Risk area (epidemiology)

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In epidemiology , a risk area is a region particularly affected by an epidemic with an acutely increased local incidence or prevalence or a (geographical) case cluster . In connection with the COVID-19 pandemic in Germany, the German-speaking media often uses the imprecise term "hotspot", taken from the English term high burden hotspot (an area with a high outbreak ). As a rule, measures to contain and reduce epidemics relate to local authorities .

Risk areas can develop into hyper-endemic regions or epidemic regions with persistently high rates of new infections if it is not possible to interrupt the chain of infection in the “hotspot” and significantly reduce the number of new infections.

Difference between risk areas and hyper-endemic regions

A hyperendemic region or a geographical case cluster is a region with an acutely increased local incidence . The adjective hyper-endemic means: "a persistently high number of new cases (incidences)". A hyperendemic region is to be distinguished from an area with a high frequency of occurrence or recurrence of diseases or drug-resistant strains ( English emergence hotspot ). Similarly, a hyper-endemic region is different from a transmission hotspot ( English transmission hotspot ), that is an area with an increased transmission efficiency (for example, an increased basic reproduction number ). Colloquially, all these different phenomena are usually imprecisely referred to as “hotspots”, but policymakers and public health researchers often fail to differentiate either, with the risk that this useful term will be rendered unusable by inaccuracy or overuse. According to the Robert Koch Institute , an epidemic region is a region with an acutely increased local incidence. A 7-day incidence of at least 50 per 100,000 inhabitants serves as a guide.

In the case of risk areas, there is hope that the acutely increased incidences will not persist but can be successfully reduced through targeted measures. In the summer of 2020, no critically increased incidence in Germany proved to be sustained.

COVID-19 pandemic in the European Union

Declaration of a region of Germany as a "region with a high incidence"

In the course of the COVID-19 pandemic in Germany , the heads of government of the German federal states decided on May 6, 2020 that a region should be declared a “region with a high incidence” (i.e. a risk area ) if there is more in it than 50 new infections per 100,000 inhabitants within seven days. In several federal states, this limit was lowered to 30 to 35 new infections per 100,000 inhabitants in seven days. Despite the options listed below for measures below contact blocks for entire districts, the approach to the level "50 new infections in the district or the independent city" triggered thinking about measures to be taken in the affected district offices and town halls in summer 2020.

On June 26, 2020, the heads of government agreed on the following regulation: If a region has been declared a "region with a high incidence", then a person who has their primary residence or permanent residence there may only be allowed outside the " Hotspots "if they have a medical certificate that confirms that there are no indications of an infection with the SARS-CoV-2 coronavirus . The required medical certificate must be based on a molecular biological test that was carried out no more than 48 hours before arrival.

If there are no increased incidences in the population of a region without taking into account those who are directly related to a suspicious establishment or another local source of an infection, then the responsible health department can refrain from or lift district-wide restrictions. This happened in mid-May 2020 in the case of a COVID-19 cluster at a meat processing company in the Coesfeld district .

Case of Gütersloh and Warendorf

In June 2020, officially ordered mass tests for the SARS-CoV-2 virus showed that 6,139 Tönnies employees tested at the Tönnies main plant in Rheda-Wiedenbrück had infected 1,413 employees, as well as a further 353 people in the vicinity of these employees, in total 1,766.

As a result, the neighboring districts of Gütersloh and Warendorf were the first regions to be declared "regions with a high incidence" during the COVID-19 pandemic. Specifically, this triggered the following specific restrictions for people in the two circles:

  • Contact restrictions: The common stay in public space was only allowed for people living in the same “family or household group” or for two people from different households.
  • Leisure activities in closed rooms were forbidden unless there was a so-called mask requirement.
  • Concerts and performances were not allowed to take place. Cinemas , museums , exhibitions , galleries , palaces , castles and memorials had to close.
  • Indoor sports and the use of fitness studios were prohibited. The same applied to indoor playgrounds , wellness facilities and saunas .
  • Bars had to close, " catering bar operations " were banned. Restaurants and eateries were only allowed to be visited by persons belonging to one household.
  • Coach trips were banned, "outskirts and holiday camps" had to be approved.

