Ministry of the Interior urges massive expansion of corona tests

In the fight against coronavirus, considerations are ripe in the federal government to contain the virus with the help of massively expanded tests. The role model here in South Korea, which has massively slowed the spread of the pathogen with mass tests and the isolation of sick people without bringing public life to a standstill. The largest possible increase in test capacities in Germany is “overdue”, according to information from the The Eastern Heraldr Newspaper, NDR and WDR in a confidential strategy paper from the Federal Ministry of the Interior entitled “How we can get Covid-19 under control”. The government must work towards a scenario called “quick control” to avert worse consequences for health, the economy, and society.

By far the most important measure against the virus, according to the experts, is “testing and isolating the infected person”. “Both people with self-suspicion as well as the entire circle of contact persons from positively tested people should be tested”. The experts hope that the test capacity in Germany can be started up “very quickly””. For example, they run through a scenario in which 50,000 tests per day are possible from April 6, 100,000 from April 13, and 200,000 at the end of April. According to Health Minister Jens Spahn, there are currently 300,000 to 500,000 a week Coronavirus tests possible. The previous method according to the motto “We test to confirm the situation” must be replaced by the approach “We test to come to the situation”. In this regard, South Korea is an “impressive” role model. Unlike China, for example, South Korea has not issued a general exit ban.

Innovative solutions are required for broad-based tests, the strategy paper says. In order to protect medical personnel from infected people, citizens should do the necessary throat swab themselves, for example in “drive-in” or telephone booth test stations. In order to facilitate the search for contacts of people who tested positive, long-term computer-based solutions and even the location tracking of mobile phones should be used. All those who tested positive would have to be isolated, at home or in a quarantine facility. As soon as these procedures have been established, “they can contain the small outbreaks that are likely to flare up again and again relatively inexpensively over several years,” the paper says. In addition, it was necessary to significantly increase the number of hospital beds. There are currently almost 300,000 beds in hospitals and rehabilitation clinics. A further 60,000 could probably be set up in hotels and exhibition halls.

Federal Interior Minister Horst Seehofer commissioned the study from his policy department on March 18. It was created under the leadership of State Secretary Markus Kerber within a few days with the help of the Robert Koch Institute and other experts, including from foreign universities. The paper is now also available to Chancellor Angela Merkel, Defense Minister Annegret Kramp-Karrenbauer and Health Minister Spahn.

The type of tests to be used to determine whether a person is infected is not mentioned in the paper. The currently common detection method is the so-called polymerase chain reaction, in short: PCR, which detects the genetic material of the pathogen. Experts estimate that around 200,000 such PCR tests for the new coronavirus are currently being carried out in Germany every week. This number was also mentioned by Spahn at the beginning of the week. However, he also spoke of the fact that chemicals required for laboratory work and test materials were becoming scarce. The paper does not specify how the additional test capacities are to be created. In order to increase the number as dramatically as outlined in the paper, however, chemicals and laboratory equipment would have to be procured on a large scale. In principle, such tests could also be analyzed in many laboratories of universities and biotech companies. The necessary machines are usually available there and also personnel who can handle them. Organizing this centrally would be very complex.

From the point of view of the experts from the Ministry of the Interior, it is crucial for success that the federal government succeeds in mobilizing the population. The paper states that it is, therefore, necessary to convince people even more than before of the seriousness of the situation and to clear up common misconceptions. It is a misconception that the virus only affects the elderly or is harmless to children. According to the experts, all citizens should recognize that they too could find themselves in a dramatic situation, for example, because critically ill relatives would be turned away from overcrowded hospitals. A “Germany-wide and transparent education and mobilization campaign” were therefore necessary. The authors of the interior ministry paper assume significantly higher death rates and critically ill people than the Robert Koch Institute (RKI). While the RKI currently estimates the lethality of the pathogen in Germany at 0.56 percent, the Interior Ministry expects that 1.2 percent of those infected will die from the coronavirus. The scenarios that the Ministry paper goes through are correspondingly more dramatic.

As part of their campaign, the interior ministry experts want to swear all Germans towards the common goal of avoiding a worst-case scenario in which the disease would spread unchecked for months, with many deaths and massive consequences for the economy and society. “In order to mobilize social perseverance, hiding the worst case is not an option,” it says. “If you want to avert danger, you have to know it.” It is common for simulation games of this type that experts go through the worst scenario: In this case, the experts assume that if the virus continues to spread unchecked, 80 percent of the patients who should actually go to the intensive care unit would be rejected by the hospitals.

The most positive scenario, however, that experts from the Ministry of the Interior are striving for is called “Hammer and Dance”. The term probably refers to an article that appeared on the English-language online platform Medium last week and attracted a lot of attention. However, this is not a scientific contribution. The scenario described therein can still be found in the paper of the Interior Ministry. It means that the virus will initially be contained with exit restrictions and school closings, and the number of cases will decrease significantly within six weeks.

After this phase of the wooden hammer, for example, at the end of the Easter holidays, the “dance” or dance phase could then begin: Kindergartens and schools would open again, the infection would then be checked through intensive testing, tracking contacts and isolation. Social and economic life will then “largely return to normality”, the paper says. Also at the end of the Easter holidays, around April 20, the experts expect the highest number of newly discovered infections per day. After that, they would decrease – following the optimistic scenario.

In this scenario, the slump in the gross domestic product could be limited to around four percent, which is the economic “best case”. Without the extensive test program, however, scenarios may arise in which the crisis recurs in waves, or in which rapid containment fails and exit restrictions over months are necessary.