Hospitalization rates — the number of people admitted to hospital with COVID-19 — have reached the highest levels of last December. Intensive care units are filling up, patients have to be transported across the country to hospitals that still have capacity. Operations have to be cancelled, leaving cancer sufferers and other patients in the lurch.

A COVID-19 patient with venous access lines and a tracheostomy sits in the intensive care unit of Dresden's municipal hospital. Using hospitalization rates as an incidence value is controversial: They show the incidence of infection, but only with a delay. Also, many COVID patients are younger than in previous waves. They spend longer in intensive care, meaning beds are not freed up as quickly.

Undertakers have been overwhelmed, with coffins lined up here in front of a crematorium oven. On one of the lids, the word "Corona" has been written in chalk — a warning to the people who work there. The elderly and the unvaccinated are still most at risk of dying of the virus, but there are more and more breakthrough infections.

In recent weeks, there have been numerous outbreaks of COVID-19 in long-term care homes and retirement communities in which residents have died. This is one reason why the German government is considering mandatory vaccinations for health care workers. Italy, France and Greece have already made the move, and Austria will soon follow suit.

Self-testing in kindergartens and schools is now routine for children. No other population group is tested as regularly and extensively for COVID-19. Yet the incidence among 5 to 14-year-olds is up to three times higher than average. In an effort to stem a rise in cases, the European Medicines Agency approved the BioNTech-Pfizer vaccine on November 25.

Since last week, new rules have applied in trains, trams and buses, such as here in Hamburg: Only those who have been vaccinated, tested negative, or have recently recovered from infection can use them. Drivers and on-board personnel are supposed to enforce this rule, but can only really do spot checks. Mask-wearing is still mandatory; those who don't comply face fines of up to €150 (about $170).

Because the vaccination rate is faltering, the German government intends to focus once again on low-threshold vaccination incentives, like vaccination drive-ins and mobile vaccination teams. It also wants to push ahead as fast as possible with the third booster vaccination — to "winter-proof" Germany's population, as Olaf Scholz, the presumed chancellor-elect, has said.

Given the increasing number of breakthrough infections and the decline in vaccination protection after six months, it seems that this is sorely needed. The only other thing that will help is systematic testing. For just one month, from October 11 to November 11, people were required to pay for tests, but these are now free again — irrespective of vaccination status.

Anyone who doesn't absolutely have to commute to work should therefore stay at home. The original working-from-home requirement ended in Germany in June — but now it's back. With infection rates spiraling, reducing contacts has to take precedence. Wherever possible, workplaces have been relocated back to the home office — to the kitchen table, or the sofa.

Christmas markets are starting to open in German towns, although many, like this one in Freiburg, have strict access rules and have limited visitor numbers. However, the state of Bavaria has responded to the extremely high infection rates by clamping down. Municipalities with a seven-day incidence of more than 1,000 must go into lockdown, and their Christmas markets must also remain closed.

A man in a cemetery in Bonn mourns his dead wife — one of the 100,000 people in Germany who have died of COVID-19. Over the past few weeks, the number of those dying of COVID and infected with the virus has risen daily. On October 1, it was 66. On November 18, the Robert Koch Institute recorded 201 such deaths.