> It very glaringly points to some failure in the healthcare system.

Does it? "Have you been near the equator recently?" is a rather common question that GPs ask when you go see them with high fever. Doctors in Germany are absolutely aware of malaria, given how much we like to travel to all those beautiful, but unfortunately malaria-ridden countries.

The only thing, of course, is: That question wouldn't have helped here. However, this[0] source says airport staff are made aware of the possibility of contracting malaria and are told to watch out for symptoms.

[0]: https://www.tagesschau.de/inland/regional/hessen/malaria-am-...

I thought anything in the US is ridiculous amounts of money, when it’s related to health/hospital.

> Globally in 2024, there were an estimated 282 million malaria cases and 610,000 malaria deaths in 80 countries

https://www.who.int/news-room/fact-sheets/detail/malaria

One question that gets asked is "have you traveled to another country?" When the answer is "no", then doctors no longer consider diseases that exist in other countries. So that is why they did not understand the parasitic infection until it was too late.

Some of the early symptoms resemble a bad cold.

The parasite that causes malaria (literally "bad air") can only survive in certain species of mosquitos. Those skeeters don't live in Germany. They used to live in the state I live in, but they were exterminated back in the 1950s & 1960s (thanks DDT!). And people from West Africa were naturally/genetically resistant, which was why slaves from that region were preferred over every other race in the southern US where malaria existed until the 1950s & 1960s. If you have 0 copies of the gene then you usually die (of malaria) before puberty. If you have 2 copies of the gene, then you die from sickle cell anemia (usually by your teen years). If you have 1 copy of that gene (another commenter used the term "heterozygote") then the parasite can't live in some of your red blood cells, so you survive to have children.

Germany never had it, and reported being malaria free in 1964. America, in 1970.

https://www.who.int/teams/global-malaria-programme/eliminati...

From the article:

"It [the Robert Koch Institute] said laboratory tests to determine the source of the infections were not expected to be available for several weeks. [...] The [Robert Koch] institute said malaria in Germany almost exclusively affects long-haul travellers who were infected in malaria-endemic areas, and that malaria transmitted within a German airport is rare. 'The lack of a travel history can lead to a delayed diagnosis. A delayed diagnosis increases the risk of a severe course of the diseases,' the institute said in its epidemiological bulletin."

Cerebral malaria is fatal with no treatment in many cases. For kids and elderly it’s fatal even with.

Likely this happened because they have no expertise and didn’t know what to do.

Imagine if you showed up in a hospital in the us with a sting from some super intense scorpion that only exists is some obscure part of the world. They’ll try to help, but likely can’t do much.

If the airport workers had travelled to another country, their doctors would have looked for tropical/travel diseases.

Usually, it is through shipping containers where unwanted insects cross borders. That's how murder hornets and flying cockroaches got into the US.

Maybe you're thinking about the The Institute of Tropical Medicine in Antwerp/Belgium?

Doxycycline can also be used. I took doxycycline monohydrate daily for a month and had no observable impact on my digestion, which surprised me.

I was there for years, you can’t take malarias that long.

Botfly. Don't cut, they dig deeper.

The proper solution is a thick layer of petroleum jelly over your skin. The larva has to come up to breathe eventually (~hours). Use tweezers and grab it. Gross, but perfectly safe.