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OPINION AND ANALYSIS

ANALYSIS: When will Germany relax its Covid restrictions?

As neighbouring countries let their restrictions fall away, the message from the Germans has been all about holding a steady course. But with calls for a reopening of public life growing louder, could we start to see a relaxation of rules in the coming weeks?

A Covid sign in Rosenheim, Bavaria
A sign in Rosenheim, Bavaria, tells customers: "Everyone's allowed to come in! No 2G anymore!" Photo: picture alliance/dpa | Peter Kneffel

When reading about Germany’s Covid rules these days, there’s no word you are more likely to hear than ‘Vorsicht’. Translated in its actual sense, it means something akin to caution, care or precaution. Taken more literally, the combination of ‘before’ (vor) and ‘sight’ (Sicht) almost sound like the English for foresight: attempting to see into the future. 

This combination of meanings says a lot about the current approach to the pandemic in Germany. With Omicron representing something of an unknown quantity, politicians and their scientific advisors have been trying to read the runes to see what may come next. When will we reach the peak of this wave? How bad will it be? And perhaps most pressingly: when can we see a return to normal life?

Over the past few weeks, calls from opposition MPs and other high-profile figures for a reopening strategy have been growing louder. Those who are worried about the economic impact of Covid rules feel emboldened by tales of a return to pre-Covid life in Denmark, Sweden and the UK. This month, France and Switzerland also look set to ease a number of rules and restrictions. So why, the critics ask, does the German government keep insisting on Vorsicht

READ ALSO: German politicians spar over Covid exit strategy

Where we are right now

As of Friday, the latest data recorded by the Robert Koch Institute (RKI) showed a 7-day incidence of 1,350 infections per 100,000 people countrywide. 

Infection rates have been breaking records on a daily basis, and Friday’s figure was once again the highest 7-day incidence so far in the pandemic. More than a million people were reported as having caught Covid this week – including almost 250,000 within the last 24 hour period alone.

These figures may be alarming, but with around three quarters of the population fully vaccinated, they are no longer central to the debate about easing restrictions.

Instead, political figures are primarily looking at two other statistics: firstly, the number of deaths and secondly, the number of people need hospital treatment or ending up on an intensive care ward. 

As the milder but more transmissible Omicron variant has taken over from Delta, experts have noted infections rising while hospitalisations and deaths remain steady. According to the RKI, this is partly to do with demographics: Omicron has overwhelmingly been contracted by the under-50 age group who are less likely to have a severe course of illness and who are mostly fully vaccinated. The Omicron variant is also less likely to result in hospitalisation and death, experts say.

All of this means that Germany is currently seeing a hospitalisation rate of 5.45 per 100,000 people, though this rises to 9.3 for the over-60s age group. According to the RKI, people over 80 and unvaccinated people are at a much higher risk of being hospitalised with Covid. 

As of Thursday, there were 2,262 patients in intensive care wards. Covid patients are currently occupying about 10 percent of intensive care beds, which is generally seen as manageable. On Friday, there had been 170 Covid-related deaths in the past 24 hours. 

Though the government’s worst fears for the healthcare sector haven’t been realised, the RKI says there’s still a chance this could happen if cases continue to rise exponentially. 

“Due to the further rapid increase in the number of infections, an overload of the health system and possibly other areas of care cannot yet be ruled out,” the public health authority wrote in its latest weekly report.

“The risk of infection is considered to be very high for the group of unvaccinated persons, high for the groups of recovered persons and vaccinated persons with basic immunisation (two vaccinations), and high for the group of vaccinated persons with basic immunisation (two vaccinations).” 

For the 54 percent of the population who’ve had a booster jab, the risk is “moderate”, they say. 

READ ALSO: OPINION: Germany is stuck in Covid Groundhog Day – it’s time to move on

Who’s calling for a reopening? 

One of the most high-profile voices calling for an easing of restrictions in CSU leader and Bavarian state premier Markus Söder. On Thursday, he set out a staged plan that included relaxing rules for entry to shops and hospitality businesses. Decisions on potential “opening steps” needed to be taken now, he argued.

