COVID-19 pandemic in Germany

The COVID-19 pandemic in Germany occurs as a regional sub-happening of the global outbreak of the infectious disease COVID-19, which particularly affects the respiratory tract, and is based on infections with the SARS-CoV-2 virus from the coronavirus family, which emerged at the end of 2019. The COVID-19 pandemic has been spreading from China since December 2019.

In Germany, the first case of infection was reported on January 27, 2020, and since then three waves of infection have been observed based on positive virus detections. During both the first (March-April 2020) and second (October 2020-January 2021) waves of infection, the highest age groups were disproportionately affected by infection, resulting in high numbers of deaths. Beginning in February 2021, the numbers of newly positive SARS-CoV-2 detections increased again through the end of April, and the 7-day incidence increased accordingly. However, this third wave of infection predominantly affected age groups younger than 65 years. The age groups with the highest lethality were increasingly immunized by the vaccinations that have been possible since the end of December 2020, resulting in significantly fewer deaths over 80 years of age than during the second wave. From mid-March to the end of April 2021, the number of intensive care beds occupied by COVID patients increased once again, due to the longer length of stay in hospital for younger patients; since then, it has been falling again. According to the Robert Koch Institute (RKI), variant B.1.1.7 has been the predominant variant of SARS-CoV-2 in Germany since March 2021, and variants B.1.351, P.1, and B.1.617 are also considered "of concern."

As of June 26, 2021, 0:00 AM, the RKI reports 3,726,172 laboratory-confirmed SARS-CoV-2 detection cases, including 90,746 deaths, and estimates that approximately 3,618,400 people have recovered.

On the basis of infection figures, further data and simulation studies, scientists are analyzing the risk situation and the effectiveness of measures to contain the pandemic. On February 28, 2020, the RKI initially assessed the risk to the population in Germany as "low to moderate," and from March 2020, initially for risk groups and later for the entire population, as "very high." On June 1, 2021, the risk assessment was changed back to "high." Numerous scientific societies, academies and advisory bodies submitted expert reports and recommendations and thus provided information on how to deal with the pandemic, including the National Academy of Sciences with a total of eight ad hoc statements on how to deal with the pandemic.

On March 25, 2020, the Bundestag declared an "epidemic situation of national scope." On March 27, 2020, the Law for the Protection of the Population in the Event of an Epidemic Situation of National Significance entered into force, which was subsequently amended and concretized on November 18, 2020. To contain the pandemic, the federal and state governments adopted broad restrictions on public life in mid-March 2020, as did many other countries around the world at the same time. Since early May, some restrictions have been gradually lifted. Due to rising positive Corona test numbers, contact restrictions and other pandemic control measures were tightened again in October and November 2020. Significant restrictions on public life in the form of a so-called lockdown have been in place again since mid-December. Measures in the health system aim to maintain sufficient capacity to treat COVID-19 patients and test suspected cases while ensuring infection protection for patients and staff. The public was urged to minimize their risk of infection by adhering to AHA rules (distance, hygiene, everyday masks) and other precautionary measures, while also containing the spread of the virus. In the fall of 2020, the rules were supplemented by a call for regular ventilation and use of the Corona warning app.

The pandemic and the associated health protection measures had and continue to have significant economic and social consequences. As part of the 2020 economic crisis, the second quarter of 2020 saw the sharpest quarter-on-quarter drop in gross domestic product since calculations began in 1970. Families were burdened by school and childcare closures. Workers faced widespread changes in their workday, such as home office telecommuting. In addition, the pandemic had numerous other consequences in a wide variety of areas of life. Many measures are the subject of legal controversy. There were also a number of controversies in politics and among the public about the appropriate responses to the pandemic.

On Pentecost Sunday, May 23, 2021, the seven-day incidence of new COVID infections was again below 100 in all 16 states for the first time, and below 50 in five states: Schleswig-Holstein (30), Hamburg (35), Mecklenburg-Western Pomerania (40), Lower Saxony (45), Brandenburg (47). About 13.6% of all people had received two vaccinations by that date, and another 26% to 27% had received a first vaccination. By May 29, 2021, all states were already below 50. The nationwide incidence was 35.2, the lowest since mid-October 2020.

Chronicle of the spread

In Germany, the first individual cases of the disease occurred in Bavaria at the end of January 2020. These cases were successfully isolated, so that initially no further spread occurred. During the carnival at the end of February 2020, new infections were detected in the Heinsberg district (North Rhine-Westphalia) and in the Göppingen district (Baden-Württemberg). In the following weeks, the SARS-CoV-2 coronavirus spread throughout Germany by the end of March.

During the contact restrictions introduced in the meantime, the number of newly known cases of infection fell significantly from mid-April 2020 and was at a comparatively low level for a time. In mid-June, this development was temporarily interrupted by a series of local outbreaks, in particular the outbreak at the Tönnies parent plant with over 1,500 infected persons. In the course of October 2020, infection figures rose again across the board, in some cases pushing public health departments to the limits of their capacity for contact tracing. In November, the infection figures rose to over 20,000 new infections per day in some cases. On November 27, 2020, the mark of one million infections was exceeded in Germany. On January 15, 2021, the total number of people infected with coronavirus reached the two million mark. During the "lockdown", case numbers then declined again; however, from mid-February onwards, the decline stagnated.

Some of the new variants of the virus, such as the British mutation B.1.1.7, have been found to be more easily transmitted, and there are also fears that the disease will be more severe. Since December 2020, infections with these virus variants have also been detected in Germany. The proportion of mutations increased rapidly in February 2021, so that a phase of exponential increase ("third Corona wave") was again feared if the previous environmental conditions and transmission routes continued. In the following weeks, the Germany-wide 7-day incidence regularly rose above 100 again; on April 12, 2021, the total number of people infected with the virus exceeded three million. At the end of April, a peak in 7-day incidence was reached in the "third Corona wave," with the value exceeding 160 for several days.

In May 2021, the number of cases decreased, so that the Germany-wide 7-day incidence was again below the value of 100 as of May 14. On May 26, 2021, this value was below 50 for the first time since October 20, 2020. On May 30, for the first time this year, all German states recorded an incidence below 50. On June 8, 2021, for the first time in 2021 in Germany, two counties, namely the counties of Friesland and Goslar in Lower Saxony, did not have to report any new SARS-CoV-2 infections to the Robert Koch Institute for seven consecutive days. Most recently, both counties had an incidence of 0 in August 2020.

Reactions and forecasts in science

Scientists and research institutions in Germany have made and continue to make significant contributions to research on the SARS-CoV-2 virus and to the understanding and treatment of COVID-19 disease. Research involving the SARS-CoV-2 virus, COVID-19 disease, and vaccine development can be found in the corresponding articles. This section presents research on pandemic development and containment in Germany.

Assessment of the hazard situation

Between January and March 2020, the assessments of the risk situation changed several times. The Robert Koch Institute assessed the risk for the population in Germany as "low to moderate" on February 28, 2020, as "high" since March 17, and as "very high" for risk groups since March 26. While there was still considerable uncertainty about the pandemic's dangerousness and speed of spread in March 2020, the state of knowledge has gradually improved since then - without all questions being conclusively clarified.

Current risk assessment of the Robert Koch Institute, as of May 26, 2021, updated on June 1, 2021.

