
With broad, random tests for antibodies, Germany seeks path out of lockdown - _Microft
https://www.nytimes.com./2020/04/18/world/europe/with-broad-random-tests-for-antibodies-germany-seeks-path-out-of-lockdown.html
======
anotheryou
But it hasn't ramped up yet and they loosen the lockdown already by monday.
The got R down to .7 at best and that only on average, not in the hotspots.

I bet in 2 weeks (I hope it's not even more delay) they will notice that
(partially) opening schools and shops was a mistake and will have to row back.
I just hope they will be as lucky as with the initial curve-flattening.

Germany has flattened the curve, but that still means they are roughly on it's
summit. There are still more infected than ever and every misstep might be
costly.

Here are the different regions, just recovered/dead are not included in the
graph I think:
[https://preview.redd.it/x7g0xnlblds41.png?width=894&format=p...](https://preview.redd.it/x7g0xnlblds41.png?width=894&format=png&auto=webp&s=b104f985de617b4f55e0585a3da32fa63778403d)

Generally it peaked at 70k infected and is back at 50k
[https://studylib.net/coronavirus#country-
de](https://studylib.net/coronavirus#country-de)

~~~
dirkt
Until a vaccine is found, 60-70% of the population will need to get infected
for "herd immunity". While at the same time making sure infection doesn't grow
exponentially, and overwhelms the health system.

Loosening the lockdown, and being prepared to row back, will achieve that if
done carefully, while at the same time getting the economy slowly back to
normal.

And that probably are a lot more people are already infected without symptoms
will help with that.

Trying to somehow contain the infection won't work, because it will just get
carried in from the outside again, eventually.

~~~
lnsru
Sorry, I have no knowledge on virology topics. But this “herd immunity” thing
is a complete nonsense. Politicians may repeat it as long as they want, but it
still makes no sense. 50 million people must be infected, 1,5 million will
die. It will take many years. While immunity very probably(????) disappear
after months. Asian countries had many different viruses in the past, all of
the contained. Why is it so difficult to follow their path?

~~~
notechback
Herd immunity is not just a buzzword. We have two options to reduce the harm
of infectious diseases: eradicate them or build herd immunity. The first
option has become impossible with this virus that's now truly global and
likely much more spread than is known. Therefore herd immunity is the ONLY
option.

The question then is how to get as many people as possible immune - you'll
either need a vaccine or many need to get the infection and survive. A vaccine
is not on the horizon for another 6-12 months, so the best course of action is
to build the number of survivors.

What brings death? Mainly the sudden onslaught on the health system. If there
is no bed, respirator, blood supply, ... Left then you're much more likely to
have patients die than if you have a hospital at regular capacity. There are
some that WILL for but by slowly building immunity (i.e. allowing some parts
of the population to get exposed) you avoid the high death toll of an
unmanaged outbreak.

So if total eradication is impossible, slow infection rates are better than
none. Why? Because if you don't build the immunity you will again have violent
outbreaks killing many. And you simply can't lock everyone at home for another
6 months.

~~~
usaar333
There is no reason you can't keep a disease at a very low level (to the point
any given person is unlikely to get the disease over their lifetime) via
testing, contact tracing and quarantine. Iceland and South Korea both prove
you can in fact.

~~~
rootusrootus
Iceland is tiny and it is a little early to proclaim SK an unqualified
success. If the only way to keep the disease at a very low level is to have a
new normal of strong quarantine indefinitely, then you are asking for
something unrealistic. Even more so in western democracies where people are
accustomed to a great deal of personal freedom.

------
ttul
I would love to know how Germany has been able to discover a sufficiently
accurate antibody assay before many excellent groups in other countries.
Finding some antibodies is one thing; making it mean something is another.
Does the presence of a particular antibody imply that someone is now no longer
infectious to others? Are they themselves now immune to reinfection?

These questions are unanswered AFAIK so I am curious as to what the Germans
are actually learning.

