Germany: COVID-19 National Strategy - World Health Systems Facts

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Daily Situation Report of the Robert Koch Institute (German & English)

German Government’s special website on COVID-19

Federal Institute for Drugs and Medical Devices (BfArM)

Federal Ministry of the Interior

German Center for Infection Research

German Covid-19 Strategy: Travel, Border Entry, and Confirmation of Vaccination

“Travelers fully vaccinated against COVID-19 as well as those recovered from an infection are able to enter Germany without any quarantine or testing requirements as of May 13, 2021, unless they are coming from a designated area with new, more contagious variants of the virus. The new regulation also stipulates that those without vaccination or prior infection can avoid a quarantine if they present a negative test result (antigen test no older than 48 hours or a PCR test no older than 72 hours), except for those form high-risk or mutation areas.”

Source: COVID-19 Health System Response Monitor. A project of the European Observatory on Health Systems and Policies, the European Commission, and the World Health Organization Regional Office for Europe. Last accessed May 20, 2021.

German Covid-19 Strategy: Measures Extended Until March 28, Some Restrictions Relaxed

“The federal and state governments agreed on March 3 to extend the current measures to contain the Corona pandemic until 28 March 2021 but also to relax some lockdown restrictions stepwise. The opening steps depend predominantly on the current infection situation in a federal state or region. Starting March 8 meetings of up to five people from two different households (excluding children) are permitted and several types of shops (bookstores, florists and gardening stores) can open, with limits on customer capacities and hygiene concept in their shops. The same applies to service businesses that are still closed and close to the body, as well as driving and flying schools. They are allowed to reopen with safety plans with regular rapid or self-administered testing for staff. If no mask can be worn during services – such as cosmetic facial treatments – a daily negative rapid test must be presented by the customer and regular testing for staff is needed.

“A third opening step is linked to a stable seven-day incidence of less than 50 new infections per 100,000 residents. In this case, a state can allow the opening of all shops with restrictions. Museums, galleries, zoos and botanical gardens, as well as memorials would be allowed to reopen (with appointment systems) and non-contact sports in small groups (with a maximum of 10 people) in outdoor areas is possible. If the incidence is above 50 but remains below 100 infections per 100,000 people, retailers are allowed to open for so-called appointment shopping (“click and meet”). It also includes reopening of other areas such as museums, zoos, group sports. If the seven-day incidence remains stable below 100 infections per 100 000 for 14 days, the fourth opening step applies (earliest as of March 22) with outdoor restaurants, theatres, concert halls and cinemas being then allowed to open (with testing and reservations booked in advance). If the incidence has not worsened for 14 days after the fourth stage, the fifth opening step can be taken. If the number of coronavirus infections per 100,000 residents in seven days stays below 50, outdoor recreational events with up to 50 people can be allowed, as well as indoor contact sports. Furthermore, if the 7-day incidence is stable or declining, and between 35 and 100 new infections/100,000 people, there would be less strict rules for entering shops. And non-contact sports indoors and contact sports outdoors would be allowed without testing.

“If at any point the seven-day incidence rises back above 100 on three consecutive days, the emergency brake kicks in and the old strict lockdown rules (prior to March 8) apply (i.e. private get-togethers will only be possible with one’s own household and one other person).”

German Covid-19 Strategy: National Lockdown Extended Until At Least February 14

“In a meeting between the Federal Chancellor and the heads of Germany’s federal states on January 19, an agreement was reached to extend the national lockdown (in place since December 16, 2020) until February 14, 2021. The leaders hope the extension will help reach a target incidence rate of 50 new infections per 100,000 inhabitants within seven days by mid-February. A new requirement to wear medical masks (FFP2, KN95 or surgical masks) in public transportation, stores and during religious services was also agreed out of fear of the spread of new, more contagious mutations of the virus.

“Furthermore, daycare centers and schools largely remain closed and employers are encouraged to extend options for working from home whenever possible. No new nationwide curfew was agreed to (though some states have already implemented their own) in addition to the previous rule of not traveling more than 15 kilometers from a hotspot that has an incidence of more than 200 new infections per 100,000 inhabitants over seven days. Economically, the federal government will extend further grants for companies’ fixed costs if they can demonstrate a significant drop in income due to the pandemic.”