This is a serious situation worldwide, in Europe and in Germany. Overall, the number of cases is decreasing worldwide, but case numbers are developing differently from state to state: after a temporary decline, some states are experiencing a third or fourth increase in case numbers, while in other states case numbers are currently declining. In many states, vaccination of the population began around the turn of the year. In most cases, the older age groups were vaccinated first, but other groups are now being included in many places. The aim of efforts in Germany is to achieve a sustained decline in the number of cases, especially serious illnesses and deaths. Only if the number of newly infected people falls significantly overall and the number of vaccinated people rises can many people, not only from the risk groups such as older people and people with underlying diseases, be reliably protected from severe courses of the disease, the need for intensive medical treatment and death. After an increase in cases in Q1 2021, 7-day incidences and case numbers nationwide have declined significantly since the end of April. The decline affects all age groups. COVID-19 case rates in ICUs increased significantly from mid-March 2021, but have been declining since late April. Severe COVID-19 diseases requiring hospital treatment increasingly affect people under 60 years of age. In most circles, it is still a diffuse occurrence, so that often no specific source of infection can be identified and one must assume a continuing circulation in the population (community transmission). Therefore, in addition to case finding and contact tracing, individual infection hygiene protective measures continue to be of paramount importance (contact reduction, AHA + L, and staying home when symptoms of illness are present). Accumulations are observed primarily in private households, in daycare centers and schools, and in the professional environment, including contacts among the workforce. The number of COVID-19-related outbreaks in nursing homes and hospitals has decreased significantly, particularly due to progressive vaccination coverage. Vaccination of the population is essential for reducing new infections, protecting at-risk groups, and minimizing severe disease. Effective and safe vaccines have been licensed since the end of 2020. As they are not yet available in sufficient quantities for the entire population, vaccine doses are currently offered as a priority to the most vulnerable and prioritized groups. Treatment of severe disease is complex and only a few therapeutic approaches have been shown to be effective in clinical trials. The dynamics of the spread of some variants of SARS-CoV-2 (currently B.1.1.7, B.1.351, P1 and B.1.617) are of concern. These variants of concern (VOCs) are also detected to varying degrees in Germany. Overall, variant B.1.1.7 is now the predominant COVID-19 pathogen in Germany. Based on available data regarding increased variant transmissibility and potentially more severe disease courses, this may contribute to a rapid increase in case numbers and worsening of the situation. According to current knowledge, all vaccines currently available in Germany protect against disease caused by variant B.1.1.7, which is mainly circulating in Germany. The Robert Koch Institute continues to assess the risk to the health of the population in Germany as a whole as high. This assessment may change in the short term as a result of new findings.

Science communication and publishing

The COVID-19 pandemic led to an enormous acceleration of scientific publishing and science communication. At the beginning, science, politics and the public were simultaneously faced with the challenge of quickly building up knowledge, classifying it, but also acting and reacting quickly. Scientific policy advice, which is also common in everyday life, attracted considerable public attention in this situation. In addition to direct advice to governments by individual scientists and research institutes, major scientific institutions such as the National Academy of Sciences published recommendations and position papers on current issues. At the same time, scientists such as Christian Drosten and Alexander S. Kekulé presented new scientific findings to the public in podcasts.

Christian Drosten's podcast in particular was widely praised for also making the uncertainty of scientific knowledge transparent and for being willing to self-correct. In 2020, the Science Barometer found that the public had a higher level of trust in science than in previous years. In January 2021, the Council of Science and Humanities came to the conclusion that those with political responsibility had shown a willingness "to take scientific findings, forecasts and scenarios into account as central arguments in their decision-making more clearly and visibly than is usually the case." At the same time, parts of the population were decidedly critical of science. Protest movements built up a "counter-knowledge" based on a fundamental distrust of political, scientific and media elites, as well as on emotional arguments and conspiracist insinuations.

See also: #Dealing with dissenting views

In order to make research results available quickly, a very large number of publications have been published on so-called preprint servers since the beginning of the pandemic. Publications in specialist journals are also sometimes made available as commentaries or reports, i.e. without the usual path of peer review, as this typically takes several months. Many scientists, such as the director of the Cochrane Center Germany, Jörg Meerpohl, see it as problematic that some of these studies are classified in the media or even by other scientists as decisive scientific findings, although the uncertainties have not yet been sufficiently taken into account.

Expert opinions and recommendations

Numerous scientific societies, academies, and advisory bodies submitted expert reports and recommendations on various aspects of the pandemic in Germany.

The National Academy of Sciences published a total of eight ad hoc statements on dealing with the pandemic. The statements were acknowledged as important contributions to the science-based handling of a situation that was completely new for politics and the public. However, the public also questioned the scientific quality of some of the Leopoldina's recommendations and accused the Academy of Sciences of being too close to politics and the German government.

Data collection and data development

As early as the end of March and beginning of April 2020, numerous scientists pointed out that looking at case numbers alone was not sufficient to assess the pandemic. These included the German Network for Evidence-Based Medicine as well as statistical experts from various scientific fields. They called, as did the National Academy of Sciences on April 13, 2020, for the symptom-based tests to be supplemented by random sampling of the entire population, because this was the only way to estimate the entire incidence of infection, including the number of unreported cases. Since April 2020, numerous studies have been initiated to investigate the presence of antibodies to SARS-CoV-2 in various populations ("seroepidemiologic studies"). Seroepidemiologic studies show how many individuals have experienced SARS-CoV-2 infection and thus allow retrospective estimates of the prevalence of COVID-19 in the population, including unreported cases. However, they do not provide daily case numbers.

→ For results of the studies, see dark figure

To improve the monitoring of viral mutations, the German Federal Ministry of Health has been funding increased genome sequencing of viruses since January 2021. The Robert Koch Institute is currently establishing a "German Electronic Sequence Data Hub (DESH)" for systematic electronic collection and analysis of the data.

Numerous research projects are collecting data to empirically assess the impact of the COVID-19 pandemic and its response on society. The Council for Social and Economic Data counts over 200 such projects. These include the COSMO (COVID-19 Snapshot Monitioring) project, which has been using surveys since March 2020 to examine the population's subjective perception of the infection event in Germany. In the SOEP-CoV study, researchers from Bielefeld University and the German Institute for Economic Research are investigating social factors and consequences of the spread of the coronavirus in Germany based on the Socioeconomic Panel. Numerous other studies are collecting and analyzing data on specific aspects such as the impact on families. The Federal Statistical Office published the Data Report 2021 in March 2021. It contains a separate chapter on the impact of the corona pandemic.

The infas Institute (on behalf of the Federal Ministry for Economic Affairs and Energy) has set up a Corona data platform together with other research institutions. It is intended to continuously code all regionally prescribed measures of the federal states and their counties and to provide further data on the epidemiological and economic situation since the beginning of the pandemic in Germany in such a way that science and research can evaluate them.

Model scenarios and forecasts

Mathematical modeling is an essential basis for assessing the situation and options for action. Epidemiological forecasting models, such as those based on the SEIR model, have been continuously adapted and improved since the beginning of the pandemic on the basis of new scientific findings on SARS-CoV-2 and COVID-19. The modeling efforts are used to generate forecasts of the spread of the pandemic and the associated health care system utilization. They are also used to retrospectively assess the effectiveness of policy measures and to estimate the economic impact.

The results of modeling studies depend on assumptions about paramaters that cannot be determined with complete accuracy. They must therefore be interpreted with a certain degree of caution. Already at the end of March 2020, statisticians from various German research institutes and universities advised to "be guided by the outlined model calculations when driving on sight, but not to be overly impressed by individual information".

