German Chancellor Angela Merkel made clear on Wednesday why the country is heading into another, at least partial, lockdown.
"We must act, and now, to avoid an acute national health emergency," she said. "If infections continue at this rate, we will push our health system to its limit."
Merkel's math is straightforward — and sobering: The 24-hour period into Thursday, according to the Robert Koch Institute for public health, saw nearly 17,000 new coronavirus cases in Germany — about double the daily case figures one week ago.
The figures are particularly dire in Berlin, which escaped the worst of the pandemic in the springtime but now struggles with one of Germany's highest infection rates — about 140 per 100,000 people.
An exponential burden
While most people experience only mild symptoms that require little, if any, medical attention, more cases mean more serious ones, too.
As of Thursday, more than 1,600 people were in intensive care around the country, with half of them on ventilators. That marks a fivefold increase from the beginning of October, according to data compiled by the German Association of Intensive and Emergency Medicine (DIVI).
Without stricter measures in place, Merkel noted in her news conference that the number of intensive care patients would double every ten days. At the current rate, Germany would max out its ICU bed capacity by mid-December, according to an analysis by researchers at the University of Saarland. More than 12,000 COVID-19 cases would need ICU care by the end of November, their projection shows, with nearly two-thirds on ventilators.
About 87% of Berlin’s 1,200 ICU beds are currently occupied. Barbara Ogrinz, a spokeswoman for the Berlin Hospital Association told DW it is not unusual for the German capital to have high ICU occupancy, but in light of the pandemic, it is cause for concern.
"There will be difficult, ethical questions to ask as we have to make space for COVID-19 patients," she said.
Non-essential procedures, which hospital representatives say do not jeopardize patient health, could be postponed. For some this may be the second delay, Ogrinz said, as non-corona needs were already pushed back at the beginning of the pandemic.
She praised Berlin's SAVE plan, which was developed by Berlin's renowned Charité hospital in March to organize and allocate ICU resources across the city. The plan determines how and where to treat COVID-19 and other patients based on severity, burden and hospitals' level of care.
Hospital and state health officials have expressed confidence in the system, and despite rising hospitalizations and dwindling ICU beds, do not yet see a need to activate reserve resources.
"We can quickly expand," Ogrinz said.
The Corona Treatment Center at Berlin's convention center has gone unused since it was finished in April. Its 488 beds and some 300 staff are on standby, according to the Berlin Senate Department for Health. Additional beds and staff training are on order in conjunction with Vivantes, Germany's largest medical care group. The extra capacity is intended for patients needing hospitalization, but not intensive care.
"The reserve clinic will be activated if the hospitals are overwhelmed," a Senate spokeswoman told DW.
Pandemic or not, not enough nurses
Materials like gloves and masks, medical equipment and training have all been beefed up since the onset of the pandemic, officials say. What's lacking is enough qualified people to meet the demand, even without the pandemic putting more pressure on the medical system. The German Hospital Federation estimates 4,700 intensive care jobs need filling nationwide.
Beds and ventilators become irrelevant without nursing staff to manage them. The DIVI figures show that 75% of Germany's roughly 30,000 operational ICU beds are occupied, mostly by non-COVID patients. A DIVI spokesman told DW there may be 20% additional ICU beds around Germany, but they are currently not operational due to personnel shortages, though precise figures are difficult to obtain.
"The situation is very grave," Natalie Sharifzadeh, the director of the German Nurses' Association northeast chapter, which covers Berlin, told DW. "It's uncertain if we have enough people to take care of patients."
Sharifzadeh said medical personnel are getting sick, forcing them home or, "even worse," to see no choice but to keep on working.
Shortages of protective equipment are also a problem, but "personnel is what's missing most," she said.
The Berlin Hospital Association has called on the government for more support for hospitals. It wants a required minimum of free ICU beds and greater flexibility in staffing medical personnel. These were nationwide measures put into place in the spring but were phased out at the end of the summer when the pandemic temporarily receded.