Söder’s words were echoed by CSU parliamentary leader Alexander Dobrindt in a recent interview with Welt.

“We still need measures like the mask requirement,” he said. “But we have to present a perspective to reduce the restrictions of daily life bit by bit – in trade, in gastronomy, in culture, sports, leisure.” 

Alongside politicians from the opposition benches, Bremen’s SPD mayor has also called on the government to present a plan.

Markus Söder (CSU)

Bavarian state premier Markus Söder has spoken out in favour of a reopening plan. Photo: picture alliance/dpa | Bernd von Jutrczenka

“Since we have a stable situation in the hospitals at the moment, I think it is the right time to discuss relaxations – not yet to implement them,”  Andreas Bovenschulte argued. 

Over the past few weeks, some states have already started to ease restrictions. Alongside Bavaria and Baden-Württemberg, Lower Saxony and Saarland have opted to scrap the ‘2G’ (vaccinated and recovered only) rule in non-essential shops. The two southern states have also gone further by loosening restrictions on public gatherings and largely getting rid of the obligation to have a test or booster jab to go to bars, restaurants and cafes. 

Now, other states include Mecklenburg Western-Pomerania, Saxony-Anhalt and Schleswig-Holstein look set to follow and are likely to ease restrictions on shoppers in the coming days and weeks. 

READ ALSO: 

And who’s against it? 

Much of the scientific community has been cautioning the government not to rush into a relaxation of rules. This includes virologist Christian Drosten, who sits on the government’s panel of Covid experts.

In a recent NRD, Drosten argued that Germany couldn’t be compared to a country like Denmark due to factors like the ageing population and gaps in vaccination coverage. 

“One thing that has not changed is the vaccination gap,” he said. “The vaccination rate in Germany has even fallen again recently.”

This could expose the relatively large group of unvaccinated over-60s vulnerable to severe courses of illness, he said.

Berlin virologist Christian Drosten, Health Minister Karl Lauterbach (SPD) and RKI chief Lothar Wieler appear a press conference on January 14th. The scientific community has called for caution in reopening society. Photo: picture alliance/dpa | Kay Nietfeld

Meanwhile, the President of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Gernot Marx, warned that the rule changes introduced by some of the states had come too soon.

Speaking to the Funke Media Group, Marx said the current measures had led to the fact that the Omicron wave in Germany was developing more slowly and hadn’t overburdened the healthcare system. This success should not be put at risk, he argued.

He said it was reasonable for politicians to carefully start considering how they could reopen society. 

“However, concrete relaxations must not be decided until the peak of the Omicron wave is behind us,” he said. The DIVI president said he feared that easing the restrictions too quickly could lead to a “rollercoaster ride with a renewed rise in infection figures” and a wave of new patients in intensive care.

Experts are also concerned about the emergence of a new Omicron sub-type which is spreading in countries such as Denmark and the UK and could be even more infectious than Omicron.

Aren’t restrictions meant to be ending in March?

That’s right. Three months is certainly a very long time in a pandemic, but people with good memories may remember a promise the government made last November.

Rather than extending the so-called epidemic situation of national importance, the incoming government transferred key Covid measures such as mask-wearing and entry rules over to the Infection Protection Act. This piece of legislation has an expiry date of March 19th and at the time, politicians promised that this date would mark the end of Covid restrictions “at the latest”.

READ ALSO: Germany could end Covid pandemic rules in March 2022

However, that was before Omicron came on the scene in Europe and prompted a wave with the highest infection rates yet. Since then, the government has played down expectations of a UK-style ‘Freedom Day’ and batted away claims that this is a final date for the easing of restrictions.

“In the next few weeks we will take a calm look at whether an extension of the corona protection measures beyond March 19th is necessary at all,” Johannes Fechner, parliamentary director of the SPD parliamentary group, told Welt. “If we actually see a drop in the Omicron variant in mid-February, the question is whether we even need these restrictions in the spring and summer months.”

He said the most likely thing was that the government would only discuss Covid measures with regard to next autumn or winter, when infections could start to rise again. 

