German Town finds a blueprint for lowering Covid-19 deaths

At the height of the first wave in April, the city had 70 Covid-19 patients in the largest hospital – of its 89,000 residents – including 33 in intensive care, forcing doctors to cancel elective surgery. Now, at the height of the much more devastating power surge, there are only 35 patients left, many of them transferred from other regions. Fifteen of them are in intensive care, less than half of whom are residents of Tübingen. The hospital has not canceled non-urgent operations.

Local authorities say such numbers are no coincidence. They point out that earlier than most German municipalities, the city started conducting regular Covid-19 tests on nursing home workers, residents and visitors. It subsidizes taxi rides for people over 65, so that they do not have to use public transport. Younger residents are discouraged from shopping between 9 a.m. and 11 a.m. to avoid the need for seniors to mingle with people who are likely to be carrying the virus without symptoms.

Tübingen’s pandemic policy has so far cost it half a million euros, all funded from the city budget. A week from the current lockdown, with restaurants and all non-essential stores closed, is costing the German economy and the state between € 27 billion and € 57 billion in lost output and subsidies, according to estimates by the Ifo Institute, a government financed economy. tank in Munich.

According to the Robert Koch Institute for Infectious Diseases, Germany registered 32,195 infections in one day last Wednesday, close to the record. The day before, there had been 962 deaths, the highest toll in one day.

While the country suffered far fewer Covid-19-related deaths in the spring than most of its neighbors, there have been more deaths in the past 14 days than in France and Spain, and is close to the UK’s level. health units across Germany are running at full speed, forcing authorities to transfer serious cases to less affected hospitals across the country. More than half of the people in Germany who die from the corona virus are residents of care homes.

Not so in Tübingen. Although the mean incidence of infections in the general population is comparable to that in neighboring regions, infection rates among the elderly are drastically lower. In mid-December, only 10% of those infected during the fall peak were over the age of 65, compared to 23% nationwide, authorities said. As a result, the death rate in the city is low. Since the start of the pandemic, only 33 people have died of Covid-19 at Tübingen University Hospital, which treats most of the city’s coronavirus patients. According to a county spokeswoman, only two people have died of the virus in nursing homes since spring, a sharp reduction from the 26 residents who died from Covid-19 during the first months of the pandemic.

City authorities say they didn’t register a single outbreak in nursing homes between May and early December, when a few of the facilities reported various infections. Under the testing program, which is mandatory for community care homes, staff and residents must be tested twice a week and all visitors tested before entering the property. While all care homes receive free testing kits from the local authorities, some private institutions did not adhere to the testing recommendations, said city officials, explaining the recent outbreaks.

In addition, mobile units offer free tests for everyone in the main squares of the city. In the run-up to Christmas, hundreds of people took advantage of the service before visiting elderly friends and relatives in care homes or celebrating the holidays together, said Lisa Federle, a senior emergency physician and head of the local Red Cross branch.

Dr. Federle pioneered the testing program in early April and has since been testing people in the main square with a group of volunteers mainly funded by donations. She and her team tested 500 people on Wednesday and another 600 on Thursday. In October, Dr. Federle’s highest civilian decoration in Germany, the Cross of Merit. Her initiative has inspired the city government to offer free mass tests to residents.

“The most important thing is to protect the vulnerable groups as much as possible, and testing everyone is the best tool for that,” said Dr. Federle. “I have grandchildren who want to get tested to spend Christmas with their grandparents, or people who want to help elderly neighbors with their Christmas shopping.”

The tests offered by Dr. Federle and the council are quick antigen tests that can give results in 15 minutes. Each positive case is then confirmed by a so-called PCR, a more sensitive test that gives results after a few hours.

Boris Palmer, the mayor of Tübingen, said his city was the first in Germany to offer free testing in September. It was also the first to offer additional N95 masks to all citizens 65 or older in early November, a move later imitated by the federal government.

Additionally, Tübingen ignored federal guidelines to test only people with symptoms as the fall wave of new cases progressed, straining testing capacity across Germany. As a result, more than 40 asymptomatic cases have been discovered in care homes, said Mr. Palmer, who could each have planted an outbreak had they not been detected early.

“The regular tests in retirement homes prevented a number of outbreaks: we found people – especially staff – who were in the early stages of infection and so we prevented them from passing the disease on to the elderly,” said Mr Palmer.

Tübingen’s efforts have inspired other cities in Germany, including 120 towns and villages in its home state of Baden-Württemberg, but Mr Palmer said more could be done nationally. However, some hard-hit communities in the east lack the funding available for relatively prosperous Tübingen. In addition, Germany’s 16 states and even cities and towns have a high degree of autonomy in health care policy, and coordinating efforts during the pandemic has proved challenging.

Michael Bamberg, head of the University Hospital of Tübingen, who has ordered that all primary care workers and patients be tested twice a week, pointed to data showing that 88% of people who die of the disease in the region are older than 70 year.

“Had we done intensive testing and distributed N95 masks around the country much earlier,” he said, “we wouldn’t have needed this lockdown.”

Write to Bojan Pancevski at [email protected]