On Monday, August 31, 2020, a medical professional will perform a polymerase chain reaction swab test (PCR) on a driver in a drive-through coronavirus test center on the Talavera car park in Würzburg.
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LONDON – Germany has been lauded for its first response to the coronavirus pandemic, but a four-week return to strict public health measures has raised questions about the effectiveness of its strategy for the second time.
Germany launched its "Lockdown Light" on Monday, which should last for the month of November. The new restrictions include closing bars, restaurants, cinemas, theaters and gyms and reintroducing physical distancing measures.
Chancellor Angela Merkel warned on Monday that Germany "has to bring the situation under control so that the local health authorities can follow up contacts again – otherwise the exponential growth will simply continue to turn upwards."
In the first wave of the epidemic, the country built on existing local infrastructure to stay one step ahead of the virus. An analysis published in the British Medical Journal (BMJ) found that Germany's intensive testing, contact tracing and quarantine system is critical to "successful control" of the outbreak.
Dr. Hajo Zeeb, department head of the German Leibniz Institute for Prevention Research and Epidemiology, told CNBC by phone that the traceability system of the country's public health authorities had "reached its limits".
With this second round of lockdown restrictions, the federal government declared that its goal was to reduce the number of new infections to around 50 cases per 100,000 people within seven days so that the local health authorities can again track all contacts. According to the daily situation report by the Robert Koch Federal Agency on Thursday, there were now almost 127 cases per 100,000 over a period of seven days.
The government said it is currently unable to track 75% of new cases.
Zeeb said a combination of factors led to the recent surge in Covid-19 infections, including easing restrictions during the summer period. However, it was people returning to Germany from vacation that were the main driver behind the start of another wave, Zeeb said. This created a "heavy workload" for the local health authorities as they then had to test these returning citizens as well.
"I wouldn't say it was uncoordinated, but in Bavaria and elsewhere some strange decisions have been made to test people on highways and in different situations too," he said.
According to the Robert Koch Institute, Bavaria, Germany's largest state, has the second highest number of coronavirus cases in the country with 119,505.
It is the only state in Germany that has introduced free coronavirus tests for everyone. The move raised concerns that it would overwhelm test centers when it was launched in June.
Indeed, since the guideline was introduced, Bavaria has detected test errors with backlogs and data entry problems.
A spokesman for the Bavarian Ministry of Health told CNBC via email that both problems had occurred once and "could be resolved quickly".
"The causes have been clearly identified and resolved," he said. "In one case the reasons were a technical defect in a computer system and in the other case a process error or an error when a new supplier took over the test stations on the motorways."
At the national level, Zeeb said the virus has now spread beyond the accumulation of cases to larger communities, making it harder to pinpoint the source of infection.
The federal government said on Monday, while 21.5 million people had downloaded their Corona warning app, "Unfortunately, only 60% of people who test a positive passport pass on their contacts."
The first time, Zeeb said Germany's effective management of the virus was aided by the fact that its epidemic "started in a young age group that didn't lead to many severe cases from the start," which gave him more time to prepare his health system .
Clear communication of the pandemic, supported by Merkel's training as a scientist, is also said to have contributed to its effectiveness. While the historical investments in the German health system and the quick reaction to the provision of particularly intensive care facilities meant that the hospitals were not overwhelmed.
"Victim of his own success"
Dr. Mike Tildesley, an associate professor specializing in infectious disease control at the University of Warwick in the UK, told CNBC that Germany could in some ways be viewed as a "victim of its own success".
A smaller first wave meant more people are likely to be susceptible to the virus, he explained, making a bigger second wave possible.
For Germany, the decision to impose another lockdown could be seen as "courageous" and seen again as Germany's preventive action.
Dr. Rowland Kao, a professor of epidemiology and data science at the University of Edinburgh, told CNBC that if a country fails to get rid of every single case of Covid-19 if restrictions are lifted, there is still a chance of a resurgence .
As such, Kao said it couldn't be that anything is wrong with the German strategy. "It might be impossible to get it right," he said, given that there are only so many tools available to a country to contain the coronavirus.
Kao added that part of what makes controlling coronavirus so difficult is the fact that people are infectious before they show clinical signs. Thus, easily symptomatic and asymptomatic people contribute to the spread of the disease, which means that "it will be increasingly difficult to do tests and follow-ups".
A spokeswoman for the Federal Ministry of Health told CNBC via email that "the number of cases where the infection rate is generally increasing (due to local accumulations of infections, family celebrations or leisure activities) has increased".
"Of course, more tests are then done – without changing the testing strategy," she added.
She said that "public life needs to be closed again to get infections back on track".