While US Struggles to Roll Out COVID-19 Contact Tracing, Germany's Been Doing It From the Start

By Loveday Morris and Luisa Beck, The Washington Post

25 May 20

 

here's no sophisticated technology in the northern Berlin office where Filiz Degidiben spends her days tracking down contacts of people infected with the coronavirus.

Her main tools are the phone by her side, a yellow calendar on the wall and a central database, accessible from her desktop computer, that was developed with infectious diseases such as measles in mind.

“When coronavirus came, I wanted to help,” said Degidiben, who used to work assisting people with filling out forms in the social services department. 

As the United Kingdom and the United States scramble to hire teams of contact tracers, local health authorities across Germany have used contact scouts such as Degidiben since they confirmed their first cases early this year.

Epidemiologists say the effort has been essential to the country’s ability to contain its coronavirus outbreak and avoid the larger death tolls seen elsewhere, even with a less stringent lockdown than in other countries. Germany has experienced around 10 coronavirus deaths per 100,000 people. The United States has seen nearly three times as many. France, more than four times. Britain, more than 5½ times.

As restrictions here are lifted, Chancellor Angela Merkel has singled out tracking infection chains as the key, above “all else.” Germany aims to have five contact tracers for every 25,000 people — or about 16,000 for its population of 83 million.

In Reinickendorf, where Degidiben works, a lack of scouts is not a problem. There are around 75 in place for the district’s 260,000 people. A post-lockdown spike in infections has not yet materialized. Four out of six contact tracing teams are in hibernation.

Degidiben picks up the phone and dials her first case for the day: an 82-year-old man whose lab results have come back that morning. It’s one of just two positive cases in the district, down from a peak of around 30 in March.

“You’ve tested positive for coronavirus,” she notifies him.

“Very nice,” he replies with wry Berlin humor.

“Exactly. Then you’ll have it behind you,” she says with a laugh. The banter keeps a jovial veneer to the conversation, even as the elderly patient tells her he has underlying conditions: hypertension and diabetes. She runs through his symptoms: A cough, but nothing else.

In contrast to the tracing programs heralded in countries such as China, Singapore and South Korea, Germany’s effort is decidedly low-tech. Privacy concerns — which run strong in Europe and particularly deep in Germany, with its not-so-distant memories of fascism and communism — have limited the potential of contact-tracing apps. So the tracing is largely a case of calling the recently diagnosed patient and asking his or her movements.

Degidiben asks the 82-year-old if he’s had contact with anyone for more than 15 minutes since 48 hours before his symptoms developed. Only his wife, who gets designated as a Category 1 contact and is put under state-mandated quarantine.

Those in contact for less than 15 minutes are put in Category 2 and advised, but not required, to isolate for 14 days.

The man’s daughter, whom he says he has seen only while wearing a mask and at a distance, is not designated at risk.

The whole conversation lasts just over 10 minutes. It’s a simple case, but that’s been normal since social distancing restrictions, health workers here say. Someone from the health department will call him daily to check in on his symptoms.

Germany’s trace-and-quarantine approach is by no means flawless. In about 65 percent of the cases here, health authorities have no idea how a person was infected. Asymptomatic carriers are no doubt falling through the cracks.

And while Reinickendorf officials have managed to call contacts for every case they’ve received, some more poorly funded and harder-hit areas have been overstretched.

Patrick Larscheid, the head of the health department at Reinickendorf, says the system there is working. He contends that contact tracing and quarantines have been more important to containing the virus than the more widely lauded testing program.

The country’s first cluster, at a car parts manufacturer in Bavaria in February — at the time, the largest outbreak outside Asia — has been held up as an example of successful containment. Sixteen people tested positive; hundreds were quarantined.

“There are two things: the contact tracing and the quarantine,” Larscheid said. In Germany, the contacts of a positive coronavirus case are not generally tested unless they have symptoms.

“Testing is nice, but if you’re tested or not tested and are in quarantine, it makes no difference,” Larscheid said. Testing could also lull someone into a false sense of security, he said — a negative result might mean it’s just too early for an infection to register on a test.

Reinickendorf began to build its contact tracing team in March, as an outbreak in a kindergarten went beyond the capacity of the usual contingent of health officials. Workers were moved from parts of the local administration for which the outbreak had caused work to slow.

“There were two options,” Larscheid said. “Sit at home or do something new.”

It’s unclear what will happen if district workers are needed back in their old jobs. Health authorities in other parts of Germany have turned to students and volunteers.

While the number of cases has remained low for the moment, they are slowly becoming more complicated, as people return to hairdressers and restaurants and the tangle of inevitable contacts that come with daily life.

Last week, a child tested positive who lives in a neighboring district but attends school in Reinickendorf. The whole class of 20 children and two teachers had to be called and quarantined. Some, including another child with symptoms, had been staying at a local refugee shelter. His family of seven were all quarantined.

The phone lines clogged with anxious parents and administrators.

“Schools are very time-consuming in comparison to elderly homes,” said Jakob Schumacher, head of Berlin’s infectious disease division. “At schools, the risk is small, but you spend huge amounts of time explaining things.”

Other countries have managed more complex cases with mobile tracking apps — mandatory, in some cases — that help health officials stay ahead of potential outbreaks. But such efforts have been more tricky in privacy-conscious Europe.

Germany’s app has been delayed, and authorities had to reverse course on one that would have involved centrally stored data. Instead, to be mindful of privacy concerns, data will be completely anonymized and won’t be available to health officials.

Epidemiologists say tracing apps need to be used by 60 percent of the population to be effective. Larscheid said he expects adoption to be far lower in Germany.

And although the app might complement what his tracing teams are doing, he said it won’t be useful to them without allowing access to names and contact information.

“But it’s also something that reminds me of states like China, and so it’s not what I really want,” he said.

So for the moment, it’s old-fashioned phone work.

The district’s health department is split on whether they’ll see more cases soon. Germany saw a bump in the infection rate after it loosened its lockdown, but health officials have not directly linked that to the lift in restrictions.

They say the numbers are distorted by isolated outbreaks in several nursing homes and a meatpacking plant. In Berlin, where there’s no requirement to wear a mask, there are only a few dozen new cases a day. Parks and markets have remained busy throughout the pandemic.

Degidiben believes that caution among the population is limiting the spread. Schumacher, the infectious disease doctor, said seasons might be playing a role. “Either we’ll see more cases next week, or the summer effect is really strong,” he said.

Larscheid said he expects a rise in cases in the coming weeks.

“Everything is getting a little bit less tight, and the people feel it,” he said. But while no one can say for sure if there will be a second wave, or a third, he said, “now we have a way to handle it that works, that’s already proven to work, so we sleep a bit better than before.”