Data-based investigation of the effectiveness of political measures

The extent to which the prescribed "non-pharmaceutical measures" in Germany contributed to the containment of the pandemic in spring 2020 has been and continues to be controversial in the scientific community. Initially, two prominent published studies in particular were widely received: A modeling study by scientists at the Max Planck Institute for Dynamics and Self-Organization published in the journal Science on May 15, 2020, examined the relationship between policy actions in Germany and inflection points in the rate of infection growth. According to the study, only the general contact restrictions introduced on March 9, 16 and 23, 2020, would have led in their aggregate to declining infection rates. A study by scientists at Imperial College London published in Nature on June 8, 2020, compared the situation in Germany with that in other countries and attributed the comparatively low infection figures in Germany to the measures taken early on.

The statements about the effectiveness of the measures did not remain uncontroversial. Medical statistician Gerd Antes told Deutschlandfunk radio on June 16, 2020, that the lockdown in March was the right thing to do as a purely precautionary measure, but that it had been decided "certainly without evidence. However, the opportunity for systematic accompanying research was missed, so that the knowledge about the effectiveness of individual measures is "very, very poor". Virologist Hendrik Streeck wrote: "To be able to assess the effectiveness of individual measures separately, we went into lockdown too quickly." In an article in Safety Science, a workplace safety journal, Thomas Wieland, an economic geographer, analyzed RKI data of disease onset between Feb. 15 and May 31, 2020, which could be used to more accurately estimate the infection timing critical to an impact of measures than reporting data used by the Science study mentioned above. He concludes that the decline in infection incidence in early March can be attributed to "relatively minor interventions and voluntary behavioral changes." Neither did his approach clearly identify effects of subsequent interventions, nor did liberalizations of government actions on April 20 lead to a resurgence in infections.

Simulation as well as statistical studies of the effectiveness of contact restrictions to control the pandemic in Germany and worldwide are detailed in the article Mass quarantine.

The opinions of the Leopoldina had considerable influence.

Policy responses and actions

Objective and strategy

The basis for the policy measures to combat the pandemic is the National Pandemic Plan for Germany of March 2017 with its COVID 19 Pandemic Supplement of March 2020 and the Strategy Supplement of October 23, 2020. The overarching goal of the pandemic plans is to "minimize the spread and health impact of the pandemic while minimizing disruption to overall social and economic life (including educational institutions) in Germany."

In the course of the pandemic, the federal and state governments set various concrete goals. On March 22, 2020, the federal and state governments decided on contact restrictions with the aim of preventing an uncontrolled increase in the number of cases and keeping the healthcare system efficient. On February 10, 2021, they set the goal of effectively combating the virus in the long term by rapidly vaccinating the population. This, they said, should enable normalization of everyday life and a return to a life free of pandemic-related restrictions. The goals and strategy of pandemic control have been the subject of debate and controversy since the beginning of the pandemic.

Legal framework and competencies

In Germany, infection control is a shared competence of the federal and state governments. In this respect, the German Infection Protection Act regulates the tasks and cooperation of the federal government, the states, local authorities, the health care system and other parties involved in combating infectious diseases in humans. While the federal government defines the framework conditions, the states are largely responsible for implementation and concrete design. If necessary, important fundamental rights such as freedom of the person and freedom of assembly can also be restricted for this purpose. In addition, the European Union has also taken on some coordinating tasks (despite having fewer competencies in the area of health). In concrete terms, the distribution of tasks is as follows:

• Bundestag:
• Framework legislation (e.g. regarding permissible protective measures or quarantine and notification requirements in the event of illness)
• Empowerment of federal and state governments
• Federal government:
• Legal ordinances on, among other things, vaccination sequence (BMG), travel restrictions (AA), border closures (BMI), and home office entitlements (BMAS) based on recommendation of RKI
• Calling and distribution of vaccine doses from the EU quota
• Coordination of support by the Bundeswehr (BMVg)
• Approval of vaccines on the recommendation of the EMA and the PEI
• Approval of rapid tests on the recommendation of the BfArM
• Financing and distribution of economic aid (BMF / BMWi)
• State governments:
• Legal orders, among others, to implement all protective measures (e.g., lockdown, contact restrictions, quarantine on entry, etc.)
• Education Policy
• Partial financing and distribution of economic aid
• Municipalities (health departments):
• Enforcement and execution of the applicable rules
• Implementation of vaccinations
• European Commission:
• Ordering the vaccines
• Coordination

On March 25, 2020, the German Bundestag passed the Act on the Protection of the Population in the Event of an Epidemic Situation of National Significance, which in particular supplements the Infection Protection Act, and immediately thereafter determined that an epidemic situation of national significance existed. This gave the federal government additional powers for one year to deal with the crisis, for example in the procurement of medicines and medical products and in border controls. With the "Third Act for the Protection of the Population in the Event of an Epidemic Situation of National Significance," the Bundestag passed an amendment to the Infection Protection Act on November 18, 2020, among other things. Unlike before, the Infection Protection Act now explicitly specifies which infection protection measures are possible against COVID-19: for example, exit or contact restrictions, closures of retailers, or prohibition of sporting events. The measures are tied to infection rates, such as the threshold of 50 new infections per 100,000 population within a seven-day period within a county. At the same time as the law was passed, the Bundestag confirmed that there was still an "epidemic situation of national significance".

The federal government has established a number of committees and cabinet committees, such as the small Corona Cabinet and the large Corona Cabinet, to coordinate actions and prepare decisions:

Small Corona Cabinet

Meets every Monday and prepares the resolutions. Participate in it:

Large Corona Cabinet

Meets every Thursday, after the regular Cabinet meeting on Wednesday, and consists of all members of the small Corona Cabinet plus line ministers concerned in individual cases. There is a weekly situation report by the RKI.

After each Corona Cabinet meeting, the roundtable of Permanent Secretaries, led by the Chancellor's Office, also meets to address any pressing Corona issues.

Crisis teams

In addition, there is a "crisis team" made up of the Ministries of Health and the Interior and a "procurement team" made up of the Ministries of Health, Foreign Affairs and Finance to deal with the implementation of the resolutions. A "Test Logistics Task Force" headed by Transport Minister Scheuer and Health Minister Spahn is to speed up the procurement of rapid tests.

Joint resolutions of the federal and state governments

Numerous key measures to combat the Corona pandemic were discussed and jointly decided upon during informal conference calls or meetings between the German Chancellor and the heads of government of the German states (known as "federal-state conferences") in order to maintain a uniformity of approach despite the formal responsibility of the states. Between March 12, 2020, and June 17, 2020, a total of eight official meetings were held - under normal circumstances, one would have taken place. By February 2021, there had been seventeen meetings. In addition, regular conferences of the heads of the respective state chancelleries and ministers of health were held to coordinate details of the measures. The federal and state governments are responsible for implementing the joint decisions. In some cases, the state governments were explicitly given the opportunity to deviate from certain regulations. There has been repeated criticism that certain measures are not being implemented adequately or inconsistently.

Current applicable federal and state resolutionsDecember 13, 2020; January 11 and 19; February 10; March 3 and 22, 2021.

