We are on thin ice.
Those were German Chancellor Angela Merkels words to Germanys Bundestag (parliament) on April 23, describing the countrys fight against the coronavirus.
One could even say on thinnest ice.
Merkels warning came as Germany began to pull back some of the lockdown restrictions that states had implemented in mid-March. Merkel consulted with experts and coordinated among the 16 states ahead of these reopening plans.
But even then, the moves were modest.
Shops smaller than 800-square-feet previously deemed nonessential were allowed to reopen on April 20, though with limits on the number of customers allowed inside at one time. Merkel strongly urged the use of face coverings inside shops or on public transit, though some states have since gone farther and mandated masks.
Playgrounds, museums, and churches can open again starting May 4. So can hair salons. Many secondary and primary school students will be allowed to return to school that day, though some states and localities opened slightly earlier, with priority going to students who needed to take exams to advance. Other schools will open May 11, though with social distancing rules and likely reduced schedules.
Kindergartens and daycares remain closed. So do bars, sit-down restaurants, nightclubs, and movie theaters. Mass gatherings are prohibited, for now, until August 31.
Yet Merkel continues to caution Germans against taking this fragile success for granted. Germany will re-evaluate the measures every two weeks, and any decisions will be smart and careful, based in science.
The world is watching Germanys careful approach. The country has managed the coronavirus pandemic better than many of its European neighbors, much of it credited to its testing capacity, which reaches 350,000 per week, according to the New York Times.
A country of more than 80 million people, Germany has the fourth-highest number of confirmed coronavirus cases in Europe, with about 163,000 as of May 1. But the recorded death toll is just 6,600. In comparison, France, with a population of 66 million, has more than 167,000 cases, and more than 24,000 deaths for the same period.
But one week in, German public health officials are already warning how precarious that success is. One indicator suggested earlier this week that the number of infections might be rising again. Lothar Wieler, president of the Robert Koch Institute (RKI), Germanys public health agency, encouraged Germans to continue to stay at home as much as possible, keep observing the restrictions and keep a distance of 1.5 meters from one another.
Germanys slow and tentative steps toward reopening might offer a blueprint for the other parts of the world that want to start slackening some of their more stringent lockdown measures.
And it is showing how delicate a process that is. One that exists, as Merkel said, on the thinnest of ice.
Germany recorded its first confirmed case of coronavirus on January 28. A little more than three months later, cases are now around 163,000.
Even as cases surged, the country has kept its death toll low. So far, it has only registered about 6,600 deaths.
How Germany achieved that has to do with a combination of good government policy and some lucky breaks.
Germany acted early and aggressively to roll out comprehensive testing. That meant a lot more people who had no or mild symptoms got tested, helping to identify outbreaks and slow the spread.
Germany also has a robust public health care system. And, critically, its leaders carefully coordinated on any lockdown measures. Germany has 16 states, each of which is largely responsible for managing their own public health. But Merkel worked closely with the states to harmonize Germanys very strict policies.
And Merkel, a scientist by training, straightforwardly communicated information to citizens and government officials, consulting with experts and using data to guide decisions. That likely helped increase trust among Germans about the governments actions.
Merkel has stuck to that approach as Germany sought to reopen. Germany is closely tracking whats known as the effective reproduction number basically the number of additional coronavirus cases directly generated by one infected person. The goal is to keep that number low in order to avoid exponential growth and overload the health care system.
Merkel explained this in mid-April when she talked about the delicate balance of reopening that if that effective reproduction number got too high too quickly, it would overload the health system. Merkel indicated that keeping that number below one was essential. For that reason, Germanys social distancing measures would require constant reevaluation.
The video of her explanation went viral, and she gained a lot of international attention for her no-nonsense breakdown of the situation.
The effective reproduction number isnt a perfect assessment, as it based on the number of those who have tested positive, and theres typically a two-week lag time because of the coronaviruss incubation period. But its still concrete data that can help inform choices, rather than just winging it.
Germany is relying on experts from a broad range of fields to help guide its reopening decisions. Leopoldina, Germanys independent National Academy of Sciences, has been advising Merkel and Germanys governments, and along the way, publishing ad hoc statements that are recommendations on best practices. In March, a working group of experts recommended a country-wide temporary shutdown for about three weeks, with physical distancing.
On April 13, shortly before Merkel announced adjustments to the measures, the working group put out another statement that offered strategies for a gradual reopening, and weighed priorities by assessing some of the legal, political, psychological, and economic implications of the lockdown measures.
Social, cultural and sporting events should begin taking place step by step, subject to the possibility of physical distancing and provided the intensity of contact is low, the statement reads. Infection rates must continue to be monitored.
The advisory grapples with the challenges of easing measures amid a global pandemic where theres still a lot of information experts simply do not know. For example, it its plan to gradually reopen schools, it notes that closures have led to a decline in daycare services and learning, and may have worsened inequality.
There are also practical concerns that factor in as Germany prepares to map its future. Some places, specifically Bavaria, were hit harder than others. Some regions had key industries that had to be considered. Merkel has acknowledged there will be differences in how each state handles the easing of restrictions, but she has consulted with state governors before making announcements on lockdown plans and tried to find ways to unify politics, where possible.
