HSRM GerGreItaSwe 20200403

Search list of contents:
Health communication
Overview and publication details 2
Health communication Germany 2
Health communication Greece 3
Health communication Italy 4
Health communication Sweden 5
Physical distancing
Physical distancing Germany 6
Physical distancing Greece 8
Physical distancing Italy 9
Physical distancing Sweden 10
Isolation and quarantine

Isolation and quarantine Germany 11
Isolation and quarantine Greece 12
Isolation and quarantine Italy 13
Isolation and quarantine Sweden 14
Monitoring and surveillance

Monitoring and surveillance Germany 15
Monitoring and surveillance Greece 17
Monitoring and surveillance Italy 18
Monitoring and surveillance Sweden 19
Testing
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Testing Germany 20
Testing Greece 21
Testing Italy 22
Testing Sweden 23
Physical infrastructure
Physical infrastructure Germany 24
Physical infrastructure Greece 27
Physical infrastructure Italy 28
Physical infrastructure Sweden 29
Workforce
Workforce Germany 30
Workforce Greece 33
Workforce Italy 34
Workforce Sweden 35
Planning services
Planning services Germany 36
Planning services Greece 38
Planning services Italy 39
Planning services Sweden 40
Managing cases
Managing cases Germany 41
Managing cases Greece 42
Managing cases Italy 43
Managing cases Sweden 44
Maintaining essential services

Maintaining essential services Germany 45
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Maintaining essential services Greece 46
Maintaining essential services Italy 47
Maintaining essential services Sweden 48
Health financing
Health financing Germany 49
Health financing Greece 50
Health financing Italy 51
Health financing Sweden 52
Entitlement and coverage

Entitlement and coverage Germany 53
Entitlement and coverage Greece 54
Entitlement and coverage Italy 55
Entitlement and coverage Sweden 56
Governance
Governance Germany 57
Governance Greece 58
Governance Italy 59
Governance Sweden 60
Measures in other sectors

