HAILED as an example to follow for its initial coronavirus response, Germany is now struggling to curb surging infections amid Europe鈥檚 second wave.
鈥淲e are now at a point where, on average nationally, we no longer know where 75 per cent of infections come from,鈥� German chancellor Angela Merkel said during a press conference on 28 October.
Unlike many nations, Germany didn鈥檛 have to build up its testing and contact-tracing infrastructure from scratch when the pandemic hit. During its first wave in the spring, the country鈥檚 400 or so local health authorities facilitated rapid identification of source cases and tracing of their contacts.
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Ahead of a gradual easing of restrictions in early May, Merkel and German state leaders focused on expanding the country鈥檚 tracing capacity further, agreeing in April that local health authorities should each have at least five contact tracers for every 20,000 citizens. Combined with Germany鈥檚 large testing capacity and its use of localised restrictions to quash emerging hotspots, this worked to keep cases and deaths low through the summer months.
鈥淚 think also the fact that Germany had a high number of beds in ICU [intensive care units] really helped to control the situation,鈥� says C茅sar Mu帽oz-Fontela at the Bernhard Nocht Institute for Tropical Medicine in Hamburg. 鈥淭he system was never really overwhelmed.鈥�
Germany has the most hospital beds per 1000 people in the European Union and has had a much lower death rate from covid-19 than other European countries with a similar population size. During the first wave, deaths in Germany , compared with 13.88 in the UK, 13.59 in Italy, 16.87 in France and 18.57 in Spain, according to data from the European Centre for Disease Prevention and Control.
Yet Germany鈥檚 success in containing its first wave and its low death rate from covid-19 may be the reasons why it is now finding it difficult to prevent infections.
鈥淲e have been living with the pandemic for many months now, and most people have not yet seen friends or family fall very ill or even die from covid-19,鈥� says Sandra Ciesek at Goethe University Frankfurt. This makes the threat of the virus seem abstract and may be responsible for a drop in adherence to restrictions, she says.
Cases have been climbing rapidly in Germany, and the country has been reporting record daily increases in new infections recently. Its contact tracers are also having a much harder time keeping up this time around.
鈥淥ne of the very few things we have to manage the epidemic in the country is contact tracing,鈥� says Ralf Reintjes at Hamburg University of Applied Sciences. But contact tracing stops working above a certain threshold of cases and contacts, he says. The relaxation of rules over the summer has meant that each coronavirus case now probably has more contacts on average, compared with the cases in the spring, says Reintjes.
鈥淭he second wave in Germany is distinct from the first in many regards. The first wave was driven by relatively few introductions of the virus into the community 鈥� returning travellers from ski trips in the Alps were responsible for many of the cases. This made tracing of the cases relatively straightforward,鈥� says Ciesek.
In an effort to regain control of this second surge of infections, Merkel announced a partial nationwide lockdown for a month, which started on 2 November. Under the new restrictions, nicknamed 鈥渓ockdown light鈥� by the German media, bars and restaurants are only allowed to serve takeaway items, and public recreation centres 鈥� such as gyms, swimming pools and saunas 鈥� are closed.
People are also being advised to work from home where possible and restrictions on meetings have been tightened. However, schools and nurseries remain open.
鈥淚 think Germany is acting quite fast, because the number of cases is still not as bad as other countries that are also implementing measures at the moment, like Italy or Spain,鈥� says Mu帽oz-Fontela. The goal of the new restrictions is to bring infections back down to levels that are controllable with contact tracing, he says.
If the new restrictions in Germany aren鈥檛 successful, the only alternative will be to bring back tougher measures, says Stefan Kaufmann at the Max Planck Institute for Infection Biology in Berlin. 鈥淭his is the light version. If it doesn鈥檛 work, then we have to immediately respond to introduce a stricter response.鈥�
