Enlarge image
Gargle test: For many children, more comfortable than a throat swab
Photo: Nicolas Armer / dpa / picture alliance
SPIEGEL:
Mr. Kabesch, the vaccine manufacturer Biontech has announced that its corona vaccine could be approved for children aged 12 and over in just a few weeks.
From autumn on, even for younger people.
Is this good news for you as a pediatrician?
Michael Kabesch:
Oh yes, very good ones.
Finally a glimmer of hope that the children will not be the last to be thought of.
SPIEGEL:
So all children should be vaccinated as soon as the vaccine is approved for them - before the adults?
Kabesch:
I think children should be vaccinated as soon as possible.
Who comes first shouldn't be discussed so much now.
These current distribution struggles are a consequence of the shortage of vaccines.
In order to achieve herd immunity, we also have to vaccinate at least the older children, otherwise it won't work.
They are also the ones who are very active and have a lot of social contacts, not least at school.
To person
Photo: Clemens Mayer
Michael Kabesch
is chief physician and clinic manager at the clinic and polyclinic for pediatric and adolescent medicine in Regensburg.
He is a specialist in pediatric and adolescent medicine, a pediatric pneumologist and an allergist.
Since March he has been head of the "Wicovir" study, which aims to offer schools an opening perspective through the early detection of infections with pooled Gurgel PCR tests.
SPIEGEL:
Can't you say that everyone has to restrict themselves a little right now?
Kabesch:
It cannot go on like this, that the pandemic is carried out on the back of the children. Schools are closed again and again, the children have to work on the learning material at home, have few or no social contacts - this is so important for the development of children. This leads to the point that many pediatricians in private practice are now reporting that there are massive signs of depression or even suicidal thoughts among children that we have never seen before. There are no longer any theoretical considerations that the pandemic could have a dramatic impact on the children. We are already in the middle of it.
SPIEGEL:
You want to enable face-to-face teaching with a test strategy that goes under the motto “Homegurgling instead of Homeschooling”. How Can Gargling Make Schools Safe?
Kabesch:
I am of the opinion that tests and vaccinations will lead us out of the pandemic: Those who have not yet been vaccinated must be tested regularly and sensibly. This applies, among other things, to children and adolescents for whom vaccinations have not yet been approved. So that they can still go to class, schools have to be tested in such a way that infections are detected as early as possible and infections prevented. This works best with PCR tests, because antigen tests do not detect infections until relatively late. And that is exactly what is dangerous: Many infections take place at a stage in which you have no symptoms and do not know that you are infected, but are already contagious.
SPIEGEL:
PCR tests can detect infections very reliably even before symptoms begin.
Kabesch:
Exactly.
Students who go to school usually have no symptoms, otherwise they would stay at home.
So you need a very sensitive method to detect possible infections anyway.
Gargle is also much more pleasant for children than the throat swab - no one would like to have a stick stuck into their throat two or three times a week.
They willingly join in when they gargle, and many even enjoy it.
SPIEGEL:
The RKI warns on its website of the dilution effects of gargle tests.
Is this sample collection reliable at all?
Kabesch:
We have been testing the gargle tests for a year and can now say, based on our data, that they work well.
We carry out the gurgle tests in schools in addition to the antigen tests that are mandatory in Bavaria.
We found that we often find results when the antigen test is still negative.
This shows that gargling is actually much better and more sensitive than the quick tests.
SPIEGEL:
But also more complex: In contrast to antigen tests, PCR tests have to be evaluated in the laboratory.
Doesn't that take too long?
Kabesch:
Because we pool the tests in one class, we do it on the same day: the children submit their gargle samples in the morning, everyone is put together in a shared class container and sent to the laboratory.
If this so-called pool is positive, all children in the class have to submit a second sample, which is then tested individually.
SPIEGEL:
Wait a minute, so the children take samples at home on their own?
Kabesch:
Yes.
The challenge with the school gargle tests is that they have to be safe.
Because when you gargle, aerosols are created, which could be dangerous if everyone in the classroom were gargling.
In addition, it takes almost an hour to test the whole class.
The little time our children spend at school shouldn't be occupied with tests.
Therefore it is logistically much better if the students gargle at home and then bring the sample to school.
In addition, every test works best if one also obtains material where the virus can be detected.
Gargling before brushing your teeth or breakfast makes more sense than afterwards.
SPIEGEL:
So the children get up tomorrow, go to the bathroom ...
Kabesch:
... and then the gargle is already ready.
You fill it with tap water, gargle and spit the liquid back into the tube.
They then take it to school and then it goes into the shared container, which then goes to the laboratory.
SPIEGEL:
Can't you cheat and just give off tap water?
Kabesch:
Of course you can cheat, as with all test procedures.
Individual children will certainly do that too.
But this is noticeable at the latest when they infect others and their samples are then positive.
The classes are tested regularly, alternating lessons either two or three times a week.
So there are a maximum of four days between two tests, as soon as someone from the class is infected, you notice this at a very early stage of the infection - often even before they are even contagious.
SPIEGEL:
How often is such a pool positive?
Kabesch:
We observe that around one in 100 pools is positive.
That's not that much, despite high incidences.
I explain it to myself that the children mostly get infected in families.
So if mom or dad are positive, then the children are not sent to school, but are quarantined.
In one of around 100 class tests, there was probably an unknown infection.
And then it could be found.
SPIEGEL:
You say that PCR pool testing is particularly suitable for groups that regularly come together in the same constellation.
Would that also be transferable to companies where rapid tests are mainly used?
Kabesch:
Yes, of course. Our WICOVIR center in Erlangen also works with the Chamber of Commerce and Industry in Erlangen, which has tested exactly the same procedure in companies, also with great success. Of course, the tests do not change whether someone is infected. But you recognize the infection so early that you can protect everyone around it and break the chains of infection. There is actually an ideal area of application for every test. Testing groups is easier, cheaper and more sensible with the PCR method, because you can pool, have a regular overview and know about new infections at an early stage. Antigen tests provide a result very quickly and are easier to carry out in terms of logistics and organization.
SPIEGEL:
We have been living in a pandemic for a year, why is there still no standardized and functioning test procedure for all schools and companies?
Kabesch:
I ask myself that too.
In Austria we are much further along.
There is already a large gargling center there and an even larger one will now go into operation in May, there will be a capacity of around 300,000 tests per day at the start.
At the end of May, the capacity should then increase to around one million tests.
We finally have to get ahead of the wave and not always lag behind: So don't always react when there is an occasion.
SPIEGEL:
You mean, like the federal emergency brake that was only decided when the number of cases was higher than ever before?
Kabesch:
Yes, exactly. The number of cases will not decrease this way, they will only increase more slowly. The virus is now spreading among the younger population who have not yet been vaccinated. But even with younger people, a corona infection is not to be trifled with. Last but not least, as long as the incidences are so high, we will not return to normal. I fear that many children will not see the inside of the school this school year.