“When coronavirus came, I wanted to help,” said Degidiben, who used to work assisting people with filling out forms in the social services department.
As the United Kingdom and the United States scramble to hire teams of contact tracers, local health authorities across Germany have used contact scouts such as Degidiben since they confirmed their first cases early this year.
Epidemiologists say the effort has been essential to the country’s ability to contain its coronavirus outbreak and avoid the larger death tolls seen elsewhere, even with a less stringent shutdown than in other countries. Germany has experienced about 10 coronavirus deaths per 100,000 people. The United States has seen nearly three times as many. France, more than four times. Britain, more than 5½ times.
As restrictions here are lifted, Chancellor Angela Merkel has singled out tracking infection chains as the key, above “all else.” Germany aims to have five contact tracers for every 25,000 people — or about 16,000 for its population of 83 million.
In Reinickendorf, the Berlin district where Degidiben works, a lack of scouts is not a problem. There are about 75 in place for the district’s 260,000 people. A post-lockdown spike in infections has not yet materialized here. Four out of 6 contact tracing teams are in hibernation.
Degidiben picks up the phone and dials her first case for the day: an 82-year-old man whose lab results have come back that morning. It’s one of just two positive cases in the district, down from a peak of around 30 in March.
“You’ve tested positive for coronavirus,” she notifies him.
“Very nice,” he replies with wry Berlin humor.
“Exactly. Then you’ll have it behind you,” she says with a laugh. The banter keeps a jovial veneer to the conversation, even as the elderly patient tells her he has underlying conditions: hypertension and diabetes. She runs through his symptoms: a cough and fatigue.
In contrast to the tracing programs heralded in countries such as China, Singapore and South Korea, Germany’s effort is decidedly low-tech. Privacy concerns — which run strong in Europe and particularly deep in Germany, with its not-so-distant memories of fascism and communism — have limited the potential of contact-tracing apps. So the tracing is largely a case of calling the recently diagnosed patient and asking his or her movements.
Degidiben asks the 82-year-old if he’s had contact with anyone for more than 15 minutes since 48 hours before his symptoms developed. Only his wife, who gets designated as a Category 1 contact and is put under state-mandated quarantine.
Those in contact for less than 15 minutes are put in Category 2 and advised, but not required, to isolate for 14 days.
The man’s daughter, whom he says he has seen only while wearing a mask and at a distance, is not designated at risk.
The whole conversation lasts just over 10 minutes. It’s a simple case, but that’s been normal since social distancing restrictions were implemented, health workers here say. Someone from the health department will call him daily to check in on his symptoms.
Germany’s trace-and-quarantine approach is by no means flawless. In about 65 percent of the cases here, health authorities have no idea how a person was infected. Asymptomatic carriers are no doubt falling through the cracks.
And while Reinickendorf officials have managed to call contacts for every case they’ve received, some more poorly funded and harder-hit areas have been overstretched.
Patrick Larscheid, the head of the health department in Reinickendorf, says the system there is working. He contends that contact tracing and quarantines have been more important to containing the virus than the more widely lauded testing program.
The country’s first cluster, at a car parts manufacturer in Bavaria in February — at the time, the largest outbreak outside Asia — has been held up as an example of successful containment. Sixteen people tested positive; hundreds were quarantined.
“There are two things: the contact tracing and the quarantine,” Larscheid said. In Germany, the contacts of a positive coronavirus case are not generally tested unless they have symptoms.
“Testing is nice, but if you’re tested or not tested and are in quarantine, it makes no difference,” Larscheid said. Testing could also lull someone into a false sense of security, he said — a negative result might mean it’s just too early for an infection to register on a test.
Reinickendorf began to build its contact-tracing team in March, as an outbreak in a kindergarten went beyond the capacity of the usual contingent of health officials. Workers were moved from parts of the local administration for which the outbreak had caused work to slow.
“There were two options,” Larscheid said. “Sit at home or do something new.”
It’s unclear what will happen if district workers are needed back in their old jobs. Health authorities in other parts of Germany have turned to students and volunteers.
While the number of cases has remained low for the moment, they are slowly becoming more complicated, as people return to hairdressers and restaurants and the tangle of inevitable contacts that come with daily life.
Last week, a child who lives in a neighboring district but attends school in Reinickendorf tested positive. The whole class of 20 children and two teachers had to be called and quarantined. Some, including another child with symptoms, had been staying at a local refugee shelter. His family of seven were all quarantined.
The phone lines clogged with anxious parents and administrators.
“Schools are very time-consuming in comparison to elderly homes,” said Jakob Schumacher, head of Berlin’s infectious-disease division. “At schools, the risk is small, but you spend huge amounts of time explaining things.”
Other countries have managed complex cases with mobile tracking apps — mandatory, in some cases — that help health officials stay ahead of potential outbreaks. But such efforts have been more tricky in privacy-conscious Europe.
Germany’s app has been delayed, and authorities had to reverse course on one that would have involved centrally stored data. Instead, to be mindful of privacy concerns, data will be completely anonymized and won’t be available to health officials.
Epidemiologists say tracing apps need to be used by 60 percent of the population to be effective. Larscheid said he expects adoption to be far lower in Germany.
And although the app might complement what his tracing teams are doing, he said it won’t be useful to them without allowing access to names and contact information.
“But it’s also something that reminds me of states like China, and so it’s not what I really want,” he said.
So for the moment, it’s old-fashioned phone work.
The district’s health department is split on whether they’ll see more cases soon. In Berlin, where there’s no requirement to wear a mask, there are only a few dozen new cases a day. Parks and markets have remained busy throughout the pandemic.
Health officials had played down the increase in Germany’s infection rate after the country began to reopen schools and nonessential shops, saying it was driven by isolated outbreaks in several nursing homes and a meatpacking plant and not directly linked to openings.
However, outbreaks linked to a restaurant and a church in the country’s east in recent days have sparked concerns, and local health authorities are looking into whether distancing guidelines were broken.
Degidiben believes that caution among the population and continued distancing rules are still limiting the spread.
Schumacher, the infectious-disease doctor, said seasons might be playing a role. “Either we’ll see more cases next week, or the summer effect is really strong,” he said.
Larscheid said he expects a rise in cases in the coming weeks.
“Everything is getting a little bit less tight, and the people feel it,” he said. But while no one can say for sure if there will be a second wave, or a third, he said, “now we have a way to handle it that works, that’s already proven to work, so we sleep a bit better than before.”