~~~
sarnowski
My vague understanding is, that the tests can also test positive for
antibodies from other similar viruses. They have a significant false-positive
rate that you should not rely on a positive („you are immune“) result but
overall they will provide a big picture approximation how many citizens might
have already resistance. They are not good enough for a rumored „immune
certification“.

~~~
iso1210
Currently we have no idea how many people have had covid. We have a good idea
how many have died, but no country has managed to do the kind of testing that
would give a good indication of how many people have been infected. Do 2% of
people getting it die, or 0.2%, or 0.02%? Testing 1 million people at random
across the country will give good results of not only how deadly it is, but
also how likely it is to spread in different areas of the country.

~~~
dboreham
We have a pretty good idea it isn't 0.02% because there's an upper bound on
the infection rate (around 75%) and the number of bodies is known and in all
cases exceeds 0.3% of the maximum possible infections.

~~~
quersive
How did you come up with 0.3% number of bodies / maximum possible infections,
aka total population? I'm trying to wrap my head around this whole mess...

Take Lombardy, hardest hit region in Europe. 1130 deaths / million, or about
0.1% death rate. All German states are under 100 deaths per million, which is
less than 0.01% death rate. Sanity check: Bayern, 1.2k deaths/13M people ~
0.01%.

Of course, this is a lower bound estimate assuming all people in a given
region have got through the disease. Which is definitely not true. To figure
out how bad is going to get we need the total number of infected people.
Hopefully the random testing strategy will shed some light on that number. But
at least we start [much] lower than 0.3%.

[https://covid19.quersive.com/chart?c=M&e=IT-Lombardy&e=DE-
BW...](https://covid19.quersive.com/chart?c=M&e=IT-Lombardy&e=DE-BW&e=DE-
BY&e=DE-BE&e=DE-BB&e=DE-HB&e=DE-HH&e=DE-HE&e=DE-MV&e=DE-NI&e=DE-NW&e=DE-
RP&e=DE-SL&e=DE-SN&e=DE-ST&e=DE-SH&e=DE-TH&f=DE-BY&t=D&tb=P&w=1)

~~~
akavi
In NYC, 0.16% of the population's died from it, so that's a hard lower bound.

~~~
quersive
Thanks!

------
KCUOJJQJ
According to a diagram [1] of the Robert Koch Institute the effective
reproduction number was already down to 1 two days before the measurements of
March 23. It also didn't go down further in this diagram.

[1]
[https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/17...](https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/17/Art_02.html)
[https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/Au...](https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2020/Ausgaben/17_20_SARS-
CoV2_vorab.pdf?__blob=publicationFile) \--> Page 14, "Abb. 4"

~~~
anotheryou
I looked into that a bit. Basically everyone was already self-quarantining.

I looked at mobility on sundays (because that isolates it to the private
lockdown as ordered on the 23rd and excludes school, shops and work quite a
bit):

    
    
        14.3.: -10% Mobility
        21.3.: -46% Mobility
        23.3.: ----- official Lockdown -----
        29.3.: -55% Mobility
    

So the bulk of it happened in advance, because people where already isolating
themselves during the initial "panic".

Data from here [http://rocs.hu-berlin.de/covid-19-mobility/mobility-
monitor/](http://rocs.hu-berlin.de/covid-19-mobility/mobility-monitor/) (I
wonder why there is no Sunday dip for the 5th of April though)

------
s9w
> The generosity and solidarity [...] have been missing in Germany’s response
> to poorer European nations in the south, which were hit hardest by the
> virus.

Germany gave away _many hundreds_ of respirators, took in _hundreds_ of
patients from all neighboring countries (including Italy). Italy was offered
money under the ESM which they didn't want. All while high ranking officials
from Italy called Germans Nazis _multiple times_. All that although the
Italian population has a higher median wealth, lower taxes, higher rate of
home ownership and lower retirement age.

