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HEALTH

German doctors want to grant sick leave by phone amid Covid wave

German GPs say they are in favour of bringing back the special regulation for granting sick leave to patients over the phone due to the high number of people with respiratory infections.

A person with a mild illness lies on the sofa.
A person with a mild illness lies on the sofa. Photo: picture alliance/dpa/dpa-tmn | Christin Klose

Earlier in the pandemic, German authorities changed the law so that people with a mild upper respiratory tract illness, such as the common cold, were able to get their sick note to stay off work by simply calling and speaking to their GP.

But the rule was reversed on June 1st. Since then people have had to go back to the practice – or do a video call – to get an incapacity to work certificate or AU-Bescheinigung, often shorted to AU in Germany.

Germany’s GPs are now calling for a return to the option of handing out sick notes following a telephone consultation.

In view of the high number of colds and Covid infections circulating, the chairman of the German GP Association, Ulrich Weigeldt, said: “The telephone AU would provide real relief.”

READ ALSO: Germany sees spike in respiratory infections over summer

“A personal consultation with the family doctor is not always absolutely necessary, for example, in the case of a simple flu infection or a mild course of corona.”

When a patient has a mild respiratory infection or Covid, Weigeldt said it would be better for GPs to be able to grant sick leave for a few days after a phone call with the patient. He said abuse of this system is very rare because family doctors and patients have usually known each other for some time.

“Instead, patients are now again forced to drag themselves sick to the doctor’s office without this being medically absolutely necessary,” he said.

According to the Federal Joint Committee (G-BA), the special regulation for granting sick leave by phone could return to Germany. 

READ ALSO: Sick leave granted by phone ends in Germany

The committee is the body that includes representatives of the medical profession, health insurance organisations and hospitals. It decides on the services of the statutory health insurance organisations and on rules such as those for sick leave.

In spring of this year, the committee discussed whether it was “right to let the previous special regulations for sick leave by telephone expire at the end of May 2022”, a spokeswoman told DPA.

At the time, all G-BA members and therefore also the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), representing the medical profession, had agreed that these rules could be withdrawn because of the calmer pandemic situation.

However, the spokeswoman said that if the pandemic gains “strong momentum”, the Federal Joint Committee could “reactivate” the special regulation.

READ ALSO: The 10 rules you need to know if you get sick in Germany

This could happen in certain regions or – if needed – nationwide. 

According to the Robert Koch Institute (RKI), there is currently a strong increase in Covid infections across Germany. Furthermore, data from doctors and pharmacists show that there is an unusually high number of other respiratory infections for the time of year.

The 7-day incidence of Covid infections in Germany stood at 702.4 infections per 100,000 people on Tuesday. Germany reported 154,729 new Covid infections and 165 deaths within the latest 24 hour period.

However, experts say many Covid infections go unreported. 

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HEALTH

Who can get the monkeypox vaccine in Germany – and how?

The monkeypox virus continues to spread in Germany and the vaccines panel is recommending that three groups of people get a jab. Here's who can get one - and how.

Who can get the monkeypox vaccine in Germany - and how?

What’s the current monkeypox situation in Germany? 

The monkeypox virus is still spreading in Germany, with 2,982 confirmed cases of the disease recorded by the Robert Koch Institute (RKI) as of Tuesday.

The virus, which causes small lesions on the skin alongside flu-like symptoms, is primarily transmitted through close physical and sexual contact. The vast majority of cases have so far been found in gay men, though five women have also had the virus in Germany to date. 

On Tuesday, the RKI reported that a four-year old girl in Baden-Württemberg had contracted monkeypox from two adults in her household but was asymptomatic. Before that, two teenage boys aged 15 and 17 were also found to have picked up an infection. 

READ ALSO: Monkeypox in Germany: Two teens ‘among new infections’

With the number of cases rising globally, the World Health Organisation (WHO) has declared the situation an “emergency of international scope” – the highest alert level possible.

This is a sign for members of the WHO like Germany to implement containment and preparation measures, such as rolling out vaccination campaigns. For its part, the Robert Koch Institute (RKI) is tracking the cases and has put out an information sheet about the best practices for avoiding the measures and what to do in the case of an infection.

What should people do if they contract the virus?

If people think they have a monkeypox infection, the first thing they should do is seek the advice of a healthcare practitioner such as a GP or sexual health advice clinic. However, the RKI advises people to phone the clinic beforehand to let them know they believe they may have the virus.

In confirmed cases of monkeypox, people should self-isolate at home until the lesions on their skin scab over and peel over, but for a minimum of 21 days. They should avoid physical contact and sharing items like hand towels or bed sheets with others and should wear condoms during sex for at least eight weeks.

