Study from the first community transmission center in Germany. Brand new. https://www.land.nrw/sites/default/files/asset/document/zwis...

Preliminary results and conclusions of the COVID-19 Case Cluster Study (Gangelt municipality)

Prof. Dr. Hendrik Streeck (Institute for Virology)

Prof. Dr. Gunther Hartmann (Institute for Clinical Chemistry and Clinical Pharmacology, Speaker of the Cluster of Excellence ImmunoSensation2)

Prof. Dr. Martin Exner (Institute for Hygiene and Public Health)

Prof. Dr. Matthias Schmid (Institute for Medical Biometry, Informatics and Epidemiology)

University Hospital Bonn, Bonn, 9 April 2020

Background: The municipality of Gangelt is one of the places in Germany most affected by COVID19 . It is assumed that the infection is due to a carnival session on 15 February 2020, as several people tested positive for SARSCoV2 in the aftermath of this session. The carnival session and the outbreak of the session are currently being investigated in more detail. A representative sample was taken from the community

Gangelt (12,529 inhabitants) in the Heinsberg district. The World Health Organization (WHO) recommends a protocol in which, depending on the expected prevalence, 100 to 300 households are randomly examined. This random sample was coordinated with Prof. Manfred Güllner (Forsa) to ensure its representativeness.

Aim: The aim of the study is to determine the status of SARS-CoV2 infections (percentage of all infected persons) in the community of Gangelt, which have been and are still occurring. In addition, the status of the current SARS-CoV2 immunity shall be determined.

Procedure: A serial letter was sent to about 600 households. In total, about 1000 inhabitants from about 400 households took part in the study. Questionnaires were collected, throat swabs taken and blood tested for the presence of antibodies (IgG, IgA). The interim results and conclusions of approx. 500 persons are included in this first evaluation.

Preliminary result: An existing immunity of approx. 14% (antiSARS-CoV2 IgG positive, specificity of the method >.99 %) was determined. About 2% of the persons had a current SARS-CoV-2 infection detected by PCR method. The infection rate (current infection or already been through) was about 15 % in total. The case fatality rate in relation to the total number of infected persons in the community of Gangelt is approx. 0.37 % with the preliminary data from this study. The lethality rate currently calculated in Germany by Johns-Hopkins University is 1.98 %, which is 5 times higher. The mortality in relation to the total population in Gangelt is currently 0.15 %.

Preliminary conclusion: The lethality calculated by Johns-Hopkins University is 5 times higher than in this study in Gangelt, which is explained by the different reference size of the infected persons. In Gangelt, this study covers all infected persons in the sample, including those with asymptomatic and mild courses. In Gangelt, the proportion of the population that has already developed immunity to SARS-CoV-2 is about 15%. This means that 15% of the population in Gangelt can no longer become infected with SARS-CoV-2, and the process has already begun until herd immunity is achieved. This 15% of the population reduces the speed (net reproduction rate R in epidemiological models) of a further spread of SARS-CoV-2 accordingly.

By adhering to strict hygiene measures, it can be expected that the virus concentration in a person infected can be reduced to such an extent that the severity of the disease is reduced, while at the same time immunity is developed. These favourable conditions are not given in the case of an exceptional outbreak event (superspreading event, e.g. carnival session, après-ski bar Ischgl). With hygiene measures, favourable effects with regard to total mortality can be expected.

We therefore expressly recommend implementing the proposed four-phase strategy of the German Society for Hospital Hygiene (DGKH). This strategy provides for the following model:

Phase 1: Social quarantine with the aim of containing and slowing down the pandemic and avoiding overloading critical supply structures, especially the Health care system

Phase 2: Beginning of the withdrawal of quarantine while ensuring hygienic conditions and behaviour.

Phase 3: Lifting of the quarantine while maintaining the hygienic conditions

Phase 4: State of public life as before the COVID-19 pandemic (status quo ante).

(Statement of the DGKH can be found here:

https://www.krankenhaushygiene.de/ccUpload/upload/files/2020... adug_Lageeinschaetzung.pdf)

Note: These results are preliminary. The final results of the study will be published and presented to the public as soon as they are available.