And we're still the bad guys.

~~~
danielrpa
American here, I can only dream of the United States having a response as good
as Germany's. Your country is an example of a how a democracy should react in
a situation like this and demonstrates that we don't need a totalitarian
regime to handle a large scale crisis. I'm not saying it is perfect (what
is?), but just that it is one of the free countries setting a strong standard.

~~~
JPKab
To add to your point, Germany actually has a federalized system similar to
what the United States has. A key difference in this specific scenario was
that the United States didn't fully trust the federalized system for
healthcare and disease prevention like the Germans did. Our CDC ended up
owning the development, manufacturing, and distribution of test and therefore
were able to tell doctors in all 50 states who could be tested and who
couldn't. I think that this is a grossly inferior model and we should have
instead allowed the states to have more money and therefore more control over
creation of the tests.

I think that the big issue that was exposed was not lack of centralization but
too much of it with the wrong organizations. A nation of 330 odd million is
much harder to govern especially in a centralized manner.

an additional question I have is what do you think has been so awful about the
United States response? From a pure numbers perspective I feel like the US
isn't really doing badly from a per capita basis.

Nobody has run out of ventilators yet. Infection rates are below the 95%
confidence interval of the original models. Just curious as to your
perspective. Do you think that these numbers are due to bad models and luck or
due to the fact that the population has largely adhered to social distancing?

~~~
danielrpa
I don't want to get into partisan politics, but the US central authorities
weren't serious about the problem until relatively late in the process, and
our testing ramp up was also very slow. The move to block travel from China
was well timed, but it can arguably be seen as more influenced by geopolitics
than health concerns.

The US now is catching up fairly well as the country started playing on its
strengths, such as the extremely strong industrial base, financial power and,
for better or worse, international leverage.

Regarding the more centralized system, it has advantages and disadvantages.
The advantage of Germany's central coordination is that it made generally good
decisions from the get go, so the country was able to move quicker. The US had
a confused central response and the states were able to implement local fixes
that prevented the entire system from falling apart.

So I think the US model has the advantage of offering a second layer of
defense from poor central planning, which perhaps wouldn't be as easy in
Germany (I'm speculating here, I don't know much about Germany democratic
guards against bad central decisions).

~~~
gnusty_gnurc
The US had the issue of complete failure of a federal monopoly. CDC and FDA
failed at the most critical time and prohibited private enterprise and states
from rushing in.

~~~
jakeogh
Measured by what? We achieved better results than every single pre-peak best
case estimated outcome. If you know of a predicted outcome that we havent come
in under, please link to it.

~~~
gnusty_gnurc
Measured by a month of delayed testing at the outset of a virulent pandemic?

> Forced to suspend the launch of a nationwide detection program for the
> coronavirus for a month, the C.D.C. lost credibility as the nation’s leading
> public health agency and the country lost ground in ways that continue to
> haunt grieving families, the sick and the worried well from one state to the
> next.

