Germany is set to mark 100,000 deaths from Covid-19 this week, passing a somber milestone that several of its neighbours crossed months ago but which Western Europe's most populous nation had hoped to avoid.
Teutonic discipline, a robust health care system and the rollout of multiple vaccines — one of them homegrown — were meant to stave off a winter surge of the kind that hit Germany last year.
Yet complacency and a national election, followed by a drawn-out government transition, saw senior politicians dangle the prospect of further lifting restrictions even as Germany's infection rate rose steadily this fall.
"Nobody had the guts to take the lead and announce unpopular measures,” said Uwe Janssens, who heads the intensive care department at the St. Antonius hospital in Eschweiler, west of Cologne.
“This lack of leadership is the reason we are here now,” he said.
Doctors like Janssens are bracing for an influx of coronavirus patients as confirmed cases hit fresh daily highs that experts say is also being fueled by vaccine skeptics.
Resistance to getting the shot — including the one developed by German company Biontech together with its US partner Pfizer — remains strong among a sizeable minority of the country.
Vaccination rates have stalled at 68 per cent of the population, far short of the 75 per cent or higher that the government had aimed for.
“We've increasingly got younger people in intensive care,” said Janssens.
"The amount of time they're treated is significantly longer and it blocks intensive care beds for a longer period.”
Older people who got vaccinated early in 2021 are also seeing their immunity wear off, making them vulnerable to serious illness again, he said.
Echoing problems seen during the initial vaccine rollout, authorities have struggled to meet demand for boosters even as they tried to encourage holdouts to get their first shot.
Some German politicians are suggesting it's time to consider a vaccine mandate, either for specific professions or for the population as a whole.
Austria took that step last week, announcing Covid-19 shots will become compulsory for all starting in February after seeing a similar reluctance to get vaccinated fuel fresh outbreaks and hospitalizations.
Germany's outgoing Chancellor Angela Merkel said in June that she didn't favour such a measure.
Signaling a possible shift in position, Merkel summoned leaders from the three parties negotiating to form the next government for talks Tuesday at the chancellery to discuss the pandemic situation.
Merkel's likely successor, current Finance Minister Olaf Scholz of the center-left Social Democrats, has refused to be drawn on whether he would back compulsory Covid-19 shots.
Together with the environmentalist Greens and the pro-business Free Democrats, his party recently passed a law that replaces the existing legal foundations for pandemic restrictions with narrower measures, starting Wednesday.
These include a requirement for workers to provide their employers with proof of vaccination, recovery or a negative test.
But the change also makes it harder for Germany's 16 governors to impose hard lockdowns without getting approval from state assemblies.
Getting those majorities may be hardest in those states where case numbers are highest. A recent study found infection rates are higher in areas where support is biggest for the far-right Alternative for Germany, a party that has campaigned against pandemic restrictions.
Last week Saxony, an eastern state with the highest infection rates and where the Alternative for Germany is particularly strong, announced that crematoria would be allowed to operate on Sundays to cope with the higher-than-usual number of deaths.
Meanwhile, German authorities have activated an emergency system to coordinate the distribution of seriously ill patients across the country.
Earlier this month, two patients were taken from southern Germany to Italy for treatment, a significant change from last year, when Italian patients were being sent to German hospitals.
Germany boasted almost four times as many intensive care beds per capita as Italy had then, a factor that experts say was key to the low German death toll at the time.
Since January, Germany has had to cut its ICU capacity by 4,000 beds due to lack of staff, many of whom have quit because of the pressure they endured earlier in the pandemic.
“It's hard for people to cope with this, physically and psychologically,” Janssens said of the situation doctors and nurses face in the coming months.
“We'll survive, somehow,” he added.
The World Health Organisation's European office warned this week that availability of hospital beds will again decide how well the region copes with the expected rise in cases over the coming months — along with vaccination rates.
Based on current trends, Europe could see another 700,000 deaths reported across the 53-nation region by next spring, with 49 countries expected to see “high or extreme stress in intensive care units,” the agency said Tuesday.