BERLIN — Felix Germann was not expecting anyone when his doorbell rang last week. Outside was a doctor who looked like she had just stepped out of an operating theater, green scrubs, face mask and all — and a policeman. “I didn’t do it!” Mr. Germann said, throwing up his hands, and everybody laughed. The unusual visitors had come with an usual proposal: Would he allow them to test his blood for Covid-19 antibodies?
Every month? For a year? Starting next week? He would be helping to further the science that would ultimately allow for a controlled lifting of social and economic restrictions and save lives.
“Of course I said yes,” said Mr. Germann, a 41-year-old project manager at a media company.
“I want to help. This is a collective crisis. The government is doing what it can. Everyone needs to do their bit. ”With that, Mr. Germann and his girlfriend joined 3,000 households chosen at random in Munich for an ambitious study whose central aim is to understand how many people — even those with no symptoms — have already had the virus, a key variable to make decisions about public life in a pandemic. The study is part of an aggressive approach to combat the virus in a comprehensive way that has made Germany a leader among Western nations figuring out how to control the contagion
while returning to something resembling normal life.
Other nations, including the United States, are still struggling to test for infections. But Germany is doing that and more. It is aiming to sample the entire population for antibodies in coming months, hoping to gain valuable insight into how deeply the virus has penetrated the society at large, how deadly it really is, and how immunity is evolving. The government hopes to use the findings to unravel a riddle that will allow Germany to move securely into the next phase of the pandemic: Which of the far-reaching social and economic restrictions that have slowed the virus are most effective and which can be safely lifted?
The same questions are being asked around the world. Other countries like Iceland and South Korea have broadly for infections, or combined testing with digital tracking to undercut the spread of the virus. But even the best laid plans can go awry; Singapore attempted to reopen only to have the virus re-emerge. In the United States, President Trump is in a hurry to restart the economy in an election year, but experts warn that much wider testing is needed to open societies safely. Both Britain and the United States, where some of the first tests were flawed, virtually forfeited the notion of widespread testing early in their outbreaks and have since had to ration tests in places as they scramble to catch up. In Italy, one of the worst hit countries
in the world, the central government and regional leaders sparred over how widely to test.
Germany, which produces most of its own high-quality test kits, is already testing on a greater scale than most — 120,000 a day and growing in a nation of 83 million. Chancellor Angela Merkel, a trained scientist, said this week that the aim was nothing less than tracing “every infection chain.” That high level of testing has helped her country slow the spread of the virus and keep the number of deaths relatively low. More people in Germany now recover from the virus every day than are infected by it. Every 10 people infected with the virus now pass it to seven others — a sharp decline in the infection rate for a virus that has spread exponentially.
Even so, Ms. Merkel, too, has had her stumbles in dealing with the virus Germany has been criticized for failing to offer forceful leadership to the European Union at a moment of profound crisis. The generosity and solidarity on such striking display inside of Europe’s largest and richest economy have been missing in Germany’s response to poorer European nations in the south, which were hit hardest by the virus. At home, however,
the chancellor’s mixture of calm reassurance and clear-eyed realism — as well as her ability to understand the science and explain it to citizens — also has been widely praised and encouraged Germans to follow social distancing rules!!
Her approval ratings are now higher than 80 percent. That broad confidence in government has given
Germany a tremendous advantage. It is much of the reason a knock on the door by a police officer and strangers dressed like aliens asking for blood can engender good will rather than alarm, even in a country where past authoritarian governments have left citizens protective of their privacy. The Munich antibody study, run by the Division of Infectious Diseases and Tropical Medicine at Munich University Hospital, and co-financed by the government of the state of Bavaria, is the biggest of several regional studies
being rolled out in various corners of Germany.
Still, scientists caution that there is no proof yet that the detection of antibodies signals effective immunity
and even if it does, it is not known how long that immunity might last. Nationally, the Robert Koch Institute, the government’s central scientific institution in the field of biomedicine, is testing 5,000 samples from blood banks across the country every two weeks and 2,000 people in four hot spots who are farther along in the cycle of the disease. Its most ambitious project, aiming to test a nationwide random sample of 15,000 people across the country, is scheduled to begin next month.
“In the free world, Germany is the first country looking into the future,” said Prof. Michael Hoelscher,
who heads up the Munich study, noting that a number of countries had already asked him for the protocol to be able to replicate it. “We are leading the thinking of what to do next.”Mr. Hoelscher was co-author of what has become a widely influential research paper about how the virus can be transmitted before someone develops symptoms. “There’s no doubt after reading this paper that asymptomatic transmission is occurring,”
Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases in the United States, told CNN on Feb. 1, three days after the paper was published.
