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Risk assessment for COVID-19

Changes from the Version dated 23/09/2020: Adaptation in the section “Risk assessement”, “Transmissibility” and “Infection control measures and strategy”

The global spread of COVID-19 was declared a pandemic by the WHO on March 11, 2020. The Robert Koch Institute continuously ascertains the current situation, evaluates all information and assesses the risk for the population in Germany.

Basic principles of the RKI risk assessment

The RKI adapts its risk assessment as required and depending on the circumstances, taking into account the current epidemiological situation. This includes:

  • Transmissibility: Case numbers and trends for reported cases according to the Infection Protection Act in Germany and in other countries.
  • Severity of illness: Proportion of cases with severe, clinically critical and fatal progression of illness as well as long-term sequelae of COVID-19 in Germany and in other countries.
  • Resource burden on the health system (public health system, clinical care) in Germany and in other countries, taking into account the adopted measures and all possibilities of prevention and control.

The risk assessment is the description and evaluation of the situation regarding the population in Germany. It does not relate to the health of individuals or specific population groups, nor does it make any predictions for the future. Instead, it describes the current situation for the general population. The risk perception in the population does not form part of the risk assessment of the RKI.

Situation in Germany

Case numbers in Germany are available via the RKI dashboard https://corona.rki.de, detailed to the district level. A situation report (www.rki.de/covid-19-en) gives a daily overview of the dynamic infection process and provides epidemiological evaluations.

General assessment

At the global and the national level, the situation is dynamic and must be taken seriously. The number of cases continues to increase rapidly worldwide, including bordering European countries. Since the end of August (calendar week 35) transmissions within Germany have again increasingly been observed.

Nationwide, larger and smaller outbreak events continue to occur, particularly in connection with celebrations with family and friends and at group events. The proportion of cases without a known source of infection is increasing. The number of reported outbreaks in retirement and nursing homes is also increasing, and the number of patients requiring intensive care treatment has more than doubled in the past two weeks. There are still no approved vaccines and the treatment of severe disease progression is complex and lengthy.

The Robert Koch Institute continues to judge the risk to the health of the German population to be high, and very high for risk groups. This assessment may change in the short term due to new findings.

Transmissibility

SARS-CoV-2 can be transmitted easily from person to person. The risk of infection depends heavily on individual behaviour (physical distancing, hygiene measures and community masks), on the regional distribution and on living conditions. In this regard, contacts in situations with increased risks (such as face-to-face contact for a longer time) play a special role. This also holds for situations with contact to family members and friends outside the household and in occupational settings. Aerosol emission is increased markedly when speaking loudly, singing or laughing. Indoors, this significantly increases the risk of transmission, even if a distance of more than 1.5 m is maintained. If the minimum distance of 1.5 m is not complied with among persons without community/face masks, e.g. when groups of people sit at a table or in large gatherings, there is also an increased risk of transmission outdoors.

Disease severity

In most cases, the disease is mild. The probability for serious or fatal disease progression increases with increasing age and underlying illnesses. The individual risk cannot be derived from epidemiological/statistical data. Thus, even without known underlying illness and in young people, the course of the disease can be severe or even life-threatening. Long-term consequences, even after mild progressions, cannot yet be assessed.

Burden on the health care system

The burden on the health care system depends largely on the geographical distribution of cases, the main population groups affected, the health care capacity and initiation of containment measures (isolation, quarantine, physical distancing etc.). In large parts of Germany it is currently low, but is increasing rapidly at the local level, and can then place a large burden on the public health system in particular as well as medical care facilities.

Infection control measures and strategy

The three pillars of the strategy encompass containment (including contact tracing), protection (of vulnerable groups) and mitigation (of sequelae). These measures must be applied jointly such that they enhance one another, to minimize the sequelae of the COVID-19 for Germany. The massive efforts at all levels of the public health service form the basis for the detection of infections in Germany as early as possible and containing outbreaks and chains of transmission. To avoid infections in private, professional and public areas as far as possible, efforts by society as a whole remain essential. These include hygiene measures, keeping distance, observing coughing and sneezing etiquette, wearing a community / face mask in certain situations and good ventilation when staying in closed rooms. All persons who suffer from possible symptoms of COVID-19 should avoid further contact with others, contact a doctor and be tested for SARS-CoV-2 as soon as possible. The Federal Foreign Office is currently warning against unnecessary tourist trips to a large number of countries.

It is critical to keep the number of people affected as low as possible and prevent outbreaks. This should buy time for the development of antiviral drugs and vaccines. Stress peaks on healthcare resources should thereby also be avoided.

Date: 26.10.2020