German Covid-19 Strategy: Lockdown Extended Until At Least January 31

“On January 5, Germany’s state and federal governments agreed to extend and expand coronavirus lockdown rules that came into force on December 16 2020. The current lockdown regulations, including the closure of schools, will now be in place until at least January 31, and new rules have been introduced:
“- Private meeting limits will be restricted to just one other person not living in the same household
“- A hot spot travel ban will be introduced. From now on, residents of areas deemed coronavirus hotspots (7-day incidence > 200/100.000 inhabitants) will be restricted from traveling more than 15 kilometers (9.3 miles) from their town without a valid reason. Day trips are specifically ruled out
“- Double testing will be introduced. People arriving in Germany from high-risk areas will be required to submit two negative test results. A minimum five-day quarantine period will be mandated, even if the first test is negative
“- Extra leave for parents will be introduced. Parents will receive an extra 10 days leave to look after children, while single parents will receive an extra 20 days.

“The overall objective of tightened measures is to reduce the 7-day incidence below 50/100.000 inhabitants. It is expected that under this threshold public health offices are able to perform effective contact tracing again.”

German Covid-19 Strategy: Occupational Health And Safety: Working From Home

“On January 21, the Federal Ministry of Labor and Social Affairs (BMAS) released a new Occupational Health and Safety Ordinance (SARS-CoV-2-Arbeitsschutzverordnung). Aim of this ordinance is to reduce the risk of infection with the SARS-CoV-2 at work and to protect the health and safety of employees. From January 26 on, employers must offer employees to carry out their work at home, if there are no compelling operational reasons to the contrary. This applies to any case of office work or comparable activities. The ordinance will expire on March 15, 2021.”

German Covid-19 Strategy: Restrictions On Travelers Entering Germany

“As of January 14, a new regulation from Germany’s Federal Cabinet mandates that anyone entering the country who stayed in an area with notably high COVID-19 incidences or where mutated strains are known to be present in the last 10 days must present a negative test result up to 48 hours after arrival. The Federal Ministry of Health made the announcement and said that tests may be requested by officials at German borders.

“Furthermore, those traveling to Germany from other risk areas must provide proof of a negative test no later than 48 hours after entry. A ten-day quarantine applies in all of Germany following a stay in a designated risk area, which is enforced at the state level. Starting March 1, 2021, those entering Germany will also be informed of current entry policies in the country via SMS.”

German Covid-19 Strategy: Vaccination Roll-Out and Priority Groups

“On December 15, a new ordinance regarding the entitlement for vaccination against the coronavirus SARS-CoV-2 came into force after being announced by the Prime Health Minister. Due to at least initial scarcity vaccination will follow of a hierarchical order with three priority stages.

“First, the highest priority is given to persons above the age of 80; persons working in inpatient facilities or in medical facilities with a very high risk of exposure (e.g. intensive care units, in emergency rooms, in emergency services), in outpatient palliative care, in the vaccination centers; persons that are treated, cared for or are active in in-patient facilities for the treatment, care or nursing of elderly persons or persons in need of care; persons providing ambulatory long-term care services caring for elderly (e.g. in palliative care), providers of specialised, and persons working in treatment areas with a very high risk of serious or fatal disease course after being infected (e.g. oncology or transplant medicine).

“Second, persons with higher vaccination priority include those over 70 years old; persons with a very high or high risk of serious or fatal disease course (trisomy 21, dementia or with an intellectual disability, patients after organ transplantation); persons with high or increased risk of exposure to the SARS-CoV-2 coronavirus (e.g. doctors and other staff with regular direct patient contact: staff from blood and plasma donation services and in SARS-CoV-2 test centers); those who live or work in close contact with people in care or pregnant women; those who work in residential facilities and ambulatory care for the treatment, care or nursing of mentally disabled persons; police and law enforcement officers who are exposed to a high risk of infection during (e.g. demonstrations); persons working at public health services or in a particularly relevant position to maintain the hospital infrastructure.

“Third, persons with high priority comprise those above the age of 60; persons with an elevated risk of serious or fatal disease course (e.g. BMI>30, chronic kidney/ liver disease, immunodeficiency or HIV, COPD or bronchial asthma, diabetes, cancer, autoimmune or rheumatic disease, CAD, heart failure), persons who work in particularly relevant positions in state institutions (e.g. in the constitutional organs, in governments and administrations, in the armed forces, police, fire brigade, disaster management including the Federal Agency for Technical Relief (THW) and in the justice system) or relevant positions in other institutions and companies in the critical infrastructure (e.g. in the food industry, in the water and energy supply, in pharmaceutic industry and pharmacies, in wastewater disposal and waste management, in transport and traffic as well as in information technology and telecommunications); those working in medical facilities with a low risk of exposure to the SARS-CoV-2 coronavirus (medical laboratories); people who work in the food retail sector; persons who work as educators or teachers and people with precarious working or living conditions.