But legal experts and members of the Green Party have argued that restrictions such as masks will have to remain in place.

“It is by no means the case that a kind of Freedom Day will be proclaimed with the expiry of the fixed deadline for measures under section 28a of the Infection Protection Act,” constitutional lawyer Steffen Augsberg from the University of Gießen told Welt

March and April: a possible timeline 

Much like neighbouring Switzerland, there are signs that the current government may be keen to consider an easing of Covid restrictions once we’re past the peak of the current wave. Once this high-point of daily infections has been reached, many believe we’ll have a good sense of the worst-case scenario in terms of hospitalisations and deaths and can slowly start to relax the rules.

The next meeting of the federal and state governments is due on February 16th. According to the RKI and Health Minister Karl Lauterbach (SPD), this could coincide with the height of the Omicron fifth wave. 

Speaking on ARD’s Tagesthemen, Justice Minister Marco Buschmann (FDP) suggested this meeting would present a good opportunity to discuss a staged reopening process. However, politicians should start considering a potential timeline now, he said. 

“I think we need to get out of this mode of improvisation, of muddling through, of spontaneous decisions at midnight,” said Buschmann. He said it was questionable whether Germany would be at the point of reopening when it had reached the peak of the wave in mid-February. 

“However, I think we should now begin the preparation work and look at which measures can be lifted in which order,” he explained.

Justice Minister Marco Buschmann (FDP)

Justice Minister Marco Buschmann (FDP) gives an interview to DPA on February 3rd. Photo: picture alliance/dpa | Michael Kappeler

But while the pro-business FDP are sounding increasingly bullish, its coalition partners – the SPD and Greens – have tended to strike a more cautious tone. 

“We will not be able to do without certain measures such as compulsory masks or a reduction in contacts now,” Greens parliamentary group leader Britta Haßelmann told Welt. 

Nevertheless, as Buschmann pointed out in his ARD interview, the March 19th deadline puts pressure on the government to reach a decision. In early March at the latest, officials will need to start considering whether they want to extend pandemic measures beyond this point, simply let them lapse or (most likely) take a gradual approach to phasing out the current restrictions.

This could mean that some of the more intrusive restrictions like 2G-plus and 2G could soon fall away, while lower-impact measures like mask-wearing in indoor spaces remain in place.

The cautious Christian Drosten, meanwhile, has set his sights on the Easter holidays for a potential relaxation of the situation. 

“We clearly have the evidence that the transmissions are being fed by school operations at the moment – but the Easter holidays will put a stop to that at the latest,” he told NDR. “In addition, it will be warmer after Easter and the incidence will probably not pick up as much.”

With Vorsicht the motto of the day, one thing’s clear: the government won’t be relying solely on predictions to reopen public life. Instead, they’ll be watching the data and trends to see whether falling hospitalisations and deaths can justify it. 

And if the scientists are to be believed, none of that could happen for a number of weeks. 

READ ALSO: ANALYSIS: Are Germany’s Covid rule changes backed up by science?

Member comments

  1. They are taking too long. There’s no caution involved there’s just guesswork and I thinks. How have these panels of unelected fear mongers gained so much influence. I want to see them named and held accountable for the damage their guesswork has done.
    I bet none of them have missed a single paycheck since this all began. I want them in court explaining their actions.

    These last 3 months we have seen more and more evidence that show these restrictions don’t work. They haven’t worked for 2 years.we know whats going to happen. They will take so long to open up the numbers will creep up again. They will use that as an excuse to tighten the restrictions again. And it’ll be 2G+×4 .

    But I think there’s something shady going on and do not expect relaxing of the rules for part or all of society until the vaccine mandate is in force. Someone is making bank from this

    1. For me it’s simple:

      * politicians will NOT admit wrong. They know restrictions have outlived their usefulness, they know we know, but they will never admit it. Otherwise they open themselves to legal issues or worse.

      * The so called “experts” (the unelected fear mongers you correctly point at) do NOT want this to end. They relish the attention, cameras and power. They will NEVER give this up voluntarily.

