Taking Stock A Look at the Worst Mistakes Germany Made in the Coronavirus Pandemic
When Germany's first coronavirus patient , a 33-year-old employee of German automotive supplier Webasto, was admitted to a hospital in Munich’s Schwabing neighborhood on Jan. 27, 2020, a highly qualified team was on hand. With regular disaster drills and a special isolation ward, staff was well-prepared to treat patients with Ebola and Lassa fever.
The article you are reading originally appeared in German in issue 20/2022 (May 13th, 2022) of DER SPIEGEL.
"We were aware that this was a special patient," says Clemens Wendtner, the hospital's chief physician for infectious diseases. "So, it was good that we could go through our routines." The patient would go on to spend 18 days in isolation, with doctors and nurses protecting themselves with FFP3 masks. A task force was also immediately established at Webasto. Because the 33-year-old had contracted the virus from a coworker from Wuhan who was in Germany on business, all employees who had close contact with the woman were tested.
That was possible because a coworker of chief virologist Christian Drosten at Berlin's Charité University Hospital had began preparing a test to detect the new virus around New Year's Eve. From mid-January, the analysis tool, soon to be known to everyone in Germany as the "PCR test" would be available. With the help of the test, infected Webasto employees and relatives were quickly identified and placed in isolation.
That is how Germany managed to quickly interrupt the first known chain of infection in the country. Chief Physician Wendtner was initially optimistic. "If you had told me then that we would treat more than 5,000 corona patients in our hospital network over the next two years, I would have said you were crazy."
Alena Buyx, chair of the German Ethics Council
But this isn't a story with a happy ending. This is story of how, despite good baseline conditions in Germany, the fight against the pandemic went worse than in many other countries. How downplaying and poor decision-making, poor communication and planning, and misplaced priorities ultimately led to thousands of deaths – and to the possibility that the country could be hit with yet another wave this coming autumn.
Germany has already experienced two pandemic summers – happy, carefree summers. But it has also been through two pandemic winters which didn't go so well – in part because periods of low infections rates were not used to prepare for the next wave.
Now, the question is whether another summer will pass with nothing being done. Whether people will again have to suffer from limitations imposed on society to prevent the spread of the virus or whether some will die because nobody likes learning from their mistakes – even as new mutants may already be emerging that could evade our immune defenses.
"I don't think we will have another largely virus-free window this summer like the last two summers," says Isabella Eckerle, a virologist and professor at the Geneva Center for Emerging Viral Diseases. She says Omicron is simply too good at infecting people. The "rude awakening," says Munich physician Wendtner, could come in the autumn, if the new variants and sub-variants encounter a decline in vaccination protection within the population. "If we're not careful, we're going to be dealing with this virus for years to come."
If Germany wants to prepare for the autumn, it would be good to look for and recognize the mistakes made so far in its pandemic response. DER SPIEGEL interviewed more than a dozen leading scientists to document some of the lessons learned over the past two years. The responses point to three major mistakes made in the pandemic response.
1. A Lockdown That Came Too Late
Germany got through the first phase of the pandemic relatively well. After the lockdown in spring 2020, which broke the first wave, the situation quickly eased. "We managed it well, it didn't end in disaster," says Melanie Brinkmann, virologist at the Helmholtz Center for Infection Research in Braunschweig.
But few realized at the time that an adverse development had already begun brewing in the spring and summer of 2020. An idea, scientifically baseless yet seductive nonetheless, began to seep into the popular imagination and received significant media attention: namely that SARS-CoV-2 isn't a particularly dangerous virus, but more like a problematic flu that primarily poses problems for the elderly and those with underlying illnesses. That as long as those vulnerable groups were protected, the virus could be given free rein.
There is much to suggest that this narrative contributed significantly to one of the three major missteps of the pandemic in October 2020. Those responsible violated the golden rule of disease control: Hit hard and early. Instead, a shutdown of the kind seen in the spring was delayed by two weeks, before the authorities then tried out what was quickly dubbed "lockdown light." It took several more weeks for decision-makers to realize that the second, more severe wave, also couldn't be controlled without a hard lockdown. The delay ultimately resulted in the deaths of 50,000 people, according to estimates at the time.
