Worried that either you or a member of your family has coronavirus? Here’s an overview of how COVID-19 testing works in Germany, including information on who can get tested and where, how the PCR and antigen tests work, and what the results mean. 

Who can get a COVID-19 test in Germany?

Unfortunately, simply presenting to your doctor with cold symptoms is now not enough to qualify for a coronavirus test in Germany. If health authorities were to test everybody with cold symptoms, they would need to process more than three million tests every week! Germany’s already-overstretched laboratories only have capacity to process just over one million tests per week. 

The government has therefore adopted a targeted approach to testing - with the aim being to test more, but also more specifically. Essentially, only people who have been exposed to a risk of infection should be tested. 

The Federal Ministry of Health specifies that coronavirus tests are only recommended for: 

• People with severe symptoms typical of coronavirus (dry cough, shortness of breath, fever, loss of sense of smell or taste).
• People who have come in contact with a confirmed case of coronavirus (for instance, a member of their household, or if the Corona-Warn-App sounds the alarm), regardless of whether they are displaying symptoms.
• People in communal facilities and accommodation (e.g. schools, daycare centres, refugee accommodation, penal institutions), if a coronavirus case has been found in the facility. 
• Patients, residents and staff in care facilities, dental practices or hospitals that have an outbreak of the virus. 
• People who have returned from a risk area abroad. They must immediately go into a 10-day quarantine, or they can take a coronavirus test on the fifth day at the earliest.

What to do if you think you have coronavirus

Take your symptoms seriously. Even if you only have slight signs of a respiratory tract infection, you should contact your doctor - preferably by phone rather than in person. Discuss your symptoms with your regular GP, or you can contact the medical on-call service out of hours by calling 116 117. 

If you have only mild symptoms and you do not belong to a risk group (elderly or with a pre-existing health condition), or if you have not been in contact with a person infected with the Sars-CoV-2 virus, you will most likely not be tested - although the final decision rests with your doctor or local health authority (Gesundheitsamt). 

Instead, you will be instructed to isolate at home in order to have as few contacts as possible. According to the Robert Koch Institute, this period of isolation should last at least five days plus two days after your symptoms have disappeared. 

If you fulfil any of the criteria laid out above, however, your doctor may decide that a coronavirus test is necessary. In this case, the cost will be covered by statutory health insurance. 

How does a coronavirus test work? 

First of all, a doctor or nurse will take a swab. The virus multiplies in the mucus membranes in the nose and throat. Therefore, a special swab is used to collect a sample from the back of the throat and / or the nose. The sensation is usually a little unpleasant, causing your eyes to water and often provoking a gag reflex, but not outright painful. 

Once the sample has been collected, the swab is placed in a phial of liquid and sent off for testing. Two test methods are currently available for the detection of SARS-CoV-2: the polymerase chain reaction (PCR) test and the antigen test. 

What’s the difference between a PCR and an antigen test?

Both PCR tests and antigen tests are diagnostic tests that can be used to determine whether someone currently has a coronavirus infection (or did at the moment the swab was taken). While antigen tests look for the proteins on the surface of the virus, PCR tests look for the genetic material which serves as instructions for the virus to make these proteins. 

How do PCR tests work?

PCR tests use a process called reverse transcriptase polymerase chain reaction (RT-PCR) to detect tiny amounts of viral genetic material in a sample. If this genetic material can be duplicated above a set level in any given sample, that person is deemed to test “positive” for the virus. 

PCR testing is an established scientific technique with a high accuracy rate that is already used in things like paternity testing and genetic fingerprinting. It is currently the most widely used method to detect coronavirus in Germany. The test itself takes around five hours, and results are available after one to two days. 

How do antigen tests work?

Antigen tests, on the other hand, detect SARS-CoV-2 proteins - similar to the way we test for pregnancy. The test swab is placed on a strip; if the sample contains the SARS-CoV-2 virus, the protein components react with the test strip and result in discolouration. 

The major difference is that, compared to PCR tests, antigen tests are cost-effective and can be turned around in less than 30 minutes, since the strip doesn’t need to be evaluated in a laboratory. For this reason, the antigen test is also called the “rapid test”. 

However, the tradeoff for this speed is that the antigen test is less sensitive than the PCR test, meaning that coronavirus genetic material has to be present in much greater quantities before the test will pick it up. 

This increases the chance of the test displaying a false negative, although false positive results are relatively rare. The use of antigen tests is not so widespread in Germany, but the government is beginning to encourage their use in nursing homes and hospitals to regularly test staff, visitors, patients and residents. 

What about antibody tests?

Note that neither a PCR test nor an antigen test can tell you if you’ve previously had coronavirus or if you have immunity to it - only the antibody test can do that. 

What happens if I test positive for coronavirus?

If the test result is positive, both the patient and the local health authority must be informed. Then the patient must go into quarantine at home until they get a negative test result. If their condition requires it, they may be hospitalised. 

It is also important to trace all of the infected person’s contacts, in order to prevent the virus from spreading further. All known contacts will be contacted and asked to quarantine before getting themselves tested. 

Anyone who violates the obligations to report, test, provide evidence, or self-quarantine faces a fine. 

What does it mean if I get a negative test result?

Coronavirus tests are accurate, but there is still no guarantee. If you are displaying symptoms, you should self-isolate for at least five days - even if your test result was negative. Coronavirus has a long incubation period, meaning that the tests can sometimes turn up false negative results, even if someone is actually infected with coronavirus. As mentioned above, this is more likely to happen with antigen tests than PCR tests, but neither test is totally infallible. 

Even if your test comes back negative, and you are not displaying symptoms, that only means that you did not have coronavirus at the specific moment in time when the test was carried out. It is therefore important not to be filled with a false sense of security. 

You must still continue to observe the AHA + L rules (distance, hygiene, face masks and well-ventilated rooms). It’s also a good idea to install the Corona-Warn-App, which can inform you if you have come into contact with someone who has tested positive for the virus.