Measures in other sectors Germany 61
Measures in other sectors Greece 63
Measures in other sectors Italy 64
Measures in other sectors Sweden 65
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Germany
Germany: Health communication
1. Preventing transmission
The section on PREVENTING TRANSMISSION includes information on key public health measures that
aim to prevent the further spread of the disease. It details how countries are advising the general public
and people who (might) have the disease to prevent further spread, as well as measures in place to test
and identify cases, trace contacts, and monitor the scale of the outbreak.
1.1 Health communication
Health communication
In early February (07 February) the government released official recommendations regarding hand
hygiene, respiratory etiquette, and physical distancing when sneezing and coughing. An explanatory
video was published by the Ministry of Health and the Federal Centre for Health Education and spread
on social media. On 17 February, specific recommendations on hygiene, respiratory etiquette during
carnival season were published and released by the Federal Centre for Health Education. In a press
conference on 2 March 2020 recommendations on hand hygiene, physical distancing and respiratory
etiquette were communicated to the wider public.
Information on outbreak severity is regularly communicated in daily press briefings held by the Robert
Koch-Institute (RKI). The RKI is the government’s central scientific institution in the field of
communicable diseases. Its main tasks are the identification, surveillance and prevention of diseases,
especially infectious diseases and informing and advising political decision-makers, the scientific sector
and the general public based on scientific evidence. It is continuously monitoring the situation,
evaluating all available information, estimating the risk for the population in Germany. The Ministry of
Health and the Federal Centre for Health Education also communicate information regularly through
press briefings, via social media and on their websites. The federal government also set up a special
website on COVID-19 (https://www.zusammengegencorona.de/) which provides information for
specific population groups, recommendations regarding prevention, detection, treatment, support and
care, physical distancing etc.
Source: https://www.bzga.de/presse/pressemitteilungen/
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Greece
Greece: Health communication
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Italy
Italy: Health communication
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Sweden
Sweden: Health communication
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Germany
Germany: Physical distancing
1.2 Physical distancing
Physical distancing
Initially, social distancing was advised only for those who were isolating, either because they were
cases, contacts of confirmed cases or had returned from a high-risk area but remained asymptomatic.
On March 10, the government recommended cancellation of events and public gatherings with 1000 or
more people. In the days following this initial recommendation, the federal states suspended all public
gatherings and events with more than 1,000 people.
There are no nation-wide regulations on physical distancing given the federal governance structure of
the country. Each federal state takes own decision on restrictions, school closing etc. based on their
pandemic preparedness plans (see section 5. Governance). However, in the wake of the COVID-19
outbreak in Germany, the federal states largely agreed on similar measures to delay the spread of
infection and the associated burden on the healthcare system. On March 13, most German federal
states decided to close their schools, nurseries, universities and cultural institutions from 16 March until
mid-April (dates differ slightly by federal state). As of March 16, the heads of all federal states and the
chancellor decided that also bars, clubs, theatres, discotheques, pubs, operas, concert halls, public
libraries, cinemas, leisure parks (indoor and outdoor), museums, trade fairs, exhibitions, zoos, special
markets, amusement arcades, casinos, betting shops, prostitution businesses, brothels, sports in
public and private sports facilities, swimming pools, gyms and playgrounds would be closed.
Restaurants, cafeterias and hotels could remain open from 6 am to 6 pm. Supermarkets, chemist's
shops, banks, pet shops, and all business that sell essential basic needs are allowed extended
opening times including on Sundays, while non-essential shops are to be closed at all times.
On 17 March 2020 the government released more extensive recommendations for the public on
physical distancing. People are advised to stay at home, to keep physical distance from others, to
avoid use of public transport, public gatherings and shopping during peak hours; to work from home if
possible and to avoid traveling within the country. The public was also advised to avoid close contact
with individuals considered vulnerable (elderly people and those with chronic conditions).
On 20 March, Bavaria was the first state to declare a curfew, inspired by and identical to Austria. On
Sunday (March 22), the chancellor agreed with all heads of federal states on more drastic restrictions
on public and social life to be implemented nationwide. However, the restrictions are not as far
reaching as the curfew agreed in Bavaria and movement restrictions agreed in Saxony where leaving
the house will only be permitted in certain circumstances. Most federal states introduced the following
measures:
• Public gatherings of more than two people will be banned. There will be exceptions for families and
those living together.
• General contact with others should be reduced to a minimum.
• A 1.5-meter distance should be kept at all times when in public.
• Gastronomy businesses must close. Businesses offering food delivery and collection will be allowed
to remain open.
• Service providers such as hairdressers, cosmetic, massage and tattoo studios where a 2-meter
distance between people is not possible must also close. Businesses and centers offering medical
treatments may remain open.
• Police and other law enforcement agencies will enforce any infractions of the new rules — Merkel did
not state what the
punishment would be for anyone not abiding by the new measures.
• Hygiene regulations must be implemented for staff in the workplace, or for visitors.
• Commuting to work, helping others and exercising alone outside will still be permissible, as long as
the activities are carried out in abidance with the guidelines.
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Germany
• The measures will remain in place, initially for the next two weeks.
Special regulations are defined for visitors of long-term care institutions and hospitals. In most federal
states visitors to nursing homes and hospitals are not permitted except if they are for medical reason,
in case of end-of-life care or parents of sick children (this holds in Bavaria, Brandenburg, Baden-
Wurttemberg, Bremen, Mecklenburg-Vorpommern, Lower Saxony, Thuringia, North Rhine-Westphalia,
Saxony-Anhalt, Saxony and Thuringia). In all other federal states, there is a limitation on visitors to
hospitals and nursing homes of maximum one visit per day for one hour.
Sources:
https://www.bundeskanzlerin.de/bkin-de/aktuelles/vereinbarung-zwischen-der-bundesregierung-und-
den-regierungschefinnen-und-regierungschefs-der-bundeslaender-angesichts-der-corona-epidemie-in-
deutschland-1730934
https://www.bzga.de/presse/pressemitteilungen/2020-03-17-verhaltensempfehlungen-zum-schutz-vor-
dem-coronavirus-im-alltag/
https://www.dw.com/en/what-are-germanys-new-coronavirus-social-distancing-rules/a-52881742
https://www.biva.de/besuchseinschraenkungen-in-alten-und-pflegeheimen-wegen-corona/
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Greece
Greece: Physical distancing
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Italy
Italy: Physical distancing
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Sweden
Sweden: Physical distancing
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Germany
Germany: Isolation and quarantine
1.3 Isolation and quarantine
Isolation and quarantine
The public health offices specify the procedure for isolation and quarantine for confirmed cases and
contact persons. People with confirmed infection with COVID-19 must stay in isolation at home. The
recommendations of the public health office for confirmed and suspected cases can include: staying at
home, keeping a certain distance from others, washing hands regularly, as well as ventilating living
rooms and bedrooms properly and not sharing household objects (dishes, clothes, etc.) with third
parties without washing these beforehand. If possible, bathroom and hygienic articles should not be
shared and clothing should be washed regularly and thoroughly. It is important to observe the rules for
coughing and sneezing. It is advised to use disposable paper handkerchiefs.
Sources:
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Quarantaene/Flyer.pdf?
__blob=publicationFile
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Kontaktperson/Management.html
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Flyer_Patienten.pdf?
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Greece
Greece: Isolation and quarantine
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Italy
Italy: Isolation and quarantine
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Sweden
Sweden: Isolation and quarantine
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Germany
Germany: Monitoring and surveillance
1.4 Monitoring and surveillance
Monitoring and surveillance
Laboratory testing for COVID-19 should be performed for suspected cases according to the following
criteria (regularly updated by RKI) (see also section 3.2):
1. Acute respiratory tract infection and having been in close contact with a confirmed or probable
COVID-19 case in the last 14 days prior to onset of symptoms;
2. Clinical or radiologic characteristics of viral pneumonia in the context of increased number of
pneumonias in care facilities or hospitals.
3. Clinical or radiologic characteristics of viral pneumonia with no indication of any other cause
4. Any acute respiratory tract infection and a) activity in care, medical practice or hospital, b) high-risk
patients or c) without any known risk factors (testing for COVID-19 only if sufficient capacity)
A person suspected to have COVID-19 needs to be quarantined if there is a high risk of infection:
either a) if within the last two weeks the person had close contact with a person who has contracted
COVID-19 (close contact means either that the person spoke with the sick person for at least 15
minutes or was coughed or sneezed on at a time when the sick person was infectious i.e. two days
before the first symptoms), or b) whenever the public health office places a person under quarantine.
A person does not have to be quarantined if in the past two weeks he or she was in the same room as
a person with COVID-19 but had no close contact. However, persons working with people who have
pre-existing diseases (workers in hospital, elderly care, etc.) should by all means inform their company
medical officer. Every person, however, should perform daily self-inspection for symptoms of disease.
Any person who is healthy but has had contact with a family member, friend or acquaintance who, in
turn, had contact with a laboratory-confirmed COVID-19 patient, does not have to be quarantined. In
this case, the person is not a contact person, has no increased risk of contracting COVID-19 and
cannot infect anyone else either. If, however, the person is showing (light) symptoms of acute
respiratory tract infection, he or she should have a test. If it is not possible to receive a test, the person
should self-isolate at home, avoid any contacts with a distance less than 2 meters and respect hand
hygiene and respiratory etiquette.
Extensive contact tracing is implemented by public health offices. Someone who had close contact with
a person with confirmed COVID-19 (see definition above) is registered and informed about the virus
and possible symptoms. The contact person must be quarantined (see above). The RKI is currently
training students to help with contact tracing.
If a person has been in a high-risk area (defined and regularly updated by the RKI) during the last 14
days and the public health office is aware, the person receives information and the individual risk is
assessed and necessary measures are defined. If the person who has spent time in a risk area does
not show any symptoms, it is recommended to avoid unnecessary contact with others and stay at
home, if possible. Should symptoms develop within 14 days, a doctor should be consulted after calling
in advance to announce the visit.
Sources:
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Massnahmen_Verdachtsfall_Infografik
_DINA3.pdf?__blob=publicationFile
https://www.rki.de/SharedDocs/FAQ/NCOV2019/FAQ_Liste.html
https://www.bundesgesundheitsministerium.de/en/press/2020/coronavirus.html
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Einreise_aus_RG.html?nn=13490888
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Germany
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Greece
Greece: Monitoring and surveillance
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Italy
Italy: Monitoring and surveillance
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Sweden
Sweden: Monitoring and surveillance
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Germany
Germany: Testing
1.5 Testing
Testing
People with respiratory infection (cough, runny nose, sore throat) can ask to be tested for COVID-19 if
the following conditions apply: 1) if they have had contact with a laboratory-confirmed COVID-19
patient during the last two weeks; 2) if there is a pre-existing condition or the respiratory infection gets
worse (develop high fever, cough etc.); 3) if there is contact with individuals who are considered
vulnerable during work or voluntary work (e.g. in hospitals or elderly care). Prior to test results, these
persons should self-isolate (stay at home, avoid contacts with distance less than 2-meter, respect hand
hygiene and use a mask during contact to others (if available).
Criteria for possible cases requiring testing has changed throughout the course of the pandemic.
Initially people who returned from a high-risk area were also tested to identify possible cases. On
March 25, the stay in a high-risk area was taken from the list of criteria for testing.
Persons who have had personal contact with someone confirmed as carrying SARS-CoV-2 should
immediately, and irrespective of symptoms, contact their competent health office, get in touch with the
doctor or call the 116117 non-emergency medical on-call service (directing patients to medical
assistance when the need is urgent but not life-threatening) – and stay at home. In general, hospitals
and family physicians decide who will be tested. They base their decision on the recommendations of
the RKI. Also, public health offices provide information on COVID-19 testing and provide appointments.
The RKI launched a nationwide laboratory survey to determine the number of laboratory tests being
performed for COVID-19 in Germany. This survey is supplemented by three further data collections
from the Network for Respiratory Diseases (RespVir, RKI), the national network for the surveillance of
antibiotic resistance in Germany (ARS, RKI) and the Association of Accredited Medical Laboratories in
Germany (ALM e.V.). From the response of 174 laboratories, a total of at least 483 295 samples were
tested up to and including week 12/2020, most in calendar week 11 (127 457 samples) and week 12
(348 619 samples). According to the Professional Association of German Laboratory Doctors 40 000
tests are currently performed per day in Germany with increasing tendency.
After the first COVID-19 PCR test was developed by the German Center for Infection Research (DZIF)
at Charité Berlin, German scientists are currently preparing to carry out a test in April to find out who
has already developed antibodies to fight off the COVID-19.
Sources:
https://www.aerzteblatt.de/nachrichten/111346/RKI-Aufenthalt-in-COVID-19-Risikogebiet-nicht-mehr-
Kriterium-fuer-Test-auf-SARS-CoV-2
https://www.bundesgesundheitsministerium.de/en/press/2020/coronavirus.html
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-03-26-en.pdf?
https://www.charite.de/service/pressemitteilung/artikel/detail/erster_test_fuer_das_neuartige_coronavir
us_in_china_entwickelt/
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Greece
Greece: Testing
1.5 Testing
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Italy
Italy: Testing
1.5 Testing
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Sweden
Sweden: Testing
1.5 Testing
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Germany
Germany: Physical infrastructure
2. Ensuring sufficient physical infrastructure and

workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for
dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability
of health workers. The section considers the physical infrastructure available in a country and where there
are shortages, it describes any measures being implemented or planned to address them. It also
considers the health workforce, including what countries are doing to maintain or enhance capacity, the
responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health
workers.
2.1 Physical infrastructure
Physical infrastructure
Initially, medical testing was performed either at office-based medical practices or at the hospital. With
the rapidly evolving situation, testing takes place at an increasing number of facilities. In many cities,
testing pods have been rapidly set up close to hospitals or other areas to protect others using the
hospitals who may have vulnerable immune systems as well as to allow general medical practices to
ensure basic medical service provision and protect staff and patients. In some federal states, drive-
through test stations have been set up (e.g. in Munich, Oberhausen, Bochum, Rhein-Neckar-Kreis and
Kreis Esslingen). Other communities send staff home to patients to take a test at the apartment door.
Already on 15 March 167,000 tests (2023.3 tests per 1,000,000 population) were performed. Until 17
March, there were about 100 000 tests performed in the ambulatory sector. The German Society for
Virology reports 55 testing facilities for COVID-19 based at medical universities (28 testing facilities)
and private laboratories or institutes (23 testing facilities). Four testing facilities are operated by the
local health offices. However, the capacity to test everybody with mild symptoms is currently not
sufficient given the limited availability of medical laboratories. Long waiting times for testing results
occur in many locations reaching up to 7 days in Bavaria and Saarland. The Professional Association
of German Laboratory Doctors warns of bottlenecks of SARS-CoV-2-tests in particular due to
shortages of laboratory supplies (e.g. extraction material, testing swabs, RT-PCR reagents and PPE).
However, German laboratories adapted quickly by doubling staff in order at least to prevent human
resource shortages. In addition, an increasing number of facilities rearranged their services, for
example the laboratory of the DKMS stem cell donor registry at the University Hospital Carl Gustav
Carus in Dresden and public chemical and veterinary investigations offices in some federal states
started to provide laboratory testing for COVID-19.
According to the Federal Institute for Drugs and Medical Devices (BfArM) the supply of
pharmaceuticals is not affected in regions that are particularly affected by COVID-19. Still, the Federal
Institute (BfArM) released instructions to pharmaceutical companies and pharmaceutical wholesalers
regarding storage and adequate supply of pharmaceuticals.
Regional associations of SHI physicians have reported that medical practices, especially GP offices,
are facing shortages of personal protective equipment (PPE) without being able to purchase more
protective material. Also hospitals, long-term care facilities and ambulatory long-term care providers
report insufficient resources of PPE and disinfecting agent and are awaiting supply from the
procurement of the federal government. The lack of PPE (especially masks) led hospitals to re-use
disposable masks. The insufficient PPE supply is raising serious concern among health care
professionals, which is reflected in urgent letters to politicians. The purchasing is now centrally handled
by the Ministry of Health (see section 2.1), and first deliveries have arrived . On March 04, the Ministry
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Germany
of Health started central procurement of personal protective equipment (PPE) for medical practices,
hospitals, nursing homes, ambulatory care and federal agencies. In the meantime, companies have
donated PPE, if available . Export of PPE abroad is prohibited, except under very stringent conditions
such as concerted international aid campaigns.
On March 13, the RKI provided recommendations on resource-efficient use of face masks in health
care facilities due to shortages. Several alcohol manufacturers have started to deliver disinfectants or
alcohol to pharmacies and hospitals. Since early March, pharmacists are allowed to produce certain
hand sanitizers.
The German armed forces provide support in different ways. Its medical units - comprising around 20
000 soldiers - are preparing the military's five hospitals for the general public. German armed forces
have also started to provide food, camp beds and mobile doctors' facilities and they are storing medical
goods in their barracks. The military also started to mobilize reservists to augment Germany's military
services and to help with medical duties. In addition, the military's procurement office now has EUR
241 million allocated to find medical protective gear on the global market, which the Health Ministry is
to distribute among clinics and doctors' offices across Germany. Within 24 hours the procurement
office could contract the delivery of 300,000 eye protections and protective masks of type FFP-2.
Even though the number of hospitals decreased over the last years, Germany has the highest number
of hospital beds per population in Europe (8.0 hospital beds per 1 000 population). In addition, the
German hospital sector is highly decentralized resulting in a very good accessibility. In 2017, there
were 28 031 ICU beds provided by 1,160 hospitals resulting in 33.7 ICU beds per 1 000 population
which is a relatively high density compared to other countries. According to the Ministry of Health,
currently 25,000 ICU beds have ventilation capacity. The occupancy rate of ICU beds was 79.0% in
2017. The Government and the federal states released a statement on a Hospital Emergency Plan
which aims to double ICU bed capacities through use of provisional facilities (e.g. rehabilitation
facilities, hotels, public halls). In many hospitals, capacities are shifted from planned and elective
procedures to increase general and ICU bed capacity (see sections 3.1 and 3.3).
Sources:
https://www.deutschlandfunk.de/covid-19-tests-auf-das-coronavirus-wann-wo-und-wie.1939.de.html?
drn:news_id=1113302
https://ourworldindata.org/covid-testing#covid-19-test-coverage-estimates-as-of-20-march
https://www.aerzteblatt.de/nachrichten/111113/Bislang-rund-100-000-Tests-auf-SARS-CoV-2-im-
ambulanten-Bereich
https://www.g-f-v.org/node/1233
https://www.aerzteblatt.de/nachrichten/111346/RKI-Aufenthalt-in-COVID-19-Risikogebiet-nicht-mehr-
Kriterium-fuer-Test-auf-SARS-CoV-2
https://www.aerzteblatt.de/nachrichten/111151/Coronavirus-Lange-Wartezeiten-auf-Testergebnisse
https://www.sol.de/news/update/News-Update,459115/Corona-Tests-im-Saarland-Lange-Wartezeiten-
auf-Testergebnisse,459180
http://www.bdlev.de/laboraerzte-warnen-vor-engpass-in-der-covid-19-diagnostik/
https://www.aerzteblatt.de/nachrichten/111424/Labormediziner-fuer-Priorisierung-von-SARS-CoV-2-
Testungen
https://www.aerzteblatt.de/nachrichten/111388/DKMS-Labor-unterstuetzt-Uniklinik-Dresden-bei-
Coronatests
https://mlr.baden-wuerttemberg.de/de/unser-service/presse-und-
oeffentlichkeitsarbeit/pressemitteilung/pid/ab-sofort-zusaetzliche-laborkapazitaeten-zum-test-auf-das-
corona-virus-im-chemischen-und-veterinaerunte/
https://www.bfarm.de/DE/Service/Presse/Themendossiers/Coronavirus/_node.html
https://www.bfarm.de/SharedDocs/Downloads/DE/Service/Presse/Corona/Anordnung_Kontingentierun
g.pdf;jsessionid=5A02E3A14701870B560E19F18856CC55.2_cid333?__blob=publicationFile&v=2
https://www.kvberlin.de/40presse/10pressemitteilung/pe200325.html
https://www.kvberlin.de/40presse/10pressemitteilung/pe200325.html
https://www.spiegel.de/gesundheit/corona-krise-in-deutschland-mangel-an-masken-und-kitteln-liefert-
irgendwas-a-ff2ded09-b53f-43e3-8f58-09624113b448
https://www.bundesgesundheitsministerium.de/weiterere-beschluesse-krisenstab-bmi-bmg.html
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Germany
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Ressourcen_schonen_Masken.pdf?
https://www.kbv.de/html/1150_44709.php
https://www.dw.com/en/how-the-german-military-is-fighting-coronavirus/a-52931817
https://www.bmvg.de/de/aktuelles/corona-pandemie-bundeswehr-beschafft-medizinisches-material-
224904
https://www.wido.de/fileadmin/Dateien/Dokumente/Publikationen_Produkte/Buchreihen/Krankenhausre
port/2018/Kapitel mit Deckblatt/wido_khr2018_kap09.pdf
https://www.destatis.de/DE/Themen/Gesellschaft-
Umwelt/Gesundheit/Krankenhaeuser/Publikationen/Downloads-Krankenhaeuser/grunddaten-
krankenhaeuser-2120611177004.pdf?__blob=publicationFile
https://www.sciencemediacenter.de/fileadmin/user_upload/Fact_Sheets_PDF/Auslastung_und_Verfue
gbarkeit_ITS_FactSheet_24032020.pdf
https://www.destatis.de/DE/Presse/Pressemitteilungen/2020/03/PD20_N011_231.html;jsessionid=CD6
1326BE187F6C0FC6BCCB28023B1A5.internet741
https://www.degemed.de/wp-content/uploads/2020/03/200317-Bundesregierung-Grobkonzept-
Infrastruktur-Krankenhaus.pdf
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Greece
Greece: Physical infrastructure

