As the Oktoberfest festivities in Munich are in full swing, concerns are rising about the potential for a surge in COVID-19 cases. The extent of this year's post-Oktoberfest COVID wave and its impact on hospitals remains uncertain, but experts are unanimous that it is inevitable.

Ulrike Protzer, the Director of the Virology Institute at the Technical University of Munich and the Helmholtz Center, anticipates a similar surge as seen last year. "Last year, after Oktoberfest, a wave of respiratory infections spread from Munich. We must prepare for this to happen again this year," the professor warns. The fact that respiratory infections increase after the Oktoberfest is a well-known phenomenon, often referred to as the "Wiesn-Grippe," although it doesn't refer to influenza. "Now, in addition to the spectrum of viruses, we have COVID," Protzer adds.

Oliver Keppler, Head of Virology at Ludwig Maximilian University, also predicts, "We will see a significant increase again." He explains that the first signs of this will appear in Munich's wastewater, only about a week after the Oktoberfest begins. These samples are analyzed by the Bay-VOC network, of which Keppler is the spokesperson. Staff from various Bavarian university institutes regularly collect samples from municipal wastewater and sequence the genomes of SARS-CoV-2 to monitor the spread of different virus variants.

Keppler reassures, "There are many new COVID variants, but none are critical. Population immunity, achieved through vaccination and infections, is quite robust." It is partly for this reason that Keppler, from a virological perspective, has changed his stance on the Oktoberfest. He acknowledges that last year, he was one of the strongest voices of caution. "This year, I see it differently." While COVID is not trivial, it now needs to be placed in a different context. "This virus has now joined the ranks of respiratory infections," says Keppler. The experience of the past year showed that although there was a significant impact on the working world and medical practices, there was no strain on intensive care units.

Keppler's prognosis for this year is that "the healthcare system is unlikely to be overwhelmed." Clemens Wendtner, Chief Physician of Infectious Diseases at the Munich Clinic Schwabing, recently stated that it is now entirely justifiable to celebrate the Oktoberfest as in previous years. "The Oktoberfest will not lead to overcrowded intensive care units," assures the infectious disease specialist.

So, is optimism warranted? After two years of Oktoberfest cancellations due to COVID-19, the festival was greeted with excitement and trepidation last year. Just before the festivities began, Mayor Dieter Reiter (SPD) stated in an interview that people wanted to get out, meet, and have fun again. "Of course, we will see rising infection rates after Oktoberfest," he acknowledged. This truth was echoed not only by Reiter but unanimously by all virologists and infectious disease specialists. Appeals were made for personal responsibility as legal restrictions were lifted. People no longer wanted just warnings and constraints; they wanted to celebrate again. So, it was proclaimed, "Ozapft is!" However, shortly after the Oktoberfest ended, the coronavirus reared its head once more.

Before the Oktoberfest, the seven-day incidence rate in Munich was just under 200. Four days after the festival, it had surged to over 1000, one of the highest values since the start of the pandemic. Surrounding districts also saw a sharp increase in numbers. Beatrix Zurek, the City's Health Commissioner, estimated the actual infection rate to be five times higher than reported within just a week and a half of the Oktoberfest. However, it was also said that hospitals still had "everything well under control." Even at the end of the Oktoberfest, COVID-19 patients made up only about seven percent of those in intensive care units.

However, just one day after the festival ended, the city reported a 137 percent increase in hospital occupancy compared to the last day before the Oktoberfest began. It was reported that the wave had reached the intensive care units. Federal Health Minister Karl Lauterbach (SPD) even predicted more severe cases. Suddenly, the world was once again discussing the "hospital situation." LMU Hospital stated that hundreds of employees had called in sick, and the institution had returned to crisis mode. In addition, influenza numbers also increased significantly. Then, the Munich Clinic's works council sounded the alarm: "The emergency centers are overcrowded, patients are piling up in the corridors." They declared that a "new low point" had been reached. According to Hans Theiss, a cardiologist, intensive care specialist, and CSU parliamentary group deputy in the city council, the Munich healthcare system was "on the verge of collapse" as many doctors and nurses had contracted COVID-19. The Oktoberfest, a superspreader event, and a shortage of skilled workers had collided.

In 2023, there is no longer the same level of caution surrounding the Oktoberfest. Even the near-collapse of hospitals is forgotten. No one wants to be the party pooper. However, this year's situation is different. In the week before the Oktoberfest opening in 2022, the city reported 3257 COVID-19 cases. This year, during the same period, there were only 195 cases. Furthermore, the majority of the population has been vaccinated multiple times and has recovered from COVID-19.

"Nevertheless, it must be said that the Oktoberfest promotes infections," warns virologist Oliver Keppler. Ulrike Protzer adds that "a beer tent provides the optimal microclimate for virus spread." Therefore, Protzer advises that individuals at risk should be cautious. She also offers a recommendation: "If you are at the Oktoberfest, it's better to stay outside and avoid crowded tents. And don't forget your mask while using public transportation during the Oktoberfest weeks."

Bierzelt Ochsenbraterei, © Muenchen Tourismus, B. Roemmelt