And that despite the fact that scientists had calculated precisely such a scenario in advance. On Oct. 14, with the infection rate rising, modeler Michael Meyer-Hermann of the Helmholtz Center for Infection Research was invited to the Chancellery, then under the leadership of Angela Merkel. The Braunschweig-based physicist was asked to explain to a meeting of state governors and federal ministers the effects that different decisions would have. He brought along scenarios showing how many people were likely to contract an infection if a strict lockdown was immediately put in place (few), if a strict lockdown were imposed later (more) or if light contact restrictions were imposed later (a lot more).
Despite his presentation, "nothing happened for two weeks," Meyer-Hermann would later say. Germany, he says, would have had "a good chance" of preventing the second wave if it had acted earlier. But decisions were postponed for two weeks, until the next meeting between the states and the federal government.
On that day, Oct. 28, the National Association of Statutory Health Insurance Physicians held a press conference to present its "Position Paper of Science and the Medical Profession on Strategy Adaptation in Dealing with the Pandemic," which in many respects echoed the narrative of giving priority to protecting vulnerable groups. The paper argued in favor of a new approach to fighting the pandemic: "Focus on imperatives rather than prohibitions."
Looking back, it was a rather "undercomplex" paper for the moment, says a critical Alena Buyx, the chair of the German Ethics Council, "but not without influence." She says it ultimately had an effect on the positions held by a number of politicians.
Alena Buyx, head of the German Ethics CouncilFoto: Frederic Kern / Future Image / IMAGO
Friedemann Weber, head of the Institute of Virology at the University of Giessen, says he was "shocked" when he heard about the statement in the news. "We already knew at the time that it wouldn't work. And that it would end badly." It is, he says, a principle well known in veterinary medicine: "If you have a pandemic running loose outside, you can't protect the animals inside the barn. It's only a matter of time before they become infected as well."
Keeping the virus away from the most vulnerable would have required banishing those at risk "to an island," Weber says, adding that the position paper reminded him of the Great Barrington Declaration, in which some scientists had called for exposing the young and healthy to SARS-CoV-2 contamination to achieve herd immunity.
The vast majority of virologists and disease experts share Weber's conviction. In a separate paper, they called for contact restriction measures to keep the number of infections as low as possible, at least until comprehensive vaccinations were available.
By then, though, it was already too late. In the public eye, a "false equivalence" had long since emerged. Essentially, that means that two views of a situation are presented – in a talk show, for example – as holding equal merit, even though one is far more deeply rooted in science and enjoys far more support in the scientific community. On talk shows, though, there is always exactly one representative in the studio for each position, and both are taken equally seriously. That alone gives the impression that both analyses are equally important and equally well founded.
Virologist Melanie BrinkmannFoto: Julian Stratenschulte / dpa
"At the time, we were harshly criticized for our prediction that a second wave was on its way," says virologist Brinkmann. Some scientists, she says, even lent credence to the idea that the worst had passed. "It was so extreme that I even doubted my own predictions," she says. The message should have been, she says, "that we're going to pursue a low-incidence strategy until we have a majority of the population vaccinated." Instead, she says, there was "no plan at all, zero strategy." And rather than acting, "we were as dormant as Sleeping Beauty in the summer of 2020," she says.
From the mid-October meeting between governors and federal ministers attended by Meyer-Hermann in the Chancellery to the moment the wave ultimately subsided in June 2021, around 80,000 people died from the coronavirus in Germany. During Christmas week of 2020 alone, nearly 5,900 people died.
"Sometimes, five patients died in our COVID ward on a single day," says Munich physician Wendtner. When a living will was in effect, he says, medical and nursing staff often were only providing "palliative care for the critically ill nursing home COVID patients, injecting morphine to relieve respiratory distress, and then they were dead within a few hours."
Looking back, German Ethics Council Chair Buyx agrees that "the lockdown light in autumn 2020 was probably too soft." She views the decision to impose those late and lax contact restrictions as a "real mistake" – as did nearly all the experts interviewed for this analysis. Too many people had to die, Buyx says.
2. The Needs of Children Were Never Taken Seriously
The Ethics Council, though, which has since published a detailed review of the crisis, has also identified another elementary error: How the country has dealt with children and youth. "They just never became the top priority."