Its a balancing act, between the risks of a deadly pandemic, and the economic, political, and social health of the nation and different regions of Germany. And its an imperfect one.
Its basically an exercise of compromise, Ralph Hertwig, a director at the Max Planck Institute for Human Development in Berlin, told me. Merkel is a very consensus-oriented political leader and tries to bring these different views together.
Hertwig added that, even in making those compromises, these decisions have been informed by scientific input.
Its still wait and see, said Frank Rsler, professor of biological psychology and neuropsychology at the University of Hamburg, who has contributed to Leopoldinas three ad hoc statements about the pandemic.
The problem, I think, is nowhere in the world does anybody have real good data to make a good prediction of whats going to happen, he added.
Small shops have reopened, but so far, the crowds havent come. Employees wear masks; so do shoppers. Strict limits are still in place on how many people can be in stores at once.
Some schools have resumed operations, and others are preparing to reopen next week, with desks placed 1.5 meters apart and facilities stocked with disinfectants. But some students, fearful about contracting and spreading the virus, or unsure about how they will learn in such a strange environment, are boycotting.
Playgrounds, zoos, museums, and houses of worship could be allowed to reopen as soon as Monday as long as they continue to meet social distancing guidelines and hygiene requirements though some states may adopt different timelines.
On May 6, Merkel and state governors will meet again to discuss a further-reaching package for bringing Germany, gradually, to emerge from the lockdown. By then, much more data will be available on how the openings of some shops and services have affected, or not, the spread of the coronavirus.
But Merkel remains circumspect. Every time the restrictions are relaxed, people move around more, she said. Therefore, we must constantly keep an eye on the effects of the relaxation. We have to stay disciplined, keep a safe distance, and follow hygiene measures.
She warned that if infections crept up again, governments would need to react.
Germany, then, is at a critical moment, this in-between time where it is not fully opened but no longer fully closed. Now that it has begun to creep toward normalcy, it may be even harder to pull back if infections pick back up, or another wave arrives.
And in weighing what can reopen and what cant, new complications will emerge that could threaten some of the consensus-building Merkel has so skillfully executed.
I think its the moment now, when Germany is slowly opening up, that you begin to hear critique, sometimes regarding certain decisions, like why open this up and why keep this closed, Sudha David-Wilp, a senior transatlantic fellow at the German Marshall Fund, told me.
Shop owners or companies of bigger stores might complain that only stores of a certain size are allowed to open, for example. Parents of young kids might complain: Why cant my kids go back to school? And parents of older kids and teenagers might say: Why do my kids have to take the risk and be the first to go back?
You have this dynamic that immediately starts when you make an exception here, and thats a problem, Hertwig said. Its like a chain of domino pieces, and once you kick up the first one, it starts this dynamic process.
It might be harder, then, to pull back new freedoms if infections begin to rise again. Germans were remarkably unified in backing the lockdown measures (even 83 percent of the far-right party Alternative for Deutschland supported social distancing measures, according to a poll) in the beginning of April, but as time wears on, that may wane.
Germany saw some protests this week against the lockdown measures, even after some restrictions were loosened. These are likely still outliers. But moving out of lockdown, even slowly and deliberately, is not easy.
Germanys experiment with reopening is happening in real-time. And that might be the biggest lesson for the rest of the world, including the United States, as it continues to evaluate how to reopen society: Its not necessarily a linear path toward normalcy.
Right now, Germany is relying heavily on data, including that effective reproduction number. That number ticked up to just under 1 this week, and public health officials reiterated the importance of maintaining social distancing measures.
But, on Thursday, that number fell back down to .70, according to the Robert Koch Institute. This is of course also a positive development. And as I said, lets keep it that way, Wieler, the president of the Robert Koch Institute said Thursday.
What that number looks like in the next few weeks might offer more clarity on whether Germany can keep the measures where they are, loosen them further, or maybe tighten them up.
William Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health, told me on a press call with reporters Wednesday that even if the effective reproduction number goes up, that doesnt necessarily mean refining or relaxing restriction isnt possible.
But it does indicate, very clearly, that these actions have consequences, he said. And so we should be similarly prepared as we start doing things in United States, to be watching very carefully and to be trying to look at those changes in the effective reproductive number, and then gaming them out into the future to ensure that we dont find ourselves riding another exponential.
But, as experts I spoke to noted, even beyond the data, evaluating the lockdown is going to involve weighing the risks of the coronavirus which are very real with the economic and psychological necessity of giving people back their freedom. But there is no magic formula for that right now, because there is no way to predict the future and all of the unintended consequences of reopening.
And Germany isnt the only country reopening. Others, such as Denmark and Austria, have also loosened measures. Places in East Asia, like Hong Kong, have taken their own approach to social distancing. Experts told me that ideally, the world would coordinate together on best practices, and try to figure out what works and what doesnt, improving the reopening model in real-time.
There is no perfect solution to this, David-Wilp said. Germany, as other countries, are in uncharted territory.
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Germany is reopening. Cautiously. - Vox.com
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