“This study lays the question to rest.
”Asymptomatic transmission is what has made containment so difficult because a large number of infections are not detected. Measuring the number of hidden infections and getting a sense of the true scale of the disease is key to fine-tuning the gradual loosening of restrictions and minimizing income loss and social isolation, scientists say.“ We will have a better idea of the number of undetected infections once we have done these representative studies,” said Lothar Wieler, president of the Robert Koch Institute for infectious diseases, which is conducting a number of the antibody tests. “A lot is being done to measure well.
”Some interim results have already come out. In Gangelt, a small town of about 12,000 in northwest Germany, tests of a first group of 500 residents found that 14 percent had antibodies to the virus. Another 2 percent tested positive for the coronavirus, raising hopes that about 15 percent of the local population may already have some degree of immunity.“ The process toward reaching herd immunity has begun,” Prof. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, who is leading the study, said in an interim report. And even if 15 percent of Gangelt has some degree of immunity, levels of immunity are
almost certain to be lower elsewhere in the country.
Gangelt was hit early and exceptionally hard by the virus following a carnival event in mid-February that acted as a super spreader. But it may hold valuable insights for places that lag behind as the pandemic runs its course. The mortality rate in the town, for example, turned out to be 0.37 percent, much lower than the national rate of 2.9 percent which is calculated based only on detected infections.The Munich study is expected to be more nuanced in its findings because it follows participants like Mr. Germann for a whole year. In addition to regular blood tests, there will be questions about everything from mental health to income loss. “We are at a crossroads,” said Mr. Hoelscher, the professor. “Are we going the route of loosening more and increasing immunity in the summer to slow the spread of this in the winter and gain more freedom to live public life?
Or are we going to try to minimize transmissions.
“This is a question for politicians, not for scientists,” he added. “But politicians need the data to make an informed risk assessment.”Mr. Hoelscher got the idea for the antibody study in the shower. It was March 19, the day before the state of Bavaria announced its lockdown. “I thought to myself if we’re going into lockdown, we need to start working on an exit strategy now,” he said. The next day, he said he wrote a short pitch to the Bavarian government. Six hours later, he had the green light. It took another three weeks until the test kits had arrived, a new lab was opened and teams of medics started fanning out across the city. Six days after they first rung his doorbell, a doctor and two medical students came back to Mr. Germann’s apartment,
household number 420 out of 3,000.
They put on disposable protection suits, gloves and goggles and one of them sat down on a plastic stool they had brought along to take a small vial of his blood. Then they removed and bagged their suits, disinfected the stool and any surface they had touched and left.
It took all of 10 minutes. “I was like, wow,
it was a perfect choreography,” said Mr. Germann. “It’s impressive to think they have teams doing this all across the city. And we’re only like one month into this. ”An interim result of the study could be released as early as June. Mr. Germann will get his first results already next week. He is curious.
“You kind of wonder, was that last cold I had corona?”
Christopher F. Schuetze contributed reporting from Berlin.
In Germany, a small town near the Netherlands border called Gangelt in the larger area called Heinsberg has a festival marking the beginning of Lent called Karneval. This town of Gangelt (about 12,000 residents) has been called ‘Germany’s Wuhan’ as it has had the largest number of infections and deaths in the country; Heinsberg (the larger principality with about 42,000 residents) as of this writing (10th April) has 1,521 cases and 45 deaths. On 31 March 2020 it was announced they would test 1000 residents that were representative of the population, with the goal of determining at greater detail how the SARS-CoV-2 coronavirus spreads.
Dr. Hendrik Streeck a Bonn virologist said at that time.
If there are ways of preventing the illness from spreading in our environment, we want to know what they are, with the goal of finding out how we can freely move about in the environment together.
https://translate.google.com/
Dr. Hendrick Streeck, in The Guardian on 31 March 2020
It is surmised through active research across countries worldwide that the coronavirus is not spread through casual contact, such as grocery shopping or sitting next to some random people in public transit, but close social interaction such as hugging, singing, laughing and social kissing. (In Rhineland Germany they greet each other with a Bützchen, or kiss on the cheek.)
On 15 February 2020, a group of about 350 gathering for the Karneval listened to live music, mingled with food and drink, heard the town leaders and generally socialized for a total of four hours. 7 individuals, all attending that event, later tested positive, among the first of all cases in Germany. Of the 1,000 volunteers who submitted for both rRT-PCR testing (via throat swab for active virus infection) and antibody testing for resistance to SARS-CoV-2 (via blood draw to test for anti-SARS-CoV-2 antibodies, specifically IgA and IgG),
the results of the first 500 samples were released yesterday.
