Germany's Robert Koch Institute (RKI) has changed its recommendations to doctors on who should be tested for Covid-19 in order for laboratories to cope during the winter season, and to avoid overloading doctors' surgeries.
The changes came into force on November 11th.
Previously, anyone who had any kind of Covid-19 symptoms (which can be similar to other illnesses) could be tested in Germany, with the cost covered by their health insurance. The final decision on testing was at the discretion of a doctor.
However, now there's a special focus on patients with more pronounced coronavirus symptoms.
“Due to currently limited testing capacities, and the frequency of colds in the winter months, it is not possible to confirm all Covid-19 diseases in Germany by testing,” writes the RKI in its situation report, reported Welt.
Test capacities should be used “efficiently”, says the RKI.
Therefore, testing should only be carried out if people have “severe symptoms”, i.e. respiratory distress, bronchitis or pneumonia, or relatively clear Covid-19 symptoms such as loss of sense of smell or taste, says the RKI.
Other factors will be taken into account when deciding on testing, such as if the patient has had contact with an infected person, possible clusters or if the person works in close contact with people on a regular basis (for example teachers).
People with “acute respiratory symptoms of any severity” who belong to risk groups, care for vulnerable people or work in the medical field will also be tested.
Anyone with possible Covid-19 symptoms who is unsure should contact their doctor who will advise them – but they shouldn't visit the surgery.
Why the change?
Germany has been praised throughout the crisis for its widespread testing.
However, the reason for adjusting the test criteria now is due to autumn and winter's common cold season. As more people pick up colds, the number of people with potential Covid-19 symptoms is also high.
“This is to avoid overloading in the event of a change in the epidemiological situation (greatly increased incidence in the autumn/winter season) and insufficient capacity and resources in terms of implementation (doctors' surgeries, test centres, hospitals) and evaluation of tests (laboratory capacity),” said the RKI when explaining the changes.
The backlog of non-evaluated tests for coronavirus, which accumulated in laboratories, grew steadily over autumn, reported Welt. The peak was reached in the first week of November, with over 98,000 unprocessed tests.
And it could get worse, with the RKI warning of up to 2.5 to 3 million people having cold symptoms every week. The current “real” test capacity of laboratories in Germany is 1,677,221 tests per week.
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Under optimal conditions, up to two million tests are possible, but 54 laboratories alone report delivery problems for reagents, plastic consumables and pipette tips. In addition, there is more staff sickness at this time of year across the board, including in labs and elsewhere in the health sector.
So the justification is that not every patient with cold symptoms can be tested due to limited lab capacity.
Instead, the German government and states earlier this week said that anyone with cold symptoms should stay at home and self-isolate.
The RKI says people with “should isolate at home for at least five days in the event of any respiratory symptoms and only end the isolation after a further 48 hours without symptoms”.
They can contact their doctor and receive a sick note without going to the surgery. Their doctor can also decide if a coronavirus test is needed.
How has it affected overall numbers?
The RKI reported 65,413 new coronavirus cases in the first four days of the current week. In the previous week, 69,048 new infections were reported in the same period.
Although it's possible that the infection curve is flattening slightly, the other explanation could be because the new testing strategy is having an impact on the numbers.
Last week the number of PCR tests recorded fell for the first time in weeks by around 200,000 to 1,384,943. At the same time, the positive rate rose from 7.86 per cent to 9 per cent.
Meanwhile, the introduction of antigen rapid tests should also have an impact on figures in the coming weeks.
Are there any risks, or positives of this move?
The risk of testing fewer people with symptoms does mean that there could be some difficulties in assessing the overall situation.
Experts believe that the higher the positive rate, the higher the estimated number of unreported cases, i.e. the number of undetected infected people in the population. And the higher the number of undetected cases, the easier it is for the virus to spread undetected.
“It may be that the number of undetected cases is now increasing somewhat,” said RKI boss Lothar Wieler at a press conference on Thursday.
Studies have shown that the number of unreported cases in Germany is four to five times higher than the number of reported infections, said Wieler.
But he also pointed out that there are other indicators for the current outbreak: incidences and hospital occupancy rates. “From all this we can conclude that the under-recording is not significantly higher than a few weeks ago,” said Wieler.
The shift in testing strategy may also have advantages in containing the pandemic because there will be less of a backlog of tests to get through.
That means contact tracing can become more efficient.