A new data center campus could be coming to the borderlands of West Germany Aachener Zeitung reports that an unnamed investor is looking to develop a data center campus in Gangelt a municipality in the district of Heinsberg The campus would be located on a 20-hectare site on the L47 adjacent to an existing industrial estate on the outskirts of Gangelt AZ suggests the site could host up to 13 buildings each totaling 6,300 sqm (67,813 sq ft); the campus would reportedly also have its own substation the investor wants to first clarify any outstanding questions such as the adequate power supply and present the project in detail to the public in the first quarter of 2025 Gangelt is located some 75km west of Cologne Last month the Gangelt council unanimously approved a 20-hectare special area called "Data Center Industrial Park" west of Gangelt behind the construction yard and fire department on the L47 Local Mayor Guido Willems suggested the potential to reuse excess heat from the data center could be beneficial to the town Data Centre Dynamics Ltd (DCD), 32-38 Saffron Hill, London, EC1N 8FH Email. [email protected]DCD is a subsidiary of InfraXmedia Metrics details A SARS-CoV2 super-spreading event occurred during carnival in a small town in Germany Due to the rapidly imposed lockdown and its relatively closed community this town was seen as an ideal model to investigate the infection fatality rate (IFR) a 7-day seroepidemiological observational study was performed to collect information and biomaterials from a random The number of infections was determined by IgG analyses and PCR testing We found that of the 919 individuals with evaluable infection status 15.5% (95% CI:[12.3%; 19.0%]) were infected This is a fivefold higher rate than the reported cases for this community (3.1%) 22.2% of all infected individuals were asymptomatic The estimated IFR was 0.36% (95% CI:[0.29%; 0.45%]) for the community and 0.35% [0.28%; 0.45%] when age-standardized to the population of the community Participation in carnival increased both infection rate (21.3% versus 9.5% p < 0.001) and number of symptoms (estimated relative mean increase 1.6 While the infection rate here is not representative for Germany the IFR is useful to estimate the consequences of the pandemic in places with similar healthcare systems and population characteristics Whether the super-spreading event not only increases the infection rate but also affects the IFR requires further investigation different PCR-testing capacities and regulations have contributed to the variability of reported CFRs epidemiological modeling is currently associated with a large degree of uncertainty valid epidemiological modeling is urgently needed to design the most appropriate prevention and control strategies to counter the pandemic and to minimize collateral damage to societies The IFR includes infections based on both PCR testing and virus-specific antibodies PCR testing allows the inclusion of active infections before seroconversion into IFR-calculation testing for virus-specific antibodies also includes past infections and those with mild and moderate disease courses which do not tend to be captured and documented by PCR testing alone ELISA tests for a reliable serological analysis of SARS-CoV-2-specific antibodies (specificity higher than 98%) became available only recently the reliability of serological analysis is also strongly dependent on seroprevalence We chose to perform a seroepidemiological study in the German community of Gangelt 3.1% of the population were officially reported to be SARS-CoV2 PCR positive at the time of the study 2020 were followed by a massive outbreak of SARS-CoV2 infections Strict measures were immediately taken to slow down further spreading of the infection Given its relatively closed community with little tourism and travel this community was identified as an ideal model to better understand SARS-CoV2 spreading The study presented here was designed to determine the total number of infected and the IFR co-morbidities and participation in carnival festivities a carnival celebration became a SARS-CoV2 super-spreading event in the German community of Gangelt The resulting increase in SARS-CoV2-infected people was instantly countered by a complete shutdown (schools the number of reported cases (PCRrep) reached its peak around March 13 (85 reported in a four-day period) and declined thereafter with 48 new cases reported in the seven-day study period (March 30 to April 6) at the starting point of the study (March 30) the main wave of new infections had already passed The number of PCR-positive cases found in the study population (PCRnew) was 33 (four of those reported PCR positive in the past) This situation in the community of Gangelt was ideal to assess the cumulative real number of SARS-CoV2-infected individuals (area within dotted line: PCRrep b Enrollment and flow of participants through the study statistical analysis and handling of missing values are given in the Methods section IgA and IgG were quantified (Euroimmun ELISA) in single plasma samples obtained from the study participants at one time point during the seven-day acquisition period a IgG plotted against IgA in plasma of 919 study participants (log-scale The gray line indicates equality of log(IgA) and log(IgG) b Estimated percentage of IgA reactives (>0.8; black circle: 10.63% [7.48%; 13.88%]; gray circle: raw sample proportion 170/919 18.50%) and IgG reactives (>0.8; black circle: 14.11% [11.15%; 17.27%]; gray circle: raw sample proportion Estimates were corrected for household clustering (cluster bootstrap) and for sensitivity and specificity (matrix method) of the IgA (sensitivity 100%; specificity 91.2%) and IgG (sensitivity 90.9%; specificity 99.1%) ELISA Error bars refer to 95% confidence intervals c Absolute numbers of IgG reactives (rectangle with black border) PCRnew positives (rectangle with dashed border left side) and PCRrep positives (rectangle with dashed border right side) as well as the respective overlaps of values (percentages in brackets) The number of infected (total gray area) is defined as participants positive for at least one of either IgG 15.02%; raw percentages not corrected for sensitivity and specificity) d NT titers were determined by a microneutralization assay using 100 TCID50 Titers indicate the reciprocal value of the plasma dilutions that protect 50% of the wells at incubation with 100 TCID50 Samples able to suppress the cytopathic effect (CPE) in at least all three wells of the 1:2 dilution (NT titer ≥ 2.8) are depicted above the dashed line Samples for which the CPE was suppressed in one or two wells of the 1:2 dilution are shown directly below the dashed line Samples showing a CPE in all wells with either equal or reduced severity compared to the negative control were depicted at the level of the x-axis e Samples below the dashed line in d were re-evaluated using a plaque reduction neutralization test (PRNT) The neutralizing titers were calculated as the reciprocal of serum dilutions resulting in neutralization of 50% input virus (NT50) Dotted line: upper borderline for ELISA IgG ratio Source data for b is provided as a Source Data file a The number of SARS-CoV2-positive reported cases in the study population is r = 22 The observed number of infected in the study population is known from the data available (at least one of either IgG +  919) = 0.1502 is a raw estimate of the number of infected in the whole population of Gangelt (i = 0.1502 × 12,597 ≈ 1892) A raw estimate of the IFR in Gangelt is given by the number of SARS-CoV2-associated deaths (f = 7)/(i = 1892) = 0.370% b The infection rates estimated from the IgG and PCR data in the study population corrected for both sensitivity/specificity of the ELISA (matrix method) and household clustering (cluster bootstrap) An additional correction was made for the underrepresentation of reported PCR positive (PCRrep + ) in the study