Indeed, one of the first major controversies in the pandemic, in May 2020, involved children. Virologist Drosten and his team had discovered that school-aged children could carry a viral load in their throats nearly as great as that in adults, meaning they could presumably be just as contagious. The tabloid Bild newspaper picked up on a dispute between scientists over the statistics in a preliminary version of the study, one that was resolved a short time later, and ran with the headline: "Drosten Study on Contagious Children Grossly Inaccurate." This paved the way for another narrative, namely that "children are not drivers of the pandemic." Some people "just didn't want to hear that children can also spread the virus," says virologist Friedemann Weber of the University of Giessen. "At the same time, anyone who has children knows that they spread disease. Why would that be any different with a pandemic virus?"
This resulted in the creation of two camps in Germany that stood in irreconcilable opposition to each other: While some wanted to prevent children from getting infected at all costs, also to protect vulnerable elderly people, others downplayed the dangers posed by the virus and warned more about the psychological consequences of masks, lockdowns and school closures. This created an artificial opposition with fatal consequences. Children's' needs weren't taken seriously and they weren't adequately protected from the virus.
It was a major mistake of the pandemic "not to think of infection control and psycho-social child protection in concert," says infectious disease specialist Jana Schroeder, chief physician at the Institute for Hospital Hygiene and Microbiology at the Mathias-Spital Foundation hospital group in the state of North Rhine-Westphalia. In January 2022, Schroeder and seven other experts, including child and adolescent psychotherapists, released a statement calling for just that.
School children during lockdown: The economy was always given the top priority in the pandemic.Foto: Sibylle Fendt / OSTKREUZ
It has long been clear that SARS-CoV-2 isn't always harmless for children and adolescents. In Germany, 83 children and adolescents have died from the virus to date. In rare cases, infected individuals can also develop "PIMS ," a multi-organ inflammation, or they can suffer from long-term effects of infection. Last autumn, a study of more than 11,000 children was published with the participation of the Robert Koch Institute, Germany's center for disease control, and several health insurers, which came to the unequivocal conclusion "that long-COVID in children and adolescents simply cannot be dismissed." Munich-based physician Wendtner reports: "We've seen children, adolescents and young adults here with severe long-COVID in some cases, even though they were only mildly ill during the acute phase of the infection."
On the other hand, there are also now several studies documenting the negative psychological consequences for children and adolescent from the emergency measures imposed to combat the pandemic, including school closures and the lockdowns. Cases of depression, anxiety, sleeping disorders and eating disorders all increased. Child psychotherapists reported that their waiting lists had grown longer. But instead of focusing on children, says Jana Schroeder, political decisions almost always prioritized adults and the economy. "There is much to suggest," the infectious disease specialist says, "that schools wouldn't have had to close until later if they had been made more infection-proof or if there had been stricter adult corona measures earlier to keep the incidence level down."
Child and adolescent psychotherapist Cornelia Beeking of Münster says that even at the beginning of the pandemic, it was clear to experts that the psychological consequences of school closures and the lockdown could have been mitigated without neglecting efforts to prevent coronavirus infections. Instead of dramatizing the psychological symptoms, Beeking says, it would have been important to educate children thoroughly and make them feel they can do something themselves to keep the situation under control, like wearing masks and keeping their distance.
"But teachers were often overwhelmed, too," Beeking says. "They were required to continue following lesson plans, conduct performance reviews and thus maintain pressure for good grades. There should have been much more recognition for the fact that the pandemic is an exceptional situation for children, young people, families and also teachers." Instead, she says, children and teachers were expected to function just as they would in normal times.
Many overburdened parents were left to their own devices, which political scientist Elvira Rosert of the University of Hamburg views as the "privatization of suffering." For example, Germany's Standing Committee on Vaccination (STIKO), still hasn't issued a general recommendation for the vaccination of children between the ages of five and 11. Vaccination rates among children are correspondingly low: Only just over 19 percent of five- to 11-year-olds are vaccinated.
And now, each person is responsible for protecting themselves against infection following the expiration of government measures to contain the pandemic. Yet there have long been guidelines in place on how to make classrooms corona-proof. "But these guidelines," Schroeder says, "simply aren't being implemented across the board."
