Wiesn: Corona, flu, monkeypox: How high is the risk of infection at the Oktoberfest?

A few days after the start of the Wiesn, the coughing started in Munich: Wiesn flu.

Wiesn: Corona, flu, monkeypox: How high is the risk of infection at the Oktoberfest?

A few days after the start of the Wiesn, the coughing started in Munich: Wiesn flu. It was always like that, it was part of it. Then Corona came - and now monkeypox. The world has changed since the last Oktoberfest in 2019. Millions of guests from all over the world are now expected back in Munich for the first time after two canceled Oktoberfests - and with them various pathogens.

"We have known for a long time that the first wave of flu-like illnesses in autumn is very closely linked to the Wiesn," said Johannes Bogner, head of the Clinical Infectious Diseases Section at the LMU Clinic at the University of Munich. The phenomenon has been known for over 100 years. "You catch the first fall flu at the Oktoberfest."

As a result, doctors are registering increased numbers of influenza infections – earlier than in other parts of the country. For the influenza, however, the festival is almost too early, because the "real" flu usually only runs rampant after the turn of the year until March.

And Corona? Physicians have no doubt that there will be a Wiesn wave. "Of course it will lead to an increase in the number of cases," said Bogner. The pandemic officer of the Klinikum Rechts der Isar of the TU Munich, Christoph Spinner, has also made it clear: "For those who go to the Oktoberfest: The probability of transmission there is high."

In the past, it has already been shown several times that the number of infections skyrocketed after public festivals (read more about this here). Most recently, the incidences increased after the end of the Straubing Gäuboden folk festival: on Monday – two weeks after the end of the festival – according to the Robert Koch Institute (RKI), Straubing clearly had the highest value nationwide with a seven-day incidence of 667.9 The district of Straubing-Bogen followed in second place with 650.6.

Nevertheless, medical professionals see no reason to cancel the largest folk festival in the world, which could have a greater impact due to its international nature. "We need more normality again and can afford it," says Bogner. However, the Oktoberfest is not "normal", but has always been a state of emergency. "If only because of the crowds that gather there, it is of course a place where infectious diseases can be rampant."

It was not for nothing that events with large crowds were banned to contain the corona pandemic. Almost 170 years ago, the Oktoberfest was canceled due to a pandemic. Although cholera was raging in the world, the first German industrial exhibition had previously opened in Munich on July 5, 1854. In order not to endanger them, the danger of a cholera outbreak was presented as a rumor. The show was visited by 5,000 and more people on individual days. The disease broke out on the very first day - although the infection does not usually occur from person to person, but via contaminated water and food.

The epidemic also killed Ludwig I's wife, Therese, at whose wedding 44 years earlier the Wiesn took place for the first time and after whom the Theresienwiese is named. In 1873 the Wiesn was canceled again because of cholera.

Cholera is not a threat today, but in addition to Corona, monkeypox is also circulating. However, health experts agree: The risk of monkeypox at the folk festival is low if you don't get very close: the vast majority of all infections have so far occurred after sexual contact. Of course, the Oktoberfest does harbor a certain risk due to its mostly beer-related disinhibition.

Despite densely packed masses, infectious agents have apparently rarely been exchanged beyond the Wiesn flu. Gastrointestinal diseases, herpes, scabies, lice - at least none of that played a major role. Vomiting is a typical Oktoberfest phenomenon, but mostly as a result of excessive alcohol consumption.

There are always patients who report to the medical station with diarrhea and vomiting, says Michel Belcijan, manager of the Aicher outpatient clinic, which has been running the Wiesn medical service for several years. Especially when several guests were affected, one is alarmed and also thinks about the norovirus, a typical diarrhea pathogen. If an infectious disease is suspected, patients would be isolated, receive medical treatment and the case would be reported to the authorities. But: "There was no "eruption" during the last events that we took care of with the medical service."

The "main business" for the Wiesn doctors, but also for the surrounding clinics, are injuries caused by fights or broken beer mugs and alcohol intoxication. Occasionally there are also other diseases - such as strokes and heart attacks. "Everything that happens in a medium-sized city - and that's the Wiesn with its six-digit number of visitors every day - also happens here," says Belcijan.

The Aicher team is currently preparing for the Wiesn - and is also planning corona measures. An FFP-2 mask requirement will probably apply to the employees of the medical station, and patients will probably be required to wear a medical mask. Regular hand disinfection and ventilation are generally standard.