April 19, 2022 | News | No Comments
This story is one in our six-part series The Pandemic Playbook. Explore all the stories here.
Last summer in Berlin, Christine Wagner could safely do something Covid-19 prevented much of the world’s population from doing: go to a movie theater.
The possibility of strangers sitting together, indoors, for hours, taking off masks to eat popcorn and other snacks, led even big chains like AMC to shut down for some time in the US. But in Germany, things were different: The virus was under enough control for the country to reopen with some social distancing and masking rules. So Wagner could go out — and indoors — with her friends.
“Everyone was free,” Wagner, the head of pandemic communication and strategy at a local German health department, told me. “We could go out to travel, meet friends. … It was like normal life.”
That summer, the streets of Berlin and other German cities were busy. Foot traffic at retail outlets hovered around pre-pandemic levels, according to Google’s mobility data. The number of reservations to dine out actually increased at times compared to 2019, based on the online reservation app OpenTable’s restaurant data. In hospitals, doctors saw way fewer Covid-19 patients than a few months before: In a country of roughly 80 million people, new cases had dropped into the hundreds per day — half the daily rate of new cases in the European Union and United Kingdom last summer, and 95 percent less than the United States.
Today, Germany’s streets are emptier. Few people trickle along the sidewalks, and even fewer enter indoor establishments, as many of the businesses Germans could visit last summer have closed down. Dining out across the country has dropped nearly 99 percent compared to before the pandemic. Trips to retail and recreation outlets are now down around 38 percent compared to pre-pandemic times, according to Google’s mobility data. Daily new Covid-19 cases are below the second wave’s peak over Christmas 2020 but remain high — and have recently risen in Germany’s third wave.
“The only thing I do with other people is work in the intensive care ward, treating patients sick with Covid,” Petra Dickmann, a doctor and researcher at Jena University Hospital, told me. “There’s effectively no private life.”
In the span of a few months, Germany has gone from a shining example of a country that rallied the public behind a Covid-19 strategy to a cautionary tale about what can happen when that strategy falls apart.
No country has had a perfect response to Covid-19. But nations around the world took steps to successfully limit the pandemic’s damage. In this series, the Pandemic Playbook, Vox is exploring the victories and setbacks in six places, including Germany, where a summer of virus suppression eventually gave way to fall, winter, and now spring waves. Unified, clear public health communication saved lives — but as the months dragged on, it was no match for shifting national politics, a fragmented system of government, and a public so tired of the pandemic that they came up with a word for the exhaustion: “coronamüde.”
Germany still reports about two-thirds the Covid-19 deaths per capita as the rest of the EU, and about half the per capita death toll of the US. But its lead has shrunk over time, and at some points in the past few months, the country has reported more deaths relative to its population than either the EU or the US.
So what happened? Germany’s federalist system — in broad strokes, similar to the US’s division between federal and state governments — allowed discord among the country’s leaders to have a major impact on the country’s response, slowing down major decisions. Politics played a growing role as well: In 2018, well before the pandemic, Chancellor Angela Merkel announced she would retire in 2021; the political jostling to replace her featured politicians trying to draw contrasts, often with a less cautious approach to Covid-19 than Merkel’s.
All of this turned a nationwide response that was once marked by unity into one that was fragmented, dividing both the public and its leaders.
“It was very much complacency,” Ilona Kickbusch, a political scientist focused on global health at the Graduate Institute of International and Development Studies in Geneva, Switzerland, told me. “There was a feeling that we’ll get through this relatively quickly. Many, many countries made that mistake — they thought this pandemic response would be a question of three to six months, but it’s turning out to be between 18 months and two to three years.”
Germany’s experience during the coronavirus pandemic shows how a country can unite behind a single public health message and mission. But it also shows how fragile that victory can be — and how quickly an initial success can collapse once something goes wrong.
Germany was initially united on Covid-19
Merkel’s first major speech on Covid-19 could be summarized in three words: “Es ist ernst.” This is serious.
With the Reichstag parliamentary building and German and EU flags behind her, Merkel delivered a speech in her standard, matter-of-fact terms. “Take it seriously,” she urged. “Since German unification — no, since the Second World War — no challenge to our nation has ever demanded such a degree of common and united action.”
In my interviews with people in Germany, they all described tuning in to Merkel’s speech. It was even a family affair. “We were all sitting in front of the TV, listening to her,” Klaus Wälde, an economist who’s done Covid-19 research at the Johannes-Gutenberg University Mainz, told me.