“Rollout of COVID-19 Vaccine Distribution

“Vaccination will be carried out in vaccination centers and by mobile vaccination teams that are affiliated with the vaccination centers (see also Section 1.1 Preventing transmission: Health communication). The vaccination centers are set up and operated by the federal states or on behalf of the federal states. The federal government can operate its own vaccination centers to carry out protective vaccinations for federal employees, in particular for people who work as functionaries in relevant positions.

“The National Association of Statutory Health Insurance Physicians develops and operates a standardized module for telephone and digital arrangement of appointments in the vaccination centers, which enables the countries to organize appointments is made available. A nationwide uniform telephone number will be used for this. The costs of setting up and organising the vaccination centres are borne by the Länder and the liquidity reserve of the Central Reallocation Pool as well as the private health insurances. Vaccinations are financed by the federal government.

“On December 23, Germany’s federal institute for vaccines and biomedicines (Paul Ehrlich Institute (PEI)) officially released 4.1 million doses of the COVID-19 vaccine from Pfizer/BioNTech in anticipation of beginning vaccinations in the country on December 27. This comes after the EU Commission approved the vaccine for member states in the past few days.”

German Covid-19 Strategy: Complete Lockdown Between December 16 and January 10

“On December 13, a complete lockdown was announced to be in place as of December 16. The new restrictions include shutdown of non-essential stores, along with closure of schools and day care centres. These new restrictions will be in effect until at least January 10 to help tackle the second wave:

“-Schools are urged to send students home and continue lessons online as well as extending the Christmas holidays until January 10.

“- Daycare centers will also close, but parents will be able to take paid holidays in order to look after their children

“- Employers are encouraged to allow employees to work from home.

“- People will not be allowed to drink alcohol in public.

“- Religious events in churches, synagogues, and mosques may take place if they follow hygiene rules, but communal singing is not allowed.

” – States still plan to ease stricter contact restrictions for December 24 to 26 so that close family members can spend Christmas together — a household may, during this time, invite up to four adults from other households but only from the immediate family, plus any number of children under 14.

“- People may not purchase fireworks for New Year’s Eve.”

German Covid-19 Strategy: Continuously High Infection Rates And Different Restrictions In Federal States Around Christmas

“Despite the partial lockdown since early November, which was expected to pull rates of infection back down to an acceptable level, infection numbers continue to remain at a high level and every day’s death tolls are far above levels of spring 2020. Germany’s hospitals are also pushed to their limits. According to the President of the German Hospital Federation (DKG), there are 40% more COVID-19 intensive care patients in hospitals than in spring 2020 and hospitals are coming under increased financial stress. Regarding these developments, a tightening of restrictions in Germany is becoming more likely. Several states have already announced tougher restrictions.

“The Free State of Bavaria put stricter COVID-19 regulations into place on December 9. The state government has once again declared a “disaster” situation, moving crisis management responsibilities from the municipalities to the state government. Furthermore, residents should only leave their homes for justified trips and overnight curfews from 9pm to 5am will come into effect in local hotspots (200 new infections per 100,000 inhabitants within seven days). Further, a maximum of five people from two households are allowed to meet. The regulations also include plans for dividing school classes into alternating classes and distance learning. The regulations are in place until January 5.

“The state of Saxony enters a lockdown phase on December 14 by closing its schools, daycare centers and most stores, while grocery stores and stores for basic needs remain open. The lockdown will last until January 10 and includes a ban on alcohol in public places.”

German Covid-19 Strategy: Lockdown Extended Until At Least Dec. 20

“Germany’s partial lockdown is set to be extended until at least December 20 following an agreement between the leaders of the federal states, with a decision for January scheduled to be made on December 15. Hotels, gyms and restaurants will remain closed, private gatherings will remain limited to five adults (from two different households) and mask decrees also stay in place. There will also be a holiday exception, from December 23 to January 1, where people from more than two households and up to 10 total (not counting those under 14 years of age) will be able to meet. The government is encouraging people who plan on meeting to self-isolate for several days ahead of this holiday exception. Furthermore, schools will start their holidays on December 19, 2020 and masks should be required from the 7th school year and up in areas with more than 50 cases per 100,000 residents. In areas with more than 200 cases per 100,000 further measures can be implemented to reduce the number of students such as staggering school start times or distance learning on certain days per week The current economic programs to support businesses and the self-employed will receive further funding for December.”

