Coronavirus in Germany: Health care system under pressure

Michael Kegler wasn't expecting to go viral for his coronavirus tweets. On Monday, the 53-year-old translator who lives near Frankfurt posted a tweet that has since been shared over 2,000 times.

"I'm currently experiencing firsthand how seriously [the state of] Hesse is taking the coronavirus: Yesterday I found out from Portuguese media that an author with whom I worked in Povoa de Varzim has been infected with COVID-19," he wrote.

What follows is a thread describing Kegler's odyssey with German health authorities — how he called the coronavirus hotline set up by the state of Hesse's Ministry for Social Affairs and Integration as well as Germany's nationwide hotline for out-of-hours care, followed by the Frankfurt University Hospital, his local health department, the doctor they recommended, and his own general practitioner — all in an effort to get tested for the virus.

The saga went on for days until his local health department called and had him get tested after all. As someone who'd come in contact with a confirmed coronavirus patient, Kegler told DW he expected to be sent straight away to get tested.

"In the end, I was shocked and amazed that it wasn't as easy as I'd thought," he said.

Read more: Coronavirus, cold, or flu symptoms? When you should be worried

'I didn't feel well-informed at all'

Kai Clemens* also has firsthand experience with Germany's efforts to clamp down on the spread of COVID-19 — over 500 people have tested positive in the country. Clemens, who is in his early 30s and lives in the southwestern state of Baden-Württemberg, recently spent several days in quarantine in a hospital. He shared his experience under the username "Coronavirus Influenza."

Clemens has since been released and has been placed under a 14 day-long quarantine at home. The situation started after his girlfriend exhibited flu-like symptoms following a business trip. She later learned that she'd been in contact with a person infected with the coronavirus.

The nationwide hotline for out-of-hours care sent the two to a hospital where they were then separated. Clemens tested negative for the virus three times, while his girlfriend tested positive. Clemens believes that the doctors and the local health department did their best, but that he nonetheless "didn't feel well-informed at all."

"That is still a big problem. The doctors, for example, said: We don't actually need to keep you here due to health reasons. Quarantine at home protects others just as well from infection, but now you're here and we have unclear criteria or contradictory statements or no clear instructions on when or how we can let you go," he told DW.

The local health department seemed overwhelmed on the telephone when he called, Clemens said. He added that it's still "quite unclear" why the German government hasn't set up a central hotline specifically dedicated to handling coronavirus concerns — one that would be able to field calls and give advice around the clock to people exhibiting mild symptoms and could then direct suspicious cases to the local health departments.

Read more: What you need to know about the coronavirus

One system, multiple players

The nationwide hotline for out-of-hours care (which can be reached under the number 116117) is currently serving as a central coronavirus hotline. The call center is available around the clock with a network of on-call doctors and hopes to relieve pressure on family doctors and general practitioners.

The hotline, however, is also still responsible for fielding a wide range of other medical concerns — from vomiting and diarrhea to acute back pain. A spokesperson told DW that the hotline received over 140,000 calls last weekend. The service can currently keep up with the demand, the spokesperson said, but callers may also face waiting times.

The complexity of Germany's decentralized health care system has become glaringly apparent during the COVID-19 outbreak.

Germany's federal Health Ministry and its 16 states also have telephone hotlines to field questions about the virus, although the numbers are only available during certain times.

Alongside the national pandemic action plan, each of Germany's states have developed their own plans and processes. Both federal and state governments as well as local administrators and the Robert Koch Institute (which is responsible for Germany's response to the outbreak) are in constant contact with one another.

The main actors on the ground are the general practitioners, hospitals and local health departments. The latter are responsible for disease control and receive instructions from state governments and follow recommendations issued by the Robert Koch Institute.

But both doctors and local health authorities can sometimes deviate from these recommendations — leading to different procedures throughout Germany for dealing with coronavirus patients.

Read more: Coronavirus and climate change: A tale of two crises

'Not all procedures are in place yet'

Just a few phone calls and emails reveal exactly how overwhelmed local health authorities are at the moment. Four departments that DW contacted said that they couldn't find time for an interview. A spokesperson for the western city of Bonn wrote in an email that currently all staff are working on the issue.

Colleagues have been pulled from other departments to field calls on Bonn's public service hotline, which is currently receiving around 100 calls a day — just recently there were 700 calls.

In the western state of North Rhine-Westphalia, where the majority of Germany's COVID-19 cases are located, numerous positions for doctors remain unfilled, according to a report from local public broadcaster WDR.

"All of the [officials and doctors] are under great pressure at the moment in the affected regions," Health Minister Jens Spahn said, adding: "Of course not all procedures are in place yet."

According to Veit Wambach, the deputy head of the German Association of Practicing Doctors (NAV-Virchow-Bund), there's a reason why the procedures aren't set yet — the situation is constantly evolving.

"At the very beginning, we were told that any suspected case should first be kept in in-patient treatment. Now we're being told that we have to reserve the hospital space for those who need it medically," Wambach told DW. "Such adjustments are always necessary when the situation is changing — and it really is changing all the time."

Read more: Will warmer weather stop the spread of the coronavirus?

Progress in testing

Like in other areas of the world, Germany faces considerable issues with acquiring protective gear such as respiratory masks and full-body protective suits. The German government's coronavirus crisis management team now wants to centrally procure protective gear.

The head of the German Hospital Federation, Georg Baum, said that hospitals are "in the best possible position" to deal with the virus and that they are already preparing for an increased number of patients.

Progress has also been made with regards to coronavirus tests. They are currently being carried out in university clinics, private laboratories, doctor's offices, large hospitals and other institutions.

The southern state of Bavaria already offers an on-call service where doctors will come to a patient's home and swab them there before bringing the test to a laboratory. According to the National Association of Statutory Health Insurance Physicians, there's currently the capacity to carry out 12,000 tests per day nationwide.

Read more: Germany rules out EU-wide coronavirus travel curbs

Controversy over school closures

The virologist Alexander Kekule has meanwhile called for much stricter measures to be enacted in Germany. In order to halt the spread of the virus, Kekule urged for all kindergartens and schools to be closed nationwide for 14 days. Large events should also be called off, he said.

The German Teachers' Association and Health Minister Spahn, however, rejected calls to close Germany's schools.

For Kai Clemens, his coronavirus quarantine will come to an end this weekend.

"I'm most looking forward to the time when I can laugh about this crazy experience with my friends and family — and above all my girlfriend when she's fully recovered," he said.

Michael Kegler, on the other hand, has already been given the all-clear. He ended up testing negative for the virus after waiting 54 hours for the results.

*Name changed to protect the identity of the patient.