population (22/919 = 0.0239) as compared to the real proportion of PCRrep + in Gangelt (388/12,597 = 0.0308) increasing the infection rate by the factor 0.0308/0.0239 = 1.2866 to 19.98% [14.13%; 32.00%] (third bar from left Note that the latter confidence interval accounts for additional uncertainty in the correction factor The bars in light gray depict the values corrected for a theoretical specificity of the ELISA of 98% (light gray) instead of the 99% provided on the data sheet of the company c Infection fatality rate calculated based on the estimated infection rate and the number of SARS-CoV2-associated deaths (7 by the end of the acquisition period the estimated IFR of 0.36% [0.29%; 0.45%] (left bar) may be an estimate at the upper limit of the real IFR in Gangelt IFR estimates were obtained by dividing the number of SARS-CoV2-associated deaths (7) by the point estimates and 95% CI limits of the infection rates in b Clinical symptoms reportedly associated with SARS-CoV2-infection were analyzed (questionnaire data) a Estimated mean number of symptoms in non-infected study participants (1.61 [1.42; 1.81]) and SARS-CoV2-infected study participants (3.58 [3.01; 4.27] estimated relative mean increase in infected = 2.23 [1.82; 2.73] rho = 0.248 [0.164; 0.332]; Poisson GEE model adjusted for age and sex: estimated relative mean increase in infected = 2.18 [1.78; 2.66] Results are based on the 876 study participants without missing values in any of the symptom items (range of the observed numbers of symptoms: 0 to 12 b Raw percentages of symptoms in the 126 SARS-CoV2-infected study participants without missing values for any of the symptoms 22.22% reported that they did not have any (most left bar on x-axis: 0) of the 15 symptoms Numbers above bars indicate the total number of individuals in the respective group c IgA and IgG levels and intensity of symptoms The boxplots depict the log(IgA) (light gray) and log(IgG) (dark gray) levels in the 126 infected study participants no association between the number of symptoms (response variable) and log(IgA) (covariable) was found Similar results were obtained from a quasi-Poisson model with the number of symptoms as response variable and log(IgG) as covariable Note: Quasi-Poisson models were used instead of Poisson GEE models because the number of households was large relative to the number of analyzed study participants No adjustments for multiple comparisons were made Source data are provided as a Source Data file study participants were clustered within households a Estimated per-person infection risk by household cluster size (black dots; 95% CIs: gray lines) Estimates and CI limits were determined by fitting a logistic GEE model with the infection status as response variable and household cluster size as a factor covariable No association between household cluster size and the per-person infection risk was found (p = 0.933) b Per-person infection risk in household clusters in which at least one person was found infected (black curve based on 86 household clusters The gray line below the black curve shows the expected per-person infection risk under the assumption that infection statuses of the household cluster members are independent Estimates and CI limits were determined by fitting a logistic GEE model with the infection status as response variable and household cluster size as a factor covariable (excluding 13 household clusters of size 1 each) An association between household cluster size and the per-person infection risk was found (p < 0.001) The excess per-person infection risks are given by the deviations of the black curve from the gray reference curve (71.79% – 54.21%  = 17.59% Under the assumption that transmissions to household members occurred independently and were due to only one infected person in each household the black curve further allows for an estimation of the secondary infection risk: Assigning a 100% risk to the already infected household member these risk estimates are given by (71.79% × 2 – 100%) = 43.59% and 4-person household clusters (compared to an unconditional estimated infection risk of 15.53%) The boxplots depict the log(IgG) levels of the infected study participants in subgroups defined by the presence of co-morbidities and celebrating carnival In Gaussian models with log(IgG) as response variable Analysis was based on the 127 infected study participants that had complete data in the co-morbidity and carnival variables Absolute numbers of study participants (left to right): 19 a The association with the lifestyle factor “celebrating carnival” was analyzed (questionnaire “have you celebrated carnival?” yes/no) Celebrating carnival was not limited to attending the main carnival event (Kappensitzung in Gangelt) Estimated infection rate (%; with 95% CIs) of participants not celebrating carnival (light gray) and participants celebrating carnival (dark gray) Point estimates (filled circles) and CIs were obtained by fitting a logistic GEE model with infection status as response variable and carnival (yes/no) as a factor covariable The bars represent the raw percentage values There was a positive association between celebrating carnival and infection status (OR = 2.56 [1.67; 3.93] Similar results were obtained when adding sex and age as covariables to the GEE model (OR = 3.08 [1.92; 4.95] Analyses were based on the 915 participants that had complete data in both the carnival and the infection variables b Estimated mean number of symptoms in infected participants not celebrating carnival (light gray) and in infected participants celebrating carnival (dark gray) Point estimates (filled circles) and CIs were obtained by fitting a quasi-Poisson model with the number of symptoms as response variable and carnival (yes/no) as a factor covariable The quasi-Poisson model was used instead of a Poisson GEE model because the number of households was large relative to the number of analyzed study participants There was a positive association between celebrating carnival and the number of symptoms (estimated relative mean increase = 1.63 [1.15; 2.33] Similar results were obtained when adding sex and age as covariables to the model (estimated relative mean increase = 1.62 [1.12; 2.34] Analyses were based on the 124 infected participants that had complete data in both the carnival and infection variables c Raw percentages of infected participants celebrating carnival Adjustments for multiple comparisons were made as indicated an infected participant was defined as either PCR positive thus including present and past infections seropositives were expected to cover all infections except the very recent This may become different as the pandemic continues since a decrease in antibody titers over time needs to be considered in the calculation of the IFR the collection of materials and information including the reported cases and deaths was closed at the end of the study acquisition period (April 6) and the IFR was calculated based on those data some of the individuals still may have been acutely infected at the end of the study acquisition period (April 6) and thus may have succumbed to the infection later on in the 2-week follow-up period (until April 20) one additional COVID-19 associated death was registered The inclusion of this additional death would bring up the IFR from 0.36% to an estimated 0.41% ([0.33%; 0.52%] in Gangelt [0.21%; 0.84%] if accounting for uncertainty in the number of deaths) in the same situation including the 8th death correction for underrepresentation of reported PCR positives would bring the estimated IFR from 0.41% down to 0.32% [0.20%; 0.45%] in the community of Gangelt asymptomatic infected individuals in our study presented with substantial antibody titers at this point our study uses IgG values as an indicator whether an individual was infected but not as evidence for existing immunity a certain degree of protection might exist even if the IgG levels