Flatten the Curve! Modeling SARS-CoV-2/COVID-19 Growth in Germany at the County Level

Since the emerging of the "novel coronavirus" SARS-CoV-2 and the corresponding respiratory disease COVID-19, the virus has spread all over the world. Being one of the most affected countries in Europe, in March 2020, Germany established several nonpharmaceutical interventions to contain the virus spread, including the closure of schools and child day care facilities (March 16-18, 2020) as well as a full "lockdown" with forced social distancing and closures of "nonessential" services (March 23, 2020). The present study attempts to analyze whether these governmental interventions had an impact on the declared aim of "flattening the curve", referring to the epidemic curve of new infections. This analysis is conducted from a regional perspective. On the level of the 412 German counties, logistic growth models were estimated based on daily infections (estimated from reported cases), aiming at determining the regional growth rate of infections and the point of inflection where infection rates begin to decrease and the curve flattens. All German counties exceeded the peak of new infections between the beginning of March and the middle of April. In a large majority of German counties, the epidemic curve has flattened before the "lockdown" was established. In a minority of counties, the peak was already exceeded before school closures. The growth rates of infections vary spatially depending on the time the virus emerged. Counties belonging to states which established an additional curfew show no significant improvement with respect to growth rates and mortality. Furthermore, mortality varies strongly across German counties, which can be attributed to infections of people belonging to the "risk group", especially residents of retirement homes. The decline of infections in absence of the "lockdown" measures could be explained by 1) earlier governmental interventions (e.g., cancellation of mass events, domestic quarantine), 2) voluntary behavior changes (e.g., physical distancing and hygiene), 3) seasonality of the virus, and 4) a rising but undiscovered level of immunity within the population. The results raise the question whether formal contact bans and curfews really contribute to curve flattening within a pandemic.