most cases, an algorithm was developed to estimate the number of recovered cases.
The 2,544 COVID-19 related deaths reported in Germany concerned 1,522 (60%) men and 1,019 (40%) women (sex was unknown in 3 cases, age was unknown in one case). The median age was 82 years. Of all deaths, 2,189 (86%) were in persons 70 years or older, but only 16% of all cases were in this age group.
Reports on COVID-19 related outbreaks in nursing homes are increasing. In some of these outbreaks, the number of deaths is relatively high.
SARS-CoV-2 infections among staff working in medical facilities
Of notified cases with a SARS-CoV-2 infection, at least 5,300 were reported among staff working in medical facilities as defined by §23 of the German Protection Against Infection law (IfSG), such as hospitals, outpatient clinics and practices, dialysis clinics or outpatient nursing services. Among these 5,300 persons 72% were female and 28% male. The median age was 42 years.
Estimation of the reproduction number (R)
The reproduction number, R0, is the mean number of persons infected by a case. R0 can only be estimated and not directly extracted from the notification system. The current estimate is R= 1.3 (95% confidence interval: 1.1-1.7) and is based on electronically notified cases (10/04/2020 12:00 AM) and an assumed mean generation time of 4 days. Cases with disease onset on the preceding 3 days were excluded from the estimation as their low number due to incomplete reporting would lead to an unstable estimate. For more details on the methodology see Epid. Bull. 17 | 2020 Online vorab: 9. April 2020
DIVI intensive care register (1)
A registry of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the RKI and the German Hospital Federation (DKG) was set up to document the capacities for intensive care as well as the number of COVID-19 cases treated in participating hospitals: https://www.intensivregister.de/#/intensivregister .
As of 10/04/2020, 754 hospitals or departments are reporting (+74 since previous day) to the registry. Migration of the registry to a new server has led to reporting delays, thus comparisons with data prior to 03/04/2020 are not meaningful. Currently, likely fewer than half of all ICU beds in Germany are captured by the registry. A total of 16,738 intensive care beds were registered, of which 9,647 (58%) are occupied and 7,091 beds are currently available (Table 3).
Assessment by the RKI
At the global and the national level, the situation is very dynamic and must be taken seriously. Severe and fatal courses occur in some cases. The number of cases, hospitalisations and fatalities in Germany continues to increase. The RKI currently assesses the risk to the health of the German population overall as high and as very high for risk groups. The probability of serious disease progression increases with increasing age and underlying illnesses. The risk of disease varies from region to region. The burden on the health care system depends on the geographical and age distribution of cases, health care capacity
and initiation of containment measures (isolation, quarantine, social distancing etc.), and may be very high in some geographical regions. This assessment may change on short notice as a result of new findings.
Measures taken by Germany
International risk areas
As of 10/04/2020 countries and regions are not longer classified as international risk areas. Due to pandemic spread, there is a global risk of acquiring COVID-19. In a considerable number of countries there are outbreaks with sometimes large numbers of cases; the exact numbers of cases in other countries are not known. Therefore there is a risk of transmission in Germany as well as in a vast number of regions worldwide.
All arriving travellers in Germany are to remain in quarantine for 14 days: https://www.bundesregierung.de/breg-de/themen/coronavirus/neue-einreiseregeln-1739634 (in German)
- Outbreaks are ongoing in many districts, some with high case numbers. Data on current disease activity can be found on the dashboard https://corona.rki.de/ and in the daily situation reports.
- RKI teams are currently supporting outbreak containment measures with a focus on outbreaks in retirement and health care homes as well as hospitals in several federal states.
- A new federal law was implemented on 28/03/2020 for the protection of the public in the event of epidemic situations, granting the federal government additional competencies for the control of epidemics. https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-quartal/corona-gesetzespaket-im-bundesrat.html (in German)
- As of 23/03/2020, gatherings of more than 2 persons (with the exception of families and household members) are banned in all federal states. Restaurants and businesses concerned with body care were closed. In public spaces, all persons must maintain a distance of 1.5 metres to other indivduals https://www.bundesregierung.de/breg-de/themen/coronavirus/besprechung-der-bundeskanzlerinmit-den-regierungschefinnen-und-regierungschefs-der-laender-1733248 (in German)
1. The situation report as of 11/04/2020 reports on data with state of date 10/04/2020, as there were no new data at 11/04/2020
available from the DIVI intensive care register.