One item in these guidelines is the use of air filters. We become infected "almost exclusively through the air indoors, where most of us spend 90 percent of our lives," says epidemiologist Nikolaos Stilianakis of the European Commission's Joint Research Center in Ispra, Italy. He says heath officials didn't take evidence from previous pandemics about the importance of airborne transmission seriously enough.
"We now have a greater awareness that there is a problem with airborne pathogens indoors," says Elvira Rosert, concurring. "We need hygiene standards for indoor air, just as we do for water and food." And these standards should "ideally be implemented with modern technology."
There are many good ideas for this: virus-destroying UV light, ultra-fine particle filters, measuring devices and fans coupled to them or windows that swap stale air for fresh air when needed. Epidemiologist Stilianakis considers smart ventilation technology "the greatest underutilized potential" of pandemic control.
3. An Inadequate Vaccination Campaign
On Wednesday, Nov. 10, 2021, a popular talk show on German public broadcaster ZDF focused on the effect of vaccination in people aged 60 and older. The host, Markus Lanz, presented an information graphic which, as he told his millions of viewers, "sends a chill down my spine."
It's a bar chart, but it is extremely misleading. It claims that 43 percent of people in that age group who died from the coronavirus had been vaccinated. Did that mean that it is pointless to get vaccinated? Not at all. And in truth, the graph showed that too – how successfully vaccination protects against disease and death. At the same time, though, it hid the true risks by not making clear that, proportionately, very few vaccinated people were hospitalized or died – but a larger share of the lower number of unvaccinated people faced precisely that fate. An example popularly shared on Twitter illustrates the problem: If the vast majority of car occupants who lose their lives in crashes were wearing seat belts, that doesn't mean that seat belts don't work.
It's conceivable that such misleading portrayals may have discouraged people from getting vaccinated – and the editorial team behind the ZDF talk show later apologized for the "misleading interpretation" of the graphic.
Particularly in times of crisis, excellent communication is necessary. Such as when a lockdown becomes unavoidable. "It is extremely important that politicians and public health experts start preparing people now with open, honest and transparent communication," British disease expert Jeremy Farrar told DER SPIEGEL back in February 2020, when the coronavirus first began arriving in Europe. "Trust is crucial, it takes time to be established and it can be lost quickly."
And that is exactly what seems to have happened in Germany: Trust was gambled away.
It didn't actually have to be that way: In April 2020, nearly 60 percent of respondents in the COSMO study conducted by University of Erfurt psychology Professor Cornelia Betsch attested to great or somewhat great trust in the German government, despite the lockdown and school closures. A year later, only just over a quarter of respondents still approved of the government's coronavirus containment policies.
The poor communication regarding risks during the vaccination campaign also had a disastrous effect. Communications researcher Felix Rebitschek is head of the Harding Center for Risk Competence in Potsdam. And he has taken a close look at what went wrong. To this day, the cognitive psychologist doesn't understand the federal government's decision to run the #sleeveup poster campaign. "A lot of money was spent to remind people to get vaccinated who were going to get vaccinated anyway," he says.
Communications researcher Felix RebitschekFoto:
Harding-Zentrum für Risikokompetenz
Rebitschek calculates that five out of 10 people were willing to be vaccinated at the beginning of the vaccination campaign, two were undecided but leaning positive, two were undecided but skeptical and only one out of 10 definitely didn't want to get vaccinated. "It makes me think: What do the four undecideds need from me?" His answer is clear: "Information about what vaccination can and cannot do."
And this information has to be taken to the people, where they are. This is called "outreach" communication, and in the city of Bremen, it worked exceptionally well, with a much higher percentage of residents getting vaccinated early on than in other places. It's also precisely the strategy that Michael Albrecht, medical director of the Dresden University Hospital, chose to persuade his staff to get vaccinated. When the Pfizer/BioNTech vaccine was approved, he says, it turned out that around one-third of his hospital's staff were skeptical. "We then made small educational films showing how an mRNA vaccine works, held educational events where people could ask questions and did our own podcast on a regular basis," Albrecht explains.
He says it was arduous work, but even before the introduction of mandatory vaccination for medical staff, the vaccination rate among physicians at Dresden University Hospital had already reached 96 percent, with 85 percent of nurses getting vaccinated and 80 percent of midwives, a particularly skeptical group. Rebitschek asks: "Why there were no letters or flyers sent to all households at the beginning of the vaccination campaign explaining, evidence-based, in understandable language, the safety and effectiveness of vaccination?"