workforce capacity
workers.
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Italy
Italy: Physical infrastructure

workforce capacity
workers.
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Sweden
Sweden: Physical infrastructure

workforce capacity
workers.
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Germany
Germany: Workforce
2.2 Workforce
Workforce
Several measures have been put in place in Germany aiming to expand the workforce in the treatment
of COVID-19 patients. In practice, these happened often at the initiative of individual hospitals, cities or
regions, with limited overall coordination and planning at the federal level. The measures are taking
place with a view to rapidly expand the workforce, provide training and upskilling and assign new roles
and responsibilities to allow for flexible reactions to surges in demand against the backdrop of a clinical
workforce facing already high workloads in ICU and other wards and a severe nursing shortage pre-
existing the pandemic. Although Germany has had an above-average density of physicians and nurses
per 1,000 inhabitants compared to other European countries, the rates are much lower per hospital
bed, particularly for nurses. In 2017, there were 34,703 nurses with a specialisation in ICU care for an
estimated 28,031 intensive care bed.
1) Additional measures to expand workforce capacity
The focus of additional measures to expand the current workforce has been fourfold: asking part-time
working health professionals to work full time, calling upon medical, nursing and allied health students
to work in clinical practice, attracting retired health professionals to return to clinical practice, as well as
easing mutual recognition procedures of foreign-trained health professionals. Germany is currently in
the preparatory phase to expand workforce capacity in case of a rapid surge of COVID-19 patients.
Several hospitals or cities have used social media or other channels to ask retirees and (primarily)
medical students to work in clinical practice, often offering additional, short-term trainings varying in
length. One call by a university hospital in Mainz resulted in over 1000 medical students showing
interest. Initiatives are usually not coordinated across settings, professions or cities and have therefore
been subject to criticism. One exception is Bavaria, where the regional Minister of Health has put in
place a system to estimate workforce supply and demand and called upon medical students or retirees
to register. At the same time, it has requested hospitals, outpatient clinics and practices to register
shortages to distribute the additional capacity. At the initiative of the federal medical student
association, a facebook group on social media “medics-vs-COVID19” was created where over 20,000
medical students have registered as of 26 March and efforts are underway to organize the deployment
of these medical students in hospitals and other practices. The president of the German Federal
Medical Chamber suggested retirees and medical students consider working for hotlines, public health
agencies, ambulatory practices or exceptionally also in hospitals, and to ensure personal safety and
liability issues . While the respective regional associations of SHI physicians are responsible to
coordinate placements, not all offer services online.
In addition, there is a potential pool of qualified physicians, as an estimated 14,000 foreign-trained

