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[17 November] How reliable are rapid antigen tests?
Unlike PCR, which identifies viral genetic material, antigen tests detect the presence of viral proteins (see ‘How does PCR work?’). The test is similar to a pregnancy test, except that it uses a respiratory specimen (usually a nasopharyngeal swab). Rapid antigen tests can be conducted at the point of care without any special laboratory equipment. Antigen tests are quick, producing results in less than 30 minutes.
Antigen tests generally perform less well than PCR tests. In some cases, they may miss SARS-CoV-2-positive samples (lower sensitivity) or falsely identify samples as positive which are not infected with SARS-CoV-2 (lower specificity). However, the comparative lack of sensitivity of antigen tests is of limited significance during the crucial early phase of the infection. Given the primary purpose of these tests is rapid point-of-care testing, the false positive rate of many of the commercially available rapid antigen tests (approximately 1%) is rather low. To ensure that a positive antigen test has correctly identified a person infected with SARS-CoV-2, the result can be confirmed with a PCR test.
It is important to note that antigen tests can only provide very limited information. They can, for instance, provide an estimate of a person’s infectiousness. They cannot, however, determine whether a person is infected or not at the time of testing. Even a negative result, therefore, cannot rule out infection: the person tested might be positive but only producing low levels of infectious virus at the time of testing. This is why antigen test results need to be evaluated by a physician.
The use of antigen tests can prove particularly useful in certain situations (see the information provided by the Robert Koch Institute), such as in point-of-care settings where a quick (initial) decision regarding infectiousness is essential – for instance when testing visitors to care homes or hospitals.
A whole range of commercially available antigen tests have been developed over the past few months. Charité’s Institute of Virology carried out its own independent testing to produce estimates of reliability for seven of these commercially available tests. To be included in testing, tests had to be either commercially available in Germany at the time of testing (late September to early October) or available as a prototype which could be ordered from either the manufacturers or dealerships within Germany. Reliability estimates were produced for a range of different samples, including nasopharyngeal swabs, cultured virus, and synthetic virus protein.
Results from this test series have been submitted for publication and will undergo peer review as part of the normal publication process. To ensure that both experts and the public have access to results as quickly as possible, the authors have also published their manuscript to a preprint server. Please click here to access the manuscript. As the peer review process remains to be completed, the published data should be regarded as preliminary. Please note: These results exclusively refer to samples collected by medical personnel. They are not transferable to samples which have been collected by laypersons (for instance in the case of home testing kits).
[1 October] Coronavirus testing stations at airports
The Senatsverwaltung für Gesundheit, Pflege und Gleichstellung has published important information for all those entering and returning to Germany at https://www.berlin.de/sen/gpg/service/oft-gesucht/artikel.968998.php. Information on corona test centres at airports can be found at https://www.berlin.de/corona/massnahmen/einreisen-und-quarantaene/ [Change on 1.10.2020].
[29 June] What is Berlin’s testing strategy and what does it entail?
The Senate voted in favor of a COVID-19 testing strategy for Berlin. The strategy, which will be implemented across Berlin, will use a coordinated approach to ensure the early identification of persons at increased risk of severe disease and persons who pose a higher risk of transmission. Testing efforts will focus on health care and care facilities, schools and child day care centers, as well as locations associated with a higher risk of transmission, such as the catering sector and correctional facilities. The new testing strategy is based on a concept jointly developed by Charité and Vivantes Netzwerk für Gesundheit. It aims to enable a return to normal life by restoring people’s health and Berlin’s economic and social order.
Initially launched in educational facilities, the testing strategy comprises the following individual components: Charité has been offering testing to asymptomatic staff from an initial selection of 48 educational facilities since June 2020. Testing was then made available (on a by-appointment-only basis) to asymptomatic staff from any Berlin-based childcare centers at the end of June 2020. Charité has been supporting these efforts by scheduling dedicated testing time slots which prevent contact between asymptomatic and symptomatic persons. The Senate Department for Education, Youth and Family has issued a letter which is mailed to staff at all participating establishments and explains the process of appointment scheduling and the existence of a strict no-cancellation policy. Testing is voluntary and free of charge. Late July will see testing extended to staff from all schools within the Berlin area.
