These days, Germany seems to be staggering like a boxer battered by endless blows on the verge of a knockout. There’s the weakened chancellor, who is unable to get her way. There are everyday Germans, who are tired of the coronavirus and staring in horror at the politicians’ muddled, directionless leadership. There is the vaccination campaign, once again shaken by problems with AstraZeneca. And there are the rising and seemingly unstoppable infection numbers.
In full view of all, Germany has been steering on a catastrophic course for weeks and the warnings have grown louder from all directions: intensive care doctors, virologists, mathematicians, BioNTech founder Uğur Şahin, influential virologist Christian Drosten and the health expert of the center-left Social Democratic Party (SPD), Karl Lauterbach. All are sharing the same message: The pandemic is threatening to go off the rails, the third wave is building up and we are facing the threat of overwhelming infection numbers. Some predict up to 100,000 new COVID-19 cases per day in early May despite the current restrictions in place.
“With 100,000 cases per day, the only thing left to do is to carry out disaster medicine,” says Christian Karagiannidis, the president of the German Society for Medical Intensive Care Medicine and Emergency Medicine. Virologist Melanie Brinkmann argues that if things keep going as they are, “everyone will know someone in their immediate surroundings who has been hospitalized, died or suffered long-term health problems.”
These warnings could hardly be more dire. But they have gone largely unheard in the German political establishment, which has been paralyzed for weeks by an escalating power struggle.
The Chancellor on One Side, the Governors on the Other
On one side, you have the chancellor, worn out by the gradual erosion of her authority. She has promised that she won’t allow things to get to the point where the worst predictions come true. But she has not revealed when or how she plans to intervene. She’s still mulling it over. Given that the next chancellor will be elected in six months, this could be her final battle.
On the other, you have the state governors. Some are almost drunk with power about the idea of being able to run their states autonomously. Others are deaf to serious scientific advice and driven by the false assumption that Germans now expect society to reopen immediately, no matter the cost.
Also hovering in the background is the growing question of who has what it takes to become Merkel’s successor as the chancellor candidate for the center-right Christian Democrats: Markus Söder – the Bavarian governor and head of the Christian Social Union (CSU), the Bavarian sister party to Merkel’s CDU – or CDU national party chair and governor of North Rhine-Westphalia Armin Laschet.
Against this backdrop, Germany’s leading politicians are continuing with their disastrous inaction, chained to a federalist system that gives broad powers to the individual states and is proving to be far from crisis proof. This power vacuum is making it impossible to implement even obvious solutions, like a two-week lockdown during nationwide Easter holidays, when all schools were closed anyways, that could have gone far in driving down the number of infections and breaking the wave. After first agreeing to the lockdown, Merkel and state leaders later backed away from it, with the chancellor apologizing to the country for what she described as a mistake.
And now? All scientific models show that permanent re-openings, accompanied by intelligent proposals and testing strategies for doing so, may only be possible in the near future if significantly tougher restrictions on public life are put in place for a few weeks to keep infection numbers down low enough to keep the hospitals from overflowing.
The models also show that it is only a matter of bridging two difficult months. Starting in late May, the accelerating vaccination campaign will be able to significantly curb the virus.
A Free and Easy Summer or Terrible Months Ahead?
But time is running out. If the tough measures come too late, it will be hard to break the third wave. Intensive care units will then be overloaded for months. And if the number of infections is too high, the vaccination campaign won’t work as well as people had hoped either.
So, what should people in Germany be expecting? A free and easy summer, with reopened businesses and permanently loosened rules? Or months marked by thousands of deaths and long-lasting restrictions? Will the people regain their rapidly dwindling trust in the government, or will the damage only intensify? Will the Merkel era end in conciliation or with a muffled thud?
The coming two weeks will decide.
If things continue as some would like – a few more loosened regulations here (as in Berlin and the northern state of Schleswig-Holstein) and a few even looser ones there (in the southern German city of Tübingen and in the western state of Saarland) – most scientists agree that the infection curve will climb ever higher, with the cold relentlessness of exponential growth.
By mid-April, only just under 15 percent of the German population will have received at least their first jab of vaccine. That’s still too few to effectively fight B.1.1.7, the far more contagious mutation.
“We underestimated B.1.1.7” says Michael Meyer-Hermann, a modeler at the Helmholtz Institute for Infection Research in Braunschweig. He says the case numbers rose much earlier than he had calculated in his scenarios. “People are obviously tired of the pandemic and are ignoring the contact restrictions,” the physicist says.
