Pass the salt: the minute details that helped Germany build defenses against viruses

MUNICH (Reuters) – A January lunch at an auto parts company, a worker turned to a colleague and asked to borrow the salt.

In addition to the salt shaker, at that moment, they shared the new coronavirus, according to the scientists.

The fact that their exchange has been documented is the result of intense scrutiny, part of a rare success story in the global fight against the virus.

Co-workers were the first links in what would be the first documented chain of multiple human-to-human transmissions outside Asia of COVID-19, the coronavirus disease.

They are located in Stockdorf, a German city of 4,000 near Munich in Bavaria, and work at auto parts supplier Webasto Group. The company was pushed under a global microscope after it revealed that one of its employees, a Chinese woman, detected the virus and brought it to Webasto headquarters. There, it was transmitted to his colleagues, even, scientists would learn, a person having lunch in the canteen with which the Chinese patient had no contact.

The canteen scene on January 22 was one of dozens of mundane incidents that scientists recorded in a medical search to track, evaluate and isolate infected workers so that the Bavarian regional government could stop the spread of the virus.

That hunt has helped Germany gain a crucial moment to build its COVID-19 defenses.

The time Germany bought may have saved lives, scientists say. Its first locally transmitted COVID-19 outbreak started earlier than Italy’s, but Germany has had far fewer deaths. The first local transmission detected by Italy was on February 21. By then, Germany had launched an information campaign by the health ministry and a government strategy to combat the virus that would depend on widespread testing. In Germany so far, more than 2,100 people have died from COVID-19. In Italy, with a smaller population, the total exceeds 17,600.

“We learned that we must carefully trace the infection chains to interrupt them,” Clemens Wendtner, the doctor who treated patients in Munich, told Reuters.

Wendtner partnered with some of Germany’s best scientists to address what became known as the “Munich cluster,” and advised the Bavarian government on how to respond. Bavaria led the way with the blockades, which spread nationwide on March 22.

Scientists, including England’s chief medical officer Chris Whitty, have credited that early and widespread testing in Germany slowed the spread of the virus. “‘ We all know that Germany was ahead in terms of its ability to test for the virus and there is much to learn from that, “he said on television earlier this week.

Christian Drosten, the chief virologist at Charite Hospital in Berlin, said Germany received help by having an early and clear group. “Because we had this Munich cohort from the start … it became clear that with a big push we could inhibit this spread even further,” he said in a daily podcast for NDR radio on the coronavirus.

Drosten, who declined to be interviewed for this story, was one of more than 40 scientists involved in the group’s scrutiny. Their work was preliminarily documented in a working document late last month, intended for The Lancet. The document, not yet peer-reviewed, was shared on the NDR site.

ELECTRONIC JOURNALS

It was Monday, January 27, that Holger Engelmann, CEO of Webasto, told authorities that one of his employees had tested positive for the new coronavirus. The Shanghai-based woman had facilitated several days of workshops and attended meetings at Webasto headquarters.

The woman’s parents from Wuhan had visited her before she traveled to Stockdorf on January 19, according to the newspaper. While in Germany, she experienced unusual chest and back pain and was tired throughout her stay. But she attributed the symptoms to jet lag.

She became feverish on the flight back to China, tested positive after landing, and was hospitalized. Her parents also later tested positive. She told her managers the result and they e-mailed the CEO.

In Germany, Engelmann said he immediately set up a crisis team that alerted medical authorities and began trying to locate staff members who had been in contact with his Chinese colleague.

The same CEO was among them. “Only four or five days before receiving the news, I had shaken his hand,” he said.

Now known as Germany’s “Case # 0”, the Shanghai patient is a “long-standing, proven project management employee” that Engelmann knows personally, he told Reuters. The company has not revealed its identity or that of other people involved, saying that anonymity has encouraged staff to cooperate in Germany’s effort to contain the virus.

The task of finding who had contact with her was easier thanks to the electronic calendars of the Webasto workers; For the most part, all the doctors needed was to check staff appointments.

“It was a stroke of luck,” said Wendtner, the doctor who treated the Munich patients. “We got all the information we needed from staff to rebuild the infection chains.”

For example, Case # 1, the first person in Germany infected by the Chinese woman, sat next to her in a meeting in a small room on January 20, the scientists wrote.

When the calendar data was incomplete, the scientists said, they could often use whole-genome sequencing, which looks at differences in the virus’s genetic code from different patients, to map its spread.

By following all these links, they discovered that Case # 4 had been in contact with the Shanghai patient multiple times. Then Case # 4 sat back to back with a colleague in the canteen.

When that colleague asked to borrow the salt again, scientists deduced, the virus passed between them. The colleague became Case # 5.

Webasto said on January 28 that it was temporarily shutting down its Stockdorf site. Between January 27 and February 11, a total of 16 cases of COVID-19 were identified in the Munich group. All but one were to develop symptoms.

All those who tested positive were sent to the hospital so that they could be observed and the doctors could learn from the disease.

Bavaria closed public life in mid-March. Since then, Germany has closed schools, shops, restaurants, playgrounds, and sports facilities, and many companies have closed to help the cause.

HAMMER AND DANCE

This does not mean that Germany has defeated COVID-19.

Its 1.9% coronavirus mortality rate, according to data compiled by Reuters, is the lowest among the most affected countries and compares with 12.6% in Italy. But experts say more deaths in Germany are inevitable.

“The death rate will increase,” said Lothar Wieler, president of the German Robert Koch Institute for infectious diseases.

The difference between Germany and Italy is partly statistical: Germany’s rate seems much lower because it has been extensively tested. Germany has carried out more than 1.3 million tests, according to the Robert Koch Institute. It is now conducting up to 500,000 tests per week, Drosten said. Italy has carried out more than 807,000 tests since February 21, according to its Civil Protection Agency. With some local exceptions, Italy only evaluates people taken to the hospital with clear and severe symptoms.

The German government is using the weeks gained from the Munich experience to double the number of intensive care beds from approximately 28,000. The country already has the highest number of critical care beds in Europe per head of population, according to a 2012 study.

However, even that may not be enough. A document from the Interior Ministry sent to other government departments on March 22 included the worst case scenario with more than 1 million deaths.

Another scenario saw 12,000 deaths, with more evidence after partial relaxation of the restrictions. That stage was called “hammer and dance”, a term coined by blogger Tomás Pueyo. It refers to the “hammer” of rapid and aggressive measures for a few weeks, including strong social distancing, followed by the “dance” of calibrating such measures depending on transmission speed.

The German government document argued that in the “hammer and dance” scenario, the use of big data and location tracking is inevitable. Such monitoring is already proving controversial in Germany, where memories of the East German Stasi secret police and their informants are still fresh on the minds of many.

A later draft of the government-compiled action plan proposes rapid tracing of infection chains, mandatory wearing of masks in public, and meeting limits to help enable a gradual return to normal life after Germany’s closure . The government is supporting the development of a smartphone app to help track infections.

Germany has said it will re-evaluate the blockade after the Easter holidays; For the auto parts maker at the center of its first outbreak, the immediate crisis is over. Webasto’s office has reopened.

The 16 people who captured COVID-19 there have recovered.