There is growing concern in Europe about access to vaccine doses during the Covida-19 winter wave. But one city claims to have found a formula to avoid a high mortality rate without a draconian lockdown.
The city of Tübingen in southern Germany was hit hard by the virus in the spring, but measures such as extensive testing and even subsidised taxi fares have since protected the elderly, who make up the majority of the dead.
At the height of the first wave in April, the city had 70 Covid 19 patients in its largest hospital of 89,000, 33 of whom were in intensive care, forcing doctors to cancel planned surgeries. Today, amid a much more damaging wave, there are only 35 patients left, many of whom have been transplanted from other areas. Fifteen of them are in intensive care, less than half come from Tübingen. The hospital did not cancel the non-surgical procedure.
The local authorities say these numbers are not random. The city, they establish, started carrying out frequent Covid 19 tests for nursing home staff, residents and visitors earlier than most German municipalities. It subsidises taxi fares for over-65s so that they are not dependent on public transport. Younger residents are advised not to shop between 9 a.m. and 11 a.m. to avoid contact with elderly people, who are more likely to carry the virus without symptoms.
Tübingen’s pandemic policy has so far cost half a million euros, all financed from the city’s budget. The current one-week blockade, which has led to the closure of restaurants and all active businesses, is costing the German economy and government between 27 and 57 billion euros in lost production and subsidies, according to estimates by the Ifo Institute, a government-funded economic think tank in Munich.
Tübingen, like other German cities, is under a national blockade announced earlier this month.
Sebastian Golnow/Zuma Press
Last Wednesday, 32,195 infections were reported in Germany on a single day, which is a record, according to the Robert Koch Institute for Infectious Diseases. The day before there were 962 dead, the highest number in one day.
Although there have been far fewer deaths this spring in connection with Covid-19 than in most of its neighbours, over the last fortnight there have been more deaths than in France and Spain and the level is close to that of the United Kingdom. Many intensive care units in Germany are at full capacity, forcing the authorities to transfer serious cases to less affected hospitals throughout the country. More than half of the people dying of the coronavirus in Germany are residents of nursing homes.
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This is not the case in Tübingen. While the average prevalence of infections in the general population is similar to neighbouring regions, infection rates among the elderly are much lower. By mid-December, according to the authorities, only 10% of the infected persons in the autumn wave were over 65 years of age, compared to 23% at national level. As a result, the mortality rate in the city is low. Since the beginning of the pandemic, only 33 people have died of covid-19 in the university hospital of Tübingen, which treats most of the city’s coronavirus patients. Only two people have died from the virus in nursing homes since spring, a county spokeswoman said, a significant drop in the 26 residents who entered Covid-19 in the early months of the pandemic.
The municipal authorities claim that no outbreaks were recorded in nursing homes between May and the beginning of December, while several facilities reported multiple infections. The screening programme, which is mandatory for locally operated nursing homes, requires staff and residents to be tested twice a week and all visitors to the facility to be tested before entering. While all retirement homes receive free test kits from local authorities, some private facilities do not meet the test guidelines, city officials said, which explains the recent outbreaks.
Local physician Lisa Federle takes a nasal smear from a fallen patient.
Thomas Niedermannüller/Getty Images
What’s more, the mobile devices offer free testing for everyone in key locations across the city. As Christmas approached, hundreds of people took advantage of this service before visiting elderly friends and relatives in nursing homes or celebrating the holiday together, according to
head of emergency medicine and head of the local Red Cross department.
Dr. Federle launched the screening program at the beginning of April and since then has been testing people on the main square with a group of volunteers who are largely funded by donations. She and her team tested 500 people on Wednesday and another 600 on Thursday. In October, Dr Federle received the highest citizens’ prize in Germany, the Bundeskreuz der Verdienstnung. His initiative inspired the city council to offer free mass trials to the residents.
The most important thing is to protect vulnerable groups as much as possible, and testing everyone is the best way to do that, Dr. Federle said. I have grandchildren who want to take the test to spend Christmas with their grandparents, or people who want to help their older neighbors with their Christmas shopping.
The tests offered by Dr. Federle and the community are rapid antigen tests that can produce results within 15 minutes. Each positive case is then confirmed by PCR, a more sensitive test that gives a result after a few hours.
The mayor of Tübingen said that his city is the first in Germany to offer a free test for everyone in September. In addition, at the beginning of November, additional N95 masks were made available to all citizens aged 65 and over, a measure subsequently approved by the federal government.
The mayor of Tübingen, Boris Palmer (Orange), said that the city’s approach has inspired other municipalities throughout Germany.
Tom Weller/Zuma Press
Moreover, as the wave of new cases progressed and screening capacity spread across the country, Tübingen ignored federal guidelines to test only those with symptoms. As a result, more than 40 asymptomatic cases have been detected in nursing homes, Palmer said, each of which could have caused an epidemic if they had not been detected in time.
Regular tests in nursing homes have prevented a number of epidemics: We have discovered that people – especially those in the early stages of infection – prevent them from passing the disease to the elderly, Palmer said.
Tübingen’s efforts have inspired other cities in Germany, including 120 towns and villages in his home state of Baden-Württemberg, but Mr Palmer said that more can be done on a national level. However, some municipalities in the east, faced with difficult living conditions, do not have the resources that the relatively prosperous city of Tübingen would have. Combined with the fact that the 16 German Länder and even cities and municipalities have a high degree of autonomy in health policy, coordinating efforts in the event of a pandemic has proved to be a challenge.
The head of the University Hospital of Tübingen, which had all staff and patients tested twice a week, pointed to data showing that 88% of the people dying from the disease in the region are over 70 years of age.
If we had done intensive tests much earlier and had spread N95 masks across the country, he said, we wouldn’t need this lockdown.
New research could explain why thousands of Covid 19 survivors still struggle with debilitating neurological symptoms months after their illness. The WSJ analyses how the coronavirus affects the brain and what it can do for patients in the long term. Illustration: Nick Collingwood/WSJ
Write to Bojan Panczewski at [email protected].
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