      * Denmark etc are showing the way forward. It will be VERY difficult to justify measures in Germany when the Danes are living a completely normal life. Truth and sanity will prevail but it may take longer than we would like

      1. Agree, it’s about power and control. No exit ramps to end restrictions because officials don’t want to let go. If not COVID, then they’ll justify the measures for some other reason.

        Hard to put the genie back in the bottle after it’s released.

  2. That is my fear, they spent all this money developing an app and don’t want give up the power, why else would they be talking about the pass expiring. As more and more countries open this will pressure the government to finally open up.

    Oh and for the unvaxed knowing the end is nigh will give them hope if they just hold on life will soon return to normal, at least till cross international borders.

    1. I just feel we will be stuck in this kind of loop forever. Promised the next harsher step will be closer to freedom returned.

      I think now with international travel. I will take into account how free a country is. IE. The way it treats its citizens.
      Australia, Austria, France and italy are all not for holiday locations anymore and the list is ever growing.

  3. The EU, under Van der Leyen, have purchased enough vaccines doses to inject every many woman and child ten times. Commission President Van der Leyen is under investigation for refusing to reveal her SMS’s with the boss of Pfizer. We are in for some pretty shocking revelations, I fear, before this is all finished.

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For members

OPINION AND ANALYSIS

OPINION: Why it’s becoming harder to get a doctor’s appointment in Germany

Germany's health service is known as one of the best in the world but securing a timely appointment with a doctor is getting harder. A creaking system and the culture around excessive doctor visits are part of the problem, argues Brian Melican.

OPINION: Why it's becoming harder to get a doctor's appointment in Germany

Germans have always been known for being health-conscious – some would even say hypochondriacs. That has its down-sides (see Covid…), but also some notable advantages. One is the ability to go to any doctor’s practice and request treatment, skipping general practitioners, referrals, and all of the attendant bother.

As a result, in any well-to-do area of a major German city, you’ll have a bewildering array of medical practitioners within walking distance, from general physicians (Allgemeinmedizin) and orthopaedic practices (Orthopädie) to ones that will have you Googling (HNO stands for Hals-Nase-Ohren – ears, nose, and throat – by the way. You’re welcome.)

The strength of this patient-choice system is that it allows people to manage their own care. So if one doctor can’t see you, you go and find another. And if you’ve moved towns or fall ill away from home, you can still access care. In theory, this spreads demand and keeps people with non-urgent complaints out of casualty wards. Yet in practice, the system is now creaking audibly. 

In recent months, I’ve tried to get appointments for several routine procedures with doctors’ offices I have been visiting for years – and the earliest I could get anything was, to my surprise, now several months off. Both dentists and dermatologists are currently, it would seem, planning their schedules for September and October. And when a rather unpleasant case of shoulder pain struck earlier this year (fittingly, just ahead of my 39th birthday…), the earliest appointment I could get at any of the three(!) local orthopaedic practices was at least a month off.

This isn’t just me getting unlucky here. In a recent representative survey, only 25 percent of respondents reported having no trouble getting a doctor’s appointment. The rest are having to wait anything between two weeks and two months – and I’m clearly now one of the 15 percent who report even longer delays. 

I’m not alone in thinking – knowing – that it didn’t used to be this way. So what has gone wrong? 

READ ALSO: Seven things to know about visiting a doctor in Germany

Structural changes in medical practice: fewer doctors working fewer hours

First off, there are changes afoot among Germany’s niedergelassene Ärzte – literally ‘settled doctors’ with surgeries, called so in order to distinguish them from hospital medics. For one, these doctors are getting old and retiring – just like the population they serve (or rather: have served). And as younger cohorts are less numerous, physicians looking to pass on their practices are having difficulty finding takers – especially in disadvantaged urban areas or out in the sticks.

A patient undergoes a consultation with his doctor.

