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Germany Reaching the Upper Limit of Coronavirus Testing Capacity

April 4, 2020

By Paul Homewood

 Climate matters have certainly been pushed into the background, now that people have real problems to worry about.

I spotted this article in Der Spiegel, which might generate some discussion.

Mass coronavirus testing seems to be the current obsession of the self appointed experts in the media, but it does not appear to be the panacea in Germany which we have been led to believe:

 image

When Sascha Stoltenow held a training course back in March, the new coronavirus, SARS-CoV-2, had already made an appearance in his life. The only problem was that Stoltenow didn’t know it yet.

Four days later, back in his hometown of Wiesbaden, the communications consultant learned that the Hamburg Academy had to be closed temporarily because someone there had tested positive for the virus. One phone call later, Stoltenow realized: "I had direct contact with the infected person."

The next day, the 50-year-old Stoltenow felt a "slight scratching" on his tongue and the roof of his mouth. He called the medical hotline 116 117 and was told go to Frankfurt to undergo a virus test. At first, the doctor there didn’t want to test him, Stoltenow recalls. "She thought the symptoms were too mild."

But he was able to convince the doctor to perform the test anyway. "Luckily," he says. The result was supposed to be available the next day, but Stoltenow didn’t hear back. Another day went by and he eventually called the local health department. "I was told they didn’t have a file on me." Stoltenow suspected the test hadn’t been processed and stayed home, just in case. Then he heard about two other people who had attended the conference in Hamburg whose tests had come back negative. "That’s when I stopped quarantining."

It wasn’t until eight days after being tested that Stoltenow received the news: His results were positive. The health department had apparently misfiled his results. The 50-year-old immediately went into quarantine with his entire family. But there was a problem: Before he discovered he was positive, he had attended a university event and had been in contact with around 150 people, all of whom could theoretically have been infected by him.

There are countless reports like this one. They involve constantly busy telephone hotlines, testing being either refused or postponed and people waiting days for their test results — if they hear back at all.

Incessant Pestering

One family from Munich relates how they were ignored by the authorities after telling them that they had returned from a ski holiday in South Tyrol and their children, 4 and 7, had developed symptoms. "The hotline 116 117 didn’t work at all. The health department took down our information but never got back to us," says the 39-year-old father.

In the end, by virtue of sheer incessant pestering at a testing facility, the family managed to obtain a test for their daughter. Fortunately, it came back negative.

cgs

In Hamburg, kindergarten teachers report trying in vain to get coronavirus tests from their doctor after one of the children in their emergency daycare center tested positive. In the southwestern state of Saarland, the interior minister called in the army to help after lines a hundred meters long formed in front of one of the test centers. Some of the people who had been waiting for hours outside were sent home empty-handed. The facility couldn’t handle any more people.

In the region of Upper Swabia, as many as 2,000 samples that had been submitted to a lab expired because important ingredients for the test procedure were missing. The state health ministry called the people back to be retested, but only those who "now have flu-like symptoms and a fever of at least 38 degrees."

Those who try in vain to get tested for the coronavirus these days can count on little more than the sympathy of German Health Minister Jens Spahn. It’s a "deeply relatable feeling" that people want to know whether they’re infected. However, in view of the "limited capacities," public health officials must decide "together" who gets to be tested and who doesn’t.

Not even Spahn knows just how big Germany’s testing capacity is. There are hundreds of private laboratories distributed throughout the country, and that’s in addition to university clinics and hospitals overseen by state governments.

Well Equipped Yet Far From Sufficient

Last Monday, Spahn provided the figure of 200,000 tests per week. Statistics from his ministry put the number at 300,000. The virologist and government advisor Christian Drosten, from Berlin’s Charité hospital, spoke last Thursday of estimates in the "range of half a million." But even at that rate, it would take around three years to test the entire German population.

Compared to other countries around the world, Germany is well equipped with its current laboratory infrastructure, experts say. Nevertheless, the laboratory operators’ association ALM admits the country’s testing capacity is far from sufficient to meet the high demand.

"Ideally we would be testing aggressively throughout Germany," says Hendrik Streeck, director of virology at the University of Bonn. "We see in South Korea that this is the best strategy." There, comprehensive testing has made it possible to find virtually every infected person and separate them from healthy ones. "This enabled them to minimize the chains of infection very quickly," says Streeck. "The epidemic was contained there before it broke out."

