BERLIN — Susanne Herold, pulmonary infectious-disease specialist at the University Hospital in the central German town of Giessen, is not looking forward to Christmas.

While the hospital’s intensive care ward has 50 of its 150 beds available, it only has the staff to service around 100 — meaning the unit is now effectively full.

“We are struggling,” she said. Four out of 12 doctors on her team are currently home after contracting the coronavirus.

While many countries across Europe introduced lockdowns in early November to bring down soaring case numbers and ease the burden on hospitals, Germany opted for what it called a “lockdown light” — closing bars and restaurants for eat-in meals but keeping hair salons and most businesses and retail open. Restrictions will be loosened in much of the country over the Christmas holiday week.  

Already, contrasts around Europe are striking.

The coronavirus pandemic stopped many Christmas markets from opening in Germany this year, but one Bavarian innkeeper has opened a drive-through market. (Reuters)

In France, where a lockdown required people to fill out a form to leave the house and nonessential businesses closed, cases have plummeted from more than 50,000 a day in early November to around 10,000 a day. Belgium, which had the highest per capita infection rate in Europe before its lockdown, has seen cases fall from more than 17,000 a day to around 2,500.

And although Germany stopped its exponential growth in its tracks, its number of daily cases has barely budged, hovering at around 20,000 per day.

It marks an about-face for Germany, which had been praised for its measured response in the first wave of the pandemic. That initial success may be hurting it now, some experts say, with people less inclined to take restrictions seriously.

Meanwhile, a decentralized federal state system makes agreeing to nationwide measures complicated, while its history with dictatorship makes for discomfort with anything seen as too authoritarian.

'Very tense'

“Even when Germany was seen as so successful, and taken as an example for many, we always knew we were always looking at one window of time,” Lothar Wieler, the head of Germany’s Robert Koch Institute, the federal agency responsible for infectious-disease control, said this week. “Right now, we just can’t get the numbers down. The situation remains very tense.”

Germany now has higher per capita infection rates than any of the five biggest countries in Europe besides Italy, where restrictions have nonetheless triggered a decline in daily infections of nearly 40 percent since a November peak. In Italy, people in “red zones” can only leave home for work, essential shopping and health reasons, with nonessential stores closed.

“When you put everything together, it validates the idea that short and intense lockdowns are the solution,” said Dirk Brockmann, a professor at the Institute for Theoretical Biology at the Humboldt University of Berlin who does coronavirus modeling. “I guess it’s a cultural thing [in Germany] not to be too radical about it, even though it would have been the right decision.”

Despite having had some of the least restrictive lockdown measures in Europe from the outset, Germany has had one of the most vociferous anti-lockdown movements on the continent. Chancellor Angela Merkel has said that keeping the economy and schools open remains a priority — within the limits of the health-care system.

But corralling leaders of the country’s 16 federal states to agree on tougher measures has not been easy. Merkel pushed for restrictions to be tightened a few weeks into the country’s “lockdown light,” but was unable to forge an agreement to do so with state leaders, who hold the decision-making power.

Speaking after a meeting Wednesday, when state leaders opted to continue the status quo until Jan. 10, Merkel said Germany was still a long way from achieving its aim of 50 new cases per 100,000 people over a seven-day period. It’s currently at 134.

But as cases drop elsewhere, politicians are increasingly hinting at tougher measures. Markus Söder, the state premier of Bavaria, said that at “some point in Germany, we will have to decide again whether we might have to be more strict.”

“We shouldn’t shy away from being very strict,” he said, “and maybe to act more strictly for a shorter period of time than semi-strictly for longer.”

Speaking to German television on Friday, Health Minister Jens Spahn said it was “absolutely necessary” to bring in stronger measures for areas that are hot spots.

Even with the prospect of a vaccine on the horizon, Merkel has still warned of a difficult winter. Germany is racing to construct large-scale vaccination hubs, but experts have said it could be many months before everyone receives a jab.

Pandemic fatigue

In the first wave of the pandemic, Germany closed schools, stores and workplaces but managed to avoid the more stringent restrictions on movement seen elsewhere in Europe.

But in late October, Merkel announced that the country’s contact tracing could not keep up with the virus’s spread, with health authorities unable to identify where 75 percent of cases came from.

Pandemic fatigue was hitting much of Europe at the same time. German experts say that given its success the first time around, the country is particularly prone to what they’ve dubbed the “prevention paradox,” with people being more lax because they’ve been touched less by the pandemic.

“There were many people who had no contact with covid patients at all,” said Wieler. “There are still people who deny this disease.”

Herold attributed the slide to lax rules for summer travel, combined with families coming home just as schools opened and colder weather arrived. The exact role schools have played in spreading infections has been a matter of intense debate in Germany.

But while numbers have flattened, it’s not enough, she said.

Given the length of time that coronavirus patients stay in the wards, even a plateau in the number of cases adds to the cumulative pressure. Last month, the final patient among those admitted in the first wave in spring was finally discharged from Herold’s hospital, after a stay of around six months.

“We are all currently dealing with numbers of patients that we are just able to handle,” she said. “If the numbers rise again, it’s going to be very tough.”

That’s why Christmas is such a concern, she said. While Germany has extended its measures until Jan. 10, there is a week-long amnesty over the holidays, when families in most of the country will be in groups of up to 10 adults — and unlimited numbers of children under 14. Brockmann said that could be counterbalanced by the fact that schools are closed and more people are home from work, but no one knows for sure.

“I’m worried,” said Herold.

In recent days, an elderly woman who had suffered a fall needed an operation. Elective surgeries have already been canceled.

“We had to wait for the next covid patient to die before we could get her surgery,” Herold said.

Luisa Beck contributed to this report.