In response to several COVID-19 'super-spreader' events in Germany in May-June this year, the government quickly locked down, first the hot-spots and then nation-wide, and initiated aggressive targeted testing with hugely innovative, technology-driven interventions. The result of these and other strategies is an exceptionally low fatality rate compared to neighbouring countries and globally.
Germany has emerged as a world leader in using high science and technology to lower the northern hemisphere summer decline in C-19 infection rates. The German population’s behavioural compliance further strengthened the fights against the coronavirus.
This emerged from a webinar featuring Professor Dr Hendrik Streeck of the University of Bonn, a respected virologist and COVID-19 researcher who is currently spearheading some of Germany's most important and innovative regional studies. Streeck is director of the Institute of Virology at University Hospital Bonn and also directs the Centre for HIV & AIDS there.
He was guest speaker in a webinar hosted by the Desmond Tutu Health Foundation and MedicalBrief and held on Tuesday 1 September 2020. The webinar was moderated by Professor Linda-Gail Bekker, a leading researcher with the Institute of Infectious Diseases and Molecular Medicine at the University of Cape Town and COO of the Desmond Tutu Health Foundation.
Massively boosted testing capacity
Streeck told an audience of mostly South African healthcare workers and clinicians that besides three 'super spreader' events, many infections in Germany happened in refugee camps and homes for the elderly, both of which were under-protected.
He partially attributed a recent infection rate rise in Germany to a huge increase in testing capacity, decrying the term ‘second wave'.
“We’re performing nearly 1m tests a week, double that of two months ago, and finding even more infections. The percentage of test-positives is surprisingly stable, but a month ago we had an increase in the positive rate which nobody really noticed," he said.
"If you look at the pattern of the of 1st and ‘2nd’ wave in Germany, it is similar to all of Europe, except Sweden, but there’s been no increase in deaths." This was in marked contrast to Spain and Italy where healthcare facilities were overwhelmed as the infection rate soared.
Streeck put the lack of severe COVID-19 cases in most of Europe down to behavioural and hygiene compliance, adding his suspicion that the prevalence of multiple flu viruses historically might be boosting immunity for up to two years. He added; “1,200 infections per day in Germany, with 80m inhabitants, is pretty low.”
Bekker observed how the COVID-19 outbreak pattern was markedly different to the tragic 'Spanish flu' pandemic of 1918 – adding that with COVID-19, case fatality rates mattered far more than the actual number of infections in ranking how serious an epidemic was.
Streeck said the German government’s current spring-summer strategy included the continued cancellation of all large events until December, while focusing on how many people were being hospitalised and/or becoming very sick.
“We have about 30,000 ICU beds, but only 200 are currently being used for C-19 patients. It’ll be more important to focus on health system resources than to look at infection numbers, though that helps in predicting ICU and medical ward requirements,’ he added.
Germany’s innovation outlined
Asked by Bekker to expand on Germany’s “extraordinary” testing and its innovative technological responses, Streeck said polymerise chain reaction or PCR testing was still the gold standard but that a confirmatory test had been added to increase accuracy.
Streeck's department has been working with the university’s human genetics department “using tons of robots and a large machine to do hundreds of PCRs and extraction at the same time. With this platform we can do 4,000 tests per day, but have only reached 1,200 [per day] so far. We’re discussing using even more advanced technology to allow one lab to do up to a million tests per week,” he revealed.
However, this provided “only a small snapshot” of when the swab was taken. Streeck emphasised that quick test turn-around times were vital for efficacy. Beyond a three-day test result turn-around, a person was no longer infectious
Testing in Germany was only done for close COVID-19 contacts or symptomatic people to avoid the drain on common re-agent resources globally. Testing turn-around times in Germany, dependent on the degree of urgency, varied from between 90 minutes and, more generally, six hours. South Africa’s initial turn-around result times, although geographically patchy, were very often longer than three days, although now they are at between 24 and 48 hours in most labs.
A 'no-harm' German government-backed cell phone application that uses Bluetooth technology to detect anyone who has been within two metres of a COVID-19 infected person for longer than 15 minutes and alerts its owner, had already had 20m downloads in Germany, Streeck told the webinar.
The cell phones apps, which are fully data-protected to ensure confidentiality, exchange code numbers via Bluetooth and recommend COVID-19 testing to their owners if they’re exposed to risk. Streeck described the application as a “very good experimental programme, and another tool in our box”.
On 3 September, Germany would experiment with a live television show with a volunteer, mask-wearing audience sitting safely apart, undergoing COVID-19 testing before and after the show – to see if such events were safe to resume.
How Germany handled ‘super-spread’
Streeck outlined three 'super-spreader' events in Germany, the first being a 15 February 2020 evening carnival in Gangedlt, where 44% of carnival-goers were found to be infected 13 days later, resulting in a lock-down of the city and 1,000 party-goers being quarantined. His research shows that the carnival-goers had more symptoms and were sicker than people infected elsewhere (by a factor of 1.63), emphasising the relevance of airborne spread.
Then, in the tiny ski resort of Ischgl in the Tyrolean Alps, one of Europe’s worst COVID-19 outbreaks saw the virus spread to 45 countries as holiday-makers returned home. Hundreds of people are preparing to sue local authorities, with lawyers ready to bring the first cases at the end of this month.
The third began on 28 June 2020 at a slaughterhouse in the west German town of Gütersloh. Within five days there were 2,203 coronavirus infections recorded in the town district, most of them workers at the meat plant or people associated with it. An estimated 21 people died.
Streeck said Germany had adapted very well to the pandemic, its government admitting to having over-reacted in closing down certain areas where COVID-19 was not spreading and subsequently conducting ongoing rational analyses. He felt strongly that a multi-disciplinary mix of expert viewpoints was need early on to manage pandemics, with lessons from other countries also taken on board.
“We could have learnt a lot more from the early days of the outbreak, but at the same time people were hesitant to trust the data from other countries,” he added.
Click here to watch the webinar: COVID 19 At the Frontline – The German Experience