Merkel knew what she was doing. A scientist herself, with a doctorate in quantum chemistry, she explained the need for open communication on scientific and public health issues: “This is part of an open democracy: that we make political decisions transparent, and explain them, that we establish and communicate our actions as well as possible, so that it becomes relatable.”
She would continue to deliver these direct messages, breaking down what was going on and why Germany needed to take action. In another moment that went viral worldwide, Merkel explained the epidemiological concept of a pathogen’s reproductive number, or its R0, used by scientists to measure a virus’s potential spread. She warned that letting the virus spread at even a 10 or 20 percent higher rate could doom the country’s health care system months earlier than would otherwise be the case.
The message trickled down to the local level. Cities and states were eager to avoid the horrors reported at the time in Italy, where hospitals were overwhelmed and death rates were high.
One of those places was Jena, a city of around 110,000 located in the southern part of former East Germany. It had a major university hospital that left it well-positioned to confront the pandemic. In March, the Jena University Hospital made a crucial decision: It required staff involved in patient care to wear masks, well before mask mandates became the norm outside of East Asia. It subsequently found that masks sharply decreased Covid-19 infections among health care workers.
It wasn’t perfect evidence — certainly not a gold-standard randomized controlled trial — but it was good enough during an emergency, and public health officials took it to Jena Mayor Thomas Nitzsche.
“In a pandemic, you cannot wait for the evidence,” Mathias Pletz, director of the Institute for Infectious Diseases and Infection Control and a doctor at Jena University Hospital, told me. “Sometimes, you have to make pragmatic decisions.”
The mayor embraced the idea of masks. He told me he knew he wanted to get ahead of Covid-19. So he and his team devised what was in the spring a solution untried in Germany: a mask mandate.
Nitzsche’s decision, announced on March 30, was not without risks. As in the US and other parts of the world, there were concerns across Germany about shortages of protective equipment, including masks, for health care workers. Some worried the public would reject a mask mandate as a violation of their freedoms.
Nitzsche knew the key to avoiding both these problems would likely come down to how the city’s leaders told the public about the policy. The government would need to transparently communicate the benefits of masks while acknowledging the downsides: Yes, they can be uncomfortable, but masks could flatten the curve, save your family and neighbors, and get life back to normal quicker. And to avoid a run on surgical masks, the local government would emphasize the value of cloth coverings, and encourage people to make masks not just for themselves but for others, too.
“This took a lot of arguing and a lot of information campaigning,” Nitzsche said. “It’s very important to do this together with the people and not on the people. They need to understand. They need to accept. They need to intrinsically want to participate. Then it can work.”
The city took a week before the mandate went into effect to persuade the public through its “Jena zeigt Maske” campaign. The local government blanketed public streets and walls with posters encouraging people to make and wear masks. City officials appeared on local and national media to explain their thinking and to push everyone to take the mandate seriously. Nitzsche posted his own messages on social media and YouTube.
The city was also helped by two factors: The university hospital, a local economic engine, made the population more receptive to public health action. And the national media took a deep interest in Jena’s first-in-the-country experiment, giving the city’s campaign free publicity.
When the mandate took effect in April, Nitzsche was at first surprised, then relieved. It seemed to work. People quickly and eagerly adopted cloth coverings. In public, mask use was nearly universal, as documented by media outlets in videos and photos that proliferated across the country.
Then the numbers came in: Jena was successfully keeping its curve flat. As a study by Wälde and three other researchers for the nonprofit institute IZA in June 2020 found, the difference between actual coronavirus cases in Jena and the number estimated without a mask mandate, as predicted by a mathematical model, widened over time. After 20 days, the level of Covid-19 cases was 23 percent below the predicted level.
Nitzsche began receiving calls from his peers who saw the results in Jena: How did you persuade people? How did you get masks to the public? What were the challenges?
By the end of April, each of Germany’s 16 states made masks compulsory. (By then, only seven states in the US had mandated masks; the total would never climb above 39.)
Wälde’s study also found the nationwide adoption of mask mandates worked: The policies “reduced the cumulative number of registered Covid-19 cases between 2.3% and 13% over a period of 10 days after they became compulsory” and reduced “the daily growth rate of reported infections by around 40%.”
Germany’s quick adoption of mask mandates shows what can happen in a united country. Germany’s federalist system, like the US’s, splits governing powers along local and state channels — a structure built, in part, to safeguard the former Third Reich against the risk of a takeover by a tyrannical leader.
In good times, the system enabled local experiments, like Jena’s mask mandate. With the public on board and public officials following Merkel’s lead, one city’s success could spread to the entire country in just a few weeks’ time.