Such a strategy, though, would run into technical and organizational limits in Germany. Many labs have automated, high-performance instruments capable of evaluating more than 1,400 — sometimes even more than 4,000 samples — in 24 hours. But analysis is a multi-stage process that requires special substances, chemicals and other resources.

Sascha Stoltenow: "That's when I stopped quarantining."

Sascha Stoltenow: "That’s when I stopped quarantining."

BERT BOSTELMANN / BILDFOLIO / DER SPIEGEL

"These aren’t just any random chemicals that can be mixed together," Streeck says. "We need enzymes that are produced through biological processes by cells or yeasts. Such complex processes "can’t be ramped up at will on short notice." Manufacturers, some of which are based in the U.S., are currently receiving inquiries from all over the world.

But the biggest bottleneck at the moment isn’t even due to the lack of reagents, with which the genetic material of the coronavirus can be specifically detected, says Hendrick Borucki from the Bioscientia laboratory network. There’s also a shortage of the substances that can be used to break open the virus envelope and isolate the genetic material for the actual test. Other laboratories complain that even plastic pipettes or carrier plates that are calibrated for the analytical instruments are becoming increasingly difficult to obtain.

"Wasting Valuable Reagents"

There is a danger that the lack of reagents could soon mean that fewer tests will be available than there are today. Meanwhile, the number of infections is expected to continue increasing.

To manage the looming shortage, lab operators have called for an even stricter decision-making process for who gets tested and who doesn’t. Only people who are at risk or showing symptoms should be tested, they argue. "At the moment, we’re still testing way too many healthy people," says Borucki. Well over 90 percent of the tests evaluated by Bioscientia come back negative. "We’re wasting valuable reagents."

The Robert Koch Institute now feels the same way. "We don’t have enough tests to be able to use them senselessly," the institute’s director, Lothar Wieler, warned last week. At the same time, though, the institute has loosened the recommendation that has thus far been in place – namely that patients with symptoms should only be tested if they had contact with an infected person or had been in a region with a high number of confirmed cases. Given that the pathogen is now essentially everywhere, the focus on at-risk regions no longer makes sense, an institute spokeswoman said.

Limiting tests to people showing symptoms is a matter of some disagreement among experts. "We know of cases where the test returned a positive result even though the test subject was showing no symptoms at all," says Streeck, the virologist. A study from Hong Kong found that as many as 40 percent of the infections took place in the phase before symptoms developed, Streeck says. These virus carriers who have no symptoms can spread the pathogen and unwittingly endanger others, he adds.

The rule is also inscrutable for many of those affected. "We didn’t have any symptoms, but we were concerned," says a 45-year-old mother from Hesse. The father of her two sons had been in the Austrian ski resort of Ischgl with friends, and after he returned home, the boys spent a weekend with him. Soon thereafter, Ischgl was declared a high-risk area for the virus and the father and five of his friends all tested positive for the virus. The mother contacted their family doctor, who referred them to the health authorities. There, she was told that tests would only be performed if she or the children developed symptoms. "We wanted peace of mind, so we fibbed," the woman admits. Together with her children, she drove to a test center set up in front of a hospital in Worms and said she had a slight fever.

Some of those who cannot get tested through the public health-care system turn to the free market to get what they want. In parts of the industry, says a leading lab doctor in Baden-Württemberg, there is "gold fever."

A lab in Hamburg, for example, is offering a coronavirus test that patients can perform at home. The process for taking the swab is explained on the company’s website with the help of diagrams. Users insert the swab into their mouths until it extends behind the uvula. It is then placed in a test tube and sent to the laboratory or placed directly in their mailbox.

Out of Pocket

Some 300 such tests are submitted each day, says laboratory director Jens Heidrich, and the results are generally available just 24 hours later. "Getting rapid clarity is an enormous relief for people," he says. But the test costs 150 euros and has to be paid out of pocket.

Heidrich insists that the tests adhere to WHO standards and are reliable and adds that he ends up with more positive results from those who send in samples privately than tests performed by doctors on patients. A Hamburg association of doctors in the public health insurance system, however, warns against using the tests "because it is extremely likely that the samples from patients are not being obtained properly."

The samples have to be taken so far back in the throat that it generates severe gagging in most patients, say experts. That leads to many self-performed tests not being done correctly, and even some family doctors do it incorrectly as well: "They just swipe around a bit," says the lab doctor from Baden-Württemberg. The result, he says, is likely many incorrect negative results.

