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What’s behind Germany's low coronavirus death rate?

Early mass testing, good healthcare system seen as key factors in fighting off COVID-19

Oliver Towfigh Nia   | 31.03.2020
What’s behind Germany's low coronavirus death rate?

BERLIN

Like other European countries, Germany is in the grip of the novel coronavirus, with nearly 67,000 people infected to date.

But what has stunned other countries like France, Spain and Italy – which are desperately struggling with a worrisome surge in coronavirus deaths – is Germany's relatively low mortality rate.

The death toll in Germany is currently around 645 – a surprisingly small figure compared to the number of confirmed cases.

In mathematical terms, this is a lethality rate of around 0.8%, significantly smaller than in many other countries including Italy and Spain, both of which are grappling with rates around 10%.

According to Christian Drosten, Germany's leading coronavirus expert and a government adviser, the high number of tests carried out in the country may provide a possible explanation for the comparatively low death rate.

"We have so few deaths because we do a lot of laboratory diagnostics," said Drosten, who is also director of the Institute for Virology at Berlin's famed Charite Hospital.

Head start

Germany recognized the virus outbreak very early and was thus got a two- to three-week head start in detecting the epidemic, according to Drosten, who also developed one of the first tests for the virus in January.

Germany also has a network of independent laboratories, many of which started testing in January, when the number of cases was still very low. Thanks to the high laboratory density, it is easier to get tested in Germany than in other countries, shown by how the country does over half a million coronavirus tests every week.

Heyo Kroemer, Charite’s CEO, also stressed how Germany started testing earlier than other countries affected by the pandemic. This also helped in that there was more time in Germany to prepare the tests before there were many cases.

Some 410,000 tests have been carried out in Germany since March 9, said Andreas Gassen from the National Association of Statutory Health Insurance Physicians (KBV).

The tests themselves do not reduce the death toll, but more people tested gives a more accurate picture of the overall situation.

When fewer people are tested, but more of those are people who are symptomatic or hard hit by the virus, this tends to show a higher lethality rate.

Conversely, more testing, including people who have mild or no symptoms, tends to produce a lower lethality rate.

ICUs and ventilators

It is also suspected that the quality of healthcare systems in individual countries has an impact on death rates.

One thing is clear: when a country’s intensive care beds and ventilators reach their limits, the number of deaths also increases.

This is already evident in some regions in Italy, where doctors report that they have to make hard decisions which patients to connect to one of the few ventilators available and which not to.

Due to the later outbreak and earlier knowledge of it in Germany, hospitals in the country gained time to increase their capacity. For example, work is underway to double the number of beds in intensive care units, which currently total 28,000.

The German government also plans to increase its stock of ventilators from 25,000 to 35,000.

In comparison, in France, there are around 7,000 ventilators, and in Italy only around 5,000. According to British authorities, there are only slightly more than 4,000 intensive care beds and 5,000 ventilation devices available.

German hospital officials have also postponed non-urgent surgeries, while personnel from other hospital units are being retrained to take care of coronavirus patients.

Separating out the infected, different family units

Another factor is also important: it has been reported from Italy that at least initially, special areas for coronavirus patients were not always set up in hospitals, allowing the virus to spread and infect already weakened patients.

In Germany, separate areas are currently being set up in hospitals for coronavirus patients. In order to keep hospital beds free for the seriously ill, the federal and state governments drew up an emergency plan to convert halls and hotels into provisional treatment centers for milder cases.

Another piece of the puzzle on very different death rates was provided by Moritz Kuhn and Christian Bayer, two professors from the University of Bonn.

Kuhn and Bayer looked at the differences in the form of cohabitation and social interaction in various countries related to their coronavirus death rates.

The result: the more working people that still live with their parents, the higher the proportion of deaths at the beginning of the epidemic.

In Italy and Spain, for example, several generations often live under one roof. Older relatives are heavily involved in family life, and younger people who cannot afford an apartment move out of their parents' home relatively late.

"If the working population becomes highly infected, it is less dramatic for population structures like in Germany or Scandinavia, where we know there are fewer cross-generational forms of living together," said Kuhn.

As soon as the virus has spread into the elderly, however, there is a chain reaction that overloads the healthcare system.

In Germany, the average infected person is younger and healthier than those in other countries. According to Lothar Wieler, head of the Robert Koch Institute, more than 70% of confirmed cases in Germany are between 20 and 50 years old.

Elderly people and people with pre-existing health conditions are considered to be a risk group. Around a quarter of the population in Germany is currently age 60 or older.

As a result, experts fear that the number of deaths could skyrocket in the near future as the virus spreads.

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