At least one free rapid test per week should be made available to each person in schools and in presence work in companies. Even asymptomatic citizens should be given the opportunity for one free rapid test per week, including confirmation of the test result. Beginning March 1-8, 2021, certain businesses may reopen (e.g., bookstores, florists, and garden markets) and body-related services will again be permitted if sanitation requirements are met. The federal states decide on concrete opening steps in schools and daycare centers. If the 7-day incidence is greater than 100, private gatherings are allowed with up to 3 people from two households plus children, including up to 5 people. Since December 16, employers are to examine whether they can offer either company vacations or home office. Since January 11, contact restrictions at the workplace are to be strengthened by home office and closure of company cafeterias. The Jan. 19 decision will require employers to allow home office work wherever possible. The federal Ministry of Labor subsequently issued the SARS-CoV-2 Occupational Safety and Health Regulation on January 21, 2021. Delivery and pickup of take-out meals remain permitted. Church services remain possible under strict conditions. Nursing homes and mobile care services are to take special protective measures. Tests in old people's and nursing homes are to be intensified again from January 11, with the support of the German armed forces and volunteers. There are to be further protective measures such as mandatory FFP2 masks for employees in contact with residents. In public transport as well as in stores, the wearing of medical masks ("so-called surgical masks or also masks of the standards KN95/N95 or FFP2") is to be mandatory. In counties with a 7-day incidence of more than 100, more extensive steps should be implemented, such as requiring passengers to wear medical masks, even in private cars, if they are not part of the driver's household, and exit restrictions. Within the framework of time-limited model projects, the countries can carry out opening steps in some selected regions, with strict protective measures and test concept, in order to investigate the feasibility of using a consistent test regime. Travel and quarantine requirements remain in place as far as possible. Under the January 19 decision, more stringent testing and quarantine requirements are to apply to entries from risk areas. In addition, these will apply to entries from "virus variant areas" where certain variants of the virus have spread. With a 7-day incidence of more than 200 per 100,000 population, a restriction of movement radius to 15 km around the residence will apply from January 11 for anyone who cannot claim a valid reason for moving further away from home. Compensation arrangements are in place. Financial assistance programs ("November aid") are extended. Commercial tenants are to be relieved by stipulating that significant (use) restrictions as a result of the COVID 19 pandemic may constitute a serious change in the basis of business. Return to rules in effect until March 7 (emergency brake) if 7-day incidence per 100,000 population rises above 100 for three consecutive days in a state or region. Further opening steps are to be taken in several stages depending on the incidence. From a stable or declining 7-day incidence below 100 per 100,000 population in a country or region, "click and meet" offers in retail outlets and the opening of museums, zoos, and similar facilities with appointment booking are provided for. In addition, individual sports involving up to 5 people from two households and group sports for children and youth are allowed. A series of further opening steps are envisaged when the 7-day incidence is stably below 50 per 100,000 population.

Course

First lockdown from March 2020

Some nationwide measures at a glance (federal/state)
Dated	Measure
31.1.2020	Reporting requirements.
8.3.2020	Recommend cancellation of events with >1000 participants.
17.3.2020	Entry ban for third-country nationals, "worldwide" travel warning, restriction of non-essential travel to the EU, closure of many stores.
22.3.2020	Contact Restrictions.
10.4.2020	14-day domestic quarantine requirement for returnees from abroad.
15.4.2020	Federal-state agreement: restrict contacts until at least May 3, schools open gradually beginning May 4, businesses under 800 sq. ft. open April 20 (or later), no major events until Aug. 31, Strongly recommend everyday masks.
22.–29.4.2020	Mandatory wearing of masks on public transport and in stores.
6.5.2020	Relaxations for stores, popular and recreational outdoor sports, visits to clinics, nursing homes and facilities for the disabled. Minimum distance remains. Contact restrictions extended until June 5, but members of two households may meet. Up to a cap of 50 new infections per 100,000 residents per week, states are largely given responsibility for further relaxation. Emergency care is extended in schools and daycare centers.
7. and 14.10.2020	Reaffirmation and specification of the "hotspot strategy". Restrictions on social contacts according to incidence in the county.
28.10. and 25.11.2020	"Lockdown light": renewed Germany-wide restrictions on public life and social contacts.
13.12.2020, 11. and 25.1.2021	"Hard lockdown" with restrictions throughout Germany
d Date: Decided on or valid from this date.

On March 13-17, the federal and state governments agreed on a series of measures to prepare the healthcare system for the expected increase in treatment of COVID-19 cases. These included postponement of scheduled surgeries and a hospital contingency plan to double intensive care capacity. At the same time, quarantine measures for travelers from abroad and travel restrictions were adopted.

On March 22, 2020, the federal and state governments agreed on a comprehensive "restriction of social contacts": among other things, a minimum distance in public spaces of at least 1.50 meters was introduced, and staying in public spaces was only permitted alone or with another person outside one's own household. Gastronomy and numerous other service businesses were closed.

On April 15 and May 6, the German Chancellor and the heads of state governments decided to gradually open up public life. Stores, restaurants and other service establishments and cultural institutions such as museums were gradually allowed to reopen to the public - subject to clearance and hygiene requirements. Popular and recreational sports were permitted outdoors, and emergency care was extended in schools and daycare centers. A minimum distance of 1.5 meters from each other was still to be maintained, and contact restrictions were extended until June 5. Large events remained prohibited. In addition, a recommendation was made to wear everyday masks in public transport and retail outlets. At the same time, residents of nursing homes and homes for the elderly without isolation were to be protected, the number of public health workers and the capacity of corona testing were to be increased.

Situation as of May 2020

The May 6, 2020 decision largely gave the states responsibility for further relaxations. At the same time, it was decided for the first time on May 6 that stricter infection control measures should apply in counties or independent cities with particularly high incidence. This so-called hotspot strategy was subsequently expanded and specified in joint resolutions of October 7 and 14, 2020.

In two further video conferences on August 27, 2020, and September 29, 2020, Chancellor Merkel and the heads of government of the German states agreed on a number of adjustments to infection control measures. This concerned, for example, the testing strategy for people entering from abroad, additional funding for digital teaching services, and the expansion of recommended individual hygiene measures to include regular ventilation and the use of the Corona warning app.

Tougher measures and "lockdown light" as of November 2, 2020

After the German Academy of Sciences Leopoldina criticized the current resolutions as inadequate, the German Chancellor and the heads of government of the German states agreed on a "lockdown light" on October 28, which went into effect on November 2 and was further tightened by resolution on November 25. Citizens were ordered to reduce social contact to an absolute minimum and public spending was restricted to small groups. Numerous establishments were again closed: These included cultural, catering and service establishments. Schools, kindergartens and wholesale and retail businesses remained open. Additional economic aid was decided for businesses affected by closures. The obligation to wear a mask in public spaces was further extended.

Second lockdown from December 16, 2020

On December 13, 2020, due to continued high infection rates, the heads of government of the German states agreed with the German Chancellor that infection control measures would be further tightened effective December 16, 2020, through January 10, 2021.

In particular, this includes closures of most stores and service businesses. Daycare centers and schools were closed or converted to distance learning. Businesses were to switch operations to home offices as far as possible. Tighter mobility restrictions were adopted for areas with high infection rates. At the same time, compensation rules for companies and additional entitlements to children's sick pay for parents who have to care for children at home were introduced. Travel from risk areas abroad was to be more strictly regulated. Further infection control measures were also laid down, such as the obligation to wear medical masks on public transport and in stores and increased testing in old people's and nursing homes. The background to the measures was the persistently high number of infections, but also the danger that new virus variants could lead to "a serious worsening of the pandemic situation".

