Coronavirus: Germany’s opaque path to normality
In international comparison, Germany has come through the coronavirus pandemic well. However, the easing of restrictions became a race between the federal states.
Text, photos and videos: Lena Reiner and Niklas Golitschek
Cornelia Dürkhäuser could hardly believe this news. Usually, she spends most of her time in the intensive care unit of a hospital near Dresden. Nevertheless, in the midst of the coronavirus pandemic – on April 15th – she was sent to short-time work. “We were told about a week before. I was quite stunned, angry too,” she says, and continues: “How can it be that in the course of Corona management, capacities are empty, treatments are not carried out, staff are sent to short-time work because of a lack of work, because – sorry for the expression – there are not enough seriously ill Corona patients?”
It is in itself a good thing that in Germany significantly fewer people were severely ill with Covid-19 than presumed. At the same time, she considers it important to quickly open the capacities for other treatments.

Whether intensive care places could be better coordinated, for example redistributed nationwide? “If you want, a lot is possible,” the doctor replies, but restricts: “However, this involves a lot of logistical effort: you don’t transport intensive care patients with a random ambulance.” In addition, transport naturally poses risks for patients.

This is another reason why Cornelia Dürkhäuser sits at home and waits to return to work in the hospital. She thinks the development in the health care sector in Germany is “very absurd”, says Dürkhäuser: “Until four weeks ago, I never expected that I would ever be threatened with short-time work. On the contrary, the workload has increased steadily since the beginning of my career.” However, she does not see the impending collapse of the health system, which is often discussed in the media because of the coronavirus. “At least not nationwide and not by Corona,” she adds. If anything, this collapse has been threatened for years by personnel policy and forced austerity.

„There is no need to register short-time work.“ – Statement of the Marburger Bund:

“We know from our membership surveys that doctors employed in the hospital work about 65 million hours of overtime each year. Compensation in leisure time in consultation with colleagues is certainly more sensible than applying for short-time work in the case of less work,” explains the Federal Association of the Marburg Confederation in a statement, adding: “Wherever the number of patients is currently lower, it is important to educate employees and train them for the treatment of COVID-19 patients.” In response to a small question from the fraction of Die Linke in the German parliament, the Federal Government also stated that short-time working was “not necessary to ensure the liquidity of the hospital.” For example, hospitals receive EUR 560 per unoccupied bed and day as a flat rate via the hospital rescue parachute, and the rescue fund also includes compensation for personnel costs. The German Hospital Society also points to this.

“You don’t turn it away with applause and one-off bonuses,” she says. Fundamentally better working conditions and sustainable pay are needed. In addition, the population had to move away from the claim “because of a gotten wood chip, at night at 3 in the emergency room. Unfortunately, such cases are now common there, which have actually nothing to do in an emergency room.”

However, more than short-time working Dürkhäuser deals with public misunderstandings about medical processes, especially the discussions about the coronavirus. “There are many things in the normal working life of an intensive care doctor that the normal population does not know, but which are now suddenly communicated publicly and are completely misinterpreted.” She names the triage as an example: this is used when the number of sick or injured patients exceeds the spatial and temporal treatment capacities: “This applies to a plane crash, a natural disaster and also to an infectious disease.” It is described as “the doctors simply let the patients die”. In the case of palliation and assisted dying, this is an elaborate intensive medical procedure.

In part, the medical doctor sees her profession as discredited and faces unjustified accusations. “This also complicates our day-to-day work,” emphasizes Dürkhäuser.

Decisions on coronavirus control not comprehensible

Intensive care nurse Kathrin Seif is non-clinically active and addresses other aspects: “The handling of the pandemic was hasty and not transparent enough to make political decisions comprehensible. A curfew has been imposed, a controversial mask requirement has been introduced after weeks of the pandemic, and penalties have been imposed in the event of non-compliance.” The public lacked the conclusive justifications for the measures. Instead of explanations from politicians, she observes a flood of information that causes panic among many people:  “Thereis a lot of things that are not comprehensible or explainable to each individual at the moment.”

As a specialist, she wanted to stress that a disease like this should not be underestimated, but there is also no reason for “panicking”. Even though some of the protective masks had become scarce and were worn longer than usual, the hygiene measures were nevertheless relatively feasible throughout. “We have been able to deal with other epidemics in the past. Germany is very well positioned in the healthcare sector Our professionals are even admired abroad for their handling of the virus.”

“Toughly said” the politics only became aware of the work that medical personnel in Germany do on a daily basis through the pandemic. “Our profession, whether a doctor or a nurse, is suddenly in the spotlight,” Seif says. They would never have received as much recognition as they do today, even if they had long wished for it. “For so many years we have been fighting for more staff, more pay and more justified recognition,” she says. Unfortunately, bonus payments have only been announced so far, as it is unclear who will ultimately pay the money. “So now only Bavaria will certainly get a reward.”

