Pandemic: Why the number of corona infections is declining on Sunday

SIf you look at the number of new infections each day, the pandemic takes a short break every Sunday and Monday. The Robert Koch Institute (RKI) reported 2,507 cases the Saturday before the last, but only 1,410 on Sunday, 1,192 on Monday, and again a lush 2,089 on Tuesday. This fluctuation at the beginning of the week has existed since the beginning of the crisis of Crown. The reason for this is that health authorities are reporting fewer infections on weekends.

The number of new infections is one of the most important parameters of the crisis. It is true that the weekly average, the so-called seven-day incidence, is calculated locally from nine infections per 100,000 inhabitants. But the RKI national numbers, which are announced daily, are also used as the basis for political decision-making for the crown’s measures, and as an important guide for citizens.

So why don’t health authorities report your data every day eight months after the pandemic broke out?

When asked at the Robert Koch Institute what reasons they see for the reporting gap and what steps need to be taken in the future to close it, he says: “The RKI does not assess this as a ‘reporting gap.” A spokeswoman refers to the Infection Protection Act, which provides for a notification of the disease “no later than the next working day” to the responsible state authority, which in turn transmits it “from there to the Robert Koch Institute at the latest. the next business day. ” Translated this means: You are not legally obliged to send the data the same day. However, the RKI spokeswoman adds: “In the Covid 19 pandemic, almost all authorities go beyond the legal requirements, even on weekends.”

However, the question remains why twice as many infections are reported during the week than on Sunday or Monday. “On the weekend, the number of cases is lower mainly because fewer people go to the doctor and fewer laboratory tests are performed,” he says.

The size of the health department is also crucial

Frank Renken describes another reason for the reporting delay. He is the head of the health department in Dortmund and is following the outbreak in North Rhine-Westphalia. “Whether or not it is reported over the weekend depends largely on the size of the health department,” he says. In his office, for example, 94 people worked on contact tracking about 30 Covid-19 cases each day. Since the beginning of the pandemic, part of the team has also been in the office since 8:30 a.m. on weekends.

“We are very busy”. However, in the smaller offices of the 53 North Rhine-Westphalia health authorities, things sometimes look different, Renken explains. Next door in the Soest district, where until recently there were only one or two cases a day. “It doesn’t make sense to organize weekend shifts when there are only a few individual cases. They can easily register on Monday. “

The head of the health department in Berlin-Spandau, Gudrun Widders, sees another cause for the lower number of infections on Monday. “We don’t get any reports on Sunday, so there’s nothing we can get into,” he says. The reason: “The laboratories we work with are closed on Sundays.” On Sundays, however, contacts are followed up and on-call service is offered to citizens.

The Association of Accredited Laboratories for Medicine (ALM), which represents more than 200 laboratories in Germany, confirms on request that fewer staff will be deployed on weekends. “Laboratory employees have been working on the edge since the pandemic and sometimes have to go home to their families on weekends,” says Christian Scholz, of the association’s board of directors. Unlike the health authorities, students, soldiers of the German Armed Forces or other auxiliary personnel cannot be recruited to reinforce the situation. “There is no qualification.”

But these support staff can also work in the health authorities. Weekends provide only limited relief, says Ute Teichert, president of the Federal Association of Public Health Service Physicians. “Our long-term employees have special training and experience in handling the reporting system.” Many of the attendees were trained ad hoc and were initially unable to operate the complex software, Teichert says. “Sitting there galloping on the weekend doesn’t work.”

Also, it is more difficult to get information on weekends. For example, a report requires that information about the infected person is already included in the laboratory’s certificate, such as the address and phone number. If the laboratory reports the positive test result to the health department but without this information, employees should start investigating themselves. One possible point of contact would be the doctor’s office where the smear was taken. “But it’s closed on weekends,” Teichert says. In some health authorities, the infection is only reported in the first step and then more information is added. This also explains the sometimes staggered reports of new infections from state governments and the RKI.

Why Corona Cases Are Still Reported by Fax

Another hurdle in the reporting process is transmission on paper. The four billion euros allocated by the federal government to strengthen the public health service and its digital equipment will be distributed little by little within five years. “There is nothing available yet,” says Teichert.

Most labs and doctors’ offices continue to fax their findings to authorities. Then employees manually enter them into the computer. “That takes us a long time,” says Renken from the Dortmund health department. For data protection reasons, the information cannot be sent by email; special software would be required.

Exactly such software exists in planning by the federal government since 2011 and should originally be available throughout the health system by the end of 2020. In response to the Ehec epidemic, the Federal Ministry of Health decided to improve the communicable disease surveillance system through electronic procedures .

One year later, RKI was commissioned to ask stakeholders in the healthcare system about their expectations of the system. The final report was available in 2013 and the DEMIS project started in 2016 – the German electronic reporting system for protection against infections.

Four years later, however, the results are manageable. Only a fraction of medical practices, hospitals and community facilities are connected. The RKI says the delay arose for “a number of reasons,” including the federal government’s “reliance” on TI consolidation. – a project of the Federal Ministry of the Interior, which aims to standardize IT in the administration – and due to the “lack of availability of human resources”, especially in the IT area.

Hence the forecast: “It is currently assumed that with sufficient resources available, much of the planned functional scope of DEMIS can be implemented by 2022,” as stated in a federal government response in April. The costs up to this point: 5,670,000 euros.

During the last months of the pandemic, however, work was done at full speed to at least connect the laboratories and the health authorities. Development is a bit more advanced here: according to the RKI, 28 out of 276 labs are currently actively using the system, and a total of 161 are certified. 306 of the more than 370 health authorities have installed a certificate and software.

But the installation does not guarantee the use. The Dortmund health department, for example, has been equipped with DEMIS for four weeks. One of the laboratories he works with as well. But the health department is not using the software yet and continues to receive lab results by fax, Chief Renken explains. The reason: In recent weeks, your team has expanded with 30 new employees. This includes educators, employees of other offices, and students from various fields.

Almost none of them know how to use the new reporting system. But there is not enough time for training and initiation. The number of new infections is increasing and between 200 and 400 calls must be made daily as part of contact tracking. “We just can’t do it,” Renken says. Your goal is to be able to start the new system at least throughout the year.