On March 3, 2021, the federal and state governments decided on gradual relaxations depending on a stable incidence of less than 50 new infections per 100,000 inhabitants in a country/region. At the same time, they decided to increase the availability of rapid tests.

Fourth Civil Protection Act (federal "corona emergency brake").

Since April 23, 2021, the Fourth Law for the Protection of the Population in the Event of an Epidemic Situation of National Significance has been in force in Germany as a federal law. As a result, since April 24, 2021, (mostly stricter) contact restrictions (Section 28b (1) no. 1 IfSG) have prevailed in all counties and independent cities in which the 7-day incidence exceeded 100 for three consecutive days. In addition, there is a curfew from 10 p.m. to 5 a.m. in these counties and independent cities (§ 28b para. 1 no. 2 IfSG). Pursuant to Section 28b (5) IfSG, further-reaching regulations (e.g., of the Länder as in Bavaria) remain unaffected.

Special regulations for "vaccinated, tested, and comparable persons"

Section 28c IfSG of the version after the Fourth Population Protection Act contains an ordinance authorization for special regulations for "vaccinated, tested and comparable persons". Based on this, the COVID-19 Protective Measures Exemption Ordinance was adopted by the federal government on May 4, 2021. The regulation was promulgated on May 8, 2021, making it effective on May 9, 2021.

Criteria for the adaptation of measures

The criteria for adjusting measures changed several times at the beginning of the pandemic. Initially, the priority in early April 2020 was to increase doubling times; relaxations were made conditional on a doubling time of well over ten days. The goal was to ensure that fewer people became infected at the same intervals and that the health care system was not overwhelmed by a high number of illnesses. After initial relaxations in the course of April, the RKI listed the net reproduction number "R" and the ratio of recovered to ill persons, the new infections reported daily, the capacities in the health care system and the testing capacities as further criteria.

On February 10, 2021, the German Chancellor and federal and state government leaders decided to base opening steps under the second lockdown on a stable 7-day incidence of no more than 35 new infections per 100,000 population in the states.

Hotspot strategy

Hotspot strategy: overview
7 days incidence	Key points for measures
from 35 at the latest	Complementary masking requirement in public spaces where people congregate more densely and/or for longer periods of time Celebrations: maximum 25 people in public and 15 in private room Stricter participant limits for all events Closing time in gastronomy
from 50 at the latest	extended mask requirement Celebrations: 10 people Meeting: maximum 10 people in public space Events: maximum 100 people Closing time and alcohol dispensing ban at 11 p.m. Urgent recommendation to avoid unnecessary travel
permanently over 50	Further targeted contact restrictions unavoidable Meeting of maximum 5 people
over 200	Further tightening of measures to achieve a significant reduction in the incidence of infection in the short term. e.g. hybrid and alternating teaching, restriction of the range of motion

On May 6, 2020, the federal and state governments agreed on an "emergency mechanism" to respond to new outbreaks in a regionally adapted manner. It provided for a consistent restriction concept to be implemented again within seven days in counties or independent cities with more than 50 new infections per 100,000 inhabitants. In several states, this limit was later lowered to 30 to 35 new infections per 100,000 inhabitants in seven days. Later, the "emergency mechanism" was called the "hotspot strategy" and various concrete measures for "hotspots" were defined.

Confederation

For information on the national testing strategy, see COVID-19 pandemic in Germany/Testing.

Assessments and recommendations

In January 2020, the German government did not yet assess the pandemic as an extreme threat. By March 2020, it had adjusted its assessment step by step. At the end of January, after the first confirmed case of infection in Germany, Federal Health Minister Jens Spahn declared that Germany was "well prepared". On Jan. 23, he stated, "... the course here, the infection incidence is even much milder than we see with the flu." On February 26, 2020, he stated that Germany was "at the beginning of a coronavirus epidemic." He urged state government health ministers to activate their pandemic plans and prepare for their possible entry into force. He said it had become apparent that the "chains of infection are partly not comprehensible."

In mid-March, various politicians warned of the pandemic and called on the population to exercise caution. On March 18, 2020, German Chancellor Angela Merkel gave a widely acclaimed address to the population about the situation in Germany in the context of the pandemic. She called the COVID-19 pandemic the greatest challenge since World War II. In the absence of a vaccine or therapy, she said, the guiding principle of the federal government is "to slow the spread of the virus, to stretch it out over the months and thus buy time." The risk of mutual infection must be minimized, he said. Merkel did not announce any specific measures, but appealed to citizens to avoid unnecessary encounters and to abide by the rules.

In mid-March, the German Federal Ministry of Health described imminent massive restrictions on public life as "fake news" in a tweet - just days before the introduction of comprehensive contact restrictions. Various media outlets criticized the hoax, saying, among other things, that it "creates uncertainty in dealing with real fake news."

Jens Spahn declared on April 17 that they had "managed to bring dynamic growth back to linear growth". Since April 12, more people have recovered every day than there have been new infected persons. The number of deaths, on the other hand, had continued to rise - as expected.

When infection figures began to rise again in July 2020, politicians again increasingly called for caution. On July 13, Jens Spahn and RKI President Lothar Wieler warned of a second wave of infections. They appealed to the population to observe distance and hygiene rules and to wear everyday masks. German Chancellor Angela Merkel declared on October 15, 2020, in view of the decisions of the countries responsible for health protection, that the measures adopted were not sufficient to avert disaster, and on October 17 she spoke in her podcast of a "very serious phase" of the pandemic and appealed to citizens to reduce contacts and travel.

Procurement of necessary equipment

As a result of the spread of COVID-19, there was a strong demand for disinfectants; the supply in pharmacies and drugstores quickly tended toward zero. To remedy this shortage, on March 4, 2020, the German Federal Institute for Occupational Safety and Health initially approved products containing 2-propanol in proprietary formulations for hand disinfection. This order allowed pharmacies and the pharmaceutical industry to manufacture and market self-mixed hand disinfectants. After that, however, the basic product 2-propanol also became increasingly scarce, which is why the production of hand disinfectants based on 1-propanol and ethanol was also permitted on March 13, 2020 for supply to professional users. Finally, production on the basis of ethanol was also permitted for supply to private users by general decree of April 9, 2020.

On March 4, 2020, the crisis team decided that the protective equipment needed in practices, clinics and health authorities would now be procured centrally via the Federal Ministry of Health. On the same day, the Federal Ministry for Economic Affairs and Energy issued an order prohibiting the export of medical protective equipment. In addition to mouth and nose protection, this equipment also includes protective gowns and suits as well as gloves. The order was intended to prevent or stop local undersupply. After a European implementing regulation on the licensing requirement for the export of medical protective equipment to third countries came into force on March 15, the German order was lifted.

On March 13, 2020, the purchase of protective material in the amount of 163 million euros was announced. This was done under the auspices of the Bundeswehr Procurement Office. The procurement offices of the Bundeswehr and the Ministry of the Interior were unable to procure sufficient quantities of protective clothing by the beginning of April 2020. Therefore, according to a decision of the "Corona Cabinet," companies such as BASF and VW, with their purchasing departments and contacts in Asia, were to purchase the protective clothing and other equipment directly abroad and also organize transport to Germany for the German government. On April 7, it was reported that Chancellor Merkel had achieved in direct negotiations with China's President Xi that Germany would receive protective equipment from the country.