In the report (link to the PDF in German is here, the page this PDF comes from is located here) are some surprising, and very interesting, results: about 2% have tested positive for the virus via PCR testing, and 14% have tested positive for antibodies against the disease. Originally given the population size and infected rate, the researchers were expecting a smaller number of IgA/IgG-positive samples (perhaps 5%). In other words, one in seven have been infected and have recovered with antibodies against the virus, and can be considered ‘immune’ from being infected again (although that is also being actively studied).
This preliminary data has large (dare I say huge) implications for public health policy, as questions are currently being raised as to how the economies and society of many nations (and literally trillions of dollars of economic activity) will restart again. From a translation of the German PDF, they claim a >99% specificity; will have to await the publication of the results to find out the details. ( Friendly reminder, specificity is the ‘true negative’ rate, thus 1-specificity is the ‘false positive’ rate or <1%.)
The larger implication of this 14% number is the calculation of the death rate, known as a the ‘Case Fatality Ratio’ or CFR. If the denominator is much larger (i.e. many individuals having been infected and recovered from the virus) the CFR is much lower. Here the German virologists estimate a CFR of 0.37%, compared to the ‘official’ CFR of about 2% for Germany.
As a point of reference, the CFR for the United States is about 3.6%.
Many studies of this type are going on right now in the US; Stanford University recently announced serology testing (first among healthcare workers and this week more widely to the general population) and is ongoing in New York City although not to the wider population yet. Accurate, and widespread serological testing is something to keep on the lookout for, as it will indicate who can be ‘certified’ to be virus-resistant. Antibody testing will be a vital tool in getting past this pandemic, along with a vaccine, and getting back to something or a normal life.
Preliminary results are out from a COVID-19 case cluster study in one of the regions worst hit by Germany’s coronavirus epidemic.
They are somewhat reassuring.
One often-heard statistic is the “case fatality rate”—that is, the percentage of people diagnosed with a disease who will die of it. This afternoon that figure stands at 3.5 percent for COVID-19 in the U.S., but this rate is significantly inflated because it does not count asymptomatic cases or undiagnosed people who recover at home. What we really need to know is the infection fatality rate: the percentage of all the people infected who eventually die of the disease. That’s what the German study attempts to do. Over the last two weeks, German virologists tested nearly 80 percent of the population of Gangelt for antibodies that indicate whether they’d been infected by the coronavirus.
Around 15 percent had been infected, allowing them to calculate a COVID-19 infection fatality rate of about 0.37 percent. The researchers also concluded that people who recover from the infection are immune to reinfection, at least for a while. For comparison, the U.S. infection fatality rates for the 1957–58 flu epidemic was around 0.27 percent; for the 1918 Spanish flu epidemic, it was about 2.6 percent. For seasonal flu, the rate typically averages around 0.1 percent. Basically, the German researchers found that the coronavirus kills about four times as many infected people than seasonal flu viruses do.
The German researchers caution that it would be wrong to extrapolate these regional results to the whole country. But they also believe these findings show that lockdowns can begin to be lifted, as long as people maintain high levels of hygiene to keep COVID-19 under control.
US reopening: What states are relaxing social distancing restrictions and
moving away from lockdowns?
RECOMMENDED READING!!!
The CDC’s Revised Face Mask Advice Is Based on Information That Was Available Months Ago
‘Immune system gone wild’: Why cytokine storms are so dangerous during COVID-19
Official COVID-19 Numbers Represent Just 6% of Total Infections, a New Analysis Suggests
Antibody tests could be key to reopening the country. Here’s how they work
When will a second wave of the coronavirus hit, and what will it look like?
Coronavirus updates: Cuomo says ‘we are going through hell’
Hundreds of thousands in L.A. County may have the coronavirus, study finds
What We Should Have Learned From Iceland’s Response to COVID-1
Mass Antibody Testing in This Rural Colorado County Sheds Light on COVID-19’s
Prevalence and Lethality
Antibody Tests in Colorado Highlight the Huge Gap Between Confirmed COVID-19
Cases and Total Infections
What is the Percentage by Age of those that Test Positive for Corvid-19
What We Should Have Learned From Iceland’s Response to COVID-19
U.S. Fever Trends Suggest COVID-19 Rates Could Soon Decline
Study of 72,000 COVID-19 patients finds 2.3% death rate
Why Some Corvid-19 Cases Are Worse than Others
Deadliest infectious diseases in the world, ranked
How the CDC and the FDA Wrecked the Economy
German antibody testing for corvid 19.
