The German city finds a plan to reduce Covid-19 deaths

At the peak of the first wave in April, the city had 70 Covid-19 patients in the largest hospital – out of 89,000 inhabitants – including 33 in intensive care, forcing doctors to cancel elective surgery. Now, at the height of much more devastating current growth, there are only 35 patients, many transferred from other regions. Fifteen of them are in intensive care, of which less than half are residents of Tübingen. The hospital did not cancel the non-urgent surgery.

Local authorities say such numbers are not accidental. The city, they point out, started earlier than most German municipalities in conducting frequent Covid-19 tests on nursing home staff, residents and visitors. It subsidizes taxi rides for those over the age of 65, so that they do not have to use public transport. Younger residents are discouraged from shopping between 9:00 and 11:00 to avoid getting older people to mingle with people who are more likely to carry the virus without symptoms.

The Tübingen pandemic policy has so far cost half a million euros, all financed by the city’s budget. A week of the current blockade, with restaurants and all non-essential shops closed, costs the German economy and state between 27 and 57 billion euros in production losses and subsidies, according to estimates by the Ifo Institute, a reservist-funded economy in Munich.

On Wednesday last week, Germany registered 32,195 infections in a single day, close to its record, according to the Robert Koch Institute for Infectious Diseases. The day before, it recorded 962 deaths, the highest number in a single day.

While the country has suffered far fewer Covid-19-related deaths than most of its neighbors in the spring, it has had more deaths relative to its population than France and Spain in the past 14 days and close to the UK level. German care units operate at capacity, forcing authorities to transport serious cases to less affected hospitals across the country. More than half of people in Germany who die of coronavirus are residents of nursing homes.

Not in Tübingen. While the average incidence of infections among the general population is similar to that of neighboring regions, infection rates in the elderly are drastically lower. By mid-December, only 10 percent of those infected during the fall were over 65, compared to 23 percent nationally, according to authorities. As a result, mortality in the city is low. Since the beginning of the pandemic, only 33 people have died of Covid-19 at Tübingen University Hospital, which treats most coronavirus patients in the city. Only two people died from the virus in spring care homes, according to a county spokeswoman, a drastic reduction from the 26 residents who succumbed to Covid-19 in the first months of the pandemic.

City officials say they did not see any outbreaks in nursing homes between May and early December, when some of the facilities reported more infections. Under the testing program, which is mandatory for municipality-run care homes, staff and residents must be tested twice a week and all visitors are tested before entering the premises. While all nursing homes receive free test kits from local authorities, some privately run institutions have not followed the testing recommendations, city officials said, explaining the recent outbreaks.

In addition, the mobile units offer free testing for all the city’s main markets. In the run-up to Christmas, hundreds of people used the service before visiting elderly friends and family members in nursing homes or celebrating the holidays together, according to Lisa Federle, senior emergency physician and head of the local Red Cross chapter.

Dr. Federle pioneered the testing program in early April and has since tested people in the main market with a group of volunteers funded primarily by donations. On Wednesday, she and her team tested 500 people and another 600 on Thursday. In October, Dr. Federle received Germany’s highest civilian honor, the Federal Cross of Merit. Her initiative inspired city authorities to offer free mass tests to residents.

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

The tests offered by Dr. Federle and the municipality are rapid antigen tests that can provide results within 15 minutes. Each positive case is then confirmed by the so-called PCR, a more sensitive test that gives a result after a few hours.

Boris Palmer, the mayor of Tübingen, said his city was the first in Germany to offer free tests for everyone in September. It was also the first to offer complementary N95 masks to all citizens aged 65 and over in early November, a move that was later emulated by the federal government.

In addition, as the fall season saw new cases straining testing capacity across Germany, Tübingen ignored federal guidelines to test only people with symptoms. As a result, more than 40 asymptomatic cases have been found in nursing homes, Mr Palmer said, with each being able to sow an outbreak if it were not detected early.

“Regular tests in nursing homes prevented a number of outbreaks: we found people – above all, staff – who were in an early stage of infection and therefore stopped them from transmitting the disease to people. in old age, “said Mr. Palmer.

The Tübingen efforts have inspired other German cities, including 120 towns and villages in his home state of Baden-Württemberg, but Mr Palmer said more could be done nationally. However, some affected communities in the east do not have the funding available for the relatively rich Tübingen. In addition, Germany’s 16 federal states and even cities and municipalities have a high degree of autonomy in health care policy, and coordinating efforts during the pandemic has proved challenging.

Michael Bamberg, head of Tübingen University Hospital, which has ordered all front-line staff and patients to be tested twice a week, points out that 88% of people who die from the disease in the region have more than 70 years.

“If we had applied intense tests and distributed N95 masks across the country much earlier,” he said, “we wouldn’t have needed this blockage.”

Write to Bojan Pancevski at [email protected]