On May 22, 2020, the Tagesschau reported on problems with the distribution of the protective materials that had been procured in the meantime to clinics and doctors' offices. In July, the Federal Ministry of Health said the shortage of protective equipment had largely been overcome. It said the federal government had procured more than 2.7 billion masks and 539 million disposable gloves since the beginning of March. From mid-August, the demand for respiratory protection masks will increasingly be met from German production. The German Hospital Association and the National Association of Statutory Health Insurance Physicians confirmed that hospitals and physicians in private practice are now better equipped with protective equipment than at the beginning of the year.

CDU/CSU mask affair

At the beginning of 2021, it became known that both CSU member of the Bundestag Georg Nüßlein and CDU member of the Bundestag Nikolas Löbel had received commission payments from mask suppliers in 2020, either directly or via companies involved. Löbel received the commission for transactions between a supplier in Baden-Württemberg and two private companies in Heidelberg and Mannheim. Nüßlein is accused of having brokered a manufacturer for Corona masks to the federal government and the Bavarian state government. In doing so, he is said to have received a six-figure commission and not paid tax on it. Meanwhile, former CDU member of parliament Mark Hauptmann and former Bavarian justice minister Alfred Sauter have also been linked to mask deals.

Economic aid, economic stabilization and the federal budget

The coalition agreed on March 8, 2020 to lower hurdles for short-time work. On March 14, 2020, the basis was laid with the promulgation of the Act on Temporary Crisis-Related Improvements to the Regulations for Short-Time Work Benefits. Through amendments to Section 109 SGB III and Sections 11 and 11a AÜG, it authorizes - for a limited period - the federal government to issue statutory ordinances without the approval of the Bundesrat (upper house of the German parliament) that may lower the eligibility criteria for short-time allowance.

On March 19, 2020, the German government announced 40 billion euros in financial aid for microenterprises. Ten billion euros of this is earmarked as direct grants to distressed one-person companies, freelancers and micro-enterprises as a one-off payment for three months amounting to a maximum of 9,000 euros - supplemented by emergency aid from the federal states - the rest as loans to secure liquidity. Although the social protection package is not an unconditionalbasic income as demanded by two petitions "for a situation that the state has ordered," access to basic protection has been made easier and an asset test has been dispensed with.

Starting on March 23, the German government discussed temporarily suspending the debt brake. On March 25, the German Bundestag then passed a supplementary budget for 2020 that exceeds the regular limit set in the Basic Law ("black zero") by around 100 billion euros.

In May 2020, under Federal Economics Minister Peter Altmaier, an amendment to the Foreign Trade and Payments Act was passed on the one hand, making it easier for the German government to prevent foreign acquisitions of German companies, and on the other, a law and an economic stabilization fund were created, whereby the state can in future take a stake in any company experiencing economic difficulties. On June 29, the Bundestag and Bundesrat passed the federal government's "Corona economic stimulus program" and approved the associated second supplementary budget for 2020. The measures in the package, which totals 24 billion euros, include in particular a temporary reduction in value-added tax until the end of the year and a special payment of 300 euros for each child eligible for child benefit.

In November 2020, the German government decided on compensation payments for companies and self-employed persons affected by corona-related closures. Those affected are to receive support payments of up to 75% of sales in the comparable period in the previous year.

Support for families

The government announced in January 2021 that it would double the children's sick days for 2021 (20 days instead of 10 per parent with statutory health insurance, and 40 instead of 20 for single parents) that can be used for pandemic-related care of children at home, including in the case of home offices.

Other measures

→ For decisions by the federal government on border closures, travel warnings and the federal government's repatriation program, see Cross-border mobility and tourism.

Effective February 1, 2020, the Coronavirus Notifiability Ordinance for Coronavirus Disease-2019 (COVID-19) introduced the obligation to report by name. Since May 23, 2020, it has been legally anchored in the Infection Protection Act (Section 6 (1) No. 1 lit. t IfSG).

On March 15, German Defense Minister Annegret Kramp-Karrenbauer pledged the help of the Bundeswehr. As an example, she cited the call for reservists trained in health care to report for duty in Bundeswehr hospitals. She also said that the Bundeswehr was already providing administrative assistance to the Federal Ministry of Health. On March 27, it was reported that the Bundeswehr had an actually confidential domestic deployment plan, which, according to the document, was ready to provide comprehensive administrative assistance as of April 3.

On March 25, 2020, the Bundestag amended its rules of procedure for a limited period until September 2020 to the effect that only a quarter of the members of parliament need to be present to constitute a quorum, rather than half.

Countries

In their resolutions of May 6, 2020, and May 26, 2020, the German chancellor and the minister presidents of the German states strengthened the role of the state governments in combating the pandemic. The states are to decide on the gradual opening of public life under their own responsibility. In doing so, they also take into account the regional development of COVID-19 infection figures.

The legal regulations of all federal states can be found in the list of German laws and regulations enacted as a result of the COVID-19 pandemic. The overall situation in the federal states is described in the articles on the respective states:

Baden-Württemberg | Bavaria | Berlin | Brandenburg | Bremen | Hamburg | Hesse | Mecklenburg-Western Pomerania | Lower Saxony | North Rhine-Westphalia | Rhineland-Palatinate | Saarland | Saxony | Saxony-Anhalt | Schleswig-Holstein | Thuringia

Output restrictions

In addition to the jointly adopted measures, Bavaria, Berlin, Brandenburg, Saarland, Saxony and Saxony-Anhalt issued exit restrictions that make leaving one's home or entering public spaces generally dependent on the existence of a "valid" reason. The first of these exit restrictions in Saxony and Berlin were lifted on April 20 and 22, 2020, respectively. The exit restriction in Saarland, which allowed people to leave their homes "only if there are valid reasons," was lifted with immediate effect by the Constitutional Court of Saarland on April 28, see also Legal Assessment of Exit Restrictions. Saxony-Anhalt lifted its exit restriction on May 4. Brandenburg lifted, as of May 9, that part of the ordinance that required a special reason for entering public spaces. Bavaria applied, "Leaving one's own home is permitted only if there are valid reasons." This provision was not extended beyond May 10. In October 2020, exit restrictions were again imposed in some counties in Bavaria due to rising infection rates. At the end of the year and in the first months of 2021, temporary exit restrictions were also reintroduced in cities and counties in other German states.

Mask obligation

In addition to the "urgent recommendation" of April 15, 2020, adopted by all federal states to wear everyday masks in public transport and in stores, in the second half of April all federal states successively adopted a wearing obligation. The mask requirement generally applies in public transport and in stores; scarves are accepted as masks. Some districts and cities had already decided to introduce them earlier, including Potsdam and Braunschweig in addition to Jena. In October 2020, the federal and state governments decided that, at the latest when there is an incidence of 35 new infections per 100,000 inhabitants per week, masks should be compulsory in public places where people congregate more densely and/or for longer periods.

Protective masks for the elderly, at-risk groups and the needy

On November 13, 2020, Bremen became the first German state to start issuing FFP2 masks free of charge to people aged 65 and older, with high demand resulting in the first 450,000 copies being sold out within hours.

On November 16, 2020, the federal and state governments decided to issue 15 FFP2 masks (one per winter week) to insured persons who belong to one of the particularly vulnerable groups. The masks are to be issued "against a small co-payment". However, Federal Health Minister Jens Spahn stated on November 30 that the issue would "drag on well into December."