German Covid-19 Strategy: Financial Assistance For Hospitals

“In regard to more targeted help for hospitals, the Third COVID-19 Population Protection Act, adopted by parliament on November 18, implements changes in the compensation payments for beds that hospitals reserve for COVID-19 patients. The per diem/daily payments for keeping empty beds available are to be reintroduced, but in a more targeted manner: the intensive care capacities of hospitals have to be scarce and the area’s 7-day incidence of confirmed cases has to be over 70.

“Only hospitals with intensive care capacities that postpone or cancel elective treatments to potentially treat COVID-19 patients are eligible to receive compensation payments. These hospitals, whose eligibility is to be determined by the state, can receive compensation payments if they are located in areas where less than 25% of free, operable intensive care beds are available and in which the 7-day cumulative incidence is above 70 cases per 100,000 residents. If the free ICU capacity is less than 15% of all ICU beds in the area, the respective state authorities can determine if hospitals from neighbouring communities with the same preconditions (i.e. postponing interventions to free up ICU capacities) are also eligible for compensation payments. Compensation will be paid to hospitals for the lower number of patients treated in 2020 compared to 2019, as per diem payments are to be distributed based on 90% of the difference in patients that hospitals had between both years. The basis of the per diem payment is the flat-rate fee per unoccupied hospital bed.

“In addition, rehabilitation facilities can once again be used as recovery facilities until end of January 2021 to take over discharged COVID-19 patients with mild symptoms or other patients to relieve ICUs. Residential facilities for rehabilitation and prevention are also eligible for financial support for revenue shortfalls for a limited period of two and a half months with half of the revenue loss being covered, based on the average daily flat rates.

“Compensation payments for hospitals and residential facilities for rehabilitation and prevention are refinanced through the federal budget.

“Sources: https://www.bundesgesundheitsministerium.de/drittes-bevoelkerungsschutzgesetz.html“

German Covid-19 Strategy: Testing Criteria Tightened

“As of November 3, the RKI [Robert Koch Institut] testing criteria are tightened to prevent overloading medical practices and laboratories. A SARS-CoV-2 test must be carried out by ambulatory physicians if at least one of the following criteria is met:

“- Severe respiratory symptoms (e.g. acute bronchitis or pneumonia, respiratory distress or fever),
“- Acute hypo- or anosmia or hypo- or ageusia (disturbance of the sense of smell and taste),
“- Unexplained disease symptoms and close contact (less than 1,5 metres distance for at least 15 minutes) with a confirmed COVID-19 case or
“- Acute respiratory symptoms of any severity and one of the following criteria: Membership in a risk group, work in nursing, medical practice, hospital, increased probability of exposure, contact in the household or in a cluster of persons with acute respiratory disease (ARD) of unknown cause and an increased COVID-19 7-day incidence (> 35/100,000 inhabitants) in the district, during the period of the symptoms there was the possibility (exposure setting) of further dissemination to many more persons, continued close contact with many people or with vulnerable risk patients, clinical deterioration with existing symptoms.
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Massnahmen_Verdachtsfall_Infografik_DINA3.pdf?__blob=publicationFile“

German Covid-19 Strategy: Some Restrictions Reimposed In Response To Increasing Infections

“On October 28, the Chancellor and the state premiers announced a new partial lockdown to begin on November 2.

“The new restrictions for November include:
“- Restaurants and bars will close, except for take-away
“- Large events will be canceled again
“- Unnecessary travel is strongly discouraged
“- Overnight stays in hotels for tourist purposes is banned
“- All those who can work from home should do so and employers should ease a transition into working from home
“- Meetings in public will be restricted to just two households of up to 10 people total.
“- Entertainment facilities such as theaters and cinemas will be closed
“- Public recreation centers such as swimming pools, gyms and saunas will be closed
“- No crowds at sports events

“What is allowed:
“- Schools and kindergartens will remain open
“- Church services and protests will be allowed to continue due to constitutional concerns
“- Nursing home residents will be allowed to receive visitors
“- Shops will remain open, with one customer allowed per 10 square meters (108 square feet)
“- Borders remain open

“Firms hit by the new measures would receive economic support: companies with up to 50 employees and the self-employed will receive 75% of their income in support. Emergency loans will be made available for self-employed workers such as artists and stage hands, while small businesses with less than 10 employees will gain access to very cheap loans. A total of EUR10 billion has been earmarked for support.”