At least, he claims, that’s what the mobility data suggests. “People are moving around almost twice as much as they did during in the first wave – I guess everyone is doing what they want.”
“We won’t get around a serious lockdown,” says Christian Drosten, a prominent virologist at Berlin’s Charité University Hospital. “We have seen in Paris and London that a partial lockdown with a more tiered catalog of measures doesn’t work against this more aggressive variant. The infection rate there continued to rise, as did the number of severe and often deadly progressions of the disease.”
He argues that there’s still time to avert that development in major German cities. “But this requires political action and the support of as many people as possible,” Drosten says.
Brinkmann, a virologist, shares that view: “We can get the numbers down dramatically within four weeks if people have little contact.” She argues that the R-value, which measures how many people an infected person transmits the virus to on average, must be massively reduced. If the value falls significantly below 1, the number of cases will fall as exponentially and rapidly as they rose. With an R-value of 0.7, the numbers halve each week. “The harder everyone slams on the brakes, the shorter the lockdown,” Brinkmann says.
She says she’s angry that there hasn’t been an earlier response to scientists’ warnings. “We could have an infection rate in the teens,” she says, if politicians at a regular meeting between the chancellor and the state governors in January had taken what scientists had told them seriously. The fact that the governors acted to the contrary and even relaxed measures has left the scientist bewildered.
“We’re already doing triage almost every day by default.”
The German Interdisciplinary Association for Intensive Care and Emergency Medicine has produced model calculations. The question is how full the intensive care units will get depending on the date the next lockdown begins.
If, as the governors had theoretically agreed, any loosening of lockdown rules were reversed once the infection rate reaches an incidence of 100 cases per 100,000 people per week, there would be enough space left in the hospitals. If public life is only shut down again once the incidence reaches 200, the intensive care units in large parts of the country will fill to the brim, like they did at the end of last year. If these measures aren’t reversed until an incidence of 300, the hospitals will overflow, requiring triage in which doctors have to decide who to treat with intensive care and who, if necessary, to let die.
“We’re already doing triage almost every day by default,” says intensive care physician Henning Lemm of St. Marien Hospital in the city of Siegen. “Not with the COVID-19 patients, but with the regular patients.” He says he is often forced to ask himself if a patient is stable enough for the normal ward, or which scheduled operations can be pushed back. He says that every new COVID-19 case in the isolation ward reduces Lemm’s treatment capacity for non-infectious patients in the intensive care unit. “That hasn’t sunk into the public consciousness yet,” Lemm says.
The situation in France shows that average infection rates of 200 to 300 per 100,000 inhabitants per week do not allow for peaceful coexistence with the virus. The French tried living with high infection rates for weeks. Intensive care doctor Karagiannidis is in contact with colleagues in Paris, who tell him there are now so many COVID-19 patients in the intensive care units that staff have to be deployed who have not been trained for the situation. Normal operating room operations, he has been told, have largely ceased. “And doctors are seriously preparing for triage,” Karagiannidis says.
The Wednesday before last, French President Emmanuel Macron announced a nationwide hard lockdown, including curfews. “We will lose control if we don’t do something,” he said in a televised address.
Merkel Is Not Prevailing
In Berlin, on the other hand, silence and inaction are still prevailing. Even Merkel’s confidants are confused about when and how the chancellor intends to act. Some believe she is hesitating because she recently had to rescind plans for a lockdown over the Easter break and then apologized, meaning she can’t immediately implement another measure.
Others suspect she is waiting for the rate of infections to continue rising and for the states to be forced to act. This would be a cynical and dangerous gambit, but perhaps the only feasible one, given that Merkel’s authority is badly damaged. “Unlike most other governors, I share many of the Chancellery’s assessments of the pandemic response,” says Hamburg Mayor Peter Tschentscher of the SPD. “However, the Chancellery is mostly having problems asserting itself over the states led by the CSU and the CDU.”
At the beginning of last week, the chancellor had built up what seemed to be a well-coordinated backdrop of threats. That Sunday, Merkel announced on a prime-time political talk show that if the governors don’t agree to pull the brake on loosening restrictions, she would potentially amend the Infection Protection Act to give the federal government more powers. Shortly thereafter, Söder appeared on another news show to announce that he favored giving the federal authorities more power in the fight against the virus. And last Monday, German Interior Minister Horst Seehofer of the CSU said that the federal government should take charge. “You have to act as a federal government.”
