Germany has remarkably few Covid-19 deaths - here's how its healthcare system prevented it
- Germany has had remarkably few Covid-19 deaths, which experts attribute partly to its high number of hospital beds and ICU beds.
- The country was also quick to roll out reliably tests for the coronavirus and initiate strict social distancing measures to prevent the spread.
- Part of the reason Germany was so quick to start testing for Covid-19 is that private labs nationwide were free to test, and as of April 2 have helped the country test 1 million people for the disease.
- Germany hasn't stopped the coronavirus completely. It continues to see an uptick in cases and deaths.
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With a combination of widespread testing and a robust healthcare system, Germany has provided a potential template for how countries can adapt to the coronavirus threat and blunt its impact.
Here's how Germany turned itself around as one of the European countries with the highest number of Covid-19 cases to having one of the lowest mortality rates of Covid-19 worldwide.
January: Germany's unconcerned about coronavirus
In January, when Covid-19 was ravaging China, Germany still regarded the illness as a far-off, and likely minor, threat. In late January, German Health Minister Jens Spahn said that Covid-19 posed a very low health risk.
But it took just a few days for signs of trouble to erupt. Germany had discovered its first few Covid-19 cases by January 27, but thought they were little more than local threats that could be easily managed.
Germany wasn't the only country with this reaction. On January 22, US President Donald Trump was asked whether he was worried about the coronavirus outbreak. "It's one person coming in from China, and we have it under control," Trump said. "It's going to be just fine."
At the time, Germany and the US seemed to be on the same page.
February: Germany has one of the highest infection rates in the world
Over the course of February, the situation had changed dramatically in Germany.
The coronavirus threat was increasing by the day and with 48 confirmed cases by February 28, Germany had the second-highest number of cases in Europe behind Italy's 644 cases. It was also just behind the 60 cases confirmed in the US.
That seemed to be the point at which Germany and the US started to diverge in their response to Covid-19. Just two days prior, on February 26, Trump said that the US coronavirus threat was "going down, not up." The next day, he said the threat would, "like a miracle," evaporate.
But Germany sprung into action.
Late February and early March: Germany's forceful and rapid response
By the time Trump made his comments, Germany was already taking action to address the coronavirus threat.
In late February, the country extended school and daycare facility closures and required anyone who had contact with confirmed cases to remain in isolation for 14 days. Even in unconfirmed cases - those who had been near someone with coronavirus-like symptoms - were told to self-isolate.
Meanwhile, the government said that it would limit outside travel into the country and begin acquiring protective medical equipment to prepare for the Covid-19 fight. Along the way, despite an inability to get rapid test results, Germany was ramping up its testing efforts.
"Germany was able to react to the situation unfolding in China in January and have testing established by mid-February," said epidemiology professor at Yale School of Public Health Nathan Grubaugh. "They could do this in part because Germany doesn't have a centralized diagnostic system so labs around the country were free to establish tests." In fact, as of April 2, private labs in Germany have helped the country test 1 million people for Covid-19.
Germany was one of the first countries to develop a testing system for Covid-19. It's capacity to test for Covid-19 early on meant that Germany could "get a much better handle on who was infected, isolate contacts, and treat those who need care," Jennifer Kates, the senior vice president and global health and HIV policy director at the Kaiser Family Foundation said.
March 9-10: The first deaths
Despite widespread testing efforts, the German coronavirus outbreak continued.
By March 9, Germany had approximately 1 200 cases and had recorded its first two deaths. The same day, the US had accumulated 950 cases and 28 deaths. German chancellor Angela Merkel and her administration told Germany that they would need to do "everything possible" to slow the coronavirus spread and save lives and announced that gatherings of more than 1 000 people would be shut down.
This was 7 days before Trump recommended social distancing measures based on CDC guidelines.
But perhaps what has contributed to Germany's low death rate most is an ace up its sleeve that many other countries can't match: An extremely high bed-to-person ratio. According to data from HealthSystemTracker, Germany has 8.1 hospital beds per 1,000 people and 6.1 ICU beds per 1 000 people. Italy has 3.2 hospital beds per 1 000 and 2.6 ICU beds per 1 000.
The US has 2.8 hospital beds per 1 000 and 2.4 ICU beds per 1 000 people.
"Germany hospital capacity surpasses that of many other countries," Kates said. It's been a key factor in saving lives and not overwhelming a strained healthcare system.
March 17: A bigger risk - and problems testing
On March 17, the Robert Koch Institute, which monitors public health across the country, changed Covid-19's health risk to "high" in Germany.
The German government said that because of a lag of about three to four days between testing and results, it believed the real number of cases was higher than the recorded 7 000, or so. Germany quickly expanded the number of Covid-19 beds by 1 000 to accommodate extra needs.
In the ensuing days, more curfews and quarantines went into effect. Social distancing, a core component in any country's battle with Covid-19, was further tightened as schools, daycare facilities, and other gathering limitations were extended. At the right time, Germany responded forcefully, experts said.
"The factors [in Germany's success] have not been in place in other settings," Kates said. "The US has largely bungled its testing effort and Italy's hospitals have been overwhelmed. These are very hard barriers to overcome once countries are at this point."
But Germany wasn't done.
March 22: A widespread crackdown
By March 22, Germany's cases hovered at around 25 000, but deaths were just 86 - a fatality rate of approximately 0.3% that easily outpaced China, Italy, and nearly every other country around the world.
That day, the German government announced that people would need to remain six feet apart, and gatherings of more than two people were forbidden. Germans were also asked to stay home, unless necessary.
It was a move made just a day after Italy announced similar national restrictions on movement and non-essential business activity. But by then, the differences between Germany and Italy were stark: Italy reached more than 59 000 cases that day and nearly 5 500 deaths.
In the US, the coronavirus battle was ramping up. On March 22, the US 140 deaths that day and 557 cumulative fatalities. A mortality rate of 1.2%. This is partly due to the country's slow roll out of tests early on, Grubaugh said.
Late March into April: Questions abound
Statistics indicate that Germany is in a far better place than many of the other developed countries worldwide. And testing may be central to its success.
Late last month, Germany said that it could conduct 160 000 tests each week, and has been able to test more than 2 000 per million people. It's now using rapid testing to identify patients within hours, and it's not letting up.
"It's becoming clear that the countries that rolled out rapid wide-scale testing are the ones that are also controlling the virus better," Grubaugh said.
"If countries that have yet to see surging cases can implement early widespread testing, isolation of those infected and contact tracing, coupled with shoring up their health system capacity, they can see success," Kates said.
Germany hit all the right marks. But the fight remains.
Experts cautioned that Germany may not have reached its peak. The country added about 4 000 new cases on March 28. On March 30 cases were up 4 600 to a cumulative total of 61 913.
Meanwhile, deaths are increasing. On March 29, Germany recorded 66 deaths due to Covid-19. That figure increased 128 on March 30. Germany's death rate is now 1.2% - still lower compared to many other parts of the world.
It's unclear what might be happening in Germany and whether the worst is behind the country. But there are clear indications that this story is far from over.
"Germany is not out of the woods yet," Kates said.
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