German Covid-19 Strategy: Fitness For Work Evaluations

“A resolution that doctors can issue patients sick notes via video consultation, which was adopted in mid-July by the German Joint Federal Committee, entered into effect on October 9 and will initially apply until the end of the year. Patients seeking incapacity certificate must be personally known to the practice via previous treatment and the note can be issued by video for a maximum of seven calendar days. After seven days, the patient must visit the practice if they remain unfit to work. Follow-up prescriptions are also possible to obtain via video if the patient has personally been in the practice before due to the same illness.”

German Covid-19 Strategy: Increases In Infection Rates Will Trigger Imposition of New Restrictions

“On October 15, the government and federals states agreed on new measures to control the spread of COVID-19 this autumn and winter. In line with their hotspot strategy to combat the dynamics of infection, they decided to impose new restrictions when there are more than 35 new infections per 100,000 inhabitants in a week. The restrictions include the wearing of supplementary masks, a curfew at 11 pm and limitations for private celebrations If an area records more than 35 new infections per 100,000 people over seven days, masks will become mandatory in all places where people have close contact for an extended period. The number of people allowed to gather will also be limited to 25 in public and 15 in private spaces. From 50 new infections per 100,000 inhabitants in seven days, private celebrations should be limited to a maximum of ten participants in public space and a maximum of ten participants from a maximum of two households in private space. If the new measures do not bring the increase to a halt, this will be reduced to up to five people or the members of two households. Likewise, with 50 new infections per 100,000 inhabitants in seven days, a curfew is to be imposed at 11 pm for the catering trade with bars and clubs being closed, the number of participants in events is limited to 100 persons (exceptions require a hygiene concept coordinated with the responsible health authority).”

German Covid-19 Strategy: Stricter Measures to Curb Coronavirus In Autumn and Winter

“After a virtual conference between the Federal Chancellor and state leaders on September 29, new policies concerning the containment of COVID-19 were announced. First, if a district has more than 35 new infections per 100,000 inhabitants within seven days, gatherings in public or rented rooms will be limited to a maximum of 50 participants in public or rented spaces. For celebration in private rooms, a maximum number of 25 people is strongly recommended, but it is not part of the formal regulation. If there are more than 50 new infections per 100,000 inhabitants in a district within seven days, the number of participants in public or rented spaces goes down to 25. Exceptions here could be made for registered celebrations with hygiene plans approved by public health officials. For private celebrations it is recommended to limit participants to 10 people. Furthermore, citizens who give false information about themselves in restaurants or bars will face a fine of EUR 50, with the states being responsible to implement this policy. Two letters will be added to the “AHA formula” (which stands for distance, hygiene, masks [Abstand halten, Hygiene and Alltagsmaske]) by “C” and “L”, which stand for Corona Warn App and Lüften (ventilation).”

Germany’s COVID-19 National Strategy: Transition: Health Workforce Staffing Levels

“The Ministry of Health’s temporary suspension of the minimum nurse staffing levels in intensive care and in geriatric care will cease on August 1. The requirements were suspended on March 16 to help hospitals be more agile with staffing in the wake of the COVID-19 outbreak. The requirements state that one nurse in intensive care be available for every 2.5 patients during the day and 3.5 patients at night, while in geriatrics one nurse be available for ten patients during the day and for 20 patients at night. Minimum nurse staffing levels for high-maintenance areas of trauma surgery, cardiology, heart surgery, neurology, stroke units and early neurological rehabilitation will remain suspended until December 31.”

Germany’s COVID-19 National Strategy: Transition: Public Gatherings and Schools

“On June 17, the heads of the federal states and the head of the chancellor agree that large events remain banned until the end of October. The ban was previously in place until August 31. Exceptions can be made if contact tracing and compliance with hygiene regulations is ensured at certain events. Further, they decided that schools and kindergartens will take up regular operation after the summer holidays, if possible.”