The fact that a significant amount of time can pass between when the swab is taken and when it ends up in the lab is also a problem. Lab doctors say the tests are most reliable when the samples are constantly kept cool as they are transported. Test producer Roche, which supplies many German labs, says that samples only remain viable for a maximum of 48 hours, assuming they are kept at temperatures between 2 degrees and 25 degrees Celsius (35.6 and 77 degrees Fahrenheit).

Even lab operators that do not normally analyze human samples are entering the market. The veterinarian Klaus-Peter Behr, 60, has a bucolic view of farmland and a nursery garden from his office in the village of Emstek, located not far from Bremen. Behr’s lab employs 180 people. "Without adding any capacity, we can analyze up to 1,000 tests per day for the novel coronavirus," Behr says, "seven days a week." Behr has said the same thing to public health officials, adding that he can deliver results within three to four hours.

But health officials in his state of Lower Saxony declined the offer, writing: "Cooperation requires approval and the involvement of a specialist in laboratory medicine (human medicine)." Behr is now offering the tests to private customers and pharmacies. He is also producing test kits for other laboratories.

The fundamental challenge, though – namely the exploding global demand for the reagents used in the test – cannot be solved by the veterinary laboratories either. And neither can the mini test devices that are currently being touted for their alleged speed improvements relative to those devices that have thus far been used.

"Intelligent Testing"

Streeck believes that "creative solutions" are necessary. Instead of individually testing 10 people with limited risk of having contracted the coronavirus, their samples could be "pooled" and analyzed together. When the result is negative, then nine tests have been saved. If the result is positive, individual tests can still be performed.

Such an approach, Streeck says, has proven itself in testing donated blood for HIV or hepatitis. If it is done correctly, the number of people tested using the same amount of material can be significantly increased.

Other experts recommend using the tests available for important occupational groups. "In the long term, we cannot regularly test the entire population of Germany," says Michael Hoelscher, director of the Division for Infectious Diseases and Tropical Medicine at the University Clinic in Munich.

Because testing capacity is now reaching its limits, "intelligent testing" is necessary, says Hoelscher. "Police officers, fire fighters and especially people in the health-care industry are regularly in contact with at-risk patients. There we have to be as sure as we can that these people are not infected."

The rest of the population should only be tested when they exhibit strong symptoms that require hospital care, Hoelscher says. "Those that only have mild symptoms should please stay home and not demand a test."

https://www.spiegel.de/international/germany/corona-challenge-germany-reaching-the-upper-limit-of-testing-capacity-a-4d75e7bd-dd0e-41e3-9f09-eb4364c43f2e

My understanding is that Germany has carried out about 200,000 tests, which is a drop in the ocean for a country of 82 million, who would each have to be tested at least weekly for the test to be meaningful.

Clearly the targeted tests now being recommended are sensible. But it does not appear that even Germany can push mass testing much beyond that point, and it would certainly be dangerous to rely on mass testing as some sort of panacea.

It has been claimed of course that Germany’s death toll is lower, we are led to believe because of testing. Personally I don’t believe their data, and neither does pathology expert, Dr John Lee, who wrote in the Spectator last week:

The data on Covid-19 differs wildly from country to country. Look at the figures for Italy and Germany. At the time of writing, Italy has 69,176 recorded cases and 6,820 deaths, a rate of 9.9 per cent. Germany has 32,986 cases and 157 deaths, a rate of 0.5 per cent. Do we think that the strain of virus is so different in these nearby countries as to virtually represent different diseases? Or that the populations are so different in their susceptibility to the virus that the death rate can vary more than twentyfold? If not, we ought to suspect systematic error, that the Covid-19 data we are seeing from different countries is not directly comparable.

https://www.spectator.co.uk/article/The-evidence-on-Covid-19-is-not-as-clear-as-we-think

34 Comments
  1. jack broughton permalink
    April 4, 2020 5:23 pm

    Apparently the UK “expert / scientific committees” have now realised that even if we had the test equipment there is a shortage of the specialised reagents needed. Der Spiegel mentions this too.

    Sadly, the whole issue has become politicised …… familiar territory.

