Germany’s outbreak suggests a deadly winter ahead for the region. The country’s health system is increasingly stretched even before people from the latest record surge in new infections reach hospitals. Merkel said Thursday that the country is facing a “dramatic situation.”

With cases doubling every 12 days, many hospitals that can still handle their loads will get overwhelmed by the end of November, according to Michael Meyer-Hermann, an immunology expert at the Helmholtz Center for Infection Research in Braunschweig, who sees a need for even tougher social restrictions.

Authorities need to act fast to reduce contact between people, and he says bars and clubs should be closed, since they’re often the cause of case clusters. He also recommends limiting capacity at public events and capping how many unvaccinated people can meet in private settings. But authorities are so far trying to avoid such drastic steps.

“The urgent wave that we’re in right now will not be stopped by vaccinations,” since it takes weeks for people to build up full protection, Meyer-Hermann said. “We need to keep other measures front and center and put them immediately into place.”