The threat from the Chancellery wasn’t followed-up with action.
In fact, Seehofer and Söder had spoken on the phone that weekend to coordinate their actions, and the chancellor knew about Seehofer’s move. But the trio’s threat wasn’t followed up with any action.
On the talk show, Merkel said she was still deliberating. Probably for a few days. And she said that she would not, under any condition, allow the number of new daily infections to reach 100,000. But nothing happened.
The SPD – the junior partner with Merkel’s CDU and the CSU in the government coalition – is also at a loss about the Chancellery’s plans. One person in the party says their approach was akin to someone poking around in the fog looking for something. SPD members saw Merkel’s TV appearance as a helpless act of desperation.
The Federal Government Could Regulate Everything
But Merkel’s advisers actually agree that tough measures need to be taken to prevent disaster. According to Karl Lauterbach of the SPD, who is a member of parliament and an epidemiologist, two to three weeks of curfew restrictions after 8 p.m. and mandatory testing for daycare centers, schools and businesses could be enough to break the wave. But he says we don’t have any more time to wait days for that decision.
Merkel would have two options for reacting immediately. “From a constitutional law perspective, it’s quite banal,” says constitutional law expert Sophie Schönberger. The federal government could regulate everything the states have regulated to this point. “It just needs the political will.” One option would be for the federal government to write the relevant provisions into a draft amendment to the Infection Protection Act and submit it to parliament. The other would be to transfer the powers to issue ordinances as part of the Infection Protection Act from the states to the federal government.
CDU state governors would view a new law as an affront.
Back in the fall, when Merkel and some of her government ministers were already unhappy with the decisions made by the governors, they discussed whether the federal government should potentially take over more competencies in the fight against the pandemic by law. The chancellor balked at the move. According to sources close to her, she appreciates the coordination with the states because it ensures stability and acceptance.
The week before last, the state governors who are members of the CDU party made it clear to the chancellor that they would view a federal law as an affront. Rainer Haseloff, the governor of Saxony-Anhalt, countered the chancellor’s moves by holding up a graphic to the cameras at a press conference last Tuesday. It showed the average new cases of COVID-19 in Germany and France in recent months, with the French numbers showing a steep upward trend, while the German curve was relatively flat in comparison.
For Haseloff, it was proof that a country with federalist, state-centric structures can get through the crisis better than a centrally structured one like France.
Even Merkel’s otherwise loyal supporters are openly expressing their annoyance with her. Deputy CDU leader Volker Bouffier stressed last week that he would like to know just what Merkel intends to include in the federal law. He said he could “hardly fathom” how the variety of conceivable measures to combat the coronavirus could be included in it. And even if the chancellor were to succeed, he said, she still wouldn’t have much to gain. Because “at the end of the day,” the federal government doesn’t even have the administrative capabilities to implement the regulations at the local level. “It won’t work without the states,” Bouffier warned.
Bouffier, who is also the governor of Hesse, is a good example of the fact that governors of the 16 German states don’t really know themselves how to get out of this. They face demands on one side for strategies to further open public life and calls for a strict lockdown on the other. Bouffier says he is warned “every day” by intensive care physicians that the hospitals will soon be overflowing if more restrictive actions aren’t finally taken.
At the same time, he says, mayors, associations and the media are all pressuring him for intelligent solutions. “You have to come up with something other than always opening, closing, opening and closing,” he says they tell him.
Head-Scratching over Saarland
But the governors’ most recent ideas have been incompatible with the fundamental idea they had agreed to in a meeting with the chancellor: that the “emergency brake” would be pulled on the opening of public life if the seven-day rate of infection went above 100 people out of 100,000. And the plan by Saarland Governor Tobias Hans of Merkel’s CDU to declare his state a model project for reopening public life by relaxing the corona restrictions was met with incomprehension by other state governors.
Thuringia Governor Bodo Ramelow of the Left Party criticized the fact that Saarland was granted a special delivery of 80,000 doses of vaccine because it faced an purportedly acute danger because of its shared border with France. “Suddenly, the danger is gone and Saarland is a model region for the entire country,” he says. Ramelow says he could only shake his head at the idea.