According to the Coronavirus Protective Mask Ordinance of December 14, 2020, persons who had reached the age of 60 or who had certain illnesses or risk factors were entitled to a total of 15 protective masks for a personal contribution. The pharmacies also received a lump sum from the liquidity reserve of the health fund for dispensing the masks.

The group of beneficiaries has been expanded to include people who receive unemployment benefit II or live in a community of need with such a person, effective February 6, 2021. These persons are entitled to a one-time payment of ten free protective masks, even if they are not insured under the statutory health insurance scheme.

Counties and cities

In March and April 2020, municipalities and districts responded to the pandemic and the local infection situation in many cases with independent resolutions. For example, the city of Halle (Saale) declared a disaster situation on March 17. The district office of Tirschenreuth imposed Germany's first corona-related curfew for the Mitterteich urban area on March 18, 2020, due to the pandemic. Similar curfew restrictions were imposed by several other cities and municipalities in the following days, for example in Dresden and Freiburg. These were replaced after a short time by the ordinances/decrees of the respective federal state. On March 30, 2020, the city of Jena announced an obligation to wear protective mouth-nose masks in public transport and in buildings with public traffic and called on the population to sew masks. Individual other municipalities followed suit in the weeks that followed, before state governments across Germany introduced mandatory mask use in the second half of April.

As of May 2020, the hotspot strategy envisaged that municipalities and counties would respond to the incidence of infection with locally adapted measures. Local decisions concerned, for example, the holding of public events or regulations for private celebrations. The city of Tübingen had tested a promising concept during the second and third wave of infection within the framework of the Tübingen Model initiated by Lisa Federle, in that openings and obligatory rapid tests simultaneously enabled a hopeful new start to social life and more efficient control of COVID-19. The model, like many other similar opening strategies, has been abruptly ended by the enactment of the federal emergency brake on April 24, 2021.

Blocking measure in the city bus for the protection of the bus driver, end of March 2020.


Certificates proving eligibility under the Coronavirus Protective Masks Ordinance (SchutzmV).


The center of Berlin will be largely deserted on March 22, 2020.


Measure to ban assembly in Hof (Saale), end of March 2020


Display board on federal highway 3 near Cologne: "Winter sports areas Sauerland closed!", January 23, 2021


Advertising the purchase of respirators in Hanover, April 20, 2020.

Responses and actions in the health care system

Treatment

Detailed recommendations from the Standing Working Group of Centers of Excellence and Treatment for Diseases Caused by Highly Pathogenic Agents are available for the treatment of COVID-19 patients.

Vaccination

COVID-19 vaccinations started in Germany on December 26, 2020. Since then, 43,447,927 individuals received the first of two required vaccinations (first vaccination rate: 52.24 percent, data as of June 24, 2021). On January 14, 2021, the first 115 individuals received their second vaccine dose; a total of 27,836,951 second vaccinations have been given since then (complete vaccination rate 33.47 percent).

On March 15-16, 2021, all vaccinations with AZD1222 (AstraZeneca) were stopped nationally due to unclear side effects or deaths. Vaccinations with AZD1222 resumed on March 19, 2021. The drug was effective and safe, according to the European Medicines Agency.

Treatment and personnel capacities

Numerous experts pointed out in late February and early March 2020 that if COVID-19 became more prevalent in the population, shortages in critical care and emergency medicine could occur. Since March 2020, policymakers and health system stakeholders have taken numerous steps to increase treatment capacity, increase health department case tracking capacity, and expand testing capacity.

On March 17, 2020, the federal and state governments decided to double the number of intensive care beds in Germany in the short term. In March 2020, the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), in cooperation with the Robert Koch Institute and the German Hospital Association, set up an online intensive care registry, which can be used to query hospitalized persons and bed capacities in intensive care medicine nationwide on a daily basis.

In order to create additional capacity for the care of COVID-19 patients, many scheduled surgeries (so-called elective procedures) were cancelled or postponed; patients also increasingly cancelled treatments and waiting rooms remained empty. The decline in treatments led to the paradoxical situation that in March and April 2020, reports increased of practices and clinics announcing short-time work for physicians and medical staff. At the end of April, German Health Minister Jens Spahn called for a portion of hospital capacity to be used again for scheduled surgeries starting in May, gradually moving toward a "new normality in hospital operations." In May 2020, the National Academy of Sciences presented a recommendation for the comprehensive resumption of general medical care. At the end of June 2020, the DKG stated that a return to regular care as before Corona would not be possible until well into next year due to infection control measures and keeping capacities free for Corona patients.

To increase staff capacity, for example, the nursing staff floors have been suspended until further notice, civil servants from other agencies and members of the armed forces have been deployed to support public health departments, and medical students and retired physicians have been called upon to get involved in the fight against the pandemic. In September 2020, the federal and state governments agreed to create at least 5,000 new and permanent full-time positions in the Public Health Service by 2022.

During the year, testing capacity increased many times over. The capacity of health offices to track cases also increased. However, the recruitment of new staff in the health offices in particular faltered, as newly created positions could not be filled. When infection figures rose again in the fall, there were renewed warnings that the health system's capacity was being overstretched.

Regulation

In March 2020, a number of regulations were adjusted to ensure healthcare provision under the conditions of the pandemic and the lockdown. On March 9, the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) agreed to allow sick leave for minor respiratory illnesses on the basis of telephone consultation; this regulation was limited to four weeks. The regulation was extended several times. However, it was controversial and finally expired on June 1, 2020. Psychotherapeutic online treatments were facilitated and controls under SGB XI ("Pflege-TÜV") were temporarily suspended to reduce contacts. It was also ordered to suspend the care ratio in the nursing sector. Doctors and professional associations demanded that bureaucratic hurdles for abortions be temporarily removed, because otherwise pregnant women would not be able to meet abortion deadlines. It was regulated that privately insured persons who switch to the basic tariff because of a loss of income due to the Corona crisis are given the right to return to their previous tariff within two years without a new health check.

Between March 16 and Sept. 30, 2020, hospitals received a flat rate for beds that were kept available as a precautionary measure to treat COVID-19 patients. The scheme was not extended following criticism that hospitals were overusing the flat rate. In November, the Bundestag passed a new "hospital bailout" as part of the Third Law for the Protection of the Population in the Event of an Epidemic Situation of National Significance. Only hospitals that actually care for many COVID-19 patients are to benefit from this.

The regulations on the financing of COVID 19 tests were amended several times. Among other things, it was disputed how the costs should be distributed between statutory and private health insurance and what price laboratories should receive from the insurance companies for the tests.

Triage

In March 2020, there were widespread fears that the healthcare system could become overloaded and that physicians would have to decide which patients to prioritize (triage) when medical capacity was limited. In response, the German Interdisciplinary Association for Intensive Care and Emergency Medicine drafted recommendations for decisions on the allocation of intensive care resources in the context of the COVID 19 pandemic, which were published in March and updated and expanded in April. In the winter of 2020, there were renewed concerns about a shortage of ICU beds in light of the second wave and discussions about triage. The DIVI called for legal certainty in this regard.

Dental treatment

At the beginning of the pandemic, there was great uncertainty about the risk of dental treatments. Treatment produces aerosols that can spread the virus. The problem was compounded by the lack of protective equipment. As a result, in March 2020, patients should see a dentist only for emergencies and urgent treatments. In May 2020, the German Dental Association stated that the situation regarding protective equipment had improved and hygiene standards had been adapted to the pandemic situation. So all dental treatments could be carried out again. Extensive up-to-date information is provided by the Federal Dental Association on its website.

