Germany is poised to pass the mark of 100,000 deaths from COVID-19 this week, a sombre milestone that several of its neighbours crossed months ago but which Western Europe’s most populous nation had hoped to avoid.

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.

In practice, Germans faced a confusing array of pandemic rules, lax enforcement and a national election — followed by a drawn-out government transition during which senior politicians dangled the prospect of further lifting restrictions even as the infection rate rose.

“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 sceptics.

Resistance to getting the shot — including the one developed by German company BioNTech together with 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 than 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 favor 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 particularly tricky in states where case numbers are highest. A recent study found infection rates are higher in areas where the far-right Alternative for Germany, or AfD, is strongest. The party has campaigned against pandemic restrictions and polls show its supporters take a sharply negative view of vaccine mandates, compared to the rest of the voting population.

While AfD is not expected to win any of Germany’s four regional elections next year, experts say political campaigns can distract from tough topics like tackling the pandemic.

“Often the focus is on things that will drive voting, rather than unpopular decisions,” said Catherine Smallwood, a coronavirus expert at the World Health Organization’s office for Europe.

“That can contribute to the virus spreading if measures and decision-making are not taken in a timely and … concrete manner as they as they have to be,” Smallwood said in a recent interview.

Germany’s disease control agency on reported a record 66,884 newly confirmed cases Wednesday, and 335 deaths. The total death toll from COVID-19 stood at 99,768 since the start of the pandemic, the Robert Koch Institute said. German weekly Die Zeit, which conducts its own count based on local health authority figures, said the 100,000 threshold had already been passed.

Meanwhile, health authorities in five eastern states and Bavaria have activated an emergency system to coordinate the distribution of 80 seriously ill patients to other parts of 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 Organization’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.

By DANIEL NIEMANN and FRANK JORDANS Associated Press

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Fauci: Standard for full vax ‘could change’

© Julia Nikhinson

Top infectious diseases expert Anthony Fauci said changing the definition of what qualifies a person as fully vaccinated to include a booster shot is “on the table.”

“Right now, officially, fully vaccinated equals two shots of the mRNA and one shot of the J&J, but without a doubt that could change,” Fauci said in an interview for the upcoming Reuters Next conference, Reuters reported.

“That’s on the table for discussion,” he added.

The consideration comes after the Centers for Disease Control and Prevention announced that booster shots can be given to anyone above the age of 18.

“We’d like to get as many people who were originally vaccinated with the first regimen boosted,” Fauci said, adding he hopes to see an “overwhelming majority” get the booster shot.

Proof of full vaccination has been required by many venues across the country and in some major cities has been required for dining in at restaurants.

Fauci’s comments to Reuters also come as COVID-19 cases are beginning to rise again in the U.S. In response to the increase, he also recently warned against “prematurely” dropping mask mandates.

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W.H.O. WARNS EUROPE OF ‘FALSE SENSE OF SECURITY’

The World Health Organization (WHO) is recommending that the public in Europe practice social distancing and masking, regardless of their vaccination status, as case rates skyrocket there, according to CNBC.

WHO Director-General Tedros Adhanom Ghebreyesus said that parts of Europe have fallen into a “false sense of security,” believing there is no risk of COVID-19 to the vaccinated and that the danger of infection has passed, even as Europe has become the “epicenter of the pandemic,” reports CNBC.

“Even if you’re vaccinated, continue to take precautions to prevent becoming infected yourself, and to infecting someone else who could die,” Tedros said, according to CNBC. “That means wearing a mask, maintaining distance, avoiding crowds and meeting others outside if you can, or in a well-ventilated space inside.”

Some European countries — such as Hungary, the Netherlands, Slovakia and the Czech Republic — have this week reported their highest daily COVID-19 infections since the start of the pandemic.
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What the world could learn from Israel’s Covid-19 vaccine booster rollout

Jerusalem (CNN)When it comes to Covid-19, it seems where Israel leads, the rest of the world follows. For almost a year, the country has offered other nations a glimpse into the pandemic’s future.