In August, coronavirus testing was extended to asymptomatic staff from all Berlin-based schools. Testing is available at Charité’s testing unit on Campus Virchow-Klinikum, one of three testing units provided at the Vivantes Hospitals in Prenzlauer Berg, Tempelhof-Schöneberg and Spandau, and at the Hospital ‘Gemeinschaftskrankenhaus Havelhöhe’. Letters to school staff are due to be mailed later this week. Issued by the Senate Department for Education, Youth and Family, these letters will explain the process of appointment scheduling and the existence of a strict no-cancellation policy. Testing is voluntary and free of charge.
Another component of Berlin’s testing strategy is the year-long Berlin Coronavirus School Study/Berliner Corona Schulstudie (BECOSS), which was launched in mid-June. This study involves mobile Charité teams conducting testing drives at 24 randomly selected primary and secondary schools.
The aim of this stepwise approach is to provide support, study the developing situation and identify potential risks as educational facilities gradually return to normal operations. This will provide the data needed for an epidemiological evaluation of the unfolding situation and subsequently inform future planning.
In an effort to expand testing beyond educational facilities, arrangements are currently being made to offer testing to hospitals and care homes, catering establishments, transport service providers and cultural establishments. The aim of Berlin’s testing strategy is to offer a science- and evidence-based approach to epidemiological monitoring which enables the early identification of potential clusters or outbreaks. This will produce the evidence necessary to guide and assist decision-makers from politics and the public health services (ÖGD). Charité is responsible for the concept behind the testing strategy. Responsibility for the implementation of testing is shared between Charité, the relevant Senate Departments and the ÖGD.
The testing strategy is being coordinated by a Steering Group and implemented via a number of Working Groups. Members of the working groups include representatives from the relevant Senate Departments and public health authorities, as well as experts from Charité and Vivantes, public health officers and other stakeholders.
[18 April] How does Charité support students completing their final year rotation (PJ)?
In light of the exceptional circumstances arising from the COVID-19 pandemic, Charité will pay an allowance to all of its students currently completing their final year rotation (PJ). The allowance of €744 matches the maximum rate of the federal ‘Bafög’ funding for students and will be paid monthly for a duration of three months. Charité wishes to recognize the outstanding dedication and commitment of its PJ students in helping to care for patients with COVID-19.
[26 March] How does Charité contribute to advancing research on COVID-19?
In response to an initiative by Charité which is aimed at tackling the current pandemic crisis, the Federal Ministry of Education and Research (BMBF) has allocated €150 million for a new academic research network. The network, which aims to pool all relevant expertise and support COVID-19-related research from across Germany, will be coordinated by Charité. The National Task Force of the Covid-19 research network of university medicine commenced work on 24 April.
The task of curbing the spread of SARS-CoV-2 requires a nationwide, unified approach, as does the task of ensuring optimal medical care. Increasing the knowledge base, and doing so quickly, is of the utmost importance – and requires an effective support structure. This will be provided by the new research network, an alliance which aims to include all of Germany’s university hospitals. In response to an initiative by Prof. Dr. Heyo K. Kroemer (Chief Executive Officer of Charité – Universitätsmedizin Berlin) and Prof. Dr. Christian Drosten (Director of the Institute of Virology on Campus Charité Mitte), the BMBF has agreed to provide €150 million in funding. For the first time, the nation will respond to a crisis by systematically collating and consolidating both the response plans and the diagnostic and treatment strategies of its various university hospitals and other stakeholders from within the health care system.