physicians in Germany are waiting for the recognition of diplomas; the waits have been lengthy in
some regions. Easing procedures while not compromising quality standards has been suggested, but
to date only Bavaria has identified concrete steps forward. In Bavaria, it is planned that foreign-trained
doctors meeting the requirements would get a time-limited license to work for one year, other regions
are considering a similar way forward.
Some cities or hospitals have also opened calls for volunteers with no or very limited experience in
healthcare (e.g. hospital in Giessen and Kiel, city of Koblenz offers basic training in which 60
volunteers participated, the city of Wolfsburg is looking for volunteers with informal caregiver
experience). The aim for the volunteers is to support primarily nurses and nursing assistants with basic
support tasks and thereby reduce their workload. However, there is very limited documentation of what
tasks these are, how this plays out in practice, and how the quality and supervision is ensured.
From the policy side at the federal level, the Minister of Health has announced that the pre-existing
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Germany
directive on minimum nurse staffing levels in hospitals and the professional nurse/nursing assistant
ratios in nursing homes and ambulatory nursing practices will be suspended, so that managers can be
more flexible with personnel planning and staffing in light of the anticipated shortage if the epidemic
rapidly unfolds and/or if high rates of nurses are being infected . There has been criticism of the
suspension of the law, e.g. by the Nursing Chamber of Lower Saxony, as this would put patients at risk
as well as nurses who may face excess workloads with risks to their physical and mental health.
In sum, while several initiatives are ongoing to expand the workforce, there are no reliable data
available on the scale of additional health workers this may generate. There is very limited action at the
federal level and – with the exception of Bavaria – at the regional level. Efforts show that individual
hospitals and cities are handling the situation ad-hoc and with very limited coordination. There is no
supply and demand monitoring or planning in place nationwide or across regions, which may be
important in case of regional and local surges of patients or capacity losses in case of infected health
workers.
2) Role flexibility and task shifting
The federal Minister of Health has sent an urgent request to German hospitals to provide training and
instruction for health professionals to strengthen the manpower capacity in ICUs. In Berlin this request
was implemented by an ordinance and hospitals are required to immediately train their medical and
nursing staff in the field of intensive care, ventilation and in the treatment of patients with COVID-19 . In
general, in Germany the training is organised on a decentralised level by hospitals or the federal states
e.g. in Rhineland-Palatinate the coordination is handled by the nursing association, costs are to be
reimbursed by the state. The training encompasses 16-hour short qualification on basic knowledge of
ventilation and symptom control in COVID-19-patients or a 16-hour refresher course for former
intensive care nurses. The DIVI, the German Interdisciplinary Federation of Intensive and Emergency
Medicine provides guidance to step-up the qualification of nursing staff including the organization,
implementation of the training and qualifications required. It also provides suggestions of specific
contents, e.g. for support to ICU staff by professional nurses (but with no qualification in critical care)
where the training content should focus on essential tasks and include hands-on training. Hence, there
are examples of short trainings to allow task shifting of certain specific tasks and roles to less qualified
nurses as a measure to prepare nurses for more task flexibility and ease workloads for ICU nurses so
they can concentrate on specialised tasks for complex patients. Online platforms by professional
associations and specialist publishers provide currently free access for nurses and physicians
(sometimes registration needed) to the latest instructions, news, webinars, scientific articles regarding
treatment and care of COVID-19-patients.
Sources (among others):

https://www.destatis.de/DE/Themen/Gesellschaft-
Umwelt/Gesundheit/Krankenhaeuser/Publikationen/Downloads-Krankenhaeuser/grunddaten-
krankenhaeuser-2120611177004.pdf?__blob=publicationFile
https://www.aerzteblatt.de/nachrichten/111091/Corona-Pandemie-Krankenhausgesellschaft-will-MDK-
Aerzte-in-der-Versorgung-einsetzen
https://rp-online.de/nrw/staedte/solingen/corona-appell-an-mediziner-und-pflegepersonal-in-
solingen_aid-49725791
https://www.faz.net/aktuell/karriere-hochschule/hoersaal/corona-hilfe-tausende-medizinstudenten-sind-
im-einsatz-16697231.html
https://www.welt.de/politik/deutschland/article206701055/Corona-Krise-Das-Paradox-der-Pflege-
Aussteiger.html
https://www.blaek.de/wegweiser/coronavirus
https://www.aerzteblatt.de/nachrichten/111202/COVID-19-Bundesaerztekammer-Praesident-ruft-
Aerzte-im-Ruhestand-und-Medizinstudierende-zur-Mithilfe-auf
https://www.businessinsider.de/politik/deutschland/sonderregelung-in-der-coronakrise-erste-
bundeslaender-rekrutieren-tausende-auslaendische-aerzte/
https://www.businessinsider.de/politik/deutschland/sonderregelung-in-der-coronakrise-erste-
bundeslaender-rekrutieren-tausende-auslaendische-aerzte/
https://www.br.de/nachrichten/meldung/bayern-sucht-jetzt-auch-auslaendische-aerzte-ohne-deutsche-
zulassung,3002af5d2
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Germany
https://www.giessener-allgemeine.de/giessen/sogar-laien-sollen-helfen-13606895.html
https://www.krankenhaus-kiel.de/corona-virus/anmeldung-freiwillige-helfer
https://www.sueddeutsche.de/gesundheit/krankheiten-koblenz-corona-freiwillige-lassen-sich-fuer-
pflege-schulen-dpa.urn-newsml-dpa-com-20090101-200323-99-441539
https://www.pflegekammer-nds.de/pressemitteilungen/pressemitteilung-bmg-setzt-
pflegepersonaluntergrenzen-aus-gefaehrdung-fuer-patienten-und-
pflegepersonalhttps://www.tmasgff.de/fileadmin/user_upload/Gesundheit/Dateien/COVID-
19/20200213_Schreiben_BM_Spahn.pdf
https://www.divi.de/empfehlungen/publikationen/covid-19/1526-organisation-personalnachfuehrung-
final/file
https://www.divi.de/empfehlungen/publikationen/covid-19/1527-divi-empfehlung-step-up-qualifizierung-
pflege-covid19-2/file
https://www.thieme.de/de/corona.htm
https://www.dgim.de/index.php?id=359
https://www.springermedizin.de/coronavirus-covid-19-update/17764850
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Greece
Greece: Workforce
2.2 Workforce
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Italy
Italy: Workforce
2.2 Workforce
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Sweden
Sweden: Workforce
2.2 Workforce
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Germany
Germany: Planning services
3. Providing health services effectively