are below the detection threshold of the ELISA Such individuals are not counted as infected in our study yet this hidden number of infected could possibly represent an important component towards immunity in a population The analysis of anti-SARS-CoV2 IgM might help to further close this window in the future It is important to note that the infection rate in Gangelt is not fully representative for other regions in Germany or other countries. Possible limitations of this study include the following: (i) as shown in Supplementary Fig. 1 the age group of 65 years or older is overrepresented in the study cohort compared to the community of Gangelt Reasons could be that elderly people due to retirement may have had more time to participate in a study; second there may have been a higher awareness of risk because severe cases are presumed to be more likely to occur in this age group; and third immobile individuals were offered to be visited at home (ii) Study participants (all and infected) who attended carnival were younger (mean of 41 ± 20 and 45 ± 20 years) than study participants who did not attend carnival (mean of 57 ± 20 and 60 ± 21 years) it is possible that due to the younger age of participants in the super-spreading event in Gangelt the age distribution of the infected persons is different from the age distribution of infected in situations without a super-spreading event with a possible bias of the IFR towards younger age since all individuals who died in the community until the end of the study period were older than 65 years the present study allows for calculating an estimate of the IFR specifically for the group of older people (>65 years) This estimate is given by 7/(estimated number of infected people in the community ≥ 65 years) = 1.93% [1.39%; 3.05%] and is clearly higher than the respective estimate for the whole population in the community (0.36%) (iii) Study participants who attended carnival festivities may have been more aware of the risk to acquire an infection and may have been more prone to monitor and recall symptoms the possible differences in reporting and recall rates rather than exposure to a higher viral load may partially explain the higher number of symptoms in study participants who attended carnival the IFR calculated here remains a useful metric for other regions with higher or lower infection rates if the IFR calculated here were applied to Germany with a number of 6575 SARS-CoV-2-associated deaths (May 2nd the estimated number of infected in Germany would be higher than 1.8 Mio (i.e. It will be very important to determine the true average IFR for Germany because of the infection rate of ~2% in May 2020 as estimated based on the IFR an ELISA with 99% specificity will not provide reliable data under the current non-super-spreading conditions it is more reasonable to determine the IFR in high- prevalence hotspots such as in the community studied here the data of the study reported here will serve as baseline for follow-up studies to identify the corresponding IFR under different hygiene conditions This study was conducted between March 31st a community with 12,597 inhabitants (as of January 1st 2020) located in the German county of Heinsberg in North Rhine-Westphalia For this cross-sectional epidemiological study Enrollment was based on a sample of 600 persons contained in the Heinsberg civil register (“Melderegister”) which is the public authority that collects all names and addresses of the inhabitants of Gangelt Sampling was done randomly under the side condition that all 600 persons had different surnames as it was assumed that different surnames were likely to indicate different households the 600 selected persons were contacted by mail and were invited to the study acquisition center which was established at the site of a public school in Gangelt The letters sent to the 600 selected persons also included invitations for all persons living in the respective households to participate in the study Persons aged older than 80 years or immobile were offered the opportunity to be visited at home written and informed consent was provided by the persons with care and custody of the children following aged-adapted participant information After having provided written and informed consent study participants completed a questionnaire querying information medication and participation in carnival festivities (main carnival session “Kappensitzung” and others) study participants were asked to provide blood specimens and pharyngeal swabs In addition to the data provided by the study participants aggregated data on mortality and socio-demographic characteristics were collected The latter data were provided by the district administration of Heinsberg and the Statistics & IT Service of the German federal state of North Rhine-Westphalia The results presented were obtained in the context of the larger study program termed COVID-19-Case-Cluster Study. The study was approved by the Ethics Committee of the Medical Faculty of the University of Bonn (approval number 085/20) and has been registered at the German Clinical Trials Register (https://www.drks.de The study was conducted in accordance with good clinical (GCP) and epidemiological practice (GEP) standards and the Declaration of Helsinki (2013) due to time constraints in the situation of the pandemic this epidemiological non-interventional study was registered April 14 2020 shortly after the study period (March 31 to April 6 To further assess the neutralizing activity of plasma samples exhibiting neutralizing antibody titers below 2.8 in the microneutralization test a plaque reduction neutralization test was performed heat inactivated plasma samples were serially twofold diluted starting with 1:2 up to 1:1024 One-hundred twenty microliters of each plasma dilution was mixed with 100 plaque forming units (PFU) of SARS-CoV-2 in 120 µl OptiPROTMSFM (Gibco) cell culture medium 200 µl of each mixture were added to wells of a 24-well plate seated the day before with 1.5 × 105 Vero E6 cells/well the inoculum was removed and cells were overlayed with a 1:1 mixture of 1.5% carboxymethylcellulose (Sigma) in 2xMEM (Biochrom) with 4% FBS (Gibco) After incubation at 37 °C for three days in 5% CO2 the overlay was removed and the 24-well plates were fixed using a 6% formaldehyde solution and stained with 1% crystal violet in 20% ethanol REDCap (Research Electronic Data Capture) is a secure web-based software platform designed to support data capture for research studies providing (1) an intuitive interface for validated data capture; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for data integration and interoperability with external sources Questionnaire data were recorded on site using paper case report forms and were entered into the electronic study database using double data entry by trained study personnel Comparisons between entries were made by the data management unit of the SZB; non-matches were corrected after assessing the original paper case report forms plausibility checks of demographic data were performed Study personnel were trained with respect to informed consent and study procedures prior to inclusion of first study participant The study team was supported on site in Gangelt by a quality control manager who refined workflow processes and monitored critical processes such as obtaining informed consent regulatory advice could be given whenever asked for or needed Data entry personnel was trained for double data entry prior to data entry and only then granted database access authorization Contact with the responsible data managers could be established when needed Diagnostic data were imported into the trial database automatically via validated interfaces critical data was monitored by an experienced clinical trial monitor which included (but was not limited to) a check of availability of source data (completed questionnaires) random source data verification of