Support for neighbours
Germany has so far come through the weeks of the pandemic relatively well. This is despite the fact that the government has imposed much more moderate contact restrictions than neighbouring countries. However, the intensive care beds were never fully utilized. Therefore some of the hospitals took Covid-19 patients from France or Italy.
United in the shutdown, divided on easing
While in Germany there was agreement on the shutdown except for details in the design, the 16 federal states disagreed on the easing of restrictions. In the federal system, they have far-reaching powers to decide for themselves. They agreed that stricter measures must be implemented in counties and cities from 50 confirmed new infections per 100,000 inhabitants and more stringent measures per week. However, Berlin (30) and Lower Saxony (30-35) set their own stricter ceilings. Meanwhile, the professional footballers in football are allowed to play their season to the end of their season from mid-May.

But when and how restaurants and tourism companies; Kindergartens, schools or cultural institutions will open, they handle differently – and for the affected sectors sometimes surprisingly short-term; sometimes the detailed restrictions for infection protective measures are revealed only one day in advance. Politicians say that this way, the can respond to the situation of the coronavirus regional and take the right steps.

Confusing rules
These different regulations throughout Germany led to confusion among those affected in some places. In Bremen, which as a city-state is completely surrounded by Lower Saxony, for example, the restaurants had to remain closed for a week longer than in the surrounding towns and municipalities. Lower Saxony, on the other hand, spoke in the announcement  of a reservation obligation – which was then only a recommendation.  “We  don’t know what opening hours are. Initially it was until 10 p.m., then open end,” said one restaurateur. Cultural institutions and outdoor pools nationwide said they did not know how to implement the strict requirements.
Court rulings
Several of the restrictions have now been declared illegal by courts in Germany. The Higher Administrative Court in Saxony, for example, overturned the 800 square metre limit for retail. The  Higher Administrative Court in Lower Saxony suspended the quarantine requirement for travellers from abroad. In Bavaria, the Administrative Court de facto lifted the  curfew  – even the use of a motorboat  is considered a valid reason to leave the apartment – and  imposed fines for violations of the ban on contact.
Largest aid package in history
With the largest aid package in the history of Germany, the Federal Government supports companies and the self-employed: The Federal Ministry of Finance puts the total amount of measures that will be effective in the budget at EUR 353.3 billion, in addition to EUR 819.7 billion in guarantees. Solo self-employed people can also apply for social assistance under a simplified procedure and companies can register short-time work for their employees. At the same time, a debate has been ignited about the extent to which companies whose operation is harmful to the environment should be supported.

More than black and white

Intensive care nurse Marie Krzykalla also observes misinterpretations of medical procedures through the presentation on (social) media and exchanges views with her colleagues: “The fact that medicine is portrayed in such black and white just bothers us a lot.” As an extreme example, she cites a headline in the Bild newspaper: “People die from the ventilator”. “Basically, that’s true, they die from the ventilator. But they die not because of the ventilator, but despite the ventilator,” Krzykalla comments. In the meantime, it has been shown that the majority of those who needed a ventilator in the course of a Covid-19 disease only needed it temporarily.

In fear of ventilators, Krzykalla sees a danger: “Perhaps people with symptoms who, the sooner they were treated, would require less invasive treatments, would come to the doctor or hospital much later for fear; this is a dangerous revolving door effect.”

In the video, she describes how the coronavirus is currently happening on her ward and how ventilation works:


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So far, the health system in Germany has withstood the coronavirus pandemic. In addition to the contact restrictions, this is mainly due to the nurses and their enormous commitment. Krzykalla has been working as an intensive care nurse on a specialist hospital for lung disease for the past two years and sees with her own eyes what Covid-19 means. She recently shared her experiences on Facebook and received a lot of encouragement from colleagues for a post. However, he also called conspiracy theorists on the scene. “I now also put the mail on private at night, so I don’t have to worry about who’s going to get over it at night,” she reveals.

That is why an understandable investigation into coronavirus is of great importance. Krzykalla cites the podcast by virologist Christian Drosten as a positive example, although his language is sometimes “very medical.” She wants a format that uses even simpler vocabulary. But she knows how difficult it is to explain: “You can’t teach people badly, there are no uniform symptoms, no uniform course, and no universal drug.”

Asked how she felt about the current debates about easing infection-protective measures, given her experience with Covid-19, she said: “I think it’s important that people are told much more precisely why the measure was introduced in the first place.”

Contact restrictions due to coronavirus additional load

Laura Härer, a 31-year-old nurse who works in a retirement home in Saulheim near Mainz, has also worked with Covid-19 sufferers. It is experiencing the impact of the measures particularly strongly. For the residents of the home as well as themselves, she sees the contact restrictions and visiting bans as an additional challenge. “It is astonishing the impact of visiting relatives and acquaintances. It’s never been seen on this scale before,” she says.