Germany’s COVID-19 National Strategy: Transition: Social Distancing and Public Gatherings

“On May 26, the head of the federal chancellery and the heads of the federal states agreed that contact restrictions will be extended until 29 June. Part of the agreement is that federal states may allow public gatherings of up to 10 people which belong to two households. People in public must continue to maintain a minimum distance of 1.5 metres. This measure is being supplemented by an obligation to wear a mask in certain public areas. Distancing and hygiene measures should also be implemented in private gatherings at home in closed spaces. The number of persons permitted depends on the space available and thus the possibility to adhere to the rule on distancing. What is more, adequate ventilation must be ensured. The number of persons should be restricted accordingly. Wherever possible, private gatherings should be held outside where there is a considerably lower risk of infection. The identities of the participants should be known. The measures are slightly different in Thuringia (see above), Hesse and Lower Saxony. For the time being, Hesse will retain the restriction that individuals can go outside either on their own or together with one other person of another household or with members of their own household. Lower Saxony reserves the right to uphold its regulation limiting contact to two households.”

Germany’s COVID-19 National Strategy: Transition: Testing and Warning Levels

“On May 6, when the government announced the second phase of easing far-reaching restrictions on public life that took effect in mid-March, it also defined an ‘emergency break’ to reinstate a lockdown in a region. Once infection rates spread to more than 50 new cases per 100,000 people in a given area within seven days, new lockdowns would be put in place in the respective region.

“On May 12, the state government of Berlin has adopted a much stricter early warning system. The Senator for Health and the head of state justified that the population density of Berlin required a separate policy. The city-state will utilize a traffic light system’ combining the three factors of “R” value, the number of available hospital beds and the total number of new infections.

“If there are 20 new infections per 100,000 inhabitants within seven days, the traffic light will change to yellow, and in case of 30 new infections, it will switch to red. If the reproduction number is 1.1 on at least three consecutive days, the traffic light turns yellow and at a rate of 1.3, it turns red (on May 12, the reproduction number was 0.79 in Berlin and 1.13 nationwide). Finally, if 15% of all ICU beds are being used by COVID-19 patients, traffic light turns to yellow and at 25% it turns to red (currently 9% of ICU beds in Berlin are occupied). If two of these indicators are yellow, the new situation will be evaluated. If two indicators turn red, reinstatement of lockdown measures will be considered.

COVID-19 National Strategy: Transition: Physical Distancing, Business and Facility Reopening

“On May 6, the Chancellor announced lockdown rollback for the coming weeks. While contact restrictions of 1.5 meters were extended until 5 June, the federal government and the states agreed that members of two households (two families, two couples or the members of two shared flats) may meet again. Parts of the economy will reopen. In general, the federal states assume responsibility for further relaxation of restrictions. The decisions taken at federal level constitute a framework for federal states determine the next stages of the lockdown. This allows a differentiated response to regional outbreaks and infection rates. The government also announced an ‘emergency break’: once infection rates spread to more than 50 acute cases per 100,000 people in a given area within seven days, new lockdowns would be put in place in the respective region.

“The relaxed regulations agreed on May 6 include:
“- All stores are allowed to reopen, without square meter restrictions. Stores must ensure hygiene measures, access control and avoid queues.
“- Mouth and nose protectors must be worn when shopping and on public transport. This regulation could be extended to other areas in the coming days.
“- Employees with cold symptoms can have their doctor write a sick note by telephone until at least May 18.
“- Schools will reopen in phases and emergency care services for children will be extended in all states from May 11. Federal states will decide when schools and childcare facilities will fully reopen before the summer. However, most universities will continue with distance learning.
“- Seniors in care homes in some states will be allowed to receive visitors provided there is no active COVID-19 case in the facility, and in some cases, only if the visitors are older than 16.
“- Outdoor sports for children and non-professional leagues would also be allowed to take place.
“- The reopening of cinemas, theaters and restaurants remains unclear, each state is reviewing rules for restarting these parts of the economy.
“- In most states, religious services will resume.
“- Germany’s soccer league, the Bundesliga, will be allowed to resume games in the second half of May, as long as games are played behind closed doors. The decision now passes to the German Football League (DFL) as to when to restart play.”

“On April 17, the federal state Saxony is the first German state to make wearing a face mask on public transport and in stores a requirement as of April 20. At the same time, the federal state lifts its lockdown measures which have been much stricter than in other federal states. From April 20, people can leave the house without specific reason. Social distancing measures remain in place. On April 20, the federal states of Bavaria and Mecklenburg-Western Pomerania also announced to make wearing face masks a requirement in public transport. In the subsequent days, most federal states followed and announced similar rules and implemented regulations to wear (non-medical) face masks, mostly starting as of April 27 (partly earlier). This is applied to public transport and at retail in all states.