    • Phillip Bratby permalink
      April 4, 2020 7:22 pm

      It was very noticeable to me that the questions at the end of the Government’s daily briefing were always led by political correspondents (Kuensberg, Peston etc). They only like to stir up the politics, not interested in the science or the data)

      • Harry Passfield permalink
        April 4, 2020 8:23 pm

        Cummings, when he gets well, should address this nonsense.He’s busy building a strategy to combat CV and the BBC – by arranging the hierarchy of reporter questioning – is undoing him. He needs to get a grip – when he’s fit again.

      • Tonyb permalink
        April 4, 2020 8:26 pm

        Philip

        I do find these pointless and aggressive political questions very irritating and it crowds out more thoughtful questioning lines.

  2. MrGrimNasty permalink
    April 4, 2020 5:38 pm

    No one should ever listen to the WHO again (climate change biggest threat to health, test test test etc.) after they failed to lock down the virus in China.

    The WHO failed monumentally – and yet the MSM does not mention this, just an endless stream of articles trying to put Trump and Bolsonaro in the wrong over virus policy – seems familiar!

    I hope in the future when a new disease emerges, the procedure is to lock down until it has been assessed for potency, not leave the door open until you are sure it is highly infectious and deadly. (Although at the moment I am still not convinced the measures are justified, it has a long way to go to reach first year max. estimate of 575,400 deaths from the 2009 flu pandemic).

    And another thought…..

    Ventilation seems rather archaic these days – they have heart/lung bypass machines, surely there must be/it must be possible to develop some sort of external blood oxygenation device that doesn’t require such drastic plumbing?

    • Tonyb permalink
      April 4, 2020 8:29 pm

      That is what the 300 new machines currently being delivered to the NHS are supposed to do rather than the highly intrusive models currently used but which are necessary for a number of the very ill

      • MrGrimNasty permalink
        April 4, 2020 9:04 pm

        I thought those were CPAP type machines, I meant plumb a device into the bloodstream to achieve oxygenation directly, not via the lungs.

  3. April 4, 2020 5:47 pm

    Another view of the situation in Germany.

    https://tambonthongchai.com/2020/04/03/11187/

    • April 4, 2020 7:06 pm

      That’s interesting.

      Did you notice this comment:
      The fear of a rise in the death rate in Germany (currently 0.55 percent) currently carries an intense media interest. Many people are worried that it could go up to 7% or 10% as it had in Spain and Italy. This fear likely derives from the practice of attributing deaths to the virus only on the basis that patient had tested positive for Covid at the time of his death. This practice is flawed. To attribute death to an agent it must first be determined that the agent played a significant role in the death. The Association of the Scientific Medical Societies of Germany includes this principle in its guidelines saying that to declare a cause of death, the causal chain is more important than the underlying disease. A more critical analysis of medical records should be undertaken to determine how many deaths can be attributed to this virus.

      It fits with what Lee was saying

      • April 4, 2020 7:37 pm

        Good point sir. Well made.

      • Tonyb permalink
        April 4, 2020 8:34 pm

        Paul

        Are you saying Germany only counts it as a Cv death if that was actually the direct cause of death whereas as in this country the patient may have died WITH it but not OF it which are the recent WHO guidelines.

        In other words practically everything is laid at the door of cv in the UK even when something else likely killed the patient.

        In Italy only some 12% of those who died are said to have done so purely because of cv but 100% of those who died did so WITH cv

      • April 4, 2020 9:47 pm

        That is certainly the implication

      • April 4, 2020 9:27 pm

        I don’t understand the obsession with attributing cause of death, the only thing that matters is the total number of people needing a ventilator, for whatever reason. When that total becomes less than capacity the crisis should be over, and I suspect that total deaths will not be much above average.

      • April 4, 2020 9:53 pm

        That’s right, or in more simple terms the absolute death toll.

        Compare the death totals over the year as a whole, and then measure the change.

        In the short term, though, I do accept that CV might overload hospitals, as opposed to deaths being strung out over the year.

        As a personal anecdote, my father in law died in 2002. He had had emphysema for the last few years of his life, which had become pregressively worse. In the end a heavy cold killed him off, but clearly the cold was not the cause of death.

      • Dawne Swift permalink
        April 4, 2020 11:10 pm

        Tonyb – if you are able to read the Spectator article referred to above (there is a paywall, but the site sometimes allows access) it makes very interesting points and in particular that CV19 has been made a notifiable disease in the UK and that therefore if anybody dies from any cause who is suffering with CV19 as well, then CV19 will be on the death certificate as one of the causes of death. It’s almost impossible to compare statistics between countries because of the differences in the parameters for collection of data.

