The country is not immune to the pandemic. So what explains its current low fatality rate?
By Anna Sauerbrey
March 28, 2020
BERLIN — Europe is in crisis. The New York Times
Countries across the Continent are in lockdown. Borders are closed off. Health care systems are dangerously overstretched. Economies are contracting. And people are dying, in terrifying numbers.
Here is much the same. Though not in full lockdown, schools, shops, restaurants and theaters are closed; gatherings of more than two people are banned. The economy will shrink and jobs will be lost. Even Chancellor Angela Merkel self-quarantined after learning that her doctor was infected. (She tested negative.) Germany, it seems, is not immune to the ravages of the pandemic.
Except in one way: Very few people seem to be dying. As of Saturday, of the 56,202 confirmed cases of the coronavirus, just 403 patients have died. That’s a fatality rate of 0.72 percent. By contrast, the current rate in Italy — where over 10,000 people have died — is 10.8 percent. In Spain, it’s 8 percent. Over twice as many people have died in Britain, where there are around three times fewer cases, than in Germany.
The startling numbers are something of an enigma. Some have hailed the country for breaking the spell of catastrophe; others have been far more guarded. What is going on here? And what can we learn from it?
First and foremost: Early and persistent testing helps. And so does tracking people.
Take the country’s first recorded case. On Jan. 28, a man in Bavaria who works for a car parts company that has two plants in Wuhan, China, was confirmed to have the virus. Within two days, the authorities identified the person who had infected the patient, tracked his contacts and quarantined them. The company stopped travel to China and shut down its plant in Bavaria. The outbreak — several other employees tested positive — was effectively contained. Across the country, the pattern was repeated. Local health departments and federal authorities worked together to test, track and quarantine exposed citizens.
Germany has also been better at protecting its older residents, who are at much greater risk. States banned visits to the elderly, and policymakers issued urgent warnings to limit contact with older people. Many seem to have quarantined themselves. The results are clear: Patients over the age of 80 make up around 3 percent of the infected, though they account for 7 percent of the population. The median age for those infected is estimated to be 46; in Italy, it’s 63.
And many more young people in Germany have tested positive for the virus than in other countries. In part, that’s attributable to the country’s more extensive testing. But there’s also an element of chance and culture. Germany is a skiing nation — around 14.5 million Germans go skiing every year — and the Austrian and northern Italian Alps are popular locations. This year, after vacationers traveled to one of the centers of the European outbreak, Tyrol, they seemed to bring back the virus with them — and spread it.
Closer to home, there’s carnival. One of the most substantial early outbreaks occurred at one of the centers of carnival, which involves parades and parties, popular with the young. Hundreds of cases seem to be traceable to a couple who took part in festivities in the town of Langbroich. “Both skiing and carnival may have affected the low average age of the first wave of confirmed cases,” said Karl Lauterbach, a physician and a member of the Bundestag.
Both early testing and incubation of the virus among the young go part of the way in explaining why the country’s fatality rate is so comparatively low. “It’s how much and whom we test,” Martin Stürmer, a virologist who is the director of a lab that is running coronavirus testing in Frankfurt, told me. In general, countries that test less and reserve it for those already very ill, like Italy, have higher fatality rates.
But we should be wary of reading too much into the statistics at all, particularly at this early stage. Though Germany’s health care system is overall in good shape — recently modernized, well staffed and funded, with the highest number of intensive-care beds per 100,000 patients in Europe — it hasn’t really been tested yet. Patients have only recently entered hospitals. On average, a severely ill Covid-19 patient dies 30 days after being infected. “We are only at the beginning of the epidemic,” Lothar Wieler, the president of the Robert Koch Institute, said on Wednesday. “How it is going to develop is an open question.”
It’s quite possible that Germany is just behind the curve. Opinions vary on how hard the strain on the system will be in the next weeks. “I think we are unlikely to experience a situation like in Italy,” Stefan Willich, the director of the Institute for Social Medicine, Epidemiology and Health Economics at Charité University Hospital in Berlin, said. Others are more pessimistic. Dr. Lauterbach, for example, warned that Germany’s fatality rate may yet rise. Indeed, in the past few days it has climbed from 0.48 percent to 0.72 percent.
And there have been signals that the health care system could soon be overwhelmed. More hospitals and doctors are reporting shortages of vital materials such as masks and other protective gear. A paper published by several medical associations on Wednesday predicted that it is likely that within “a short period of time, there won’t be sufficient intensive care resources in Germany to treat all patients, despite recent capacity-building.” The worst may be to come.
So there is perhaps one lesson we can draw from Germany’s experience. Don’t count your blessings — or your data — too soon.
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