diagnostic data and a check of signatures of all informed consent forms obtained According to the recommendations stated in the protocol a size of 200 samples is sufficient to estimate SARS-CoV-2-prevalence rates <10% with an expected margin of error (defined by the expected width of the 95% confidence interval associated with the seroprevalence point estimate obtained using binomial likelihood) smaller than 10% In order to rule out larger margins of error due to dependencies of persons living in the same household and to be able to analyze seroprevalence (i.e. infection rates) also in subgroups defined by participant age it was planned to recruit 1000 participants living in at least 300 households Statistical analysis was carried out by two independently working statisticians (M.S. M.B.) using version 4.0.0 of the R Language for Statistical Computing (R Core Team 2020: R: A Language and Environment for Statistical Computing Austria) and version 9.4 of the SAS System for Windows (copyright © 2002-2012 by SAS Institute Inc. Participants with a missing anti-SARS-CoV-2 IgG or PCR test result were excluded from analysis as they were not evaluable for infection status Participants that did not report a previous positive PCR test result were documented as PCRrep negative Missing and unknown values in the co-morbidity and symptom variables were not imputed as listwise deletion reduced sample sizes by less than 5% Age groups were formed according to the classification system of the Robert Koch Institute (RKI) which is the German federal government agency and research institute responsible for infectious disease control and prevention Descriptive analyses included the calculation of means (plus standard deviations sds) and medians (plus minimum and maximum values) for continuous variables with percentages) for categorical variables Associations between continuous variables were analyzed using the Pearson correlation coefficient (r) Boxplots were generated using the R Language for Statistical Computing GEE models with a logistic link function were applied Results of logistic GEE models are presented in terms of either back-transformed mean estimates (GEE models with a single covariable) or odds ratios (ORs Note that odds ratio estimates obtained from a GEE model with logistic link function are “population-averaged” in the sense that they represent ratios of population odds but not ratios of an individual’s odds Poisson GEE models with a logarithmic link function were used Results of Poisson GEE models are presented in terms of either back-transformed mean estimates (GEE models with a single covariable) or estimated relative mean increases/decreases (GEE models with ≥1 covariables) the estimated correlation between participants living in the same household cluster (rho) is reported Wald tests were used for hypothesis testing All CIs presented in this work were computed using the 95% level CIs are Wald CIs and were not adjusted for multiple comparisons unless otherwise stated All statistical hypothesis tests were two-sided The Bonferroni–Holm procedure was applied to adjust p-values for multiple comparisons as indicated The age-standardized IFR estimate and its CI limits were calculated by dividing the number of deaths (7) by the age-standardized estimated number of infected and its CI limits For the analysis of household clusters in which at least one person was found infected (Fig. 5b) the expected per-person infection probability under the assumption that infection statuses of the household cluster members are independent (gray line) was computed by evaluating the conditional probability p (person is infected | at least one person in the same household cluster is infected) Assuming the unconditional infection probability to be p = 0.1553 the aforementioned conditional probability is derived as p/(1 – (1 – p)2) = 0.542 Further information on research design is available in the Nature Research Reporting Summary linked to this article The data contain information that could compromise the privacy of research participants Data sharing restrictions imposed by national and trans-national data protection laws prohibit general sharing of data upon submission of a proposal to the principal investigator of this study and approval of this proposal by (i) the principal investigator (ii) the Ethics Committee of the University of Bonn and (iii) the data protection officer of the University Hospital Bonn data collected for the study can be made available to other researchers A source data file that contains the numbers presented in the figures (i.e. standard deviations etc.) is provided with this paper World Health Organization. Coronavirus (COVID-19) Dashboard. WHO, https://covid19.who.int/ (2020) Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): facts and myths The Centre for Evidence-Based Medicine. Global Covid-19 Case Fatality Rates. CEBM, https://www.cebm.net/covid-19/global-covid-19-case-fatality-rates/ (2020) COVID-19 with different severity: a multi-center study of clinical features Comorbidities and multi-organ injuries in the treatment of COVID-19 Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection Aerosol emission and superemission during human speech increase with voice loudness Preexisting influenza-specific CD4+ T cells correlate with disease protection against influenza challenge in humans Validation of the wild-type influenza A human challenge model H1N1pdMIST: an A(H1N1)pdm09 dose-finding investigational new drug study Viral load kinetics of MERS coronavirus infection Viral loads in clinical specimens and SARS manifestations Super-spreading events and contribution to transmission of MERS Presumed asymptomatic carrier transmission of COVID-19 Li, W. et al. The characteristics of household transmission of COVID-19. Clin. Infect. Dis. https://doi.org/10.1093/cid/ciaa450 (2020) COVID-19 National Emergency Response Center Korea Centers for Disease Control and Prevention Coronavirus disease-19: summary of 2,370 contact investigations of the first 30 cases in the Republic of Korea Secondary attack rate of pandemic influenza A(H1N1) 2009 in Western Australian households Probable secondary infections in households of SARS patients in Hong Kong Braun, J. et al. SARS-CoV-2-reactive T cells in healthy donors and patients with COVID-19. Nature https://doi.org/10.1038/s41586-020-2598-9 (2020) Serological assays for emerging coronaviruses: challenges and pitfalls Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease Non-neutralizing antibodies from a marburg infection survivor mediate protection by fc-effector functions and by enhancing efficacy of other antibodies Immune correlates of vaccine protection against HIV-1 acquisition Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor Determination of 50% endpoint titer using a simple formula The REDCap consortium: building an international community of software platform partners Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support Population-Based Age-Stratified Seroepidemiological Investigation Protocol for COVID-19 Virus Infection (HINARI Statistical analysis of correlated data using generalized estimating equations: an orientation Estimating prevalence from the results of a screening test Bootstrap Methods and Their Application (Cambridge University Press Download references The government of the German Federal State of North Rhine-Westphalia unconditionally provided 65,000 Euro to support the study are members of the Excellence Cluster ImmunoSensation EXC 2151—390873048 We would like to thank the inhabitants of Gangelt for their participation We would also like to thank the local government of Kreis Heinsberg for their support to conduct the study Art Krieg and André Karch for critical reading of an early version of the manuscript and Helmut Küchenhoff for statistical advice we would like to thank the following people who helped with the study: Gero Wilbring We thank the