Country seen as a model for its response is told it is not doing nearly enough

Germany still needs to increase its coronavirus testing rate dramatically if it wants to successfully manage the virus, scientists are advising the government.

The country has the capacity to carry out up to 500,000 tests a week, but must increase that to more than a million, or 200,000 tests a day, they say. This is despite other countries looking to Germany because of its comparatively high testing rate and relatively low death rate from Covid-19 of under 1%.

As the British government has struggled to tackle a testing shortfall, Germany has been repeatedly named as an example to follow in recent days, but a confidential scientific study commissioned by the government and recently leaked to German media showed that if it wanted to avoid a mass outbreak of the coronavirus, the country would have to greatly increase its testing capacity.

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Ever since the government’s introduction of a strict lockdown, including closing the country’s borders and shutting down schools and nurseries, the scientists said around a million people in Germany – which has a population of just under 83 million – were likely to become infected, and around 12,000 would die. That outlook, however, was based on an increase in testing to 100,000 a day and within weeks to 200,000 a day.

The study’s authors said that in order to carry out testing in the most efficient and quickest way possible, it would also be necessary in the longer term to rely on the use of big data and location tracking via mobile phones, an issue that is controversial in Germany.

Lothar Wieler, the head of the government’s main public health advisory body, the Robert Koch Institute (RKI), said that while German testing was high compared with other countries, it would have to be speeded up. “We need to increase efficiency,” he said, adding that he welcomed the news that the use of quicker and simpler tests, in addition to the current standard PCR – polymerase chain reaction test, which directly detects the DNA or RNA of the pathogen – would soon be available.

Germany has a large network of more than 85 laboratories and a good history of detecting illness early. A nationwide network set up between doctors’ practices, normally used to monitor the flu, was also used for testing for Covid-19 from February onwards, and the fact the system only detected a case on 12 March indicates that the virus was not widespread before then..

There has been huge worldwide interest in why the death rate in Germany from Covid-19 has remained much lower than many other countries. Germany’s death rate is around 0.5%, compared with Italy’s 9.5%, and a worldwide rate of around 4.7%.

“The fact is that Germany started testing early on and has tested broadly. That way, many cases but also milder cases have been detected, and they did not generally include the elderly,” Wieler said.

It has, he said, in effect distorted the figures. He warns that the situation in Germany is likely to worsen, as many more of the elderly who have so far not been so affected, are likely to get sick. “We are still at the start of the epidemic, and it is completely unclear as to how it will develop,” Wieler said. “But of course the number of deaths in Germany will rise.”

He has insisted there is not, as has sometimes been suspected, an “under-reporting” of deaths from Covid-19 by hospitals. It would in theory be possible that some deaths were not counted as deaths from coronavirus, if the patient had an underlying health condition. But that is seldom likely to be the case, due to the sensibility towards the illness right now. Only if someone with coronavirus was killed by something unrelated to the virus, such as a car crash, would they not be included, medical authorities say.

Testing laboratories across Germany report that while they have been at pains to increase their capacity, they face many obstacles. Germany’s federal system has contributed to an inefficient gathering of data – including an unclear picture of how much testing has been done – and delays in testing suspected cases, delivering results or informing contact people. Germany’s regional health bodies have recruited extra staff to help deal with the backlog, but say they are struggling to keep up. The RKI has recruited scouts – often medical students and trained doctors who arrived as refugees but are waiting to have their qualifications recognised – to support the system.

Accredited Laboratories in Medicine (ALM), the largest association representing laboratories in Germany working on the tests, has said that testing capacity has increased significantly since the first case emerged in the country at the end of January.

“We’re working around the clock, in a shift system, including at weekends,” Evangelos Kotsopoulos, head of ALM told Die Zeit newspaper. “Our main bottlenecks are staff – many of whom have young children and are affected by school and nursery closures – and supplies from industry. Around the world there are only five or six big suppliers for the materials that we need.”

Kotsopoulos said Germany should be far more focused on who it tested, to ensure those “who don’t have symptoms but just want to know whether they have it or not” are not tested, in favour of those such as at-risk patients for whom it is considered a necessity. “It is simply not practically possible right now to test everyone in a population of our size,” he said.

According to the RKI’s guideline, priority should be given to testing medical workers, people with underlying health conditions showing coronavirus symptoms and those in contact with those who are infected, so as to be able to place them under quarantine.

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But many working on the testing frontline report concerns about a lack of materials and inefficiency, as well as a shortage of staff, forcing many people to work seven-day weeks.

“The reagents we need are produced by just three manufacturers in Germany and they have run dry,” Elisabeth Koerber-Kröll from the district medical faculty in Schwäbisch Hall, in Baden-Württemberg, south-west Germany, one of the hardest hit regions told broadcaster SWR.

Increasing emphasis is also being put on antibody tests, as well as antigen tests, as a more efficient way of managing the spread of the virus, in addition to self-testing, although many are sceptical that that this is reliable enough.