Hans, on the other hand, argues that his pilot project, based on a model being implemented in Tübingen, is ultimately also a way of slowing the pandemic. Because the more you test, the more cases you discover. “People want to have prospects,” says Hans. This line of argumentation has also been used by Armin Laschet, the governor of North Rhine-Westphalia and national head of the CDU.
“We have never had a majority for loosening” the containment measures.
He argues that governors are in no way certain what “the people” want. Ramelow, who regularly consults the findings of several pollsters, reads from a recent analysis that the population is divided into two roughly equal camps: One considers the current measures to contain the spread of the coronavirus to be too strict and the other believes they are too lax.
“We have never had a majority for loosening” the containment measures, counters Wahlen, a polling institute which has been conducting surveys on the general mood in Germany since the very beginning of the pandemic. A digital survey by Civey for DER SPIEGEL provides an even clearer image. When asked, “Should Germany immediately return to a tougher lockdown?” just under two-thirds of respondents answered “yes.”
The first states have already reacted to the increasingly perilous situation. Hamburg imposed a curfew at night, and the governors of Bavaria and Baden-Württemberg – Söder of the CSU and Winfried Kretschmann of the Green Party – sent a strongly worded letter to their fellow governors. The situation, they wrote, is “serious, more serious than many believe.” They then followed up with an appeal: “That’s why we have to assume our responsibility now and not just continue discussing it.”
Yet despite all the determination and toughness Söder is seeking to project, he has already meekly scrapped his “Tübingen Plus” model, in which cities with average rates between 100 and 150 weekly infections per 100,000 residents can reopen public life in a controlled manner.
Even Saarland Governor Hans became increasingly unsure during the week whether his state-wide model trial might have to be “postponed” at short notice because of rising infection figures. North Rhine-Westphalia Governor Laschet also heralded an orderly retreat. “We are in quite a dramatic phase, and we have to do everything we can to get the infections down.”
A Time for Pilot Projects?
However, once Germany succeeds in flattening the third wave, the time will come for a loosening of containment measures. That’s the hopeful message of recent days. Depending on how early and resolutely politicians act, new model projects for a cautious relaxing of restrictions could start as early as the end of April.
In Germany, the university town of Tübingen has been a pioneer in attempts to implement mass testing to restore public life. Since March, local residents and visitors who undergo a COVID rapid test and receive a negative result are issued a “day pass,” which allows them to shop in the city center and go to cafés and restaurants. Many people have taken advantage of the offer. The question now is whether or not the approach will drive up infections in the city.
“Tests can be an important contribution to controlling the pandemic, but they are in no way sufficient on their own,” says Gerd Fätkenheuer, a professor for infectious diseases in Cologne. He says testing strategies are more effective the lower the number of infections there are. “That’s why our primary goal now needs to be reducing the number of cases by means of contact-limitation measures,” says Fätkenheuer. “If you can get (average infections per week per 100,000 residents) down to 35 or 50, then it might work to control the number of cases with the help of tests.”
But he adds that this is only promising if testing is systemically and comprehensively carried out at schools and companies. The scientist says the hope that you can reduce the number of cases by means of tests is “baloney.”
Still, that hasn’t stopped politicians from flooding the country with model projects amid the third wave. In the city of Weimar, for example, shops opened up last week for three days for people who could produce a negative coronavirus test from the same day – a move that wasn’t accompanied by any scientific measurement of its efficacy. The municipal administration in the town of Villingen-Schwenningen in the state of Baden-Württemberg says it wants to open all “possible” areas for people who have submitted to tests. Volunteers would collect the scientific data. North Rhine-Westphalia has already included a provision in its state corona ordinance that would make shopping possible for people with a negative result.
Austria has taken a more systematic approach. There, mass tests for the coronavirus have been conducted in recent months in huge field tests. School children have been tested on a regular basis in the country since the beginning of February. Vienna now offers four high-quality PCR corona tests a week, free of charge, to the city’s 1.9 million inhabitants.
The PCR test project is to be expanded to the rest of Austria in the future. Niki Popper, a mathematician and simulation researcher at the Vienna University of Technology, has been conducting a scientific study of the field tests. “Our model works,” he says, “but only up to a point.” He says that testing is one factor that has clearly helped slow the increase in cases. The country is nevertheless facing new measures for containing the disease.
“The virus can’t just be tested away,” says Michael Wagner of the University of Vienna, the scientific coordinator of an Austria-wide school study. This is also because the rapid antigen tests still don’t deliver results that are good enough. According to a review by Cochrane — a network of researchers, which reviewed and evaluated all the important studies available on the subject — the tests fail to detect an average of 40 percent of people who are infected but asymptomatic.