The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service
delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by
countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Planning services
On March 12, the federal government urged all hospitals to postpone elective surgeries and treatments
and recruit additional health professionals to prepare for the time when a growing number of people
who are infected with COVID-19 and become seriously ill will need to be admitted into hospitals. The
first specialized treatment centers for COVID-19 patients and patients with respiratory symptoms are
set up by the Regional Association of SHI Physicians in North-Rhine Westphalia. Some diagnostic
centers (see section 2.1) have been converted into specialized centers and are designated for
suspected and confirmed cases. Patients are assessed whether ambulatory treatment is sufficient or
inpatient treatment is necessary. The role of primary care providers so far is to provide testing
possibilities and care for those with light or mild symptoms. Patients with severe symptoms are treated
in hospitals. To manage patients and provide a tool for effective use of ICU capacities the German
Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) launched an intensive
care register to query free ventilation places in clinics and to present capacities throughout Germany
on a daily basis. Following a decision of the federal state government of Berlin (March 19), a
provisional COVID-19 treatment center will be set up to treat mild COVID-19 cases as well as
emergency respiratory patients. The hospital will be built with the help of the German armed forces and
will house up to 1,000 patients.
There are early signs for a growing number of tele- or video-consultations provided by physicians and
psychotherapists. Restrictions on the volume of consultations that can be provided by a physician via
video or telemedicine were relaxed. Also, the opening of a virtual hospital was brought forward to
support other departments and practices. The Charité Berlin launched the “CovApp”
(https://covapp.charite.de/), an web-based online tool to assess a patient’s medical condition, provide
recommendations for action (doctor’s visit or testing) and inform about relevant contacts, health care
services, access to hospitals or examination centres.
The RKI releases various documents providing guidance for prevention and management of COVID-19
cases for all relevant care areas (e.g. inpatient, ambulatory, elderly care), as well as updated case
definitions which impacts on reconfiguration of services in care facilities (see also section 3.2).
Sources:
https://www.aerzteblatt.de/nachrichten/111034/Corona-Krankenhaeuser-sollen-ab-Montag-alle-
planbaren-Eingriffe-verschieben
https://www.aerzteblatt.de/nachrichten/111415/KV-Westfalen-Lippe-konzentriert-COVID-19-
Versorgung-in-Behandlungszentren
https://www.aerzteblatt.de/nachrichten/111136/DIVI-startet-Intensivregister-zur-Abfrage-freier-
Beatmungsplaetze-in-Kliniken
https://www.zdf.de/nachrichten/politik/coronavirus-krankenhaus-berlin-100.html
https://www.aerzteblatt.de/nachrichten/110997/Telemedizin-Kraeftiger-Schub-fuer-Videosprechstunden
https://www.kbv.de/html/1150_44943.php
https://www.aerzteblatt.de/nachrichten/sw/COVID-19?s=&nid=111350
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV_node.html
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Germany
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Greece
Greece: Planning services

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Italy
Italy: Planning services

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Sweden
Sweden: Planning services

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Germany
Germany: Managing cases
3.2 Managing cases
Managing cases
From the outset patients (suspected cases with and without symptoms) were asked to call their general
physician or the 116117 non-emergency medical on-call service. In case a person had a direct contact
to a confirmed case, the public health service should be called. Patients with mild clinical presentation
can be managed at home with instructions to follow up if symptoms deteriorate. As of 9 March, patients
with mild disease of the upper respiratory tract can have an incapacity certificate issued for a maximum
of seven days, after consulting with their physician by phone. There is no need to go to your doctor’s
practice for this purpose. This agreement has been expended on March 24, so that physicians can now
issue an incapacity certificate for up to 14 days (agreement is in force until June 23).
The RKI continuously updates the guidance for care providers reflecting the current situation of the
pandemic. A flowchart specifies the clinical treatment protocols and pathways health professionals in
ambulatory and hospital settings are held to respect when treating a patient suspected of having
COVID-19. The clinical criteria for considering testing for COVID-19 are regularly updated and are
subject to change as additional information becomes available. Laboratory testing for COVID-19
should be performed for suspected cases according to the following criteria (last update 24 March):
1. Acute respiratory tract infection and having been in close contact with a confirmed or probable
COVID-19 case in the last 14 days prior to onset of symptoms.
2. Clinical or radiologic characteristics of viral pneumonia in the context of increased number of
pneumonias in care facilities or hospitals.
3. Clinical or radiologic characteristics of viral pneumonia with no indication of any other cause
4. Any acute respiratory tract infection and a) activity in care, medical practice or hospital, b) high-risk
patients or c) without any known risk factors (testing for COVID-19 only if sufficient capacity)
The RKI provides a list of recommendations on how to prevent infections within medical facilities, also
for the ambulatory setting. For example, physicians are compelled to provide separate consultations (in
terms of time and space) for regular patients and suspected cases of COVID-19. This also holds for
dentists. Consultations via telephone and provision of medical services via telemedicine should be
extended and patients should be referred to the 116117 non-emergency medical on-call service.
Physicians and health professionals in the ambulatory settings are also advised to wear appropriate
PPE if there is no alternative but to see patients (depending on the type and extent of exposure).
Sources:
https://www.aerzteblatt.de/nachrichten/111279/Aerzte-duerfen-bei-Atemwegsinfekten-zwei-Wochen-
per-Telefon-krankschreiben
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Massnahmen_Verdachtsfall_Infografik
_DINA3.pdf?__blob=publicationFile
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Getrennte_Patientenversorgung.html
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Hygiene.html
Page 43/67
Greece
Greece: Managing cases
3.2 Managing cases
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Italy
Italy: Managing cases
3.2 Managing cases
Page 45/67
Sweden
Sweden: Managing cases
3.2 Managing cases
Page 46/67
Germany
Germany: Maintaining essential services
3.3 Maintaining essential services
Maintaining essential services
Most hospitals implemented the ordinance of the federal states to postpone elective procedures within
days. However, the decision to postpone elective procedures is made solely by the treating physician.
The German Society for Surgery points out that the mortality risk from postponing an intervention
should not be higher than that of a severe hospitalized COVID-19 case. There exist contingency plans
for certain patient groups with chronic diseases to assure service provision, for example for dialysis
treatment.
The RKI provides guidance documents for prevention and management of COVID-19 disease in
stationary and ambulatory elderly care, for persons belonging to high-risk population, as well as
recommendations for handling contact persons under shortages of professionals in all areas of care.
Sources:
https://www.aerzteblatt.de/nachrichten/111071/Haelfte-der-planbaren-Operationen-koennte-
verschoben-werden
https://www.dgch.de/uploads/tx_news/2020-03-23_Stellungnahme_DGCH.pdf
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Altenpflegeheime.html?nn=13490888
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogruppen.html?nn=13490888
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Greece
Greece: Maintaining essential services
Page 48/67
Italy
Italy: Maintaining essential services
Page 49/67
Sweden
Sweden: Maintaining essential services
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Germany
Germany: Health financing
4. Paying for services