Healthy people with no pre-existing conditions are generally fine to remain at home with someone who has contracted monkeypox, but those with weakened immune systems, pregnant women, elderly people and children under the age of 12 should move out for the duration of the isolation. 

READ ALSO: EXPLAINED: How Germany wants to contain the monkeypox

What monkeypox vaccines are available? 

The smallpox vaccine Imvanex, which has been available in the EU since 2013, was approved for use against the monkeypox virus on July 22nd, 2022. 

People are generally protected against monkeypox for at least two years after their first dose of Imvanex, but doctors recommend a second dose after a four-week interval in order to make this protection permanent. 

The vaccine is generally seen as a preventative measure but can also be used up as a so-called post-exposure measure to lower the risk of getting ill after contracting the virus. In this case, the vaccination is most effective up to four days after exposure. 

Who are monkeypox vaccinations recommended for? 

So far, the Standing Vaccines Commission (STIKO) has recommended that two primary groups of people get a monkeypox jab: men who have multiple male sexual partners and people who work in infectious disease laboratories. 

As mentioned, the vaccine can also be used to ward off illness or prevent a severe course shortly after someone has been exposed to the virus. 

READ ALSO: German vaccine panel recommends monkeypox jab for risk groups

Nurse laboratory monkeypox PCR

A nurse sorts monkeypox test samples in a lab. Photo: picture alliance/dpa/EUROPA PRESS | Carlos Luján

Is there enough vaccine to go around?

Not currently.

In May, the German Health Ministry preemptively ordered 240,000 doses of the vaccine – but so far just 40,000 of these have been delivered. 

This is far too little to cater for the estimated 130,000 people who fall into one of the target groups for a jab.

The remaining doses are due to be delivered in August and September, though some pressure groups are already calling for more to be ordered. 

On Friday, the German Aids Federation (DAH) called on the government to secure at least one million doses of the monkeypox vaccine in order to help stamp out the virus in Germany. 

“The goal must be to reduce the number of infections as quickly as possible and to get the epidemic permanently under control,” explained Ulf Kristal of the DAH board.

This can only be done if as many people in risk groups as possible are vaccinated, he added. 

How can people book a jab?  

At the moment, this varies quite a bit from state to state, with some issuing the jabs via the local health authorities and others supplying the doses to specialist HIV clinics and hospitals.

In Saxony-Anhalt, Bremen and Hesse, vaccinations are primarily organised through the local health authorities, so this should be your first point of contact to enquire about a jab if you live in these states. In Frankfurt am Main, however, a handful of specialised HIV clinics are also carrying out vaccinations, according the FAZ newspaper. 

In Saarland, too, appointments should be booked through the health authorities, though they are carried out at Saarbrücken University Clinic. In Hamburg, jabs are being administered solely at infectious disease clinics.

UKE university clinic Hamburg

The main entrance to the University Clinic in Hamburg, where monkeypox patients have been treated for the disease. Photo: picture alliance/dpa | Axel Heimken

Berlin offers the most diverse range of vaccinations and, with 8,000, has the largest number of vaccine doses available. Vaccinations are given in HIV specialist practices, counselling centres for sexual health as well as in several hospitals. A list of vaccination centres has been compiled by the German Association of Outpatient Doctors for HIV Treatment. Neighbouring Brandenburg organises vaccinations through the local health authorities as well as through GP’s practices.

In three federal states, only hospitals are responsible for monkeypox vaccinations. In Saxony, hospitals in Chemnitz, Leipzig and Dresden have been vaccinating since the end of June. In northern Schleswig-Holstein, outpatient clinics in Kiel and Lübeck are responsible. Neighbouring Mecklenburg-Western Pomerania is administering its doses exclusively through the University Medical Centre Rostock.

Several federal states have opted to roll out monkeypox vaccinations through both HIV clinics and hospitals. These include Bavaria, which has more than 3,500 vaccination doses available, as well as Rhineland-Palatinate, Lower Saxony and North Rhine-Westphalia, for which a list of all vaccination centres was recently published.

What else should people know? 

The monkeypox vaccine is perfectly safe, but people can experience a few side effects for a day or two afterwards, including soreness on the vaccination arm, fever and headaches. 

People with HIV should talk to a specialist before getting the vaccine, because the effectiveness may vary depending on your Helper T cell count. 

For more information on the clinics offering jabs, the German Aids Federation has published a helpful Q&A along with a list of clinics in each of the federal states, which can be found here (in German).

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