Arne Zels’ phone never stopped ringing. He is a “detention reconnaissance,” meaning that he comes into contact every day with people who have tested positive for the coronavirus or who have been in contact with someone who has it. Zels is based in the small town of Seelow in the state of Brandenburg, just outside Berlin. The windows were wide open and the morning sun shone on the office in the golden autumn light.
Even so, he could see that the market square outside was nearly empty. In recent weeks, as the number of COVID-19 infections has begun to rise again, Seelow’s health departments and many others like them around the country have stepped up operations to identify and control the source of the infection.
Arne Zels is actually a specialist in economic and business psychology. But he is on sabbatical and is using his knowledge to support the health department’s efforts. As a first step, he will be trained as a detention scout at the Robert Koch Institute, Germany’s leading public health authority. So lately the main task has been to find out who has been in contact with people who have tested positive and ensure that they also get tested and, if necessary, go to quarantine. “A key aspect of our work is we are trying to break the chain of infection.”
The phone rings again: A woman calls the office, worried that her boss has tested positive. How should he respond? Zels’ response was sensitive but firm: “You must stay in quarantine. Do you have someone to look after you? Don’t go shopping and stay away from your family.” This, however, is only the beginning. Zels and two colleagues will try to identify all the people the infected woman has contacted to find out where it first started spreading.
‘Overpowered over the years’
This work, says Zels, takes time – although speed is critical: “But if we rush too much, we will leave behind people who don’t know how to deal with the situation. The best thing that can happen is that they will become depressed. But in the worst case, they will go out and harm others. “
The people at the health office say they are still on top of the problem – almost. However, they warned that if the numbers continued to increase, more people would have to join in, as they have been doing in recent months. “People hit the wall. They can’t do what their job demands,” Zels added. “However, we haven’t reached the limit where you would say we can’t get over it anymore.”
The Federal Ministry of Health acknowledged that at least nine local health departments across the country said they did not have enough staff to effectively track and trace people in the chain of infection. The bottom line is: “In most cases, it is no longer possible to fully implement infection protection measures.” In concrete terms this means that in most cases no one knows where the source of the infection is. “
The consequences can be fatal: As it becomes increasingly difficult to trace the source of infection, the more difficult it is to determine what patterns of behavior may have caused a particular outbreak. It appears that the strategies employed in recent months are no longer sufficient to contain the pandemic.
Falko Liecke, member of the city council for health and youth at Berlin district in Neukölln, have first-hand experience of the challenges. Its district was one of the hardest hit in all of Germany.
Liecke patiently gave one-on-one interviews – all outdoors despite the drizzle. The priority is clear to keep the media away from offices where staff need to focus on the task at hand. “Berlin’s health department has been understaffed for years. I’ve always said that if we face a really big crisis, we won’t have the resources to solve it. And that’s what we’re seeing now,” said Liecke.
About 200 people are working to contain the pandemic. Seventy of them specialize in contact tracing. Calls have been out for an additional 40 people to join a team that already includes 27 soldiers from the German military, and other colleagues who work every day. However, even if staff numbers are increasing and they all work 7 days a week, they will still lag behind their workload.
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Neukölln: A new approach?
Those numbers have reached a level where the health department focuses only on people who test positive or those who are considered part of a high-risk group – such as people who have had the disease before. Others outside the group have to rely on information from those transmitting the infection or by institutions and locations where the infected person has spent time – such as children at school or fellow parents of younger children in kindergarten classes -children.
All of this explains why the authorities in Neukölln have carefully adopted a new approach based on the idea of Chief Medical Officer Nicolai Savaskan. He smiled as he spoke and there was no sign that he was intimidated by the large scale of the work to come.
“Infections tend to spread in the same way as wildfires when they are out of control. There are areas where sources of fire can be found. And what firefighters should be doing is pretty clear.” The obstacle is that there are no more concrete sources. The situation is scattered and it is difficult to get an overview.
One case and ten contacts: “It’s been a very time-consuming workload for my people,” says Savaskan. So what we want to do is shift the focus to citizens who take more personal responsibility. It is possible to notify people who have tested positive and then it is up to them to pick up the phone and then inform their own contact. That will allow medical specialists to focus their efforts on the most vulnerable. Savaskan isn’t convinced that a lockdown will help: “It’s like a nuclear weapon that easily flattens everything to the ground. There are other instruments we need to try first.”
One contested possibility is for every citizen to undergo what is called a rapid home test to see if they pose a risk to others. The other is a time corridor that allows vulnerable groups to shop in relative comfort with those who are not high-risk groups away.
Savaskan to call it: “Faster than your test!” Any symptom, the slightest suspicion that someone is positive, and it should be: Responsible directly to quarantine! “However you look at it,” Savaskan painstakingly emphasizes, “this is a job for society as a whole.” And, he added: “If people don’t want to take personal responsibility, then we already have it.”