FRANKFURT (Reuters) – Germany’s health system could face strains similar to those in Italy if the coronavirus outbreak in the country worsens, the head of the Robert Koch Institute (RKI), the federal agency responsible for disease control, told a newspaper.

Lothar Wieler’s comments came as RKI data on Sunday showed the number of confirmed coronavirus cases in Germany had risen to 52,547 and 389 people had died of the disease there.

“We cannot rule out that we will have more patients than ventilators in this country … Of course, we must expect that the capacities will not be sufficient,” Wieler told Frankfurter Allgemeine Zeitung.

Italy’s Civil Protection Agency said earlier this week that the biggest difficulty facing its health service was a shortage of ventilators and masks — a problem that has dogged hospitals since the start of the outbreak.

Compared to other countries hit by the pandemic, Germany has a low mortality rate among coronavirus patients.

“This is primarily because we are testing so many people,” Wieler told the paper, adding that the large number of tests means that Germany has many cases in its statistics of younger people suffering only mild symptoms.

Initial cases of the disease were mainly among people who contracted it outside Germany — for example on skiing holidays, suggesting those affected were fitter and more active.

But the death toll could spike if the virus starts to spread in hospitals and retirement homes, Wieler said.

“We are still at the beginning of the wave, and I can only urge everyone to take the pandemic very seriously,” Wieler said, adding that it will not be possible to assess the impact of the adopted measures until Easter at the earliest.

China, where the coronavirus started, says it has largely contained domestic transmission but is cracking down on travel to the country to avoid imported cases fanning a second wave of infections.

“The disease is a pandemic, it comes in waves … Germany, too, will probably be affected by a second wave of corona,” Wieler said, adding that once new infections come down, the shutdown could be eased.

“Unfortunately we do not yet know exactly where the threshold for (being able to relax some measures) lies.”

More than 662,700 people have been infected by the coronavirus across the world and 30,751 have died, according to a Reuters tally.

(Reporting by Arno Schuetze, Editing by Catherine Evans)