Residents of the districts of Gütersloh and Warendorf were prohibited by the NRW state government from continuing to use the services provided in the Westphalian neighboring districts and cities and from attending events there. The Lower Saxony district of Osnabrück, which is adjacent to both districts, joined this regulation on June 23, 2020.

On June 24, 2020, the Prime Minister of North Rhine-Westphalia , Armin Laschet , urged residents of the Gütersloh and Warendorf districts to only leave the districts in special cases.

On June 29, 2020, the North Rhine-Westphalian state government decided to lift the mass quarantine for the Warendorf district with effect from July 1, while it should remain in force in the Gütersloh district until July 7.

The Higher Administrative Court of Münster lifted the mass quarantine for the Gütersloh district on July 6, 2020 . If the source of the infection is certain, the virus can be isolated near the source and if there are municipalities in a district that are hardly affected by the infection, then the extension of an order for the entire district is disproportionate.

Dingolfing-Landau case

In July 2020 in the Lower Bavarian district of Dingolfing-Landau , COVID-19 clusters were formed among harvest workers and factory workers in two companies where vegetables are grown or processed. In the larger of the two operations, 191 employees tested positive for COVID-19. The 7-day incidence in the Dingolfing-Landau district rose to 191.2 newly infected per 100,000 inhabitants on July 27, 2020.

Despite this high value, no lockdown was imposed on the county . Because in the district capital of Dingolfing is the largest BMW plant in Europe , the closure of which would have caused great economic damage, which the Bavarian state government is striving to avert. Apart from that, outside of Mamming , where the vegetable farm is located, there were only eight other cases in the district on July 31, 2020, and no people were currently registered with COVID-19 in eight communities in the district. The use of the circle-wide lockdown was also waived after it became known that there was another COVID-19 cluster in a vegetable factory in the Dingolfing-Landau district. On August 18, 2020, the Robert Koch Institute announced that there had been fewer than 50 newly infected people per 100,000 inhabitants in the past seven days. A day later, the district was no longer the area with the highest 7-day incidence in Germany.

The states of Schleswig-Holstein , Mecklenburg-Western Pomerania and Rhineland-Palatinate decreed that travelers from the district of Dingolfing-Landau must go to a fourteen-day quarantine when entering the country in question if they cannot prove by a test that is no more than 48 hours old, that they are not sick with COVID-19.

Application of the 7-day incidence as a limit value to EU member states

The limit value "50 new infections per 100,000 inhabitants within the past 7 days" is also applied in Germany to member states of the European Union .

On July 14, 2020, the Grand Duchy of Luxembourg , a state directly bordering Germany, was declared a "risk area" by the Foreign Office , the Federal Ministry of Health and the Federal Ministry of the Interior, for Building and Home Affairs . The Federal Foreign Office justifies this with a permanently too high 7-day incidence and a strong increase in new infections with SARS-CoV-2 . Entrants from Luxembourg therefore had to submit to a quarantine obligation. From August 8, 2020, they were also required to take part in a COVID-19 test. As a result of the drop in the 7-day incidence below the value of 50 new infections per 100,000 inhabitants, the classification of Luxembourg as a risk area was lifted again on August 20, 2020.

Individual regions in Spain , Belgium , Bulgaria and Romania also had 7-day incidences that were too high on August 7, 2020. Regulations that were first applied to Luxembourg also apply to travelers from these areas who want to enter Germany. At the end of August, the Federal Foreign Office also issued travel warnings relating to individual regions in France and Croatia .

criticism

Concentration on rural districts or urban districts

The method of always referring to areas the size of a (rural) district or an urban district when using the term “region with a high incidence” with regard to regions in Germany was particularly important during the mass quarantine of the Gütersloh and Warendorf districts criticized. The restricted area is too big. There are communities in both districts that are hardly affected by COVID-19. In areas with many employees in the meat processing industry, the source of the infection is not local authorities, but slaughterhouses, their employees and contact persons. This should be specifically isolated, not the district population as a whole. This criticism is essentially based on the above. Judgment of the Higher Administrative Court of Münster on July 6, 2020 shared.

