The inside story of Germany’s coordinated covid response

The government-run Robert Koch Institute for public health research in Berlin has been at the forefront of the country's robust pandemic response, leading the search for a vaccine and racing to push out vast stocks of tests. A career epidemiologist at the institute explains the challenges of reopening, communicating risk, and contact tracing in the German context.

9,232

Covid deaths as of August 19, 2020. Source: WHO Dashboard

The first confirmed case in Germany was not really the first suspected case. We had several suspected cases earlier on, which were all negative, but then we were not so surprised that one day, on January 27 in Munich, one of these cases proved positive. By that time, we already had several important things in place: our case definition, our test criteria, our hygiene and infection prevention and control recommendations, and our recommendations concerning contact tracing.

ROBERT KOCH INSTITUTE

Our value of R," or the reproduction number of the virus, which Chancellor Angela Merkel has used frequently in public addresses, is still something we calculate and report on a daily basis. Of course now we have far fewer cases than in March, so any outbreak at this point has a direct impact on our reproduction numbers. It's up and down, but it's around one now (meaning every patient infects on average one other person). We currently [as of June 18] have a median case number of 300 to 350 cases each day, which is low.

Of course it's possible there will be a second wave. And our main objective then is to keep the incidence of new cases as low as possible. We are already trying to do sensitive testing of anyone with any respiratory disease and in any symptomatic patients that belong to a cluster, or who live in certain risky surroundings like nursing homes. And there is the political commitment that if necessary-if a county has cases above a certain threshold-they will have to reintroduce local lockdown measures.

We are also trying to prepare for a vaccine. In June, the Health Ministry formed an alliance with France, Italy, and the Netherlands and signed a contract for pre-orders of 300 million doses of a coronavirus vaccine currently in development.

They have to do this contact tracing work, even if the numbers are high.

One of the main pillars in our attempt to keep numbers low was intense contact tracing. As of June, we have a new mobile app. But before that, we did contact tracing the traditional way-ever since this started in January until the peak, when we had six or seven thousand cases each day. We tried to convince local health authorities that they have to do this contact tracing work, even if the numbers are high, because it's important to break any infection train in this outbreak. Very early on, we discussed the possibility of a contact tracing app, and of course it was on our mind to have a GPS tracking system. But also very early on, the data protection people called us and told us that this would never happen. Then we looked for an alternative, and it became clear that Bluetooth technology could offer one. [Editor's note: GPS-based contact tracing apps track a phone's location at all times, while Bluetooth-based ones just track proximity to other phones without necessarily revealing a person's movements.] We were very much in favor of the centralized system at first, because it would give us the opportunity to have an overview of what exactly happened. But balancing the concerns of data protection, we settled on this decentralized system, which has one main disadvantage: we don't know what happened in a specific case. (As in, it doesn't make it into our server.) So we have to still supplement it with additional surveillance and investigations, but the data protection people are happy with the solution.

The coronavirus crisis has already lasted six months-a very long time for crisis management, even though we have dealt with pandemics in Germany in the past. Everyone at the institute is pretty tired right now.

This interview has been condensed and edited for clarity.