By midsummer, as the US saw its second surge of the coronavirus, Germany reported less than 5 percent the Covid-19 deaths per day as America. It was a culmination of its quick embrace of mask mandates, but also of other efforts: a lengthy lockdown lasting until early May, a scaled-up testing and tracing system that caught outbreaks before they exploded out of control, and a generally cautious public. Merkel pushed to take the pandemic seriously, and Germany did so with a range of actions.
These kinds of numbers, enabled by the spirit of collective action, allowed Germany to open for the later parts of the summer. The warmer weather helped, as people were pushed outdoors and the virus struggled to spread in the open air and extra heat and humidity. But the change of seasons clearly wasn’t enough on its own. While the US suffered a unique second wave last summer, Germans had flattened the curve to the point that they could go back to restaurants and movie theaters without worrying so much about the coronavirus.
“The first wave was managed quite well,” Clemens Wendtner, a doctor and researcher affiliated with Ludwig-Maximilian University in Munich, Germany, told me. “There was a very close interaction between scientists, physicians, and politicians. All of these things were coordinated.” In contrast to the US, he added, “we faced the facts. We knew exactly what was going on. No one was denying anything.”
Over time, Germany became more fragmented
In September, after Germany’s summer of freedom, Oktoberfest arrived. Munich’s iconic festival was canceled, but some beer halls around Germany held their own celebrations. Organizers claimed the gatherings were regulated with masking and social distancing requirements.
But in reality, many Germans came together, maskless, by the dozens in indoor spaces, sitting tightly across long tables as they drank beer, yelled, and laughed — spitting all over each other particles that can carry the coronavirus and transmit the disease.
It was emblematic of the kind of freedom, beyond Oktoberfest, that Germans embraced when they came back home from summer holidays, pouring into risky indoor spaces and disregarding some of the precautions recommended by experts and officials to contain Covid-19.
So Germany’s Covid-19 cases, along with much of Europe’s, began rising once again. It matched what experts had warned about for months: As the weather cooled and people were pushed indoors, countries needed to step up their precautions, reeling back summer freedoms to prevent a fall surge. Merkel had told Germans that the months to follow would be “even more difficult than now.”
But now, much of the country didn’t heed the warnings.
Case numbers were still low compared to worse-hit nations, but they were rising, with daily new cases roughly tripling from July to August. Officials seemed content to keep letting the virus spread at a faster rate, letting things get worse bit by bit. Some state leaders resisted anything resembling a lockdown; North Rhine-Westphalia School Minister Yvonne Gebauer, bolstered by regional cases dropping to the national average, argued masks in classrooms were “no longer necessary.”
These state leaders were backed by vocal anti-lockdown segments of the population, which marched in the streets in August to oppose Covid-related restrictions. The initial success against the virus — and the short-term economic damage a lockdown would bring — had also left more of the public cool on the need for harsher rules.
By the end of October, the scenario Merkel warned about early in the pandemic when she explained exponential spread to a worldwide audience, came true: Daily new Covid-19 cases in Germany multiplied by seven times in the span of the month.
The success of the past few months had built complacency, and the federal system that allowed Jena to experiment with masks now suffocated further progress. The country’s 16 state governments and Merkel’s federal government couldn’t come to an agreement until it was too late, after they saw the results of exponential spread firsthand.
Even then, the country’s governments by November only agreed to what they called a “lockdown lite,” which closed bars, restaurants, and several other indoor spaces. Cases remained stubbornly high throughout November — more than triple the spring peak of Covid-19. It wasn’t until late November that Merkel finally got the 16 state governments to sign on to a stricter lockdown.
“That’s a federalist problem,” Fabian Hattke, a public policy expert at the University of Hamburg, told me. Until later in the fall, “the heads of states did not agree on common measures — some went stricter, some went looser.”
Public fatigue with Covid-19 — that coronamüde — also played a role. Based on his own analysis, Christian Karagiannidis, a researcher and ICU doctor at Witten/Herdecke University, told me that the second set of lockdowns was only “50 percent [as effective] as that from the first wave.” He added, “People are more or less fed up. They are tired. They are not adherent to the measures that were implemented by the German government.”
Even after the new lockdowns, Covid-19 cases spiked around Christmas and then again in early January. An increasingly strict lockdown wasn’t enough to stop the foundation that the coronavirus had been allowed to build just before the perfect time to strike.
Merkel appeared to see much of this coming. As Germany prepared to reopen last summer, she called the country’s success in fighting Covid-19 at the time “fragile,” adding that Germany should be “smart and careful” in the coming months, regularly reevaluating the rules it set in place. But Merkel’s constant message of caution ultimately wasn’t enough to counter a fragmented federalist system — especially as politicians began competing to eventually replace her.