Other measures

In March 2020, hospitals worked to establish testing centers and create orderly access points for testing. In Berlin, for example, the Charité and the Virchow-Klinikum set up special access points to separate cases from normal emergency admissions. Other clinics worked with so-called drive-in testing centers: suspected cases could drive up in their car by prior arrangement and the swab is taken from the person to be tested without him or her having to get out of the car.

Since some of the hospitals in Italy and France were overloaded with COVID-19 intensive care patients, patients were flown out to German hospitals by the German and Italian air forces. Thus, at least 117 patients from abroad received intensive care and ventilation in Germany.

Financial impact

In the first half of 2020, the 100 statutory health insurers had earned around 1.3 billion euros because expensive operations and treatments had been postponed. As a result of a sharp rise in the number of corona tests and backlogged surgeries, the statutory health insurers reported a loss of three billion euros in the third quarter of 2020 alone.

Vaccination Express (Dortmund, May 2021)


Vaccination Center Düsseldorf, for vaccination education (December 2020).

Economic consequences

Economic crisis

Due to the pandemic and the measures taken as a result, there was a global economic crisis, which also severely affected Germany. Many industries were directly affected by plant closures during the lockdown. Others suffered indirect consequences of the pandemic, in particular the slump in demand or the breakdown of supply chains. According to a study by the Ifo Institute, the hardest-hit sectors were travel agencies and tour operators (business slumped by 84% in April 2020), the aviation industry (down 76%), hospitality (down 68%), healthcare (down 45%), arts, entertainment and recreation (down 43%) and vehicle manufacturing (down 41%). The pharmaceutical industry was the only one to benefit, with a 7% increase in capacity utilization. By April 26, companies had registered short-time work for 10.2 million people - by far the highest figure ever. Gross domestic product (GDP) for the second quarter from April to June 2020 was 9.7% lower than in the first quarter from January to March. This was the sharpest decline since quarterly calculations for Germany began in 1970.

The economy recovered significantly in the third quarter. Overall, GDP in Germany in 2020 nevertheless fell by 5.0 percent year-on-year, according to the Federal Statistical Office. According to preliminary calculations, government budgets ended 2020 with a deficit of EUR 158.2 billion (4.8% of GDP). The number of people in employment fell by 1.1% to 44.8 million. Particularly affected were marginally employed and self-employed. By contrast, according to estimates by the Federal Statistical Office, layoffs among employees subject to social security contributions were prevented by the extended regulations on short-time working.

A study by the Ifo Institute for Economic Research and the Helmholtz Centre for Infection Research published on May 13, 2020, finds that health protection and economic development are not in direct opposition. Both a very hard lockdown and too much relaxation of measures could severely limit economic development. The authors suggest the least economic damage would occur with a light, gradual relaxation of restrictions and a reproduction number of about 0.75.

Supply bottlenecks and production changeovers

Retailers recorded higher sales of disinfectants and cleaning agents, long-life foods and fresh foods, particularly at the beginning of the first lockdown. Some retailers initially experienced supply bottlenecks. Foodstuffs such as noodles, flour, rice, UHT milk and ready meals, as well as some toiletries, were temporarily affected. Sales of toilet paper increased 7-fold in some cases in February 2020. Causes include hoarding, a shift in demand to private households, and disruptions in logistics and supply chains. A number of companies responded to the change in demand by switching production: For example, from ice cream to pasta, from alcoholic beverages to disinfectants, or from clothing to respirators or face masks.

Almost empty pasta shelf in a supermarket, March 2020


Sold out toilet paper in a drugstore, mid March 2020

Health consequences

Direct health consequences of the pandemic include illness and deaths of COVID-19 patients and substantial excess mortality that is most likely attributable to COVID-19 deaths. Reliable, representative data on the proportion of ill persons with long-term sequelae are not currently available.

In addition, the pandemic had a number of indirect consequences for health and the healthcare system in Germany. Indirect consequences include a shortage of protective medical equipment in the spring, which was only gradually remedied during the early summer. There was also a drop in the willingness to donate blood and blood plasma during the spring lockdown. The German Federal Ministry of Health therefore warned on March 19, 2020, of an impending shortage of blood donations. The German Society for Transfusion Medicine and Immunohematology stepped up its call for blood donations.

During the lockdown, there was also a significant decline in physician visits and hospitalizations, including for symptoms with potentially serious causes such as heart attack or stroke. The health consequences of the decline in physician visits and treatments are unclear. According to an online survey conducted by the RKI, the majority of respondents considered the supply of medications and the opportunity for doctor visits to be guaranteed to the extent necessary.

Due to the COVID-19 infection control measures, there was also a drastic drop in cases of other infectious diseases. Significantly fewer infections of measles, influenza and other infectious diseases were registered, especially in the younger and older age groups, than in other years.

At the same time, the quality of life and mental health of children and adolescents in Germany deteriorated significantly in the course of the Corona pandemic. Almost one in three children suffered from mental health problems, according to a study published in January 2021. Children and adolescents from socially weaker backgrounds or with a migration background are particularly hard hit. Berthold Koletzko of the German Society for Pediatrics and Adolescent Medicine stated in April 2021 that almost one in ten children under the age of 14 who had previously been of normal weight had developed obesity in the past year. At the same time, as data collected by substitute health insurers indicate, the number of anorexics increased by 25 percent in the first quarter of 2021 compared to the same period last year. The increasing cases of anorexia alone, with their often severe consequences, pose a far greater threat to the lives of young people than COVID-19 itself.

Legal assessment of the measures

The measures against the pandemic were also assessed from a legal perspective. In many cases, bans on gatherings and events were examined because they restricted freedoms protected by fundamental rights. The question of unequal treatment in the measures was also the subject of court disputes, such as the 800-square-meter rule in the retail sector from spring 2020. The former president of the Federal Constitutional Court, Hans-Jürgen Papier, described the measures against the epidemic as restrictions on fundamental rights that were unprecedented in their extent and scope and that had to be examined in each individual case for their proportionality. Some courts declared individual regulations disproportionate and overturned them, including curfews, accommodation bans and demonstration bans.

Surveys on the COVID-19 pandemic and the measures taken.

From March 12, 2020, Infratest dimap published the results of its trend study "CoronaTREND Germany" on the attitude of the population to the measures taken as well as to the tightening, easing or complete abolition of measures. Since March 12, 2020, around 300 people aged 18 and over have been interviewed daily via this online survey. In August, the survey was initially discontinued. Since then, however, there have been other representative surveys of the same nature conducted by Infratest dimap, Forschungsgruppe Wahlen and other institutes.

As of January 2021, the COSMO monitoring study found stable general acceptance of the policy measures. However, there was a marked increase in anger about measures (from 24% in December 2020 to 32% in January 2021). Only 40% still trusted the government (in December 2020, the figure was 48%). According to COSMO, an absolute majority of respondents felt it was "(rather) bad" that their own state had introduced regulations that did not comply with the decisions of the video switching conference of the German Chancellor and the heads of government of the states on January 10, 2021.

See also

• List of epidemics and pandemics
• COVID-19 vaccination in Germany
• COVID-19#treatment options
• COVID-19 pandemic in Germany/testing
• COVID-19 pandemic in Germany/Statistics
• COVID-19 pandemic in Germany/Chronicle of the spread
• COVID-19 pandemic in Germany/opinions of the Leopoldina