[https://www.nytimes.com/2020/04/18/health/cdc-coronavirus-
la...](https://www.nytimes.com/2020/04/18/health/cdc-coronavirus-lab-
contamination-testing.html)

~~~
jakeogh
In science, when errors are made, we are supposed to acknowledge and correct
them, which is what the CDC did.

Why base your opinion on a second order result rather than first hand
outcomes? If we had not tested at all, and still had this _drastically better
than predicted_ result, might you still be unhappy about it?

And the NYT... They are not just a news orginization. Still run by the BBC's
Mark Thompson I see.

[https://imgur.com/VUdcIou](https://imgur.com/VUdcIou)

[https://pbs.twimg.com/media/CIMxvS-
WEAER49I.png](https://pbs.twimg.com/media/CIMxvS-WEAER49I.png)

[https://pbs.twimg.com/media/CINJUoqUwAEkSip.jpg](https://pbs.twimg.com/media/CINJUoqUwAEkSip.jpg)

------
LatteLazy
Stop testing individuals and start testing populations. That's the only way to
know what is happening. That is the only way to start controlling the epidemic
instead of just guessing.

------
neonate
[https://archive.md/L6abQ](https://archive.md/L6abQ)

------
travisgriggs
“Of course I said yes... I want to help. This is a collective crisis. The
government is doing what it can. Everyone needs to do their bit.”

I live in the wrong country. Can I come live with you Germany?

------
johnohara
It's unrealistic to use RT-PCR testing on the entire U.S. population to derive
what is essentially a binary result.

RT-PCR tests are too time consuming, too sensitive, and too reliant on
specialized laboratory equipment for that. Right now however, they are all we
have to achieve results accurate enough for some form of certification.

Immunoassays are simpler, faster, localized, and less expensive, but may also
yield positive results for other coronaviruses such as 229E, NL63, OC43, HKU1,
SARS-CoV, and MERS-CoV.

Germany may be isolating potential COVID-19 positives by using immunoassays,
then using RT-PCR to be certain. I don't know. But it doesn't mean those
"negatives" will always remain so.

~~~
beagle3
Please correct me if I'm wrong, but rt-PCR can only detect active SARS-Cov-2
shedding - meaning active disease, whereas immuno-assays check for the
existence of antibodies.

A SARS-Cov-2 naive person will be negative to both; early on, rt-PCR will be
positive[0] and immunoassay will be negative; then (if and when the immune
system manages to synthesize the right antibodies) they will both be positive;
then the virus is eradicated so rt-PCR will go negative, but the immunoassay
will stay positive (for a while; unknown yet if for life)

[0] Assuming perfect accuracy and specificity.

~~~
johnohara
I agree with your reply. Thank you for it.

The recent seroprevalence study performed in Santa Clara County [0] [1] used
an immunoassay manufactured by Premier BioTech, Minneapolis, MN.

Their page entitled "PCR And Serology Based Testing Explained" does a very
good job explaining what we both understand [2].

I stand by my opinion that it is unrealistic to use RT-PCR testing on the
entire U.S. population. It is too sensitive and too time-consuming given the
time constraints we are under. This Wash Post article (printed by MSN)
describes why the CDC had to recall its initial testing kits. [3]

[0]
[https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v...](https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1)
[1]
[https://news.ycombinator.com/item?id=22899272](https://news.ycombinator.com/item?id=22899272)
[2] [https://premierbiotech.com/innovation/pcr-and-serology-
based...](https://premierbiotech.com/innovation/pcr-and-serology-based-
testing-explained/) [3] [https://www.msn.com/en-us/news/us/contamination-at-
cdc-lab-d...](https://www.msn.com/en-us/news/us/contamination-at-cdc-lab-
delayed-rollout-of-coronavirus-tests/ar-BB12Q90W)

------
garraeth
After searching Google, I cannot find the results of the actual study. Are
they available?

~~~
Linus-Boehm
They just started the study and will last at least a year. But here is the
press release of the munich university. [https://www.lmu-
klinikum.de/aktuelles/pressemitteilungen/mun...](https://www.lmu-
klinikum.de/aktuelles/pressemitteilungen/munchner-tropeninstitut-beginnt-
stichprobenanalyse-zur-verbreitung-der-corona-pandemie-und-zur-wirksamkeit-
von-gegenmassnahmen/6afa2c06cb6745a9)

------
chkaloon
Shows what strong, competent leadership can do. And a society with fairly high
trust in it.

~~~
amelius
Angela Merkel has a Ph.D. in quantum physics, and an academic background is
probably exactly what's needed in a situation like this (versus the more
business oriented skills of e.g. Trump).

~~~
clairity
trump is terrible at business, very likely to have grossly underperformed
against putting his inheritance and loans into an index fund. he’s good at
grabbing attention and being a reality tv actor/celebrity however.

~~~
Hoasi
> he’s good at grabbing attention and being a reality tv actor/celebrity
> however.

He's good at marketing. Sadly he didn't put these skills to good use in the
current crisis so far. Virology isn't his strongest suit. He performed a worse
show than usual since it is not just about boasting about himself and branding
other people with hilarious nicknames.

