Angela Merkel has raised the prospect of far-reaching restrictions on public life in some of Germany’s biggest cities, as authorities grapple with an alarming rise in coronavirus infections across the country.

Ms Merkel said Germany was facing a make-or-break moment, and what happened next would reflect “whether we can keep the pandemic under control . . . or whether that control will slip away from us”.

The chancellor was speaking after a video conference with 11 German mayors where it was agreed a further round of regulations would be imposed in areas where new infections exceed a threshold of 50 cases per 100,000 population in a week.

These would include tighter rules on mask-wearing, upper limits on the size of private gatherings and curbs on the sale of alcohol. Some cities such as Berlin have already adopted such measures, forcing all bars, restaurants and shops to close between 11pm and 6am and limiting social gatherings in enclosed spaces to 10 people.

Germany has recorded one of the lowest numbers of Covid-19 fatalities among the large industrialised countries, and its infection rates have been far less alarming than in other EU nations such as France and Spain.

But its enviable record in handling the pandemic took a hit this week as the number of cases jumped. On Friday authorities reported 4,516 new infections over the previous 24 hours, a rate last seen at the height of the crisis in April.

Speaking at a press conference, Ulrich Frei, head of medical care at Berlin’s Charité hospital, said: “We have the beginning of exponential growth [in infections].”

Ms Merkel made an impassioned appeal to younger people who might find the new restrictions “over the top”, asking them to “think about what is most important to you” — such as the health of their grandparents.

“Everything will come back — partying, going out, fun without corona rules,” she said. “But now other things count: vigilance and [social] cohesion.”

The chancellor said Germany was “at a point where we have to be clear what is most important to us this autumn and winter, and set priorities”. Her priority, she went on, was to avoid the complete shutdown of public and economic life that Germany imposed at the start of the pandemic, and especially to avert a fresh closure of schools.

The mayors also agreed that experts of the Robert Koch Institute, Germany’s main public health authority, and soldiers from the Bundeswehr would be deployed to areas that had seen more than 35 cases per 100,000 population, to help with contact-tracing and other crisis-fighting measures.

Ulrich Frei, head of medical care at Berlin’s Charité hospital, said: ‘We have the beginning of exponential growth [in infections]’ © Markus Schreiber/Reuters

Ms Merkel was speaking as officials warned Germany’s hospitals were inadequately prepared for the expected surge in Covid-19 cases. At the height of the pandemic, the federal government ordered hospitals to free up capacity for coronavirus patients by postponing all planned operations. But they have since returned to business as usual.

“Our hospitals are full now, the intensive care wards are full, and . . . that means that we don’t have the room for manoeuvre that we had then, when we curtailed elective procedures,” Dr Frei said.

Heyo Kroemer, chief executive of Charité, said three to four weeks ago that the hospital had fewer than 10 Covid-19 patients on ventilators in its intensive care ward. But “for the last two weeks that phase is definitely over”, he said.

“Our admission numbers are rising, the number of patients on ventilators is rising,” he said. “Just as in March and April we will be forced to restrict our usual clinical activities and concentrate on the seriously ill Covid patients.”

Germany has traditionally boasted a surfeit of intensive care beds, and ministers have insisted the health system was well-equipped to deal with a new upsurge in coronavirus cases. But doctors complain of an acute shortage of medical staff, a problem that has long afflicted Germany’s health sector but has been exacerbated by the pandemic.

Experts said an increasing number of medical personnel were getting infected with coronavirus and having to go into quarantine. Dr Jürgen Graf, chief executive of Frankfurt’s university hospital, said more of his staff had tested positive in the past 14 days than in three months in the spring and summer when the virus was raging. This was partly because of the return of holidaymakers from abroad and the relaxation of the strict shutdown of March and April, he said.

“There will be a real bottleneck in the provision of care if we don’t succeed in keeping our staff healthy and fit for work,” he said.

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