Why isn’t everyone with symptoms tested for coronavirus? Do general practitioners know what to do? There is currently a lot of criticism of the authorities’ actions. Everything important about the test procedure.
The number of confirmed infections with the new coronavirus is currently increasing in Germany: on March 2 there were still 150 cases, on March 5 (as of 8:00 a.m.) there were already 349.
But how many undiscovered diseases are there in this country? Not everyone who scratches their throat can currently be tested for an infection with Sars-CoV-2. That would not make sense either, because the likelihood that a common cold or the onset of flu causes the symptoms is much higher – and the tests are expensive and the possibilities are limited.
Nevertheless, many people with colds are wondering whether they shouldn’t be tested for the corona virus. And are unsettled if they are not tested, but still should make sure that they do not infect anyone. How does that fit together?
At the moment, the responsible authorities are primarily focusing on preventing the spread of the coronavirus or at least slowing it down significantly. Many experts are now assuming that it will not be possible to contain the virus completely. That means: Probably a lot of people will become infected. The decisive factor is the period in which this happens.
The faster an outbreak runs, the more stressed – possibly overloaded – it places on the health system. As long as as few people as possible get Covid-19 at the same time, medical practices can cope with this, clinics have enough capacity to treat the seriously ill. In addition, several hundred people are still infected with the flu every day in Germany. Another goal is therefore to delay a major corona epidemic until the flu epidemic has subsided.
That is why it is important to keep a close eye on who has been infected. This is the only way to quickly find contact persons for those infected and place them under domestic quarantine so that they do not pass the virus on if they are actually infected.
How many tests are performed – and who should be tested?
Germany’s laboratories have capacities for around 12,000 corona tests per day, the National Association of Statutory Health Insurance Physicians (KBV) said on Tuesday. However, there are currently no reliable figures on how many tests have been carried out so far. According to the KBV, initial surveys – based on around 60 percent of the laboratories in the outpatient area – state that 10,700 people were tested in Germany last week alone. Around 130 cases were confirmed by the end of the week.
However, these figures are only really meaningful if the total number of tests carried out is known. This is important to see if the available resources, both material and personnel, are sufficient for a major outbreak. But also in order to gain better insights into the spread of Sars-CoV-2 through the ratio of positive to negative test results – those in which the virus was not detected.
According to the recommendation of the Robert Koch Institute (RKI), Sars-CoV-2 should be tested immediately:
- who has cold symptoms and had contact with a confirmed Covid 19 case within the 14 days before the onset of the illness, or
- who has cold complaints and has been in a risk area in the 14 days prior to the start of the complaints. Various provinces in China, Iran, Italy and South Korea are currently considered to be such. (A current list of risk areas can be found here.)
Apart from that, general practitioners can also order the test if someone has been in a region that is not officially considered a risk area, but in which the virus still spreads – for example in the district of Heinsberg in North Rhine-Westphalia. Contact with a person who is likely to be infected but is still lacking evidence can also be a reason for a test. It is always a prerequisite that those affected also show cold symptoms.
The health insurance companies have been covering the cost of the test since the end of February – if the treating doctor has decided that it is necessary. “Comprehensive tests of the clinically healthy – in the blue, so to speak – are medical nonsense,” said the head of the National Association of Statutory Health Insurance Physicians, Andreas Gassen. “The resources should be used in cases where there is a medically suspected suspicion.”
Long odyssey instead of quick tests
In recent days, however, there have also been problems with the clarification of such suspected cases, as readers report to SPIEGEL. Some describe odyssey where they are referred to the general practitioner by the health department, from there to the clinic, from there to number 116117 and from there back to the health department, which again saw the family doctor as responsible.
The same thing happened to SPIEGEL reporter Juan Moreno, who traveled to Italy to research the corona virus, right up to the border of the area that was declared a quarantine zone southeast of Milan. Back in Berlin he developed a slight cough, his nose was already running a little during the trip. Nevertheless, he only managed to get tested after countless phone calls – because he had personal contact with a doctor (read the whole story here).
Health Minister Jens Spahn (CDU) admitted on Wednesday that the fight against the rapid spread of the virus is currently not running optimally. “It sometimes takes too long before suspicious cases are tested,” he said. The responsible actors are under great pressure.
How general practitioners should deal with suspected corona
A guideline that the German Society for General Medicine and Family Medicine (Degam) published for its members on Tuesday is also intended to resolve uncertainty. If a patient reports for a possible coronavirus infection, the doctors should first clarify whether there is a reasonable suspicion, i.e. whether the patient was in contact with a Covid 19 patient or was in a risk area.
In addition, doctors are advised to only take the necessary samples for a test if they have the necessary protective clothing in practice. This is a problem in many places, because most of the clothing made in China has become a scarce commodity. If there is no protective clothing in the practice, doctors can contact the health department. The office is also responsible when patients call from home – and it is accordingly possible to take the samples during a home visit.
All patients are asked not to simply go to a family doctor’s office if they suspect coronavirus, but to call first.
Because if a test in a practice is positive, the practice could be temporarily closed by the responsible health authority for reasons of disease protection. This in turn would have consequences for the medical care of the local people – and not only of possible coronavirus cases, but above all of people with other health problems.
How to expand the test system in Germany
Various federal states are currently preparing for a major outbreak. The Ministry of Health in Schleswig-Holstein announced on Thursday (05/Mar/2020) that the test options outside the doctor’s office should be expanded. There should be more home visits without restricting the work of resident doctors.
In addition, contact points are to be created outside the practices – probably in the form of tents or containers. There should be cutbacks for the tests without the patients having to enter the waiting room. The aim is to reduce the risk of closed medical practices and to use protective clothing more efficiently
There has also been an alternative test option in southern Hesse since the weekend: The district clinic in Groß-Gerau is cutting back on the car window – a kind of drive-in for corona tests. The procedure offers great advantages for the clinic: suspected cases remained “in their own quarantine station”, so to speak, Managing Director Erika Raab. The healthcare professional who takes the smears should wear protective clothing. Other hospital staff and patients would not come into contact with the patient.
South Korea, which currently has to deal with one of the largest outbreaks worldwide, could serve as a model for Germany.
In the country, several cities have set up so-called corona drive-ins, in which drivers can be tested free of charge without having to get out. You will receive the result via SMS two days later.
Full Article from Der Spiegel:
Von Irene Berres, Katherine Rydlink und Nina Weber