A patient undergoes a consultation with his doctor. Photo: picture alliance/dpa/AbbVie Deutschland GmbH & Co. KG | AbbVie Deutschland GmbH & Co. KG

Even where there is no shortage of potential successors, ever fewer of them actually want to set up in business for themselves. For most young medics’ taste, there’s too much paperwork, too much commercial risk, and far too much work involved in running their own surgery. Instead, they prefer to merge with others or sell on to management companies who will, in turn, employ them (often part-time, with no annoying evenings or weekends on call). 

The results of all of this are as follows. Within the space of just one year, between 2022 and 2023, the number of surgeries fell by 1,987 – a drop of over two percent. Meanwhile, in 2023, for the first time ever, more than one third of Germany’s 150,000 non-hospital doctors were employees, not self-employed. That’s twice the number in 2013. Moreover, over the same period, the number of medics opting to go part-time has gone up by 235 percent to 60,000. This means that, if your local surgeries haven’t closed, the likelihood is that the doctors there are now working fewer hours – and so there are fewer appointments left to go round.

READ ALSO: Do doctors in Germany have too little time for their patients?

This would be bad news for any society, but it hits particularly hard in Germany. As a rapidly-ageing society with a relatively unhealthy population (high rates of smoking and obesity), our demand for medical services – often for complex chronic illnesses – is rising just as provision is declining.

Cultural differences in consulting doctors

Another problem is that Germans are accustomed to a historically high number of available doctors – and as serial worriers (and passionate sick-note seekers) make excessive use of them. Your average German racks up almost 10 consultations a year – not including visits to the dentists! The OECD average is closer to six. And the stoic Swedes, strong silent types that they are, go the doctor’s just 2.3 times a year.

Even if I wanted (or needed) to, I simply couldn’t to get to the quack’s almost once a month: I don’t have the time and they don’t have the appointments. But in conversation, I notice that others clearly do manage to find both. Increasingly, I’m wondering how many of them, unlike me, have private health insurance. 

This brings us to the third major issue facing non-hospital care in Germany. When the figures in the representative survey I quoted above are broken down, it transpires that almost 60 percent of people who are insured in the state system (gesetzlich versichert) are now waiting longer than two weeks for an appointment; among those who are privately insured (privat versichert), that figure is only 37 percent.

Doctors ‘keen on private patients’ 

Doctors are keen on private patients because their insurers pay more for the same procedures and will also cover all sorts of supplementary stuff – from the clinically-proven through to the just plain wacky. As such, practices reserve as many appointments as possible for private patients and try to keep the rest of us at bay.

Given that around four in five people in Germany are in the state system, however, this leaves the majority of patients competing for the minority of slots. If you want to see how the other fifth live, try “accidentally” clicking privat on surgeries’ online booking tools: you will now see a range of appointments available within days while the rest of us are being fobbed off for weeks or even months.

Not only is this, as my grandmother used to say, enough to make you want to join the Communist Party – it’s wildly inefficient. By restricting the hoi-polloi to slots often months off, doctors are creating their own appointment-management problems: sometimes, the complaint in question will have disappeared by the time the consultation rolls around; more often, it will have actually been dealt with – not infrequently by the same physician – if the patient presents as an acute case earlier.

As such, slots weeks away are booked, only to be cancelled later by conscientious patients (and left blocked by others), while those same patients crowd into waiting rooms begging to be seen urgently at an open surgery. (That’s how I got my shoulder looked at.)

A German health insurance card.

A German health insurance card. Photo: picture alliance/dpa | Jens Kalaene

The cynic in me says that, in the long run, this might not be such a bad thing. If the increasing scarcity of doctor’s appointments gets Germans thinking about whether they really, really need to be seen for yet another case of the common cold (“No, Christian, it isn’t pneumonia this time, either!”) or various nebulous self-diagnosed ills (Kreislaufbeschwerden (circulatory problems) is the day-off-work-one I love to hate), maybe it’s not a bad thing.

Swedes don’t die unnecessarily because they avoid the doctor’s: in fact, they live a good year longer than us on average. The German in me, though, says: “My shoulder hurts. Maybe I’ve got early-onset arthritis. I should probably go and get it checked out…” And even though I don’t go too often, I’ve got used to being able to see a specialist when I need one. It’s a shame that this is becoming markedly more difficult.

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