With intensive care beds filling up and health staff running short, a hospital in Bavaria's Freising made an unprecedented decision to transfer a coronavirus patient to northern Italy for treatment.
Through the highs and lows spanning 18 months of the pandemic, Germany had on many occasions taken in patients from neighbouring countries as hospitals elsewhere ran out of space.
But a fourth wave has sent infections to record highs in Europe's biggest economy, putting hospitals in parts of the country under immense strain and forcing some to look elsewhere in the EU for help.
While the absolute number of patients in intensive care still lies below the peak a year ago, this time around, hospitals are also ailing from the double hit a shortfall