“On April 30, the Chancellor and the heads of the 16 German states agreed that houses of worship, museums, gardens, zoos, playgrounds and monuments would be opened under certain conditions in the coming days for visitors after weeks of lockdown. The federal states have the final word on opening churches and other places of worship. The country’s social distancing measures stay in place at least until May 10.”

“The agreement achieved on April 15, allows car dealers, bicycle shops and bookstores to open as part of the first phase of easing restrictions from April 20. Meanwhile, shops up to 800 square meters will also be allowed to reopen. All shops are required to provide plans to maintain hygiene and strict conditions must be in place regarding access and queue control. (Shops considered essential, such as supermarkets, pharmacies and hardware stores, have stayed open throughout the lockdown. Customers have been allowed to enter only in restricted numbers and asked to stay away from one another.)

“The agreement states further:

“• Hairdressers will be allowed to open their doors from 4 May, provided they too comply with strict hygiene measures. Restaurants, cinemas, bars and theaters have been given no starting date to reopen.

“• Starting 4 May, schools will gradually and slowly reopen. Students preparing to leave secondary school are set to return to school first, on May 4, along with those leaving primary school but only after appropriate preparations of hygiene standards. However, in Bavaria, schools will not reopen until May 11. Day care centers and kindergartens are to remain closed. However, “emergency care” services will be provided and extended to parents of small children who have to go to work and for single parents. By April 29, the Conference of Education Ministers is to present a concept for further steps on how teaching can be resumed under special hygiene and protective measures.

“• Large events remain banned until 31 August at the earliest. Further, the government is keeping its suspension on religious services. The government and the Robert Koch Institute are strongly recommending, but not requiring, that masks be worn on public transport and in shops.

“• Everybody in Germany is still requested not to undertake any private travel or visits.”

Preparation and Governance

“The German Influenza Pandemic Preparedness Plan was first published by the RKI in 2005 and was regularly updated, e.g. based on evidence collected in the 2009 influenza pandemic. The plan provides the basis for pandemic preparedness plans at regional (federal states) and community level. Based on the regional pandemic preparedness plans, the federal states are in charge of implementing most infection prevention and control (IPC) measures resulting in variation of measures within Germany. In general, federal authorities such as the RKI and authorities at community level (public health offices) execute their responsibilities in support of the federal and regional responses to a pandemic.

“On March 4, the RKI extended the Influenza Pandemic Preparedness Plan in a supplement on COVID-19 for the handling of the pandemic. The supplementary plan aims to reduce morbidity and mortality, ensure treatment of infected persons, maintain essential public services and provide short and accurate information for decision-makers, media and public. The plan provides information on risk-assessment criteria, diagnostics, case definition, IPC, case-management, surveillance as well as communication regarding the COVID-19 crisis. The plan foresees three stages: containment, protection and mitigation.

“On March 27, the “Act for Protecting the Public (Health) in an Epidemic Situation of National Importance” grants the Ministry of Health expanded but timely limited power. Among other things, the Federal Ministry of Health is now authorized to take measures regarding the provision of pharmaceuticals and medical devices, including narcotics, laboratory diagnostics, items of personal protective equipment and products for disinfection. The Ministry of Health can also strengthen personnel resources in the health care system, e.g. by authorizing health professionals to perform medical work if they are personally qualified to do so. The new competencies of the Federal Ministry of Health will expire on April 1, 2021, the “authorization to treat” for nurses and emergency paramedics will expire on January 1, 2021.”

Physical Distancing, Facility and Business Closing:

“There are no nation-wide regulations on physical distancing given the federal governance structure of the country. Each federal state takes own decision on restrictions, school closing etc. based on their pandemic preparedness plans (see section 5. Governance). However, in the wake of the COVID-19 outbreak in Germany, the federal states largely agreed on similar measures to delay the spread of infection and the associated burden on the healthcare system. On March 13, most German federal states decided to close their schools, nurseries, universities and cultural institutions from 16 March until mid-April (dates differ slightly by federal state). As of March 16, the heads of all federal states and the chancellor decided that also bars, clubs, theatres, discotheques, pubs, operas, concert halls, public libraries, cinemas, leisure parks (indoor and outdoor), museums, trade fairs, exhibitions, zoos, special markets, amusement arcades, casinos, betting shops, prostitution businesses, brothels, sports in public and private sports facilities, swimming pools, gyms and playgrounds would be closed. Restaurants, cafeterias and hotels could remain open from 6 am to 6 pm. Supermarkets, chemist’s shops, banks, pet shops, and all business that sell essential basic needs are allowed extended opening times including on Sundays, while non-essential shops are to be closed at all times.