~~~
clairity
not really. he’s good at self-promotion, which you might argue is an
overlapping skillset with promotion, a component of marketing dealing with
sales, advertising, and the like.

but he’s most certainly not good at any other aspect of marketing (product,
price, distribution, etc.), which is why he’s terrible at business and why
he’s been losing credibility to state leaders.

~~~
Hoasi
Completely in agreement with you here. Replace marketing with marketing
himself in my above comment.

------
dustinmoris
What's the goal with all this testing?

The simple reality is that unless you have a large proportion of your
population immune (either due to infection or vaccine) you will NOT be able to
reverse the lockdown successfully without seeing a surge in infections and
deaths shortly after. So you can test as much as you want, but this whole
pandemic started from ONE person in China so as long as there is 1 or 5 or
more likely 100s or 1000s of cases in any country then as soon as restrictions
are loosened the infection rate will exponentially go up again.

You can play the game of opening/closing schools/shops every couple weeks for
about 2 years until everyone either got eventually infected or we might see a
vaccine hitting the public. Even if a vaccine might be available at the end of
2020, it won't be available to the public across the globe for yet another
year if not longer. That is just simple maths on manufacturing and
distribution, anyone who thinks differently is completely dillusional.

So my question remains, what is the end goal with all of the testing? Calling
testing as a way out of the lockdown is either a dumb assertion, because more
testing won't stop the spread (contact tracing and isolation will only slow
the exponential outbreak by days or couple weeks), or it is a lie to give the
public false hope.

There is only two ways out:

\- Now, by lifting all lockdown restrictions, target, shield and isolate the
most vulnerable in our society (old & fragile, people with diabetes, cancer,
HIV, etc.), ramp up hospital capacity and let the virus rage through the
remaining population, hoping that everyone else will mostly experience mild or
no symptoms and only very few people who need hospitalisation and who will die
given that the most vulnerable remain in isolation...

or

\- stay in lockdown for 24 months at a minimum until there's the capacity to
manufacture and supply a vaccine to roughly 60% of the population with a
pointless ping pong exercise of easing and tightening the restrictions

I'm honestly not sure which one is better, but there is literally NO OTHER
OPTION.

Most of Europe is currently going down the second option and Sweden is mostly
leading on the first option. I predict that if in ~ 6 months time countries
will see that there's little difference in the death rate between countries
with tright restrictinos and those with lax restrictions (because tight
restrictions only delay the deaths, but don't prevent) then everyone will
change to a more Swedish model probably.

Only time will tell the truth.

~~~
kaybe
I don't think option 1 as you wrote is is any good. There appear to be strong
signs that even with very mild symptoms patients can have significant lung
damage, and also damage to other organs.

It is not clear yet how far that will heal. Only time will tell, but from the
extend, I've seen discussions that the people affected might be patients for
the rest of their lives.