Sobering Data from Austria
Pooled PCR tests, meanwhile, have proven to be much more accurate. They are particularly well-suited to schools and daycare centers. Before meeting in the classroom or group rooms, children can gargle and spit into a collection container. If the virus is detected in a pooled test, then the pupils in that pool are then given a second test individually. These tests have already been used on a trial basis at a few schools in Bavaria.
But the sobering data from Austria shows that even regular testing can only really serve as a complementary measure. Despite the mass testing of pupils, the infection rate there increased massively in the age groups between 5 and 14; and in states like Vienna or Burgenland, the average infection rate reached over 400 per 100,000. Meanwhile, Wagner, the microbiologist, was able to compare the antigen test data with data from a school study to determine how many infected children can be tracked using this test strategy – “one-fifth of the elementary school children and a quarter of those in the higher grades,” he estimates.
The situation in workplaces is equally murky. Coronavirus tests are supposed to be deployed there to interrupt chains of infection as early as possible, but no one has any reliable estimate of how many companies are already offering these tests to their employees.
Small- and medium-sized businesses are having trouble just sourcing enough tests for their workers. Meanwhile, larger companies are facing logistical problems. At major industrial corporations like Volkswagen, several thousand employees start work at the same time when they change shifts in a single plant.
German Labor Minister Hubertus Heil of the SPD recently commissioned a survey to determine the current situation with corona tests at companies. The first findings are expected this week. “If it turns out the week after Easter that there isn’t enough testing happening in the working world, then we will make it legally binding,” Heil has announced.
“It is realistic that all adults who want to get vaccinated will be able to get a shot by the end of July.”
Ultimately, all the test strategies and pilot projects are intended to get us through to the point where the vaccination campaign starts to have an effect. Uğur Şahin, the CEO of German vaccine maker BioNTech, estimates that enough people will have been vaccinated by early June to noticeably stem the virus. This week, around 3 million vaccine doses are to be delivered, and by the end of the month, more than 6 million doses. From mid-May onward, over 7 million doses a week are expected.
“It is realistic that all adults who want to get vaccinated will be able to get a shot by the end of July,” says Sebastian Dullien, research director at the Macroeconomic Policy Institute at the Hans Böckler Foundation. He has done a comparison of the demand for vaccine and the expected delivery of doses.
“I was surprised myself by how much vaccine there is supposed to be,” says Dullien. Deliveries of the Germans’ preferred vaccine, BioNTech, are on track to increase especially dramatically in the second quarter. Deliveries are expected to swell from just under 1.1 million doses recently to more than 5 million doses a week.
Mathematically, It’s Possible without AstraZeneca
A total of almost 95 million vaccine doses are needed for the presumed 52 million people in Germany who are willing to get vaccinated. According to Dullien’s calculations, more than 107 million doses should arrive by the beginning of July, even if the vaccine from Curevac hasn’t been approved by then. He expects more than 140 million doses by the end of that month.
“In purely mathematical terms, you could achieve the goal by the end of July without any further use of the AstraZeneca vaccine,” says Dullien, provided that the other manufacturers deliver as announced, particularly BioNTech.
The European Commission sounds similarly optimistic at the moment. Following considerable criticism in recent months about its procurement of vaccines, the EU executive body now seems to be building up momentum with the vaccination campaign.
According to Thierry Breton, the EU’s commissioner for the internal market, 100 million doses of vaccine are expected each month between April and June. The French national says that, “by mid-July, it will be 420 million.” That’s enough to vaccinate 70 percent of the adult EU population, he says.
There are now 53 factories in 12 EU countries involved in vaccine production, says the Frenchman, who has headed a task force to speed up vaccine production since February. A company has also been found in Barcelona, Spain, to fill doses of Johnson & Johnson’s vaccine, which was recently approved for use in the EU.
If vaccination centers and doctors can keep up with the deliveries, there are reasonable hopes that people will be able to enjoy their summer. A research team led by Viola Priesemann of the Max Planck Institute for Dynamics and Self-Organization in Göttingen has modeled how far the vaccination campaign can go in terms of stemming the virus. Their conclusion: If vaccinations are carried according to plan, there may be permanent relaxations of the restrictions in early summer – without the infection rates soaring again.