Under the auspices of the research network, the university hospitals will be in a position to act quickly and effectively while also preserving their high standards of quality. This will be particularly useful for the use of innovative methods, such as using telemedicine to care for patients with COVID-19. Once successfully trialed, such methods can be rolled out quickly and on a large scale. Researchers will also use standardized procedures for the treatment and follow-up of COVID-19 patients, and for the analysis of data collated in connection with these patients. This will enable the researchers to develop new treatment options for specific groups of patients, such as those with pre-existing conditions. Both existing knowledge and new insights are to be communicated widely. This will enable their prompt implementation in clinical practice and ensure patients receive the best treatments available. The resulting comprehensive data sets will also help to produce new scientific insights. In addition to being of enormous benefit to the development of treatments and vaccines, they will also be extremely helpful in managing this pandemic.
[The information regarding the commencement of the National Task Force was added on 30 April.]
[16 March] Charité postpones planned medical procedures and operations
From today and until further notice, Charité is postponing all planned medical procedures/operations. This is in order to free up hospital beds and personnel capacities in anticipation of increasing number of patients in need of treatment for COVID-19. This does not however include medical procedures/operations where postponement would be medically unjustifiable. Persons for whom a planned operation at Charité was scheduled for the coming weeks will be contacted by the respective department.
As such, Charité is following a resolution from 12 March 2020 from the German Chancellor and the German Heads of State Governments. According to this resolution, from 16 March onwards, all planned admissions, operations and procedures in all hospitals will be indefinitely postponed as far as this is medically justifiable. This resolution also forms part of the Charité pandemic response plan (see 'Questions and answers on Charité's pandemic strategy').
[6 March] How will Charité alleviate the pressure on its emergency departments if there is an increase in the number of suspected cases?
Charité’s pandemic management plan makes provisions for a dedicated examination unit to alleviate pressure on its main emergency departments in the event of a rise in suspected cases. The unit is to be established in a separate part of the building. This internal measure was implemented on Tuesday, 3 March and shall serve as a model for other hospitals in the Berlin and Brandenburg areas.
The following advice remains unchanged: Citizens who are concerned that they may have contracted the virus are advised to ring either the hotline of the Berlin Senate Department for Health, Care and Equality or their general practitioner/family doctor. They will be advised as to what action, if any, needs to be taken. Only symptomatic patients should visit the examination unit. At this unit, suspected cases will undergo testing for SARS-CoV-2 (swabs will be taken from inside the nose and throat).
The Charité examination unit is situated on Campus Virchow-Klinikum, Mittelallee 1.
Mon-Fri 8 AM to 1 PM
[The opening hours of the examination unit were updated on June 8.]
[3 March] What was the public’s response to Charité’s new Examination Unit?
The newly installed Examination Unit opened its doors at 8 AM on Tuesday, 3 March 2020. This internal measure was successful in alleviating the pressure on the emergency departments, however demand for the new service was as high as had been expected; a total of 100 patients had been swabbed by 4 PM on the unit’s first day of operation.
We therefore refer to our previous advice: anyone who is worried that they may have contracted the virus should call either the hotline provided by the Berlin Senate Department for Health, Care and Equality or their general practitioner/family doctor. We are also hopeful that other facilities and hospitals will follow suit and implement similar measures in a timely manner.
[2 March] When did Berlin have its first confirmed case of COVID-19?
On Sunday, 1 March 2020, the Berlin Senate Department for Health, Care and Equality announced that they had received confirmation of the first case of novel coronavirus in Berlin. The patient is being kept in isolation at Charité’s Department of Infectious Diseases and Respiratory Medicine on Campus Virchow-Klinikum, where he is receiving treatment and in a stable condition.
The patient was brought to one of Charité’s emergency departments on Sunday suffering from neurological symptoms. Diagnostic testing included a test for influenza. All Charité patients with suspected influenza have been undergoing routine SARS-CoV-2 testing since last week. After testing positive, the patient was admitted and placed in isolation for treatment. The authorities were notified. The public health officer in charge has initiated the process of tracing and following-up potential contacts. A range of individuals who have been in contact with the patient, including emergency department staff, remain in isolation at home.