      • Phoenix44 permalink
        April 5, 2020 9:21 am

        It’s well know that Germany (and I believe Sweden and Switzerland) only count CV deaths where they can attribute the death to CV. The UK, France, Italy and Spain count any death where the person has tested positive. The increase in deaths in the UK largely (perhaps almost wholly) reflects an increasing rate of infection amongst those who due, not an actual increase in people dying.

        The cumulative all cause deaths to 20th March in the UK are a bit below the cumulative five year average, but not to statistical significance. The cumulative under 65 deaths are exactly average – the variance annually is very low.

        The simple fact is that coronavirus is not more dangerous to people under 65 than the various diseases already circulating, and it may not be significantly more dangerous to the over 65s. Its major effect seems to be that those who are going to die end up in ICU before they die.

  4. April 4, 2020 6:25 pm

    Most of the statistics bandied about are nonsense, not the ;east because there is nothing with which to compare them. However, if one can believe any of them, it would seem that the deaths caused by the virus in Italy and Spain together count for about 45 percent of worldwide deaths. If that is fact, if behoves someone to determine why. Living in Spain, I have my own ideas, but I would like to see some scientific consensus come out of all this.

  5. Ian Cook permalink
    April 4, 2020 6:27 pm

    I think the point that Lee was making was that there is no standard and that the more you test the more you find infection and thus lower the lethality overall of the disease. The suspicion is that large numbers of people have already been infected with this mainly mild virus. Counting people as Covid 19 deaths who would have died anyway of something else, doesn’t help our understanding. For instance, of the 708 deaths today, 40 apparently had no underlying illness. That is more likely the numbers of deaths the virus is ‘causing’. Note, we aren’t saying we fear the virus, we fear the NHS being swamped.

    • dave permalink
      April 4, 2020 7:23 pm

      ,FINLAND is suffering less than many other European countries from covid-19:

      https://www.worldometers.info/coronavirus/country/finland/

      FINLAND also has a better record on Vitamin D:

      https://vitamindwiki.com/Improved+health+due+to+vitamin+D+fortification+in+Finland

      Coincidence?

      “..NHS being swamped…”

      One must also acknowledge that there is such a thing as an INDIVIDUAL being swamped with infectious material. I know of a young nurse treating multiple covid-19 patients, who went from being healthy to being in intensive care in 48 hours.

      • April 4, 2020 8:20 pm

        That’s a good point Dave

        I read an article in the DT the other day about “viral overload”

        The concept is that if your first contact with a virus is slight, maybe a single cell or so, your immune system has a crucial minute or so to react before it gets overloaded.

        The typical nurse however may breathe in thousands of the germs in a few seconds.

        It’s frightening really

      • dave permalink
        April 4, 2020 8:35 pm

        We can but hope the virus will spread less easily as the weather improves in the Northern Hemisphere.

        Hubei, Milan, Madrid – all notorious for cold, dry, weather in winter:

        https://www.medrxiv.org/content/10.1101/2020.04.01.20050526v1

        To my eye, the underlying situation is improving in Italy and Spain.

      • MrGrimNasty permalink
        April 4, 2020 9:21 pm

        Probably why masks do help a bit both ways. Nothing short of biological warfare kit will get you 100% protection, but a mask will obviously catch the larger virus loaded droplets exhaled, and catch some that you might have breathed in.

        Though it is by all accounts in the nature of the progression of the disease in some people, that just as you think you have had it very mild and are getting over it, your lungs go down.

        There was a good example of rigid expert/scientist/consensus enforcement/group think on J.Vine the other day. The in-house doctor and Vine poured scorn on the panelist’s suggestion that masks were of any use whatsoever (citing a newspaper report, ‘what did she know’, ‘not an expert’ etc.) – promoting the currently UK gov. position, even though common sense, and a lot of anecdotal and expert evidence disagrees, and opinion is clearly moving e.g. in USA now.

      • Pancho Plail permalink
        April 5, 2020 8:48 am

        The point about virus overload makes the use of masks even more important. However ineffective a mask maybe it will still intercept some of the aerosol carrying the virus and reduce the number entering the system. It is a percentages game but it could make the difference between something your body can deal with and a lethal quantity.
        Also where is global warming when you really need it?