Update April 12, 2020:
Thanks to a good friend, I discovered a publication (Okba et al on the pre-print server MedRxiv.org) now up on the CDC website located here, with the details on the antigen used for their Eliza test with useful clinical-sample data. Inexplicably the CDC journal Emerging Infectious Diseases does not have this article as a tidy PDF.
https://www.youtube.com/watch?v=zuTskRhgY
https://www.youtube.com/watch?v=XF7G8t-CPAY
This may have revealed a clue about the pandemic?
1/3 Sweeping coronavirus testing of the entire 4860 crew of the U.S.S. Theodore Roosevelt with 94% having been tested. The Navy spokesperson told Newsweek the ship has seen
3,920 negative coronavirus tests. This may have revealed a clue about the pandemic: of the majority of the 660 positive cases – 60% were/are asymptomatic, with 7 hospitalized and 1 having died officials say. In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition is asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical infections.
2/3 The Diamond Princess saw its passengers and crew contract the coronavirus during February this year, sparking worldwide panic that the pandemic could become a genuine threat to human existence. It was packed full of 3,711 passengers and crew, and in total 14 people died from the virus aboard, while 712 were confirmed to have had the infection. After those on board were allowed to disembark, the rate of infection and its spread across the boat was monitored and compared to the original source of coronavirus in Wuhan, which reported the first case on December 31, 2019. Experts found that the transmission of the virus throughout the ship was four times faster than at the peak of the outbreak in the Chinese city. Debate raged as to how long those people should have been left on the cruise liner, given the overcrowded nature of the vessel and a lack of medical understanding of whether cruise goers were virus-free. Quarantined for coronavirus on the Diamond Princess https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_Diamond_Princess
3/3 The Grand Princess was kept at sea for several days before being allowed back into port.
A source familiar with the process said government officials knew for several hours that there were multiple positive results from the testing done aboard the cruise liner, which had 3,533 people. These include 2,422 guests and 1,111 teammates. In total, they represent 54 nationalities. Of the 1,103 passengers from the Grand Princess that elected to be tested, 103 tested positive, 699 tested negative. While Three passengers who traveled on the Grand Princess cruise ship have died, Over the course of several days, passengers were spread between four military bases in California, Texas and Georgia to complete a two-week quarantine.
https://en.wikipedia.org/wiki/2020_coronavirus_
pandemic_on_cruise_ships#Grand_Princess
Also a recent published report that examined data from the Diamond Princess cruise ship, which was quarantined after passengers began testing positive for COVID-19 in February. In the analysis, which utilized data from both U.S. and Japanese health organizations, the CDC reported that the virus’ ribonucleic acid (RNA) had survived for 17 days in rooms previously inhabited by symptomatic and asymptomatic in the cabins of the Diamond Princess cruise ship — after those rooms were already vacated by guests. The RNA had also survived on a “variety of surfaces,” the report said, albeit before any “disinfection procedures had been conducted,”
per Japan’s National Institute of Infectious Diseases.
The Diamond Princess was first quarantined in early February after a passenger who previously departed in Hong Kong tested positive for COVID-19. Further testing revealed that 712 of the 3,711 passengers and crew eventually contracted the virus as well. Later in February, the Grand Princess cruise ship was also identified as the source of a separate outbreak after a passenger who previously sailed on a Feb. 11-21 voyage tested positive for coronavirus and ultimately died while the ship was already on another voyage. That sailing experienced an outbreak among passengers as well, and the Grand Princess was quarantined off the coast of San Francisco amid testing.
Source: https://www.foxnews.com/health/coronavirus-
survived-17-days-cruise-ship-cabins-cdc-report
With the numbers being one in seven that might test positive for Corvid-19 infection. Though that might not seem like that big of deal. Especially when you consider most that acquire the virus are over 60 years of age and in confine spaces with air pollution around them. What is certain, the CDC says, is that cruise ships are “often settings for outbreaks of infectious diseases because of their closed environment and contact between travelers from many countries.” Both the CDC and the U.S. State Department have since advised that Americans avoid traveling by cruise ship.
NYC versus Minnesota versus Oklahoma
https://www1.nyc.gov/site/doh/covid/covid-19-data.page
https://www.health.state.mn.us/diseases/coronavirus/situation.html
https://coronavirus.health.ok.gov/
https://ourworldindata.org/coronavirus
https://www.youtube.com/watch?v=j3VMtr-6Usc