- Ralph Ranges, professor of epidemiology and public health1
- 1Hamburg University of Applied Sciences, Hamburg, Germany
The situation with the pandemic in Germany is often compared with the situation in other European countries, especially in the UK. According to the World Health Organization, the incidence rate in Germany by June 23 was almost half that in the UK (230 cases per 100,000 population). v 451/100 000), and the registered deaths from Covid-19 was the sixth share in the UK (10.7 / 100 000) v 63.2 / 100 000).
Care must be taken when comparing data from different countries,1 and various reasons may explain the observed differences 2. But from a public health perspective, experience with SARS3 suggests that Germany’s intensive testing, contact tracing and quarantine system was crucial for successful outbreak control, especially given the role of super-proliferation. events that seem to shape the current epidemic in Germany, with the most recent of them in meat factories.
Germany consists of 16 federal states that are responsible for health. Outbreak investigation and management, including contact tracing, is the responsibility of local health authorities at the city or county level, with the support of government departments of health and the National Institute of Public Health, Robert Koch Institute, when necessary.
Covid-19 became a disease to be notified in Germany on February 1, 20205 earlier than in the UK6. Disease notification requires clinicians to legally notify health authorities of suspected cases. Laboratories are likewise required to notify authorities of tests for the presence of diseases to be registered. In Germany, notifications of diseases from clinicians and laboratories are mainly sent to local authorities, where most of the practical work on fighting infections is carried out.
The first covid-19 outbreak occurred in Bavaria in late January, and was quickly controlled through testing, contact tracing, isolation, and quarantine. However, new outbreaks from other sources began to spread 7, and the need for breaking the transmission chain through nationwide measures (blocking) became apparent. At the same time, local health services were mobilized and revitalized. In April, both the federal and state governments agreed on additional investments to strengthen local public health authorities8. Public servants were transferred to public health from elsewhere, and additional staff were hired to support the tracking of local contacts. Germany was based on existing infrastructure and experience from the very beginning, unlike England, where local public health departments were ignored in favor of a centralized system run by third-party companies.
Later, when population restrictions were lifted, Chancellor Angela Merkel and the prime ministers of the federal states agreed that local governments should have five means of contact tracking for every 20,000 citizens. The inexperience of new employees was overcome by incorporating them into experienced organizational structures, helping to limit the difficulties reported in England.
Enhanced contact tracking capabilities reinforced the May 6 decision to gradually open the community. States agreed that infection control measures among the population, such as school closures or even “closures,” would be resumed at the local level if infection levels reached the threshold of 35–50 cases per 100,000 inhabitants per week in the region11. In general, the flexibility of local infectious diseases control with centralized coordination and support appears to be still effective and runs counter to the more centralized and privatized approach adopted in the UK.
As in many other countries, Germany has deployed technological solutions, including an anonymous and decentralized contact tracking application, which was launched on June 16. Concerns about confidentiality led to the cancellation of previous data collection plans more centrally and, as a result, to a delay. Data protection rights are taken seriously in Germany, and the data collected by the application is stored only on separate phones, without a central database. Public health experts, however, have limited expectations: in a recent survey, 38% of respondents from public health departments questioned the added value of a contact tracking application or found it to be potentially problematic12.
Although blocking in Germany was less intense and shorter than in some other European countries, including the UK, early adoption, combined with widespread testing, contact tracing and quarantine, was successful in reducing the incidence of Covid-19 and both Covid-19 specific and excess death. To date, the epidemic has remained stable due to the phased weakening of control measures, although recent outbreaks in several meat plants (one of which included more than 1,000 cases) are obvious problems for the system. Decisive measures have been taken to combat these outbreaks, including regional blocking.
Timely data on suspicious cases are now vital, along with quick testing, fast processing time for results and comprehensive tracking of contacts. National testing guidelines are regularly updated in response to events13. The second wave remains a risk, and authorities continue to closely monitor the situation14. Without a vaccine and special antiviral drugs, prevention of transmission through public health measures is now becoming more important. than ever.
Competing interests: I have read and understood BMJ’s policy regarding the declaration of interests, and I have no interests to declare.
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