(eg.
[https://www.rainews.it/tgr/tagesschau/articoli/2020/04/tag-C...](https://www.rainews.it/tgr/tagesschau/articoli/2020/04/tag-
Coronavirus-Lungeschaden-Forschung-Uniklinik-
Innsbruck-6708e11e-28dc-4843-a760-e7f926ace61c.html) in German)

~~~
dustinmoris
> There appear to be strong signs that even with very mild symptoms patients
> can have significant lung damage, and also damage to other organs.

This is completely contradictory. You should stop reading fake news or social
media reports, because this is where some utter stupid statements like this
come from. COVID-19 is a novel coronavirus, but it's not a novel virus. It is
a coronavirus, which means that that we know that it is a respiratory virus
like other viruses. It doesn't attack organs like so many dumb people claim.
It attacks your respiratory tract, which also includes your lungs. That itself
is harmless in most people as their immune system will quickly produce anti
bodies and then erradicate the virus from your body. In some cases the virus
multiplies faster than the immune response, which means the lungs get heavily
inflamed and your body starts to get less oxygen than needed. This is the
reason why organs fail, because of a lack of oxygen. If one person was
infected with mild symptoms and then has been cleared of the virus (~ 7 days
later, and I was one of these people myself) then the virus is gone from your
body and there's no way to magically all of a sudden get any long term damages
to anything if you don't have them to begin with. It's not like your organs
start out of nowhere to just stop working. Also before you even get to that
point you are so severly ill that you need a ventialtor to breath, so it's not
like you can get a damage to an organ out of nowhere without noticing it.

> I've seen discussions that the people affected might be patients for the
> rest of their lives.

If they fully recovered then this is not possible. If they were extremley
severely ill and lack of oxygen damanged some organs then yes maybe but that
is not the case for 99% of people.

~~~
kaybe
> This is completely contradictory. You should stop reading fake news or
> social media reports, because this is where some utter stupid statements
> like this come from.

It depends what exactly 'mild' means I guess. I might not have worded it well
(not my first language etc). Just to be sure I went to the most reliable
sources available (not just standard news - it's in German though, they cite a
lot of papers if anyone is interested, but most are for SARS-CoV-1, 45-48
specifically talk about long-term damages) and I still stand by my statement,
though the phrasing I chose make it appear more drastic than I meant it.

If everyone gets it and a few percent of the population get lasting damage
(which from a quick paper survey does not seem totally unrealistic), is that
acceptable?

([https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...](https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html))

(eg
[https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1843...](https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1843.2010.01720.x))

~~~
dustinmoris
You really need to educate yourself a bit on basics, so that you don't believe
every stupid news report. Remember, since the lockdown news papers have
nothing else to report on except coronavirus. They must find something new
_newsworthy_ every day and therefore a lot of utter shit gets printed.

1\. The news article which you originally posted is a summary of the message
which the doctor gave in a scubadiving magazine. In that magazine the message
is less sensationalist.

2\. Not every COVID-19 infection ends up affecting your lungs. COVID-19 in
particular starts in your throat (which is why many report a sore throat to
begin with). Once it is in your throat the virus multiplies and will
eventually penetrate your lungs. However, if you are fit and healthy then
normally your body will react quickly and start fighting the virus. In my case
I had really high fever for 2 days and on day 3 and after I was getting
significantly better. My immune system was able to fight the virus before it
even got to my lungs. I had a sore throat, high fever, didn't taste my food,
had a cough, fatigue, but I didn't have shortness of breath. If the virus
never enters your lungs it can't damage them.

3\. Even if the virus enters your lungs it doesn't mean anything yet. It
really depends how strong your immune system is in reacting to the virus. If
it takes 7-10 days like with old or weakend people then your lungs might get
severly infected before your body starts to fight it off, however when you're
healthy then you might fight it off before you get a bad lung infection.

4\. A lung infection is not unique to COVID-19. It doesn't matter what causes
your lung infection, once you have it the symptoms and possible outcomes are
the same. Doesn't matter if bronchitis, a flu, a bad cold or COVID-19 caused
you to get a lung infection or pneumonia. Anyways, with some medical support
even those people will get over it in most cases. However, it is VERY COMMON
to have many weeks after a lung infection still some leftover symptoms. Some
patients have a cough for two months after a bad cold or flu. It is common
that there will still be traces visible in a lung scan many weeks after, but
almost all these cases eventually clear up. An inflamation means that tissue
has gone sore. Your body fights off the virus, but your tissue takes longer to
recover from the soreness. That is normal and it's not unique to COVID-19.
EXACTLY the same would happen after a flu or cold.

Hope these facts make it a lot clearer, because the amount of false
information spread via social media and some low key fake news websites is
astonishing and really harmful.

