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Respirator

While reported COVID-19 cases in Germany are falling, and are now at some 350 per day, according to the Robert Koch-Institut (RKI), the situation varies among regions.

Some 137 districts have reported no new cases for the past seven days, but individual outbreaks of the disease have been reported recently in the towns of Gütersloh, with 1,553 cases at a single meat processing factory, and Göttingen, leading to renewed, partial lockdown measures. 

The COVID-19 situation is dynamic and prone to rapid changes, and the German “R” pass-on rate has risen to from around 1 to 2.76 since 21 June, said RKI president Lothar Wieler on 23 June. The seven-day “stable” R rate is 1.83.

Daily deaths reported to the RKI are currently in the “lower double digits,” however. There are no pinchpoints in ICU beds with assisted breathing equipment, said Wieler. Contact tracing work done by the federal health offices is helping prevent the spread of COVID-19. The new WarnApp, released after some delay on 19 June, had been download 12.2 million times by 23 June. (Also see "Germany’s COVID-19 Testing Back Up To Near Peak Levels" - Medtech Insight, 15 May, 2020.)

While there are global fears of a second wave of infection – which is the case in Iran – at-risk countries, like South Korea and Israel, are monitoring local outbreaks. Similarly, the federal health offices and state authorities in Germany are seeking to prevent precisely that. Their efforts will, again, rely to a great extent on Germany’s large national testing capacity, which has been a major factor in the relative success of the COVID-19 management strategy.

Ulrich Schmid, chairman of the national diagnostics industry association, the VDGH, believes that, in a European context, no other country has controlled COVID-19 as successfully as Germany. A key reason for this was the level of sickness fund financing made available to the labs to allow them to meet the 24/7 demands for high-volume testing. The German government decided early in the crisis that both comprehensive and targeted test strategies were required.

Hidden Champions

In vitro diagnostics companies were the “hidden champions” of health care, Schmid told a virtual meeting of his industry association in mid-June. Diagnostics receives only 3% of the sickness fund allocations, and yet IVDs play a part in 64% of all disease diagnoses (2018 figures) – and of 100% of coronavirus cases. During the pandemic, 65 of the VDGH’s 100 member companies were able to produce solutions targeting the coronavirus. Some 30-40 of them develop or sell PCR tests.

Some 350,000 COVID-19 PCR tests are performed every week in Germany. Reimbursement for these tests was established rapidly, at €59 ($66) per test, but that will be reduced by 30% to €39.40 on 1 July. That decision, of the joint federal committee’s evaluation committee on 10 June, will make it difficult for the labs, said VDGH deputy chairman Thorsten Hilbich. The same level of service and the “massive” engagement on the part of the labs will no longer be possible, he speculated.

A PCR test for SARS-CoV-2 was developed in Germany by the Charité Berlin and the center for infection research (DZIF) on 16 January. Since that time, the sector has built its COVID-19 lab testing capacity to 800,000 to 900,000 tests per week. 

This includes antibody testing capacity, some 75,000 of which tests are performed every week, with a reimbursement of around €11.10 per test. “It works, but we could wish for more,” Hilbich said of the reimbursement. COVID-19 antigen tests are in development still in Germany, and would be used if and when alternative test types are called for.

Schmid denied that Germany has “overcapacity” for COVID-19 testing, preferring to see it as good preparation.

The German government’s second law on the protection of the population during the epidemic will expand testing further, said VDGH chief executive Martin Walger. (Also see "New Package Of Measures To Break COVID-19 Chain Of Infection In Germany" - Medtech Insight, 30 Apr, 2020.)

Asymptomatic contacts of people in whom COVID-19 has been confirmed (assisted by the WarnApp) and care home and nursing home residents and staff will be able to be tested. Furthermore, proactive testing of people considered at risk of infection in their day to day activities, or those in regional disease hotspots, will be tested.

Walger added that, as the “restart” gets underway, people who have not been attending doctors’ appointments for tests or therapy should recommence. There has been an over 50% drop in routine diagnostic (non-COVID-19 pathology) tests since the crisis began.

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