Medizinischer Dienst der Krankenkasse (MDK) Nordrhein for their generous help in conducting this study In particular we would like to thank: Tanja Bell and Georg Nickenig for providing control samples and the writing of the manuscript of this study were independent of any third parties including the government of North Rhine-Westphalia Open Access funding enabled and organized by Projekt DEAL German Center for Infection Research (DZIF) Institute of Clinical Chemistry and Clinical Pharmacology Birgit Stoffel-Wagner & Gunther Hartmann Martin Exner & Ricarda Maria Schmithausen contributed to the data acquisition and analysis of the data revised the work critically for important intellectual content The authors declare no competing interests Peer review information Nature Communications thanks Leonhard Held and the other reviewer(s) for their contribution to the peer review of this work Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Download citation DOI: https://doi.org/10.1038/s41467-020-19509-y Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article Sign up for the Nature Briefing newsletter — what matters in science Study will follow 1,000 people in Heinsberg to create plan for how to deal with virus German scientists have announced what they described as a first-of-its-kind study into how coronavirus spreads and how it can be contained using the country’s worst-hit district as a real-life laboratory The virus has spread more widely among the 250,000 residents of Heinsberg – a district in North Rhine-Westphalia bordering the Netherlands – than anywhere else in Germany with 1,281 confirmed infections and 34 deaths More than 550 people have recovered from the illness so far nicknamed “Germany’s Wuhan” after the Chinese city where the global pandemic emerged is between two to two and a half weeks ahead of the rest of the country Over the coming weeks the district will be used by leading virologists and a team of 40 medical students as a sort of laboratory for studying the virus will follow 1,000 people who have been chosen because they are representative of the German population as a whole The results will be used to create a blueprint for how Germany might deal with the virus over the next few years the head virologist at the University of Bonn “This is a big chance for the whole of Germany,” Streeck told a meeting of parliamentarians that was streamed live on television “We’ll be gathering information and practical tips as to how to deal with Covid-19 and how we can achieve further containment of it without our lives having to come to a standstill over a period of years.” ShowThe World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus for which there is no specific cure or vaccine The UN agency advises people to: Many countries are now enforcing or recommending curfews or lockdowns Check with your local authorities for up-to-date information about the situation in your area.  NHS advice is that anyone with symptoms should stay at home for at least 7 days If you live with other people, they should stay at home for at least 14 days to avoid spreading the infection outside the home Thank you for your feedback.The study’s results will potentially have implications for other countries The scientists will go into 500 households They will look at every aspect ofeveryday life from the extent to which children pass it on to adults how it is spread within families – from mobile phones to door handles to cups and TV remote controls – to whether pets can spread it and whether it is transferred via certain types of food “If there are ways of preventing the illness from spreading in our environment with the goal of finding out how we can freely move about in the environment together,” Streeck said “On the basis of our findings we’ll be able to make recommendations which politicians can use to guide their decision-making,” Streeck said “It could be that the measures currently in place are fine and we say: ‘Don’t reduce them.’ But I don’t expect that that we will be able to come up with a range of proposals as to how the curfews can be reduced.” By testing the immunity to Covid-19 of the study’s participants the scientists will also be able to establish what the estimated number of undetected cases might be nationwide The first results are expected to be made public next week though the entire gathering of evidence will take several weeks and its analysis is likely to be carried out over months and years Streeck said he was unaware of any other studies of its kind being carried out in other hotspots He was surprised that the government’s advisers on public health matters had not come up with the idea already He said he hoped the study would help decision-makers in the “ethical dilemma” of establishing a balance between maintaining livelihoods and managing the death rate Please enable JS and disable any ad blocker Use of and/or registration on any portion of this site constitutes acceptance of our User Agreement, (updated 8/1/2024) and acknowledgement of our Privacy Policy, and Your Privacy Choices and Rights (updated 1/1/2025) © 2025 Advance Local Media LLC. 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District administrator tells Jessica Bateman how Heinsberg avoided huge levels of fatalities after becoming country’s first epicentre for Covid-19 I would like to be emailed about offers, events and updates from The Independent. Read our Privacy notice When Heinsberg a small rural region close to the Dutch border district administrator Stephan Pusch saw an opportunity He reached out to the Chinese city and offered a partnership “The people of Wuhan and Heinsberg have had the same experience.” Since February, this village-filled district in the state of North-Rhine Westphalia has been home to Germany’s biggest Covid-19 outbreak A total of 1,711 cases have been recorded out of a population of 250,000 Other regions in Germany had time to stock up on ventilators and PPE but Heinsberg was forced immediately into crisis mode And it worked – now there are just 337 people infected The actions taken here have become a blueprint for others on how to respond to the pandemic It started when two patients with Covid-19 were submitted to intensive care in the local Hermann-Josef hospital on 25 February yet were in real life-or-death situations,” says Mr Pusch The couple had also been at carnival celebrations the week before: “It really was the worst possible conditions for spreading the virus.” The district’s crisis unit met that day and decided to lock down the region immediately “We closed schools and kindergartens and told people how to behave,” he says The rest of the country did not enter lockdown until mid-March Intensive care capacity at the small rural hospital was reached within two weeks of the outbreak beginning and staff soon suffered PPE shortages “We used in one month what we usually use in a year,” says hospital director Jann Habbinga The solution was quick cooperation with other hospitals and 30 patients were transferred elsewhere And although Germany has been praised for carrying out large numbers of coronavirus tests Mr Pusch says that it took time to work out how to deliver these “You don’t want infected people coming to the hospital,” he says and appointments are booked by phone to avoid queues The shortage of PPE also led Mr Pusch to accept donations from Chinese enterprises – a decision criticised by some as playing into the country’s propaganda strategy It also led to the aforementioned offer of a partnership: “It’s not to connect the officials Both people had a serious problem and they had to solve it.” As the idea of lockdown was unfamiliar in Germany at that point, the politician, who is from Angela Merkel’s CDU party also knew he had to communicate with the public effectively He began making daily Facebook livestreams updating residents and explaining what decisions were being made and why He believes this has been a key factor