    • Phoenix44 permalink
      April 5, 2020 9:23 am

      Yes, and even then the 40 is probably too many. Older people die, and people with underlying health problems may not know about them at the time of their death.

  6. Tonyb permalink
    April 4, 2020 8:24 pm

    What an interesting insight which makes me wonder whether we are better after all at testing those who turn up in hospital and by definition are much more likely to have the virus than the worried well.

    I gained an insight into the probable Ineffectiveness of using digital thermometers casually aimed at the foreheads of suspect travellers. Evidently it’s a three minute programme involving a sweep of the forehand above an eye that is needed. I have never seen any of the tv footage that remotely follows this process

  7. Harry Passfield permalink
    April 4, 2020 8:41 pm

    The Execs of NHS Trusts are really laughing at how they have such security in their jobs. They need not make any major decisions – and even if they do and they go wrong – because, if it all goes tits up they can blame the Dept of Health etc.
    Politicians need to get out of ‘managing the NHS; These Execs are paid a King’s ransom to run: tell them to get on with it, or else.
    My friend is running logistics to get kit – beds, PPE, ventilators and so on to the NHS. His latest venture was to deliver hundreds of 3D printers which were set up to build (print!) face visors for front-line medics. The video of these machines making these visors is mind-blowing – as is the incompetence of NHS Execs in not getting this sorted out to begin with. But then, they can always blame BJ and Hancock. What a lovely way to earn a crust , and a giant pension.
    Sack ’em all!!!

    • Pancho Plail permalink
      April 5, 2020 8:52 am

      Nearly every 3d printer manufacturer has free files available for downloading and printing your own mask should you have access to a printer.

  8. Athelstan. permalink
    April 5, 2020 8:35 am

    Assuming that the nhs would be prepared for a scale of epidemic……………….is something akin to asking Bugs Bunny if he could prepare for WWIII.

    In 2016, in an exercise to test UK systems ‘Exercise Cygnus’ it was surmised that the UK couldn’t cope.

    we know.

  9. john cooknell permalink
    April 5, 2020 8:59 am

    When this first started I listened very carefully to the Chief Medical Officer, the thing is you cannot avoid this virus, we will all get it sooner or later. My view is it has been here for some time hiding in plain sight.

    All of this lockdown just delays the spread of the virus, till effective treatment is ramped up or in the longer term a vaccine is developed. however in the meantime the virus will almost certainly evolve (not a successful evolutionary idea to kill your host) into a less virulent form as that is what these type of virus do.

    Testing is problematic, as tests must be biased false positive and every country applies testing criteria differently, so any statistics are meaningless. The tests only provide information they don’t do anything else, and as the information they provide is of limited worth, should we be so concerned about testing.

    So we have to put up with Gove, confirming he is the hypocritical idiot we thought he was making himself look a daily fool, and how he has the nerve to stand behind a “protect the NHS” banner when he and his cronies have spent the last 10+ years actively dismantling the NHS.

    You could not make this up!

    • john cooknell permalink
      April 5, 2020 11:09 am

      I am really getting confused. I just listened as the clever professor advising Gov.UK tell us death toll FROM Covid 19 may reach 20,000 or could be as low as 7000. We are banned from doing everything to prevent this, our economy lies in ruins. The 250,000 potential deaths for people WITH the coronavirus is quietly being buried, even by its author!

      78,000 die every year in UK as a direct effect of smoking, a smaller number die from “second hand” smoking. This puts tremendous strain on the NHS and is a tragedy for the families involved. Smoking is not banned!

      Alcohol accounts for even more deaths and pressure on the NHS, as well as societal problems, and tragedies for the victims and families. Alcohol is not banned

  10. Gamecock permalink
    April 5, 2020 10:58 pm

    ‘he had attended a university event and had been in contact with around 150 people’

    We in South Carolina avoid contact with anyone. ‘Contact with around 150 people’ in these times qualifies for a Darwin Award, should he not survive.

  11. Steve permalink
    April 6, 2020 3:27 am

    It’s surprising that they were short of testing in Upper Swabia.

    • It doesn't add up... permalink
      April 7, 2020 9:28 pm

      Perhaps the needed the Lower Swabia laryngeal versions instead? The others just get up your nose…

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