Pass the salt: the minute details that helped Germany build defenses against viruses

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MUNICH (Reuters) – A January lunch at an auto parts company, a worker turned to a colleague and asked him to borrow salt.

FILE PHOTO: A medical worker shows a sample container used in a coronavirus disease testing center (COVID-19) at the Havelhoehe Community Hospital in Berlin, Germany, April 6, 2020. REUTERS / Fabrizio Bensch – / File Photo

In addition to the salt shaker, at that moment, they shared the new coronavirus, the scientists concluded.

The fact that their exchange has been documented is the result of close scrutiny, part of a rare achievement in the global fight against the virus.

Colleagues were the first links in what was to be the first documented chain of multiple human-to-human transmissions outside Asia of COVID-19, the disease caused by the coronavirus.

They are based in Stockdorf, a German city of 4000 inhabitants near Munich in Bavaria, and they work for the auto parts supplier Webasto Group. The company was placed under a global microscope after revealing that one of its employees, a Chinese woman, had caught the virus and brought it to the headquarters of Webasto. There it was passed on to colleagues – including, scientists would learn, a person having lunch in the canteen with which the Chinese patient had no contact.

The canteen scene on January 22 was one of dozens of trivial incidents that scientists recorded in a manhunt to find, test and isolate infected workers so that the Bavarian regional government could prevent the virus to spread.

This hunt helped Germany save crucial time to build its COVID-19 defenses.

Time bought by Germany may have saved lives, scientists say. Its first locally transmitted COVID-19 outbreak started earlier than that in Italy, but Germany claimed far fewer lives. The first local transmission detected in Italy took place on February 21. Germany then launched an information campaign by the Ministry of Health and a government strategy to combat the virus based on generalized tests. To date, in Germany, more than 2,100 people have died from COVID-19. In Italy, with a smaller population, the total exceeds 17,600.

“We have learned that we must carefully follow the chains of infection in order to stop them,” Clemens Wendtner, the doctor who cared for Munich patients, told Reuters.

Wendtner has teamed up with some of the best German scientists to tackle what has become the “Munich cluster”, and they have advised the Bavarian government on how to respond. Bavaria led the way with the blockages, which spread nationwide on March 22.

Scientists, including England’s chief medical officer Chris Whitty, have called the first widespread tests in Germany to slow the spread of the virus. “” We all know that Germany has moved ahead in terms of the ability to test for the virus and there is much to be learned from this “,” he said on television earlier. this week.

Christian Drosten, the leading virologist at Berlin’s Charity Hospital, said that Germany had been helped by a clear early cluster. “Because we had this Munich cohort from the start … it became clear that with a strong push, we could prevent this spread,” he said in a daily podcast for NDR radio on the coronavirus.

Drosten, who declined to be interviewed for the story, was one of more than 40 scientists involved in the examination of the cluster. Their work was documented in preliminary form in a working document late last month for The Lancet. The document, not yet peer reviewed, has been shared on the NDR website.

ELECTRONIC NEWSPAPERS

Holger Engelmann, CEO of Webasto, told authorities on Monday January 27 that one of his employees tested positive for the new coronavirus. The Shanghai-based woman had run workshops for several days and attended meetings at Webasto’s headquarters.

The woman’s parents, from Wuhan, had visited her before going to Stockdorf on January 19, the newspaper said. During her stay in Germany, she experienced unusual chest and back pain and was tired throughout her stay. But she put the symptoms on jet lag.

She became feverish on the return flight to China, tested positive after landing, and was hospitalized. Later, his parents also tested positive. She informed her managers of the result and they sent an email to the CEO.

In Germany, Engelmann said that he immediately set up a crisis team that alerted the medical authorities and started looking for staff members who had been in contact with their Chinese colleague.

The CEO himself was among them. “Only four or five days before receiving the news, I had shaken his hand,” he said.

Now known as “case # 0” in Germany, the Shanghai patient is a “long-time and proven project management employee” whom Engelmann knows personally, he told Reuters. The company did not disclose its identity or that of the others involved, saying the anonymity encouraged staff to cooperate in Germany’s efforts to contain the virus.

The task of finding who was in contact with her was made easier by Webasto staff’s electronic calendars – for the most part, all the doctors needed was to review staff appointments.

“It was a fluke,” said Wendtner, the doctor who cared for Munich patients. “We got all the information we needed from staff to rebuild the chains of infection.”

For example, case 1 – the first person in Germany to be infected with the Chinese woman – sat next to her at a meeting in a small room on January 20, the scientists wrote.

When calendar data was incomplete, scientists said, they were often able to use whole genome sequencing, which analyzes differences in the genetic code of different patients’ viruses, to map its spread.

Following all of these links, they discovered that Case # 4 had been in contact with the Shanghai patient several times. Case 4 then sat back to back with a colleague from the canteen.

When this colleague turned to borrow salt, the scientists said, the virus passed between them. The colleague became case # 5.

Webasto announced on January 28 that it is temporarily closing its Stockdorf site. Between January 27 and February 11, a total of 16 cases of COVID-19 were identified in the Munich cluster. All but one were expected to develop symptoms.

All those who tested positive were sent to the hospital for observation and for doctors to learn from the disease.

Bavaria closed public life in mid-March. Germany has since closed schools, shops, restaurants, playgrounds and sports facilities, and many businesses have closed to help the cause.

HAMMER AND DANCE

This does not mean that Germany has defeated COVID-19.

Its coronavirus mortality rate of 1.9%, based on data collected by Reuters, is the lowest among the countries most affected and compares to 12.6% in Italy. But experts say more deaths in Germany are inevitable.

“The death rate will go up,” said Lothar Wieler, president of the Robert Koch Institute for Infectious Diseases.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it’s been widely tested. Germany has performed more than 1.3 million tests, according to the Robert Koch Institute. He currently performs up to 500,000 tests per week, said Drosten. Italy has carried out more than 807,000 tests since February 21, according to its civil protection agency. With few exceptions, Italy only tests hospitalized people with clear and severe symptoms.

The German government is using the weeks gained from the Munich experience to double the number of intensive care beds by about 28,000 beds. The country already has the highest number of intensive care beds in Europe per capita, according to a 2012 study.

But that may not be enough. A Interior Ministry document sent to other government departments on March 22 included the worst-case scenario with more than a million deaths.

Another scenario left 12,000 dead – with more testing after the restrictions were partially relaxed. This scenario was nicknamed “hammer and dance”, a term coined by blogger Tomas Pueyo. It refers to the “hammer” of rapid aggressive measures for a few weeks, including a strong social distancing, followed by the “dance” of the calibration of these measures according to the rate of transmission.

The German government document argued that in the “hammer and dance” scenario, the use of big data and location tracking is inevitable. Such surveillance is already controversial in Germany, where the memories of the East German Stasi secret police and their informants are still fresh in the minds of many.

Slideshow (5 Pictures)

A draft plan of action drawn up by the government proposes a rapid tracing of the chains of infection, the compulsory wearing of a mask in public and limits to gatherings to allow a gradual return to normal life after the foreclosure of Germany. The government is supporting the development of a smartphone app to help track infections.

Germany has declared that it will reassess the lock after the Easter holidays; for the auto parts manufacturer at the heart of its first outbreak, the immediate crisis is over. Webasto’s office has reopened.

The 16 people who caught COVID-19 there recovered.

Joern Poltz reported from Munich, Paul Carrel from Berlin; Additional reporting by Markus Wacket in Berlin and Gavin Jones in Rome; Under the supervision of Sara Ledwith

Our standards:Principles of the Thomson Reuters Trust.

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