“On 17 March 2020 the government released more extensive recommendations for the public on physical distancing. People are advised to stay at home, to keep physical distance from others, to avoid use of public transport, public gatherings and shopping during peak hours; to work from home if possible and to avoid traveling within the country. The public was also advised to avoid close contact with individuals considered vulnerable (elderly people and those with chronic conditions).”

“On 20 March, Bavaria was the first state to declare a curfew, inspired by and identical to Austria. On Sunday (March 22), the chancellor agreed with all heads of federal states on more drastic restrictions on public and social life to be implemented nationwide. However, the restrictions are not as far reaching as the curfew agreed in Bavaria and movement restrictions agreed in Saxony where leaving the house will only be permitted in certain circumstances. Most federal states introduced the following measures:

     “• Public gatherings of more than two people will be banned. There will be exceptions for families and those living together.
     “• General contact with others should be reduced to a minimum.
     “• A 1.5-meter distance should be kept at all times when in public.
     “• Gastronomy businesses must close. Businesses offering food delivery and collection will be allowed to remain open.
     “• Service providers such as hairdressers, cosmetic, massage and tattoo studios where a 2-meter distance between people is not possible must also close. Businesses and centers offering medical treatments may remain open.
     “• Police and other law enforcement agencies will enforce any infractions of the new rules — Merkel did not state what the punishment would be for anyone not abiding by the new measures.
     “• Hygiene regulations must be implemented for staff in the workplace, or for visitors.
     “• Commuting to work, helping others and exercising alone outside will still be permissible, as long as the activities are carried out in abidance with the guidelines.
     “• The measures will remain in place, initially for the next two weeks.”

“On April 1, the social distancing restrictions were extended until April 19, through the end of the Easter holiday break. On April 2, many federal states have implemented catalogues of fines for those breaking the rules, and not keeping the advised 1.5-meter distance between people. For example, Berlin’s catalogue foresees a fine of EUR 25 to 500 if people form groups of more than two people and possibly resist the police’s demands. Fines for companies that infringe the restrictions are considerably higher with up to EUR 10,000 euros for example for opening of shops. According to the catalogue of fines in the state of North Rhine-Westphalia gatherings in groups of more than two are fined EUR 200, and picnics and barbecues with EUR 250. Operating a bar, club or gym will be fined EUR 5.000.

“On April 1, the Robert Koch Institute (RKI) updated its position regarding people wearing protective face masks when people go out in public. The use of temporary masks in public spaces where the safety distance cannot be maintained (e.g. public transport, grocery stores or even at the workplace) also by people without coronavirus symptoms (that might however have an asymptomatic infection of COVID-19) could help to prevent the risk of transmission. Previously, the RKI recommended that only people with acute respiratory infections should wear protective face masks. At national level there is currently no obligation to wear masks. Only few communities (Jena and Landkreis Nordhausen Stadt) decided on March 31 to make wearing protective masks obligatory in public transport and shops.”

Testing:

“After the first COVID-19 PCR test was developed by the German Center for Infection Research (DZIF) at Charité Berlin, German scientists are currently preparing to carry out a test in April to find out who has already developed antibodies to fight off the COVID-19.

“According to the RKI situation report of April 8, a total of 1,317 887 tests have been performed in Germany up to calendar week 14 of which 100,901 (7.7%) have been tested positive on COVID-19. There are currently 143 testing laboratories, of which 132 reported a cumulative testing capacity of 116,665 per day according to the RKI (calendar week 14). However, 30 laboratories stated a backlog of 7,185 samples to be analyzed and 59 laboratories reported difficulties in the supply of reagents.

“On April 8, the Charité, Germany’s largest university hospital based in Berlin, announced to start stepwise large-scale COVID-19 testing and a voluntary antibody testing for employed medical personal to better assess infection rates among medical personal.

“On April 9, the Robert-Koch-Institute announced the launch of a large-scale COVID-19 antibody study to better assess infection rates and monitor the spread of the virus more effectively. The study entails three serological tests: (1) as of early April samples of about 5,000 blood donors will be examined every 14 days, (2) as of mid-April antibody tests will be conducted in a representative sample of 2,000 people in each of four areas that had seen large outbreaks of the virus, and (3) a representative study of the broader population (15,000 people) will be carried out in 150 study locations across Germany as of mid-May (with first results expected in June).”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated May 20, 2021 by Doug McVay, Editor.

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