Pass the salt: Tiny details helped Germany build virus defences

Germany won crucial time to build its Covid-19 defences by meticulously tracing chains of infection in order to interrupt them, write Jörn Poltz and Paul Carrel.
Pass the salt: Tiny details helped Germany build virus defences

Germany won crucial time to build its Covid-19 defences by meticulously tracing chains of infection in order to interrupt them, write Jörn Poltz and Paul Carrel.

When a worker at a car parts factory turned to borrow salt from a colleague, that person then became Case #5 of coronavirus in Germany, scientists deduced. Picture: iStock

When a worker at a car parts factory turned to borrow salt from a colleague, that person then became Case #5 of coronavirus in Germany, scientists deduced. Picture: iStock

One January lunchtime in a car parts company, a worker turned to a colleague and asked to borrow the salt.

Scientists have since concluded that in that instant, they had shared not only the saltshaker, but the new coronavirus also.

That their exchange was documented at all is the result of intense scrutiny — part of a rare success story in the global fight against the virus.

The co-workers were early links in what was to be the first documented chain of multiple human-to-human transmissions of Covid-19 outside Asia.

They are based in Stockdorf, a German town of 4,000 near Munich in Bavaria, and they work at car parts supplier Webasto Group.

The company was thrust under a global microscope after it disclosed that one of its employees, a Chinese woman, caught the virus and brought it to Webasto headquarters.

There, it was passed to colleagues — including, scientists would learn, a person lunching in the canteen with whom the Chinese patient had no contact.

The January 22 canteen scene was one of dozens of mundane incidents that scientists have logged in a medical manhunt to trace, test, and isolate infected workers so that the regional government of Bavaria could stop the virus from spreading.

That hunt has helped Germany win crucial time to build up its Covid-19 defences.

The time Germany bought may have saved lives, scientists say. Its first outbreak of locally transmitted Covid-19 began earlier than Italy’s, but Germany has had much fewer deaths.

Italy’s first detected local transmission was on February 21. By then, Germany had kicked off a health ministry information campaign and a government strategy to tackle the virus which would hinge on widespread testing.

So far in Germany, more than 2,100 people have died of Covid-19. In Italy, with its smaller population, the total exceeds 17,600.

“We learned that we must meticulously trace chains of infection in order to interrupt them,” said Clemens Wendtner, the doctor who treated the Munich patients.

Wendtner teamed up with some of Germany’s top scientists to tackle what became known as the ‘Munich cluster’, and they advised the Bavarian government on how to respond. Bavaria led the way with the lockdowns, which went nationwide on March 22.

Christian Drosten, the top virologist at Berlin’s Charite hospital, said Germany was helped by having a clear early cluster: “Because we had this Munich cohort right at the start ... it became clear that with a big push we could inhibit this spreading further,” he said in a podcast for NDR radio.

It was on Monday, January 27, that Holger Engelmann, Webasto’s CEO, told the authorities that one of his employees had tested positive for the new coronavirus.

The woman, who was based in Shanghai, had facilitated several days of workshops and attended meetings at Webasto’s HQ.

The woman’s parents, from Wuhan, had visited her before she travelled on to Stockdorf January 19, the paper said. While in Germany, she felt unusual chest and back aches and was tired for her whole stay. But she put the symptoms down to jet lag.

She became feverish on the return flight to China, tested positive after landing, and was hospitalised. Her parents also later tested positive. She told her managers of the result and they emailed the CEO.

In Germany, Engelmann immediately set up a crisis team that alerted medical authorities and started trying to trace staff members who had been in contact with their Chinese colleague. The CEO himself was among them.

“Just four or five days before I received the news, I had shaken hands with her,” he said.

Now known as Germany’s “Case #0,” the Shanghai patient is a “long-standing, proven employee from project management” who Engelmann knows personally, he said.

The task of finding who had contact with her was made easier by Webasto workers’ electronic calendars — for the most part, all the doctors needed was to look at staff appointments.

“It was a stroke of luck,” said Wendtner, the doctor who treated the Munich patients. “We got all the information we needed from the staff to reconstruct the chains of infection.”

For example, Case #1 — the first person in Germany to be infected by the Chinese woman — sat next to her in a meeting in a small room on January 20, the scientists wrote.

By following all these links, they discovered that Case #4 had been in contact with the Shanghai patient several times.

Then Case #4 sat back-to-back with a colleague in the canteen. When that colleague turned to borrow the salt, the scientists deduced, the virus passed between them. The colleague was Case #5.

Webasto said on January 28 it was temporarily closing its Stockdorf site. Between January 27 and February 11, a total of 16 Covid-19 cases were identified in the Munich cluster. All but one were to develop symptoms.

All those who tested positive were sent to hospital to be observed and so doctors could learn from the disease.

Bavaria closed down public life in mid-March. Germany has since closed schools, shops, restaurants, playgrounds, and sports facilities, and many companies have shut to aid the cause.

This is not to say Germany has defeated Covid-19. However, its corona-virus death rate of 1.9%  is the lowest among the countries most affected and compares with 12.6% in Italy.

The difference between Germany and Italy is partly statistical: Germany’s rate seems so much lower because it has tested widely. Germany has carried out more than 1.3m tests, according to the Robert Koch Institute.

It is now carrying out up to 500,000 tests a week, Drosten said. Italy has conducted more than 807,000 tests since February 21, according to its Civil Protection Agency.

Germany’s government is using the weeks gained by the Munich experience to double the number of intensive care beds from about 28,000. The country already has Europe’s highest number of critical care beds per head of population, according to a 2012 study.

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Even that may not be enough, however. An Interior Ministry paper sent to other government departments on March 22 included a worst-case scenario with more than 1m deaths.

The German government paper argued that the use of big data and location tracking is inevitable. Such monitoring is already proving controversial in Germany, where memories of the East German Stasi secret police and its informants are still fresh in the minds of many.

A subsequent draft action plan compiled by the government proposes the rapid tracing of infection chains, mandatory mask-wearing in public and limits on gatherings to help enable a phased return to normal life after Germany’s lockdown.

The government is backing the development of a smartphone app to help trace infections.

Germany has said it will re-evaluate the lockdown after the Easter holiday.

For the car-parts maker at the heart of its first outbreak, the immediate crisis is over.

Webasto’s office has re-opened. All 16 people who caught Covid-19 there have since recovered.

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