Alternatives to mass quarantine in a district / an independent city

Lower Saxony's Minister of Health, Carola Reimann, criticized the fact that there was no travel ban for their residents during the exit restrictions in the Gütersloh and Warendorf districts. On the other hand, with regard to the handling of measures, the minister believes that each case has to be “individually observed and really see whether it is a local outbreak that can be localized or whether it is one that is spread across the district.” Only in the latter case to justify a lockdown.

Lack of consensus on the binding nature of the limit value

The policy of isolating areas with increased incidence is no longer supported by all countries. The city-state of Berlin is one of the countries that have decided to lift all public contact blocks . The affected country may refrain from using the "Lockdown of an entire district" instrument if the limit value is exceeded, for example. B. be thwarted by the fact that other countries forbid residents of the district or the urban district in question to enter and stay.

Section 14 (2) sentence 1 of the 6th Bavarian Infection Protection Measures Ordinance of June 19, 2020 stipulated that the operators of hotels, accommodation establishments, school camps, youth hostels, campsites and those who provide other types of accommodation of any kind “may not accept any guests ], who arrive from a district or an independent city of another country in the Federal Republic of Germany or have their place of residence there in which or in which the number of new infections with the SARS-CoV-2 coronavirus is stated in the last seven days before the planned arrival Publication by the Robert Koch Institute (RKI) is higher than 50 per 100,000 inhabitants. ”The Munich Administrative Court ruled on July 28, 2020 that this provision was disproportionate. In particular, it appears to the court as "questionable whether the fact that a 7-day incidence of 50 per 100,000 inhabitants is exceeded may result in the necessity of a ban on the accommodation of guests from these districts and urban districts.
" Unrestrictedly at the mercy of a norm-setting power "(here: the Robert Koch Institute)," which is not legitimized by the state or by membership. "This contradicts the rule of law .
In response to the question: "With what considerations does the ordinance justify that the ban on accommodation in § 14 Paragraph 2 Clause 1 6th BayIfSMV only applies to guests who arrive from a district or a city in another country in the Federal Republic of Germany or who live there but not for guests arriving from Bavaria or residing there? ”the court received no answer. It played no role in the reasons for the judgment.
The ordinance expired with effect from August 2, 2020.

In Luxembourg, criticism was voiced that Germany did not take sufficient account of the fact that COVID-19 tests were carried out more systematically in Luxembourg than in larger EU member states. It is assumed that more tests led to more positive test results.

literature

  • Justin Lessler et al .: What is a hotspot anyway ?. In: The American journal of tropical medicine and hygiene. (2017). Pages 1270-1273.