A nurse and a patient who had just died of a coronavirus infection in Leipzig, GermanyFoto: Sven Döring / laif
Even if a vaccination skeptic were to actively search for information on the internet and find what he or she were looking for on the website of the German Health Ministry (BMG), that person might turn away again immediately. An organization called Competence Network Public Health COVID-19 examined some of these official websites last year and found that the "information had only in rare cases been prepared visually and in line with needs and target groups."
Case in point: the use of celebrities like David Hasselhof on one prominent vaccine website. At the same time, the Health Ministry committed a cardinal sin by mixing advertising for vaccination with factual information. "It needs to be clearly separated," Rebitschek says. "It's obvious that people don't trust someone who is trying to persuade them to provide neutral information." Trust is lost.
In December, the first results of a survey on health literacy in 16 European countries and Israel was published. People in Germany said the most difficult thing for them was getting health questions answered, finding information and making decisions. Asked specifically about vaccination, only people in Bulgaria felt less competent than Germans.
By the end of December 2020, the first vaccine had been approved, but what did Germans really know about its effectiveness? Rebitschek and his team questioned more than 2,300 Germans in a survey conducted by Infratest dimap. The researchers conducted a poll again in May 2021. "People weren't one bit better informed," Rebitschek says.
At some point, the window of opportunity for reaching vaccine doubters, the fearful and the skeptical through effective education measures closed. Michael Bauer, director of the Department of Anesthesiology and Intensive Care Medicine at Jena University Hospital, sees the movement in Germany of corona truthers and vaccine foes as the "sin of the pandemic." In his ward, he says he could literally feel a rift between the patients who were there before there was a vaccine, "grateful for the treatment" – and the many unvaccinated who had to be treated after there was vaccination.
He says he experienced dramatic episodes during that time, including a young pregnant woman whose relatives talked her out of getting vaccinated and who then went on to spend months in the intensive care unit with a corona infection. At some point, he also received a threatening letter in his mailbox that hadn't been delivered by the postal service. "Dr. Bauer-Mengele, Angel of Death," it read. "Stop mandatory vaccination. If you hurt us, we hurt you. We do not forgive. We do not forgive. Just wait."
Looking Ahead to Next Winter
The question now is what the federal and state governments could do better next autumn. This time, in contrast to earlier pandemics, an expert commission has been appointed by the Health Ministry to examine how much certain coronavirus containment measures have actually helped. But it recently saw the departure from the commission of Christian Drosten, Germany's leading virologist. From the beginning, Drosten said, he had demanded that the panel be composed according to professional suitability. Instead, parliamentary groups and government ministries packed it with their preferred candidates. "We don't even have any full-time epidemiologists in there at all," Drosten complained on a public radio station.
Pandemic policy isn't about establishing an expertocracy. Many things cannot be decided purely on a scientific basis, and under Germany's constitution, political leaders serve the people, and not necessarily science. At the same time, serving the people also means protecting them from a potentially deadly pathogen. And the basis for decision-making must include scientific evidence.
In fact, thanks for the efforts of science, humanity knows so much about the virus that it may be possible to keep it at bay in the Northern Hemisphere during the autumn and winter without great mental or health costs.
The most powerful weapon against the virus is knowledge about it. The question is what can be derived form that. Most experts believe that the premise of "hit hard and early," should be a priority, because procrastination will cause suffering and prolong the pandemic, thus inflicting undue harm to the economy. If an immune escape variant emerges this autumn, it's possible that restrictions will become necessary once again.
Experts also believe that hygiene standards for indoor air would be helpful. With air filters or other technologies, children could continue to go to school and parents to work.
A new vaccination education campaign could also be rolled out to try and convince the holdouts and the skeptical. And if push comes to shove, there could also be a new push for mandatory vaccination – for the elderly, for example.
Isabella Eckerle isn't quite so confident in Germany's willingness to learn. "In the beginning, I thought we would be better able to deal with viral outbreaks after this pandemic," the virologist says. "But now I feel that we have never been worse prepared than we are now."