It’s taken other countries in Europe months to develop an adequate coronavirus testing regime needed to combat the pandemic. Rachel Stern examines how Germany managed it much sooner and how the country continues to lead the way.
On a sunny Friday afternoon in mid-June, Berliners enjoyed picnics in public parks, gathered at outdoor street markets and filled the outdoor terraces of restaurants.
But Hannah, a 21-year-old trainee nurse in the German capital, kicked off the weekend by starting a two-week quarantine in her flat, having just discovered she had been infected with Covid-19 after coming into contact with an acquaintance confirmed to have the disease.
“I had no symptoms, but I still tested positive,” Hannah told The Local.
When a friend told her she was infected, Hannah quickly arranged for a test at the hospital where she works and received the results the same day.
In other countries governments have been heavily criticised for not providing rapid testing for healthcare workers or indeed the general population, even those with symptoms – a factor scientists believe exacerbated the spread of the disease.
But since the first outbreak of coronavirus Germany has made testing a priority, and now as lockdowns ease and public life reopens testing has become a crucial weapon in the fight against any resurgence of the virus.
The country’s continual effort to test its residents for the coronavirus is considered one of the key factors which has led to its low per capita case numbers and low death rate, and spared its medical system from a crippling overload experienced in other European countries.
It continues to be one of the few countries in Europe with an “open public testing” policy meaning even asymptomatic people can have access to tests. In contrast countries like France and the UK are only testing those with symptoms or those who have come into contact with anyone infected.
By mid-June it had carried out over five million tests out of its population of 83 million people, according to the Robert Koch Institute.
As of Friday June 26th, Germany has had over 196,000 confirmed coronavirus cases, over 176,760 which are reported to have recovered, according to data from Johns Hopkins University. There have also been 8,940 deaths, well below the numbers seen in France, Italy, Spain and the UK.
Taking action from the beginning
Germany’s success with getting its testing system up and running was down to several factors.
Firstly it acted quickly when the first cluster emerged in the country back in January.
Germany’s first coronavirus case was detected on January 27th at a car parts manufacturer just outside of Munich, also marking the first incident of human to human transmission of the virus in Europe.
The case was traced back to an employee who had recently visited her parents in Shanghai and brought back the virus.
After confirming the virus, local health officials also ordered tests for 40 people who had been in contact with the infected employees, including colleagues and family members. Importantly the company, Wabasco, paid for 139 Covid-19 tests.
This quick-fire testing to isolate the cluster at such an early stage of the outbreak was considered crucial by experts to prevent the kind of outbreak and knock-on effects on the health service seen in other countries.
“If this cluster of infections in Bavaria hadn’t been discovered, then Germany could have had a situation like that in Italy,” Professor Jonas Schmidt-Chanasit, the chair of virology at the Bernhard Nocht Institute for Tropical Medicine, told The Local.
The example set in Bavaria was copied throughout Germany as infections spread to all 16 states.
“Infections were quickly registered and their contacts quickly reached,” so that they could be tested, said Schmidt-Chanasit.
It was exactly the kind of procedure recommended by the WHO, which other European countries struggled to put in place and only began to roll out once lockdowns were eased in May and June. The test was developed domestically by coronavirus expert Dr. Christian Drosten of Berlin’s renowned Charité university clinic.
At the peak of the epidemic in Germany, the week beginning March 30th – Germany carried out 408,000 tests a week, according to data from the Robert Koch Institute.
From the beginning of the outbreak Germany has relied on “PCR tests”, which detect viral RNA even before antibodies form or symptoms – which can take up to 14 days to show – are present.
Following the outbreak of SARS-CoV-2, as the virus is scientifically known, in Wuhan, China in December 2019, Drosten and his team of researchers got to work.
As soon as their Chinese colleagues made the genome sequence available, they were able to roll out the test which would not only be available for use by the end of January in Germany, but also worldwide.
Although not everything went smoothly in the early days of the epidemic in Germany.
Initially public health insurance companies would only pay for a test if someone showed systems of the virus.
Part of the rationale was that it was in the middle of flu season and, as such, a lot of German residents exhibited typical respiratory symptoms.
Some also reported challenges acquiring a test at the beginning.
Ali, a 34-year-old digital marketing executive who suspected he had Covid-19, was initially refused a test in a Berlin clinic because he didn’t show enough symptoms, but was able to eventually get one after “legal pressure” from his employer.
“The costs were by no means covered by the health insurance company, so my employer paid around €270,” Ali told The Local.
Things have changed since then with the German government realising it paid in the long run to invest in testing notably by covering costs that might have dissuaded members of the public from taking a test.
Following the large coronavirus outbreak in February, Philipp Freese’s first thought was how to improve testing for the coronavirus.
His company PharmGenomics had focused on screenings for colon cancer, but it quickly shifted gears, developing an at-home PCR test (CoronaScreen) from genetic information which had already been published, and testing its 17 employees.
“It was pretty apparent that the pandemic would rapidly spread,” said Freese, whose wife comes from the district of Heinsberg, one of Germany’s original coronavirus hotspots.
“We decided that we have to help fight the pandemic and focus on this topic,” said Freese, who is raising the funds to finance the tests through a crowdfunding campaign dubbed #CrowdBeatsCorona. “We would lose our scarce time if we did not follow the trend.”
‘A blended approach’
According to the World Health Organisation (WHO), testing is a crucial tool in stemming the spread of the coronavirus, but must be part of a comprehensive approach which also includes quarantining confirmed and suspected cases for two weeks, ensuring sufficient capacity in the health care system such as beds and ventilators, and enforcing social distancing measures.
“Germany has been organized, they continued to test at high rates, they continued with tracking and tracing despite challenges,” a WHO spokesperson told The Local.
“They have activated the public health and social measures and implemented the comprehensive and blended approach as recommended by WHO,” the spokesperson added.
That comprehensive approach meant the battle against the epidemic wasn’t all about the testing strategy in Germany.
For a start the strict lockdown imposed across the country is credited with saving many lives and the government also moved to bolster its health system.
By mid-March, when the country counted slightly more than 11,000 confirmed cases and 27 deaths, it announced a plan to double its 25,000 hospital beds with respiratory care capacity.
They set aside enough space to not only accept severely ill patients from Germany, but also coronavirus patients from neighbouring EU countries when their own hospitals lacked capacity and supplies.
Ana, a nurse who works in intensive care at a hospital near Cologne, told The Local that while protective medical equipment (PPE) ran low, it never ran out and Germany had far more ventilators available to the worst-off Covid-19 patients that other countries.