Individual evidence

  1. ^ Justin Lessler et al .: What is a hotspot anyway ?. In: The American journal of tropical medicine and hygiene. (2017). Pages 1270-1273, here: p. 1271.
  2. ^ Justin Lessler et al .: What is a hotspot anyway ?. In: The American journal of tropical medicine and hygiene. (2017). Pages 1270-1273, here: p. 1271.
  3. ↑ National test strategy - who is tested in Germany? Robert Koch Institute , June 17, 2020, accessed on July 8, 2020 .
  4. ↑ Hyperendemic. In: Merriam-Webster Online Dictionary , accessed August 6, 2020.
  5. ^ Justin Lessler et al .: What is a hotspot anyway ?. In: The American journal of tropical medicine and hygiene. (2017). Pages 1270-1273, here: p. 1271.
  6. ^ Justin Lessler et al .: What is a hotspot anyway ?. In: The American journal of tropical medicine and hygiene. (2017). Pages 1270-1273, here: p. 1272.
  7. ↑ National test strategy - who is tested in Germany? Robert Koch Institute , June 17, 2020, accessed on July 8, 2020 .
  8. ↑ Agreement on corona easing. tagesschau.de, May 6, 2020, accessed June 27, 2020 .
  9. ↑ Countries lower upper limit for corona hotspots. In: tagesschau.de. May 19, 2020, accessed June 27, 2020 .
  10. ↑ Number of confirmed corona cases rises to 428 people. District of Vechta, July 19, 2020, accessed on July 30, 2020 .
  11. ↑ Holidays and coronavirus: The federal and state governments agree on a rule for tourists from hot-spot areas. wa.de ( Westfälischer Anzeiger ), June 28, 2020, accessed on June 28, 2020 .
  12. ↑ Relaxation still questionable: Gütersloh fears, Warendorf hopes wdr.de, June 28, 2020, accessed on June 29, 2020 .
  13. ↑ "Lockdown" in the Gütersloh district: This is what the population now has to deal with. stern.de, June 23, 2020, accessed on June 28, 2020 .
  14. ↑ District of Osnabrück: Massive Corona outbreak: Strict rules for people from Gütersloh and Warendorf. June 23, 2020, accessed June 29, 2020 .
  15. ↑ Summer vacation despite Corona: Italians can't believe their eyes - they haven't seen their beaches like this for a long time. wa.de ( Westfälischer Anzeiger ), June 25, 2020, accessed on June 28, 2020 .
  16. ↑ Corona hotspots: Lockdown is extended for the Gütersloh district, canceled for the Warendorf district. wa.de, June 29, 2020, accessed June 30, 2020 .
  17. ↑ "Lockdown" in the Gütersloh district canceled: residents react so happily. wdr.de, July 6, 2020, accessed on July 7, 2020 .
  18. ↑ Robert Koch Institute: Daily situation report by the RKI on the Coronvirus Disease-2019 (COVID-19) . July 27, 2020, p. 4, accessed on August 3, 2020
  19. ^ Ralf Müller: Landkreis Dingolfing-Landau - government wants to save BMW from lockdown . idowa.de. July 28, 2020, accessed August 3, 2020
  20. ↑ 186 active corona cases. Graphic: This is how the corona cases are distributed in the Dingolfing-Landau district . pnp.de ( Passauer Neue Presse ). July 31, 2020, accessed August 3, 2020
  21. ↑ Alfons Deter: Corona hotspot Mamming: Travel restrictions for people from the Dingolfing-Landau district . topagrar.com. July 28, 2020, accessed August 3, 2020
  22. ^ Luxembourg: Travel and Safety Advice. Federal Foreign Office, August 9, 2020, accessed on August 9, 2020 .
  23. ↑ Information on the designation of international risk areas by the Federal Foreign Office, BMG and BMI. Robert Koch Institute, August 7, 2020, accessed on August 9, 2020 .
  24. ^ Luxembourg: Travel and Safety Advice. Federal Foreign Office, August 31, 2020, accessed on August 31, 2020 .
  25. ↑ COVID-19 travel warning. Federal Foreign Office, August 7, 2020, accessed on August 9, 2020 .
  26. ↑ Lars Pankoke and Thorsten Baumgart call for measures to be taken after the infection has actually occurred. westfalenblatt.de, July 2, 2020, accessed on July 4, 2020 .
  27. ↑ Corona hotspot Gütersloh: "It would have been better not to let the residents travel." Deutschlandfunk.de. June 26, 2020, accessed June 30, 2020
  28. ↑ Increase in corona infections: Province at the limit. taz.de, June 23, 2020, accessed June 30, 2020 .
  29. ^ Resolution of the 20th Senate of July 28, 2020. Bavarian Administrative Court, July 28, 2020, accessed on August 26, 2020 .