in the district’s success “I try not to use typical political speech but understandable that builds trust… You have to bring people together in solidarity so they know this is a problem we have to solve together.” One of his first priorities was to try prevent people taking out their stress on each other “I know the dangers of social media.” He also has also used the platform to quickly correct fake news messages and to warn against panic buying also started a #HSbestrong hashtag and Facebook page to help reinforce the message On the Facebook page “You Know You’re From Gangelt When…” a community page for the worst-hit town Gangelt residents are discussing whether Mr Pusch should receive a Merit Medal from the German government Both he and Mr Habbinga say the quick decision making and solution finding was down the good cooperation in the crisis team which practices emergency simulations every year “Our job will be to keep a really close view on how new cases spread,” he says. “When you have hundreds of cases [contact tracing] becomes impossible.” Like other politicians, he is pinning hopes on the development of an app that will help with contact tracing without infringing on privacy. “I hope this will work,” he concludes. Join thought-provoking conversations, follow other Independent readers and see their replies Pusch is just trying to say that the human can take on antisocial characteristics when placed under considerable pressure you need to tread lightly with people experiencing the kind of crisis seen in Heinsberg right now There are some moments when people just lose it Heinsberg District Administrator Stephan Pusch: "As long as I'm in charge on Tuesday morning and the district administrator glances at his watch there are 84 registered cases of coronavirus in his district The first infected people were registered a week ago They had been celebrating carnival festivities for the past 10 days in the town of Gangelt The married couple became the first registered cases of COVID-19 in the state When Germany’s federal health minister called Pusch directly the administrator knew the situation was going to be a big deal Heinsberg has become a case study for Germany of how a district can respond to a health crisis like this When the district administrator meets a reporter The crisis team is about to meet in what will be the first of two or three meetings on this day Pusch sits in a conference room in the district offices Confused local residents stand outside the administrative offices The situation in the district is anything but business as usual Heinsberg is a flat region containing villages lined with brick rowhouses single-family homes with gravel front gardens Many people are staying at home in voluntary quarantine who live just across the border and often shop here are also keeping away Even healthy residents are staying indoors out of fear of the invisible threat and there are few customers at local book and shoe stores A pharmacist wearing gloves passes cough drops and medication through the pharmacy’s night-service window even fathers and mothers who want to see their newborn babies are stopped and asked about whom they have had contact with and whether they have a fever The local jail isn’t allowing any visits at all A flea market for children’s goods has been cancelled as has a meetup for local senior citizens and all soccer matches in the district this weekend talks about the first crisis meeting on Feb 25 and his visit to the state health minister the next day Coronavirus testing site in Gangelt: What's worse The meeting was held to discuss the case of a man who had attended a large party with his wife hosted by a local carnival association on Feb The man had danced a comedic ballet performance at the party and is now in serious condition at a hospital in Düsseldorf Pusch says he also wants to share bad news with the people in his district because he believes in transparency and communication He regularly addresses residents in videos posted on the district administration’s website and on Facebook he had published 11 videos since the beginning of the coronavirus crisis The most impactful video is probably the sixth a response to false information spread on social media claiming that people weren’t complying with the quarantine and that restricted areas would be set up Pusch told residents: "As long as I'm in charge given that entire cities and villages had been sealed off in Italy "That’s not the kind of approach you can convey to the people of Germany including quarantines and restricted areas homes of people suffering from the plague were marked with a cross on the door Pusch doesn’t think much of the idea of placing police watches in front of every home He says he spent time thinking about his own own capacities and the feelings of local residents Pusch says people "grew very alarmed by the false report.” If there hadn’t been a response to it "people would have broken out in panic” and attempted to flee - the infected and the non-infected alike The district shares a 78-kilometer long border with the Netherlands and Pusch says sealing off an area that big would have required the deployment of the German military Crises like these can only be solved together Supermarket shelves in Heinsberg: "I won’t take the risk of endangering my children." The question now is how bad the crisis actually is Experts say that there are only mild symptoms or none at all in 80 percent of the people infected and the mortality rate is between 0.3 and 0.7 percent The big questions now being asked over the cancellation of trade fairs travel cancellations and panic buying around the world The biggest: What’s worse – the virus or the panic it is fueling the district administrator could be putting local lives at risk he could paralyze public life and the economy Pusch ordered the closure of local schools and daycare centers until the end of the first week of March but he doesn’t want to have everyone and everything tested determined that it wasn’t necessary to test every single person who had been to the carnival party in Gangelt They felt that telling people they should stay home for 14 days went far enough One woman who was at the party and is still awaiting her test results at home is having difficulty grappling with what is going on she explains how she contacted the local public-health authorities who directed her to get in touch with her family doctor The doctor then told her to contact the public-health authorities She says she hasn’t heard anything else from the health office since She then waited for days and decided to have her doctor test her for the illness The woman says she can’t understand why tests aren’t being given to each of the 300 people who attended the party She recalls that when she recently cleaned her bathroom and her husband asked if he should help her so that I’ll still have something to do tomorrow.” She says that the social surveillance feels very real and that she doesn’t even dare to go to the mailbox out of fear that people will start talking about it that they might accuse her of acting irresponsibly drew a cross with his fingers when he saw her standing in the window The article you are reading originally appeared in German in issue 11/2020 (March 7th Seven Decades of Quality Journalism: The History of DER SPIEGEL  Reprints: How To License SPIEGEL Articles  a Facebook group that she administers and a caring nature When she heard about the quarantine – at one point it affected around 1,000 people in the Heinsberg district – she thought to herself The offer from her and a few others was posted in a Facebook group called "You’re a Gangelt Resident If You ...,” which has been transformed since the virus arrived in the Heinsberg district the group addressed questions like: Does anyone know a good glazier People posted about trash had been left in the forest a sheep that had been caught in a fence or a highland cow that