Concern is growing in Europe about access to vaccine doses during the winter wave of Covid-19. But one city claims to have found a formula for preventing high mortality without a draconian blockade.
The city of Tübingen, in southern Germany, was hit hard by the virus in the spring, but measures such as widely available tests and even subsidies for taxi trips have managed to protect the elderly, who make up the majority of the fatal victims.
At the peak of the first wave in April, the city had 70 Covid-19 patients in its largest hospital – 89,000 inhabitants – including 33 in intensive care, forcing doctors to cancel elective surgery. Now, at the height of the current much more devastating increase, the number of patients is only 35, many of them 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 officials say these figures are not accidents. The city, they point out, started earlier than most German municipalities in conducting frequent Covid-19 tests on household workers, residents and visitors. It subsidizes taxi travel for people over 65, so they don’t have to use public transport. Younger residents are discouraged from shopping between 9 am and 11 am, to prevent the elderly from having to mix with people most likely to have the virus without symptoms.
Tübingen’s 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 stores closed, costs the German economy and the state between € 27 billion and € 57 billion in lost production and subsidies, according to estimates by the Ifo Institute, an economic study funded by the tank government in Munich.
Tübingen, like other cities in Germany, is under a national blockade announced earlier this month.
Photograph:
Sebastian Gollnow / Zuma Press
On Wednesday of last week, Germany recorded 32,195 infections in a day, close to its record, according to the Robert Koch Institute for Infectious Diseases. The previous day, there were 962 deaths, the highest number of deaths in one day.
Although the country suffered far fewer deaths related to Covid-19 than most of its neighbors in the spring, it had more fatalities in relation to its population than France and Spain in the last 14 days, and close to the level of the United Kingdom . care units across Germany are operating at full capacity, forcing authorities to transport serious cases to less affected hospitals across the country. More than half of the people who die of coronavirus in Germany live in nursing homes.
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It is not like that in Tübingen. Although the average incidence of infections among the general population is similar to that of neighboring regions, infection rates among the elderly are drastically lower. In mid-December, only 10% of those infected during the autumn outbreak were over 65, compared with 23% across the country, according to authorities. As a result, mortality in the city is low. Since the start of the pandemic, only 33 people have died from Covid-19 at Tübingen University Hospital, which cares for most of the city’s coronavirus patients. Only two people have died of the virus in nursing homes since spring, according to a county spokeswoman, a drastic reduction in the 26 residents who succumbed to Covid-19 during the first months of the pandemic.
City officials say they did not report a single outbreak in nursing homes between May and early December, when some facilities reported multiple infections. According to the testing program, which is mandatory for households administered by the municipality, employees and residents must be tested twice a week and all visitors are subjected to tests before entering the premises. Although all households receive free test kits from local authorities, some private institutions have not adhered to the test recommendations, city officials said, explaining the recent outbreaks.
Local doctor Lisa Federle collects a nasal swab sample from a patient who showed up at the hospital.
Photograph:
Thomas Niedermueller / Getty Images
In addition, the mobile units offer free trials for all major squares in the city. In the run-up to Christmas, hundreds of people used the service before visiting elderly friends and family in nursing homes or celebrating the holiday 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 square with a group of volunteers financed mainly by donations. On Wednesday, she and her team tested 500 people and another 600 on Thursday. In October, Dr. Federle received Germany’s greatest civil honor, the Federal Cross of Merit. His initiative inspired city officials to offer free mass testing to residents.
“The most important thing is to protect vulnerable groups as much as possible, and testing everyone is the best tool for that,” said Federle. “I get grandchildren who want to take the test to spend Christmas with grandparents or people who want to help elderly neighbors with their Christmas shopping.”
The tests offered by Dr. Federle and the municipality are rapid tests for antigens that can provide results in 15 minutes. Each positive case is then confirmed by a so-called PCR, a more sensitive test that provides a result after several hours.
Boris Palmer, the mayor of Tübingen, said his city was the first in Germany to offer free trials to everyone in September. It was also the first to offer complementary N95 masks to all citizens aged 65 and over in early November, a measure that was later imitated by the federal government.
Tübingen Mayor Boris Palmer, in orange, said the city’s approach has inspired other communities across Germany.
Photograph:
Tom Weller / Zuma Press
In addition, as the rise of autumn in new cases has progressed, overwhelming testing capacity across Germany, Tübingen disregarded the federal guidance to test only people with symptoms. As a result, more than 40 asymptomatic cases have been discovered in nursing homes, said Palmer, each of whom could have seeded an outbreak had it not been detected early.
“Regular testing in nursing homes prevented a series of outbreaks: we found people – especially employees – who were in an early stage of infection and therefore prevented them from passing the disease on to the elderly,” said Palmer.
Tübingen’s efforts inspired other cities across Germany, including 120 towns and villages in Baden-Württemberg, his home state, but Palmer said more could be done nationally. However, some hard-hit communities in the east do not have the funding available for the affluent Tübingen. In addition, Germany’s 16 federal states and even cities and municipalities have a high degree of autonomy in health policy, and coordination efforts during the pandemic have proved challenging.
Michael Bamberg, head of Tübingen University Hospital, which ordered all frontline staff and patients to be tested twice a week, pointed out data showing that 88% of people who die of the disease in the region are over 70 years old.
“If we had applied intense testing and distributed N95 masks across the country much earlier,” he said, “we would not need this block.”
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