Why is the death rate in Germany so low?

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Germany has received a lot of attention for having a lower death rate for COVID-19 than most comparable European countries. A simple explanation for the low death rate in Germany is that the country has tested more people, so they have more confirmed cases for the same number of deaths.

In many countries, only high-risk and most seriously ill patients are tested. This results in a fairly precise number of deaths but considerably underestimates the number of cases, since most of the cases cause a mild illness and would not be tested.

Germany’s robust and rapid testing program was helped by the use of a distributed network of tests in different hospitals, clinics and laboratories, rather than relying on tests from a single government resource, as was the case in countries like the United States and the United Kingdom. The German federated system allows greater regional autonomy, which makes it easier for local health systems to coordinate the work of different laboratories.

Distributed tests are now gradually being implemented in many countries.

Consequences of increased testing

The low death rate in Germany is not just a question of the number of tests, but also how the government reacted to the data. Germany’s strong screening program is associated with the identification and isolation of infected patients. Since the virus spreads most effectively in people in the early stages of the disease without symptoms or with mild symptoms, early identification and isolation would have a disproportionate impact on the spread of the disease.

Graffiti on Alexanderplatz in Berlin.
Omer Messinger / EPA

The slowdown in the spread of the virus in Germany has also led to better hospital preparation which is helping to reduce deaths. For example, the number of acute care beds in Germany is 621 per 100,000 population, compared to 275 beds per 100,000 in Italy and 228 beds per 100,000 in the United Kingdom.

The impact of early interventions and increased preparation can be seen in time from the first case to the first death of COVID-19. Germany had its first case of coronavirus on January 27, before Italy on January 31, but the first death was not recorded until March 9, much later than in Italy on February 21. The increased capacity for intensive care also likely plays a role in reducing death in Germany.

A question of age?

Only 20% of cases in Germany have been reported to be in people over the age of 60 (up to 50% in other European countries, such as Spain).

We know that COVID-19 causes more serious illnesses and has a higher mortality rate in the elderly, so the percentage of people over the age of 60 who are infected could significantly affect the mortality rate. But the median age of the population in Germany is 45.7 years, 21% of its population being over 65 years old, comparable to that observed in Italy (median age 47.3 years old, 23% over 65 years old) and older than that of the United Kingdom. (median age 40.5 years, 19% over 65 years).

This suggests that the low infection rate in Germany in the 1960s is more likely to be explained by rapid tests, isolation and physical distancing measures than by mere demography.

Despite Germany’s strengths in isolation, hospital readiness, etc., it still suffers from the same late reaction as many other countries. Having seen the spread of COVID-19 through China and then Italy, Germany did not adopt a national program of physical distancing measures until March 22.

For comparison, Italy started the lockdown on March 8. This probably explains why the low number of deaths in Germany was not accompanied by a low number of cases or a low rate of transmission. Earlier implementation of the distance protocols may also have reduced the spread of COVID-19 in the country.

Lessons for the rest of the world

Overall, the German response was a good example of how countries can combat the spread and severity of COVID-19. The heart of the German response corresponds very well to the recommendations of the World Health Organization: prepare, test (isolate and treat) and reduce the spread of the virus.

Many countries are now focusing on the mitigation aspect, using physical distancing measures to reduce transmission. But without widespread testing, countries will not know who is infected, they will not be able to guarantee their isolation, and they will not be able to control the pandemic.

With many of us doing our part in locking in and practicing physical distance, it is the responsibility of governments around the world to ensure that this time is used effectively. Confinement will not be possible without generalized tests.

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