had given birth to a pretty calf Now its members ask whether the district administrator will reopen schools and daycare centers I think it's too dangerous." Another mother agrees: "My children will be staying home I will teach them until everything is contained I won’t take the risk of endangering my children I’ll get a sick note for them and all will be good.” There are also numerous posts about medical care "It took me almost three hours to get through to my family doctor on the phone,” one laments "I’ve been trying for about an hour and I have already dialed the number over 150 times.” Some medical offices had to close after coming into contact with patients infected with the coronavirus and now the remaining doctor’s offices are overloaded as are the backup emergency telephone numbers These concerns are also being registered with a local district hotline for the public A central emergency center for coronavirus tests has been set up in the gymnasium of a school in Gangelt and a second clinic is open for testing in the nearby town of Erkelenz but patients and even doctors remain confused about the procedures Pusch is calling for help from the Association of Statutory Health Insurance Physicians He also says it’s impossible to adhere to the rules set out by the Robert Koch Institute ordering that any doctor who has come into contact with infected patients to stop working with patients Pusch also believes that doctors who aren’t showing any symptoms should be allowed to work says she’s worried about her husband and her children but he can’t keep substituting for other doctors at his clinic indefinitely She says there’s no protective gear available and her husband can’t protect himself or even their children some protective gear has since been delivered Pusch says that the real price of cost cuts is now being felt in the corona crisis which he describes as a "test of resilience.” He asks Pusch describes an idea that contradicts previous crisis-management efforts He says that anyone who has come in contact with an infected person should monitor whether they have any symptoms of the illness they should go on with their everyday lives "I’d have to place the entire district under quarantine.” Pusch also says he is acting pragmatically and that the situation is "dynamic.”   the current pathogen isn’t Ebola or the earlier SARS virus and most of the cases seen so far have been mild it has been something of a dress rehearsal for Germany a production most are hoping will never make it to the stage sharing drinks from the same glass all helped spread the virus On 15 February, a merry crowd wearing clown wigs and jester hats gathered in the town hall of Gangelt, a small western German municipality nestled by the Dutch border, to ring in the peak of the carnival season. Beer and wine flowed aplenty as approximately 350 adults in fancy dress locked arms on long wooden benches and swayed to the rhythm of music provided by a live band. During an interval in the programme, guests got up to mingle with friends and relatives at other tables, greeting each other as Rhineland tradition commands, with a Bützchen, or peck on the cheek. Read moreA carnival committee of 11 men in red-and-white uniforms compered the four-hour event and gave speeches on topical issues the virus that had been detected on German soil for the first time two weeks earlier Yet the coronavirus is the single reason why the carnival session in Gangelt is now drawing close attention from scientists from around the world: seven people who walked out of the event later tested positive for the virus A 47-year-old man who performed in the “male ballet” at the Gangelt carnival was the first person in Germany admitted to intensive care with the infection Gangelt is in the Heinsberg district, which is home to 42,000 people and has since had 1,442 infections and 43 fatalities more than any other administrative district in the country The national media has started to refer to it as “Germany’s Wuhan” A deserted main street in Gangelt Photograph: Lukas Schulze/Getty ImagesA hundred days after a Chinese government website announced the discovery of a “pneumonia of unknown cause” it has become clearer that the dynamics behind the virus’s rapid expansion across the globe has relied heavily on such “cluster effects” Each of the countries most heavily hit by the pandemic has reported similar stories of social cultural or religious gatherings where large numbers spent numerous hours in close company – holding hands sharing drinks from the same glass – which then turbo-charged the spread of the pandemic “One pattern we are seeing across the globe is that wherever there was singing and dancing the virus spread more rapidly,” said Prof Hendrik Streeck a virologist at the University of Bonn whose team of researchers has spent the last week carrying out the first “Covid-19 case cluster study” in Heinsberg “Most infections didn’t take place in supermarkets or restaurants,” Streeck said of his preliminary findings his team of coronavirus detectives could find scant evidence of the virus being transmitted via the surfaces of door handles Early theories that the virus at the carnival party in Gangelt could have been transmitted through the dishwater in the kitchen turned out to be a red herring: most guests drank their beer from bottles transmission took place at “events where people spent a length of time in each others’ close company” such as apres ski parties in the Austrian resort of Ischgl the Trompete nightclub in Berlin and a football match in northern Italy “Mass events are a perfect opportunity for the virus as people meet total strangers,” said Niki Popper a mathematician at Vienna’s Technical University whose team has been developing a simulation that could help governments predict the development of the pandemic more accurately Instead of merely multiplying the number of daily cases by a certain factor Popper’s example tries to account for what he calls the starting point of “local epidemic networks” “If you have 100 or 200 people spend enough time in a room with a person carrying the virus then for example 20 might walk out with the new infection and pass it on to their families and workmates the virus can thus multiply 200 times with only one new incident - and then continue.” Large parties played a key role in the pandemic’s rapid expansion not just in central Europe, but also in the US and Australia. New York may now be the centre of the US outbreak but the traditional festivities around Mardi Gras is thought to have been a catalyst for a large outbreak in New Orleans and an estimated tourist crowd of 1.4 million people from all over the world were swallowed up in a tide of music cocktails and revelry for the climax of carnival People in The French Quarter on the final day of Mardi Gras in New Orleans on 25 February Photograph: Dan Anderson/EPAAs is traditional in this Louisiana city on the Mississippi gatherings and parades had begun weeks before Many people flung the doors of their houses open and crammed in friends There were no social restrictions during carnival on 20 March did the mayor of New Orleans issue a stay-at-home order for the city with Louisiana ordering statewide restrictions two days later closing schools and all non-essential businesses The first death in the city occurred on 13 March of which 70% were clustered in New Orleans On 1 April the death toll in the state reached 273 it provided the perfect conditions for the spread of this virus,” said Rebekah Gee head of Louisiana State University’s healthcare services division We shared each other’s space in the crowds People were in close contact catching [strings of] beads It is now clear that people also caught coronavirus,” she added For health authorities that were still trying to track and contain individual infections at this stage of the pandemic party clusters represented a particular challenge since revellers would often