In the further management of the Covid-19 pandemic, a consistent strategy of testing, contact tracing, and isolation should be pursued to protect vulnerable groups. Those over 60 are of particular concern, as the infection fatality rate rises sharply in this age group. This is the recommendation of the Central Institute for Statutory Health Insurance Physicians (Zi) in a discussion paper published today. This recommendation followed an appeal by the National Association of Statutory Health Insurance Physicians (KBV) to associations and professional societies of the medical professions, requesting contributions to the development of an action plan for the further management of Covid-19 infections.
Specifically, the Central Institute for Statutory Health Insurance Physicians (Zi) recommends, among other things, continuing testing unchanged across all age groups. However, contact tracing measures for individuals who test positive should be prioritized according to relevance. This would apply, for example, if the number of contacts to be traced increases relative to the available resources and these resources cannot be further increased. With a high number of contacts to be traced, a few questions could determine which contacts of individuals who have tested positive should be the focus of the tracing efforts.
The focus would be on tracing the contacts of those who have or have had contact with high-risk groups and who, due to a large number of contacts, could contribute to cluster formation. Questions would be asked, for example, whether the person who tested positive works in a healthcare or nursing facility, regularly visits elderly relatives living alone or with certain illnesses, visits or has visited a nursing home, or lives in the same household as employees of a healthcare or nursing facility. If these questions are answered affirmatively, the corresponding contacts are traced; for all others, isolation is the only measure taken, as the probability of having infected further individuals is very low.
Based on a decision matrix developed by the Zi (Central Institute for Statutory Health Insurance Physicians), specific measures can be assigned to different risk levels, decided upon, and also communicated prospectively. These would specifically address the protection of vulnerable patient groups (e.g., mandatory wearing of FFP2 masks when in contact with elderly people) or the protection of the healthcare system from overload (temporary postponement of elective procedures).
„"Relying solely on contact tracing to combat the pandemic appears unrealistic. However, repeated and extensive contact restrictions also come with significant side effects. This can be mitigated, however, by a targeted adaptation of the contact tracing strategy and a decision matrix for further measures focused on vulnerable patient groups. This approach is not synonymous with the goal of allowing those not belonging to a risk group to live undisturbed lives and hoping for herd immunity. Rather, it is a plea to supplement general pandemic management measures with concrete steps for the special protection of risk groups. Furthermore, a significant increase in the intensity and scope of the measures for testing, contact tracing, and isolation should be implemented.".
The focus should be on protecting at-risk groups before making far-reaching decisions with high opportunity costs, explained Dr. Dominik von Stillfried, Chairman of the Board of the Zi.