Whether it’s eating together, taking a walk or just a smile: “They provide orientation through the daily visits,” says Härer. Physical closeness is particularly important: “A child can simply convey with the best love and closeness.” But the bans on visits would eliminate this and the nurses would have to compensate for this as much as possible. This makes it all the more important to pay more attention to the residents, combined with an increased effort and increasing documentation obligations. At the same time, protective masks and clothing made personal contact difficult, at least available, says Härer: “This makes it impossible to smile simply with the residents.”

In the same way, the situation is unusual for skilled workers and even more difficult to manage, since social contacts are largely dormant.

Private compensation is important and the stress level is rising, especially in the case of systemically important occupations.
Laura Härer

Elderly nurse

But it is not possible now to live out this balance in society.

This only helps to a limited extent when people applaud from their balconies. She is very pleased with such recognition, confirms Härer. “But that doesn’t solve the tragic conditions that exist in our industry,” she says. This is the only reason why nurses are called heroes “because there are enough who work in sometimes dire conditions for the residents and out of professional honour”. She believes it is the luck of the industry that skilled workers in emergency situations are pushing even more to their limits.

At the moment, like Seif, she is particularly concerned that each state deals differently with the special burden on nurses caused by the coronavirus. Here promised bonuses, meals paid there and then support from the Medical Service of Health Insurance (MDK). “For me, it is not uniformly regulated and this has to be done nationwide,” says Härer. In order to improve conditions in the long term, she believes that the financing of the health sector should be changed: “This is the only way to raise the level.” On the one hand, this includes better pay and more recognition for work. At the same time, the benefits would have to remain affordable for those affected, and additional costs should not increase. Experts would have to look for solutions here.

Rapid development

Paramedic Andreas Durner also agrees with this attitude. “The trend over the last few weeks has been rapid,” he says. With new findings, processes have been regularly optimised and changed in his institution – this is to be welcomed. That is precisely why he describes the debate on loosening as important and right, and he considers it very useful to set guidelines for distance, hygiene and masks. Durner emphasizes:

However, we should think through the steps well and not act too quickly.
Andreas Durner

Emergency medic

During this rapid period, the radiologist Prof. Dr. Götz Richter deals with the effects of coronavirus in the human body. Richter heads the Center for Diagnostics at Stuttgart’s Katharinenhospital, a clinic for diagnostic and interventional radiology, and has recently received approval from the Ethics Committee on the subject.

Meanwhile, his area has been able to analyse how the virus damages the lungs, Richter says: “In simple terms, one can say that the patient age is ‘no matter’ when it arrives in the lungs.” His clinic had determined early on that young people could also die from the virus. Based on data from the infected, an interdisciplinary team is now looking at the possible long-term consequences of different age groups.

Research in children’s boots

While politics and society talk primarily about easing and measures, research on coronavirus is still in the children’s boots. “At the moment, we only know what became known from the SARS pandemic 15 years ago. These include permanent, serious lung damage, “that was and is frightening,” Richter said. That is why good science is just as important as graduated and cautious relaxation of contact restrictions.

In order to be able to assess the situation professionally, studies are needed. “In principle, prevalence studies are an extremely important building block in pandemic assessment and are fundamental to many decisions,” Richter says. Despite the criticism of the Heinsberg study, this allows him to draw a conclusion if the re-assumed of just under 0.4 percent persists; death rate among those infected.

Based on the theory of herd immunity with 50 million infected people in Germany, about 200,000 deaths could be expected, “but they may spend 3 weeks in intensive care before that,” Richter notes. However, this is not the only reason why Richter does not seem practical:

“Even if this could be extended to a whole year, the system would collapse. This is something that policymakers have to deal with.”
Prof. Dr. med. Götz Martin Richter

Radiologist, Center for Diagnostics of the Stuttgart Katharinenhospital

Although the scientific debates in recent weeks have been mainly organized by the virologists Drosten, Kekule and Streeck, Richter speaks of a media-balanced discourse. “Many people are heard, so it is also multi-voiced, which is not always easy for laymen to understand,” he says – and there are quite different disciplines.

But just as important as the diversity of reporting is that scientists explained their findings as understandably as possible. “No scientist can expect media representatives or the ‘ordinary citizen’ to understand scientific gibberish,” Richter says.

Communication must take place

The social and economic psychologist Prof. Dr. Anja Achtziger from the Zeppelin University in Friedrichshafen sees it in a similar way: “Large parts of science are financed by taxpayers’ money. Then the population should also see what is being done with it and how society benefits from it.” Especially in times and on topics in which people fall for unsubstantiated conspiracy theories, qualitative reporting is important at the same time – combined with an objective and objective argumentation of science. In complex contexts, this is not always easy. “But such communication must take place, especially in far-reaching crises.” Unresolved issues and several explanations for a phenomenon should also be addressed openly; For this, the population must also show patience and understanding: “Some things simply take time.”