travel from and return to other regions at least 30 people including backpackers became infected after attending a crowded dance party at Bondi Beach’s Bucket List pavilion on 15 March The party took place the night before restrictions came into force on gatherings of more than 500 people during a weekend of mixed messages from the authorities Australia’s prime minister was urging people not to gather in large numbers but also saying he would go to a football game Many of those who attended the “Back to Boogie Wonderland – Tropicana” event which told people to release their “inner Caribbean dancer” later retired to local backpacker hostels with dorm rooms and shared facilities which encompasses Bondi and its backpacker community A Bondi resident leaves a Covid-19 testing clinic near Bondi Beach in Sydney Photograph: Dean Lewins/EPAPray-ins and funeralsIn many countries partygoers and organisers have found themselves on the receiving end of a backlash the Bucket List’s Facebook page is full of livid comments condemning “idiots” who gathered to party cars with Heinsberg number plates have had their windows smashed and have been jeered as “corona spreaders” But the novel coronavirus did not require social gatherings to have an overtly hedonistic character to flourish around 2,500 worshippers gathered at the Porte Ouverte Christian church in the Bourtzwiller district of Mulhouse for one of the most anticipated events in the evangelical calendar They came from far and wide including from France’s overseas territories and Corsica for a week of fasting and prayer – held annually for the last 25 years sometimes while praying during the services,” Nathalie Schnoebelen spokesperson for the church said afterwards nobody thought more of it; it would be almost a month before France went into a national lockdown A small cluster of coronavirus cases had broken out in the unfortunately named Contamines ski resort in the Alps but most coronavirus cases were still confined to China “Contrary to what certain politicians have said we didn’t ignore the basic rules because at the time there were not any,” Schnoebelen said It was only after the congregation at the Porte Ouverte had dispersed and several worshippers tested positive for the coronavirus that concerns were raised. Among those who tested positive were the church’s main pastor, Samuel Peterschmitt (son of Jean Peterschmitt, who founded the Porte Ouverte church in 1966) 8:07How coronavirus changed the world in three months – videoIn total 18 people from the Peterschmitt family tested positive for Covid-19 Samuel Peterschmitt’s son Jonathan admitted that worshippers had been in close confines for a week in “conditions relatively ideal if a virus wants to develop” By the time it had been identified as a cradle for the virus church worshippers had unwittingly passed it on to others A nurse who had been at the Porte Ouverte is believed to have originated a cluster that contaminated 250 colleagues at Strasbourg University hospital Two retired worshippers returned to their home in the Ajaccio region of the Mediterranean island of Corsica There are now at least 263 positive cases and 21 deaths on the island A delegation of five church-goers from French Guiana led by their evangelical pastor Gilles Sax returned to the French overseas territory on the north-east coast of South America Sax said he felt ill and was “trembling like a leaf” as soon as he returned. Other worshippers returned to cities and towns across France - Orléans around 100 coronavirus cases had been linked to the church prayer week Today, Mulhouse is one of the worst-hit areas in France with local hospitals overwhelmed by patients with the coronavirus.Christophe Lannelongue, until yesterday director general of the regional health authority said: “It was a kind of atomic bomb that fell on us at the end of February and we didn’t notice it.” Fans celebrate as Atalanta score in the match in the San Siro on 19 February Photograph: Kieran McManus/BPI/Rex/ShutterstockBut scientists like Massimo Galli the head of the infectious disease unit at the Sacco hospital in Milan believe the spread is more likely to have accelerated in smaller clusters in the valleys around Bergamo “We know Covid-19 is particularly efficient at transmitting within familial groups,” Galli told the Guardian it would have found a perfect environment.” A similar gathering that brought together older and younger citizens preceded an outbreak of the virus in Italy’s south-east hundreds of people gathered to pay their last respects at the funeral in San Marco in Lamis The 74-year-old man being buried had died after complications of what seemed to be a case of seasonal flu there had been seven cases of coronavirus infection in Puglia The photos of patients in the red zones of northern Italy much like the national lockdown that was extended a few days later across the entire country who had just begun mourning the death of her husband received a call informing her that her husband had tested positive for coronavirus head of the public prosecutor’s office in Foggia “a postmortem revealed the man was infected with Covid-19 but the result came out only after his body was released to the family for the funeral They should have waited for the result of the test before handing over the man’s body.” the man had infected his daughter and wife before he died they then came into contact with dozens of relatives and friends who gave their condolences to the family with handshakes and hugs opening a gateway for one of the first clusters in southern Italy dozens of whom tested positive for coronavirus The prosecutor’s office in Foggia has begun an investigation into what the governor of Puglia has called a “catastrophic error” Behind one of the most dramatic cases of the virus’s spread is human error: if doctors had waited for the test results before handing over the body to family members perhaps dozens of people could have avoided infection 4:41Why are coronavirus mortality rates so different – video explainerA loop not a curveThinking of the coronavirus pandemic as a process that can speed up dramatically through human clusters also affects the considerations of policymakers who are plotting a route out of the current lockdown When governments start to relax the current social distancing measures can they also afford to allow large social cultural or religious gatherings to go ahead “The image of the Covid-19 epidemic as a curve has taken hold in the collective imagination but my fear is that we are actually dealing with a loop,” said mathematician Popper there could be new clusters that allow the spread to accelerate again.” The story of the pandemic in Vietnam serves as a cautionary tale The south-east Asian country recorded its first cases of coronavirus on 23 January a development that prompted swift action from officials Vietnam kept many schools closed following the traditional lunar new year holiday late in January and banned flights to and from China on 1 February It also became the first country outside China to introduce a mass quarantine officials isolated villages about 25 miles (40km) from Hanoi that were home to 10,000 people Vietnam had detected no new cases for three weeks when a flight from London touched down at Hanoi’s Noi Bai international airport on 2 March Among the hundreds of passengers onboard was a 27-year-old Vietnamese woman returning after a trip to attend exclusive fashion week events in Europe she had sat among guests at a Gucci show in Milan The woman later told the New York Times that she had flown to Milan on 18 February and that and said she felt fine when she flew home that week she developed a cough and tested positive for coronavirus The effort to trace and contain the virus has to start all over again An earlier version said it was the Champions League football match between Bergamo and Valencia on 19 February that was described as a “biological bomb”