Adequate funding for health is important to manage the excess demands on the health system. This
section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how
much is spent on health and the distribution of health spending across different service areas. The section
also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in
population coverage and service coverage), and how much people pay (if at all) for those services out-of-
pocket.
4.1 Health financing
Health financing
On March 25, the parliament approved the COVID-19 Hospital Relieve Act which comprises a number
of measures to guarantee the funding of hospitals and ensure their liquidity. (1) For non-essential
surgery and treatment that has been postponed, hospitals are to receive financial compensation from
the liquidity reserve of the health fund which will be subsidized by the national budget (the additional
spending is estimated at EUR 2,8 billion in 2020). Until end of September 2020, hospitals will receive a
lump sum payment of EUR 560 a day for every bed that is not occupied. (2) For every additional ICU
bed that hospitals set up, hospitals will receive a bonus of EUR 50,000. (3) Hospitals will also receive
an additional payment of EUR 50 per patient to cover the additional costs, especially of personal
protective gear. This provision will apply for a limited period. It can be extended or raised as necessary.
Hospital do also receive a higher payment for nurses. The current nationwide nurse fee of EUR 146
per day will be raised by about EUR 38 to EUR 185 a day.
For outpatient care the COVID-19 Hospital Relieve Act also contains a number of measures. Doctors
and psychotherapists working in practices can expect to receive compensatory payments if they suffer
loss of earnings as a result of the COVID-19 pandemic. At the same time, additional costs incurred as
a result of treating COVID-19 patients are to be offset. Against this background, the financing of
extraordinary measures, such as setting up "outpatient clinics for patients with fever" is to be ensured
and the distribution of remuneration will be adapted.
The legislation also contains provisions to ensure long-term care and reduce the risk of infection to
those in need of care and professionals working in long-term care (suspending or distance long-term
care need assessments). Residential facilities for rehabilitation and prevention will also receive
compensation for every non- occupied medical rehabilitation bed of the sickness funds (equivalent to
60% of compensation for hospital beds). The additional financial costs incurred by the pandemic or any
loss of income is to be reimbursed through the long-term nursing care insurance. Bureaucratic
requirements such as quality inspections by the SHI Medical Review Board and counselling visits of
long-term care beneficiaries cared for by family members will be waived for a time. Assessments of
long-term care needs will be based on documentation and interviews. Nursing care insurance schemes
will be granted more leeway to help them avoid gaps arising in nursing care coverage for people
receiving care at home.
Sources:
https://www.bundesregierung.de/breg-de/themen/coronavirus/covid19-krankenhaus-gesetz-1735060
https://www.aerzteblatt.de/nachrichten/111445/Bundesrat-billigt-Krankenhausentlastungsgesetz
https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/2020/1-
quartal/gesetzespakete-corona-epidemie.html
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Greece
Greece: Health financing

pocket.
Page 52/67
Italy
Italy: Health financing

pocket.
Page 53/67
Sweden
Sweden: Health financing

pocket.
Page 54/67
Germany
Germany: Entitlement and coverage
4.2 Entitlement and coverage
Entitlement and coverage
Health insurance funds have been covering the cost of coronavirus testing since 28 February 2020.
The prerequisite is that the attending physician decides whether the patient should be tested. Prior to
28 February, costs were only covered if patients had contact with a confirmed COVID-19 case or was
in a high-risk area during the past 14 days.
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Greece
Greece: Entitlement and coverage
Page 56/67
Italy
Italy: Entitlement and coverage
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Sweden
Sweden: Entitlement and coverage
Page 58/67
Germany
Germany: Governance
5. Governance
5.1 Governance
The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans
and the steering of the health system to ensure its continued functioning. It includes emergency response
mechanisms, as well as how information is being communicated, and the regulation of health service
provision to patients affected by the virus.
Governance
The German Influenza Pandemic Preparedness Plan was first published by the RKI in 2005 and was
regularly updated, e.g. based on evidence collected in the 2009 influenza pandemic. The plan provides
the basis for pandemic preparedness plans at regional (federal states) and community level. Based on
the regional pandemic preparedness plans, the federal states are in charge of implementing most
infection prevention and control (IPC) measures resulting in variation of measures within Germany. In
general, federal authorities such as the RKI and authorities at community level (public health offices)
execute their responsibilities in support of the federal and regional responses to a pandemic.
On March 4, the RKI extended the Influenza Pandemic Preparedness Plan in a supplement on COVID-
19 for the handling of the pandemic. The supplementary plan aims to reduce morbidity and mortality,
ensure treatment of infected persons, maintain essential public services and provide short and
accurate information for decision-makers, media and public. The plan provides information on risk-
assessment criteria, diagnostics, case definition, IPC, case-management, surveillance as well as
communication regarding the COVID-19 crisis. The plan foresees three stages: containment,
protection and mitigation.
On March 27, the “Act for Protecting the Public (Health) in an Epidemic Situation of National
Importance” grants the Ministry of Health expanded but timely limited power. Among other things, the
Federal Ministry of Health is now authorized to take measures regarding the provision of
pharmaceuticals and medical devices, including narcotics, laboratory diagnostics, items of personal
protective equipment and products for disinfection. The Ministry of Health can also strengthen
personnel resources in the health care system, e.g. by authorizing health professionals to perform
medical work if they are personally qualified to do so. The new competencies of the Federal Ministry of
Health will expire on April 1, 2021, the "authorization to treat" for nurses and emergency paramedics
will expire on January 1, 2021.
Following the pandemic preparedness plans a crisis management was set up under leadership of the
Ministry of Health and the Ministry of Interior, Building and Community. The RKI, BfArM and the Paul-
Ehrlich Institute (PEI) provide scientific advice. The crisis management closely collaborates at
international level (e.g. WHO, ECDC).
Sources:
https://www.gmkonline.de/documents/pandemieplan_teil-i_1510042222_1585228735.pdf
https://www.rki.de/DE/Content/InfAZ/I/Influenza/Pandemieplanung/Pandemieplaene_Bundeslaender.ht
ml
https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Ergaenzung_Pandemieplan_Covid.pdf
?__blob=publicationFile
https://www.aerzteblatt.de/nachrichten/sw/COVID-19?s=&nid=111266
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Greece
Greece: Governance
5. Governance
5.1 Governance
Page 60/67
Italy
Italy: Governance
5. Governance
5.1 Governance
Page 61/67
Sweden
Sweden: Governance
5. Governance
5.1 Governance
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Germany
Germany: Measures in other sectors
6. Measures in other sectors
6.1 Measures in other sectors

