In Cologne’s old town, the Christmas market is nearly ready. The stalls are being winched in and the ice rink is taking shape. And yet hanging over it all is a sense of nervousness because nobody is quite sure what will happen next.

Will the tourists come? Will the market still be open by Christmas or will the resurgence of COVID spoil everything. Again.

Germany, like much of Europe, has a serious problem with a rapid, debilitating rise in infections. The much-feared fourth wave is now a depressing reality, sweeping in from the east.

Saxony has already been hit hard; Cologne, over on the other side of the country, now waits.

In the city’s impressive university hospital, Fabian Dussem greets us warmly and opens the door to the intensive care ward.

Last year, at the height of the pandemic, it was packed with patients and panic. Now, it is empty. But it won’t stay like that.

“I’m extremely worried,” he says. “We had three waves before where we had a lot of COVID patients to treat and a lot of them died and now we are running straight ahead to the fourth wave.

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“The incidents are rising high and we are extremely worried what will happen next.

“I’m annoyed I’m angry and I’m very tired of this situation because we are still exhausted from the past waves. We don’t want to see this anymore.”

Germany received plaudits from around the world for its reaction to the first wave when the country endured fewer deaths than its neighbours.

This time, though, it appears to be suffering far more than France where the rate of infection remains much lower.

That, of course, may change as this fourth wave arrives in Western Europe. The question that remains unanswered is exactly why.

Germany has vaccinated around two-thirds of its population, which is roughly the same as the United Kingdom. People can move easily around the huge nation, while, in retrospect, there is little doubt that Germany was too quick to scale back its COVID infrastructure, such as its excellent but expensive track and trace system.

And then there is the vaccination programme. Germany, like other nations, has seen a marked fall in the number of people coming forward to get vaccinated.

In essence, that’s because most people who wanted to get vaccinated, and qualified, have already come forward. And, among those who were reluctant at first, many have not been won over.

Dr Daniel Poerschke looks pained when I ask him about how the city can now cope with this fourth wave. He is a doctor at one of the city’s main vaccination centres, and is keen to see a reaction.

“In Cologne, during the peak time in Summer, we had around 7,500 vaccinations per day, but the vaccination centre closed by the end of September and now we only have the capacity for about 500 vaccinations here.

“But the demand is obviously increasing again, since the numbers are rising and so there is also demand for opening vaccination centres again. It’s necessary.

“During the summertime, when the numbers were low, many people thought the pandemic was over. Now, with the numbers getting that high, everybody’s aware that the pandemic is not over yet.

“Plus now we know that you’re not fully protected with two vaccinations and that there is the need of a third vaccination. We should’ve done this earlier already. We knew that. The virologists told the politicians so, in August already.

“The recommendation was in August already to have the third vaccination done but unfortunately we are only starting now to increase the number of the booster vaccination and hopefully it’s not too late.”

There is a gulf here between the vaccinated and the unvaccinated, and it is getting wider and more obvious.

Austria has already introduced rules that hinder the movements of unvaccinated people more than those who have had two or three jabs. COVID passports are common across Europe, where the requirement to prove your status in restaurants or arenas is now familiar.

And as cases start to rise, and deaths follow, so the pressure will grow on governments to bring in more restrictive measures, which may well exacerbate that feeling of division.

Already some political parties, such as the Freedom Party in Austria, are tapping into that sense of disaffection among unvaccinated people.

So COVID will not just be about health, or politics, but about the make-up of society and our definition of liberty.

Amid the infections, deaths and the efforts to stop hospitals becoming clogged once more, the virus may yet complicate Europe more than ever.

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