Israel has been at the forefront of vaccination rollouts for adults and teenagers, pioneered a vaccine passport and, in recent months, has spearheaded the use of booster shots.
At the end of July, the country began offering boosters to those over the age of 60; since late August, boosters have been available to anyone over the age of 16, five months after their second dose of the vaccine.
Now, a person is not considered fully vaccinated in Israel until they have received a third dose of the vaccine, once they are eligible for it.
More than three months on, Israeli health officials say the data is clear: Booster shots helped bring down the fourth wave of the virus that swept the country in August and September.
CDC recommends Covid-19 boosters for all adults
At its peak, that wave saw more than 8,000 new Covid-19 cases per day, and more than 500 people hospitalized at a time in serious condition.
The current seven-day average is running at between 450 and 500 cases a day, and there are 129 people hospitalized in serious condition with the virus.
The data highlights stark differences between those with the vaccine — and the booster — and those without: On many days over the past month, more than 75% of positive cases were among the unvaccinated, according to data from the health ministry.
Among those hospitalized with Covid-19 it is even clearer: Israeli officials say in October the rate of people over the age of 60 in serious condition who had only had two doses of the vaccine was 5 times that of those with three shots.
And although the caseload has declined overall since then, the differences remain: On Sunday, there were four times as many people over the age of 60 in serious condition who had only had two shots, compared to those considered fully vaccinated with three doses, according to the health ministry.

Lessons from Israel

Elderly residents wait to receive their third dose of the Pfizer-BioNTech Covid-19 vaccine at a medical center in Tel Aviv on August 2.

Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, has cited such data as a reason why he thinks it will soon be recommended that everyone get boosters once they’re eligible.
“If you look strictly at the data from Israel, it’s very clear that the differences in immunity waning is much more profound in the elderly, but it goes across the board,” Fauci told NBC last week.
The lesson from Israel is one that more and more nations are taking on, particularly as cases rise to troubling levels in parts of Europe.
Germany is recommending a third dose of the vaccine for everyone over the age of 18, and in the UK, boosters are available to everyone over 40 as of this week.
In France, demand for booster shots skyrocketed after President Emmanuel Macron announced that a third dose would be required to revalidate the “pass sanitaire,” or health pass, which is required on public transport and to enter a variety of public and private spaces.
Health experts say the rollout of booster shots across many Western nations highlights the inequity of vaccine deployment in other parts of the world.
In the UK, 88% of people over the age of 12 have had their first dose of the vaccine; 80% have had two doses, and 26% have already had a booster shot, data from November 20 shows.
By contrast, only 10% of people in African countries have had a first dose, on average, according to Our World In Data; only 7% of Africa is fully vaccinated, the data shows.

Fifth wave fears

But the news from Israel is not all good: Though case numbers have fallen since September, the decline has plateaued. And, even more concerning, the R-rate — the average number of people infected by each person with Covid-19 — is back above 1, according to health ministry data — a worrying sign that the virus may be spreading again.
Health experts, such as Professor Eran Segal from Israel’s Weizmann Institute, say it is too early to tell whether the country is entering a fifth wave of the virus. But they point to the fact that almost 1.5 million people who have had two doses of the vaccine have not gone back for their booster shot.
“There are more people whose vaccine has faded over time, when compared to the number of new vaccinations and boosters, which has led to a slow decrease in the total [population’s] immunity,” Segal tweeted last week.
Now Israel is working on holding back that potential fifth wave: Officials are encouraging the unvaccinated to get their shots, and those who are eligible for booster doses to get them. They are also getting children vaccinated, and keeping up with preventative measures.
Many of Israel’s new infections are among children aged five to 11, according to Israeli health officials. A campaign to vaccinate that age group began on Monday.
Europe is learning a crucial lesson -- vaccines work, but they alone won't stop Covid now
“About 50% of our daily infections are occurring in that age group of below 11,” Dr. Ran Balicer, chairman of Israel’s Covid-19 National Expert Advisory Panel, told CNN last Friday. “We think this vaccination campaign could actually turn the tide and perhaps bring us back to a downslope if we have a good uptick [in vaccinations], as we hope that we will.”
But even with a highly vaccinated population, health experts say it is vital that anti-Covid measures stay in place, especially during winter, as activities move indoors.
Nachman Ash, director general of Israel’s Public Health Ministry, told Israel’s Channel 13 part of the reason for the uptick in cases is people not adhering to rules like mask-wearing.
“The enforcement is not sufficient,” Ash said. “And I see the public is becoming relaxed as time passes and the infection rate goes down, so people are less careful. Therefore yes, we have to increase the enforcement.”
Balicer warned that ignoring the waning immunity of those who have had two doses of the vaccine “may, in fact, put people at risk with false reassurance.”
“There is no single magic bullet that would suffice to assure surge prevention, especially in winter time,” Balicer said. “It is a combination of measures: Indoor masks, population behavior, indoor event restrictions and green certificates, and an effective booster campaign.