Back from a skiing holiday in South Tyrol, from a visit to the opera in Milan, from a beach holiday in Tenerife – and it scratches your throat suspiciously? It is currently not easy for anyone in Germany who is concerned that they may have caught the Sars-CoV-2 coronavirus.
Federal Minister of Health Jens Spahn does not tire of declaring: “We are prepared in the best possible way.” But “best possible” is an ambiguous word in contact with German authorities. It can take hours to get through the coronavirus hotline of the Berlin Senate Department for Health.
What you then experience is not reassuring in terms of successful containment of the viruses. According to the descriptions of a cameraman who returned from the Biathlon World Cup in South Tyrol, he was only recommended to his family doctor. However, he did not want him in practice, especially since he could not carry out the test for a Sars CoV-2 infection anyway, the 35 – Year old to the broadcaster “rbb”. The Charité also flashed the man off.
It is ultimately up to the doctor's discretion whether a test is carried out or not
The criteria of Robert Koch Institute (RKI), the highest epidemic authority in Germany, is basically correct: the man did not have any symptoms such as cough, fever, shortness of breath or pneumonia. He also had no contact with proven infected people.
According to the statutes, just staying in a risk area is not sufficient to justify a test. The RKI did not want to comment on the specific case. A spokeswoman simply said by email that “the criteria for a test are relatively broad”. Ultimately, it is the “decision-making power of the individual doctor” whether a test is considered useful or not.
On its website, the institute points out that it is “unclear for early detection of an infection beyond the clarification of justified suspected cases”, for travelers from risk areas or signs of viral pneumonia “less clear Cause “to include a Covid 19 disease in the differential diagnostic considerations.
Background to the corona virus:
- With face masks against the corona virus? What really protects against the transmission of germs
- Study by Frankfurt researchers: Corona viruses are probably also transmitted by healthy people
- German coronavirus expert says: “We have to prepare for a pandemic”
- The path of the pathogen around the world : Interactive maps show how the corona virus has spread
- Dramatic situation in northern Italy: “It is as if we were in Wuhan”
According to this RKI recommendation, it would therefore be “advisable” for the family doctor to have a test for coronaviruses.
A visit to a practice would not be necessary for this, however, and it is better not to consider it at all. In order to avoid possible contagion of others, a “smear suspicion” should be taken from the affected person's throat at home, which is then tested for the viruses. Until the result is available, which can take a day or two, those affected should stay at home – isolated if possible.
Senate administration: “Clarification” for everyone who has worked in the past 14 days in risk areas was
solely due to a trip to Italy, Tenerife or China, so without It is therefore not absolutely necessary to arrange a test that there are also symptoms of the disease or that contact with a diagnosed case has been established. Nevertheless, the doctor can arrange the test, which is based on the detection of a person's virus genome, at his own discretion. According to the Association of Statutory Health Insurance Physicians, however, the costs are not borne, but only in “justified suspicions” in accordance with the RKI guidelines.
The Berlin Senate Health Administration recommends that a “clarification” should be carried out, who “has been in a risk area within the last 14 days, or has had contact with a person in the risk area or contact with a confirmed case. If only one of the three criteria applies, you should stay at home and inform the responsible health authority. “From there, a further clarification will take place.” However, this does not necessarily mean that a virus test is only initiated as a result of a trip to Italy.
However, there are experts in Germany who require far more intensive, Germany-wide testing than the current guidelines provide. They include Alexander Kekulé from the Institute for Medical Microbiology at the University of Halle, who had previously criticized the crisis management at the RKI.
In a letter to the RKI, the biochemist and doctor spoke out in favor of a strategy change in the sense of “hinterland surveillance”: “All cases of severe, influenza-like and acute respiratory diseases with unusual symptoms should be dealt with as soon as possible be tested for new corona viruses ”. This is “a necessary and adequate measure with which an epidemic spread can be avoided without unduly tying up resources or unsettling the population”.
Because about one of 20 Sars-CoV-2 infected people with Covid – 19 fell ill, Kekulé says that early testing of all patients with severe respiratory symptoms could indicate the RKI to undetected infection chains. These could possibly still be brought under control.
For this, the capacities for carrying out the tests would have to be increased in Germany and in the EU. In Berlin, all samples from clinics and resident doctors are currently being sent to a single laboratory, the “Labor Berlin” operated by Charité and Vivantes.
Early tests make early diagnoses and early containment measures possible
The RKI does not want to comment on Kekulé's suggestion – as is generally the case with proposals from individual scientists – at the request of the daily mirror. As part of the flu monitoring, however, patients with flu symptoms will now also be tested for coronaviruses, according to the influenza working group in the current “Epidemiological Bulletin”. This has the advantage that infections with less severe courses were also noticed.
It is questionable whether a quick overview can be obtained in this way, whether and how the virus circulates in Germany. The reason for Kekulé's suggestion is that various experts now assume that the viruses are already circulating – undetected – in Europe, including Germany.
The infected can feel largely healthy, but can still be infectious to others. Infections and carriers only become noticeable when the sick end up in medical practices or clinics and are also tested for viruses there.
It depends on the accessibility of the test and the will of the doctors, which overview you can get and how early about the distribution of the viruses in the country.
The World Health Organization WHO does not yet want to call the Covid 19 outbreak a pandemic, a worldwide epidemic – according to Kekulé only because of political considerations. But sooner or later a patient with severe respiratory disease will be tested positive for Sars-CoV-2 in Germany who was neither in a risk area nor in contact with a previously diagnosed patient.
For containment efforts, it is critical how early an infection can be identified. Because the longer an infected person can stay in contact with other people, the more others he or she can infect and the less likely it is to be able to trace infection chains and isolate contact persons.
Then, as an option, in addition to sealing off entire regions, there is above all preventive infection protection, for example via hygiene, isolation and wearing breathing masks.