Many MEASURES IN OTHER SECTORS beyond the immediate scope of the health system are being
taken to prevent further spread of the virus. This section contains information on many of these areas,
including border and travel restrictions and economic and fiscal measures, among others.
Measures in other sectors
Borders
As of March 16, the Federal Government has temporarily restricted cross-border traffic from France,
Austria, Luxembourg, Switzerland and Denmark and implemented temporary border controls.
Certain counties are locked down due to high infection rates which result from different events such as
large social gatherings during which many people were infected. The local public health offices are
authorized to decide on a lock down in order to protect local population and contain the spread of the
virus.
Mobility
On March 17, the Federal Government implemented entry restrictions for non-EU citizens and citizens
of non-Schengen states to Germany by plane or ship. Citizens of EU countries and the United
Kingdom, Iceland, Liechtenstein, Norway and Switzerland are permitted to travel through Germany.
The same applies for foreigners holding a residence permit in one of these countries.
Entry remains possible for German citizens. Those who are not German citizens may enter Germany
under the following conditions: (1) for work purposes or to carry out professional contractual services
(including commuters, medical and health care workers, members of the European Parliament and
accredited diplomats). In such cases, the need to cross the border for work must be proved by carrying
appropriate documentation (e.g. work contract, project contract/documents, permit for frontier workers);
(2) for other urgent reasons requiring entry (including medical treatment, the death of an immediate
family member) depending on the individual circumstances. Entry for purposes of tourism is no longer
allowed; (3) for persons returning to their home or legal residence in Germany; and (4) for transit
through Germany to return to one’s home country if no other travel connection is possible.
As of March 25, the Federal Ministry of the Interior has ordered an entry ban for seasonal workers.
Harvest workers and other seasonal workers will be refused entry into Germany. The regulation
applies to entry from all third countries and from most EU countries. In general, cross-border
commuting and transport of goods are to continue with as little disruption as possible. Contrary to the
general restrictions regarding entry to Germany eastern European caregivers are still allowed to enter
Germany based on the EU COVID-19 Guidelines for border management measures to protect health
and ensure the availability of goods and essential services 2020/C 86 I/01 to ensure sufficient
workforce supply.
Regarding travel recommendations, Germany has warned its citizens against non-essential, touristic
travels to other countries due to many recent travel restrictions in other countries. Travels within
Germany are not official restrictions. However, the government recommends reducing the number of
trips and to avoid public transport - where possible - to further reduce the risk of an infection.
Economy
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Germany
On March 25, the German parliament approved the emergency Coronavirus budget aimed at
bolstering the country's economic and medical defenses against the coronavirus. The government
announced on March 23 plans to suspend Germany's so-called debt brake. On Friday March 27, the
additional budget was approved by the upper house of Parliament, the Bundesrat. The new spending
plans foresee an extra EUR 156 billion in new government debt this year, around EUR 100 billion more
than would have been permitted under Germany's notorious debt ceiling that limits annual borrowing.
The additional budget increases the spending power of the Health Ministry by more than EUR 3 billion,
or around 20%, in 2020. A total of EUR 50 billion of the additional budget has been set aside for rapid
support for the self-employed and the smallest businesses with 10 or fewer employees. The self-
employed and businesses with five or fewer employees will be eligible for direct loans from the
government of up to EUR 9,000 over a three-month period; firms with between five and 10 employees
can apply for EUR 15,000.
In addition, an economic stabilization fund will be established that is able to take on the liabilities for
companies that require bridging loans, able to issue guarantees for up to EUR 400 billion in borrowing.
Another EUR 100 billion will be set aside for a fund designed to strengthen the equity base of
businesses (recapitalization). Tax rules are also being altered to allow companies to calculate what
they pay later in the year, rather than paying their early instalments based on projected earnings as
usual. Insolvency regulations will also be temporarily softened.
State aid
On March 25, rules on rent payments have been tweaked at least until the end of September.
According to the new rules, nonpayment of rent will not be valid grounds for eviction for people whose
income has been hit by the coronavirus. The requirements to qualify for long-term Hartz IV
unemployment benefit and for child support will be temporarily loosened as the government reckons
with a sharp uptick in applications. New applicants will not be required to submit information on their
assets or on the size of their monthly rent payments for the next six months. Families that have lost a
large share of their incomes are to be given easier access to the children's allowance. Extra funds are
also being set aside for parents forced to stop work or work less because their children can no longer
go to schools or kindergartens.
The parliament approved expanded regulations regarding the flexible short time working scheme
(“Kurzarbeitergeld”), in which the government pays a share of employee salaries (60% or more) if they
are temporarily unnecessary for production. This will make it easier for companies to hold onto workers
instead of laying them off. Companies will only need to show that 10% of their workforce are affected in
order to qualify.
Sources:
https://www.auswaertiges-amt.de/en/einreiseundaufenthalt/coronavirus
https://www.bmi.bund.de/SharedDocs/kurzmeldungen/EN/2020/03/corona-ein-und-ausreise-en.html
https://eur-lex.europa.eu/legal-content/EN/TXT/?
toc=OJ%3AC%3A2020%3A086I%3ATOC&uri=uriserv%3AOJ.CI.2020.086.01.0001.01.ENG
https://www.deutschland.de/en/news/coronavirus-in-germany-informations
https://www.dw.com/en/whats-in-germanys-emergency-coronavirus-budget/a-52917360
https://www.dw.com/en/whats-in-germanys-emergency-coronavirus-budget/a-52917360
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Greece
Greece: Measures in other sectors

Page 65/67
Italy
Italy: Measures in other sectors

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Sweden
Sweden: Measures in other sectors

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Isolation and quarantine

Monitoring and surveillance

Maintaining essential services

Entitlement and coverage

Measures in other sectors

Germany: Health communication

1.1 Health communication

Greece: Health communication

1.1 Health communication

Italy: Health communication

1.1 Health communication

Sweden: Health communication

1.1 Health communication

Germany: Physical distancing

1.2 Physical distancing

Greece: Physical distancing

1.2 Physical distancing

Italy: Physical distancing

1.2 Physical distancing

Sweden: Physical distancing

1.2 Physical distancing

Germany: Isolation and quarantine

1.3 Isolation and quarantine

Isolation and quarantine

Greece: Isolation and quarantine

1.3 Isolation and quarantine

Italy: Isolation and quarantine

1.3 Isolation and quarantine

Sweden: Isolation and quarantine

1.3 Isolation and quarantine

Germany: Monitoring and surveillance

1.4 Monitoring and surveillance

Monitoring and surveillance

Greece: Monitoring and surveillance

1.4 Monitoring and surveillance

Italy: Monitoring and surveillance

1.4 Monitoring and surveillance

Sweden: Monitoring and surveillance

1.4 Monitoring and surveillance

Germany: Physical infrastructure

2. Ensuring sufficient physical infrastructure and

2.1 Physical infrastructure

Greece: Physical infrastructure

2. Ensuring sufficient physical infrastructure and

2.1 Physical infrastructure

Italy: Physical infrastructure

2. Ensuring sufficient physical infrastructure and

2.1 Physical infrastructure

Sweden: Physical infrastructure

2. Ensuring sufficient physical infrastructure and

2.1 Physical infrastructure

1) Additional measures to expand workforce capacity

In addition, there is a potential pool of qualified physicians, as an estimated 14,000 foreign-trained

2) Role flexibility and task shifting

Sources (among others):

Germany: Planning services

3. Providing health services effectively

3.1 Planning services

Greece: Planning services

3. Providing health services effectively

3.1 Planning services

Italy: Planning services