Low mortality rates, free intensive care beds and the prospect of an early easing of exit restrictions. Germany seems to have a better grip on the virus than other countries. What could be the reason?
Earlier this week, German health minister Jens Spahn (CDU) gave a remarkable interview to American television station CNBC. The moderator wanted to know from Spahn why the coronavirus hits Germany less hard than some other countries. In English with German coloring, Spahn replied that there are now many reasons for this. “First of all” is the German health system in a “very good shape”, in other words in very good condition. The situation was taken very seriously right from the start, “very serious from the very beginning”.
It rarely happens that German health ministers are interviewed on foreign television. Success stories are even rarer. In the past, the Federal Republic was rather blamed internationally for its debauched system. It was always too expensive, too many clinics and operations – also from the Organization for Economic Cooperation and Development. It was not until 2018 that the OECD received bad grades for Germany. Bavaria’s Prime Minister Markus Soder (CSU) was probably still listening to the criticism when he boomed on Wednesday: “The German health system has passed the international test.” Germany suddenly becomes a role model.
“New York Times” puzzles over “German Exception”
It is the first pandemic that the world is experiencing in the digital age. Almost in real-time, people on all continents track infection numbers, death rates, and see pictures of disaster scenarios in hospitals. What is striking: the number of infected people in Germany is quite high, but the hospitals seem to have the situation under control, and more people have recovered than are currently ill. And then there is above all this number: 2.7 percent – that is the death rate among confirmed corona infected people in Germany (as of April 16).
This is many times lower than, for example, in Italy, Spain or Great Britain, where the proportion of COVID 19 deaths is well over ten percent. Even the “New York Times” puzzled about this “German exception”. All of this is possible, although the exit restrictions in Germany are comparatively relaxed. The population can continue to walk in public parks, even hardware stores are open. Schools can start operating again in a few days.
In the search for explanations, one comes across different approaches, much is still approximate, the data situation is sparse. This week, the deep knowledge group think tank published a highly regarded ranking. According to the London think tank, Germany is the safest country in Europe and the second safest in the world after Israel in the Corona period. A wide range of criteria were included in the assessment: exit restrictions, the government’s crisis management and also criteria that affect the health system, such as emergency measures or the number of corona tests.
A special love: the Germans and their district hospital
There are almost 500,000 hospital beds in Germany; in the UK, for example, there are just over 101,000. Efforts have been made in the Federal Republic to reduce this number for years. Health economists consider the high density of clinics to be inefficient, many houses are in the red. In 2019, the Bertelsmann Foundation published a study calling for the reduction from just under 1,400 to well under 600 hospitals.
But no elections can be won with closure plans. The Germans and their district hospital – that’s a special love. These hospitals ensure basic care, particularly in rural regions. If one of them has to close, it is like a moderate tragedy. After all, you were born in the district hospital or gave birth there, would have died there. As the director of the Institute for Health Economics, Reinhard Rychlik, observes, people in Germany associate these clinics with “a certain tradition and stability in the region”.
This proves to be an advantage in the Corona crisis. The chances of a good outcome of COVID-19 disease increase if patients are treated quickly if their condition worsens. With the beginning of the pandemic, the clinics increased the already high number of intensive care beds from 28,000 to 40,000. Operations that were not urgently necessary have been postponed to expand capacities. The federal government has guaranteed the hospitals to compensate them financially.
The director of the Institute for Health Economics at the Helmholtz Center in Munich, Reiner Leidl, also considers the networking of the clinics to be a reason why the Federal Republic has so far safely steered the pandemic. There is a central register in which the individual hospitals enter the number of free intensive care beds. The register currently reports almost 10,000 vacant beds in intensive care units. The unused capacities are large enough that Germany can accept patients from other European countries.
A handy formula for the intangible virus
Nevertheless, Germany should not think that it is in the wrong security. This is roughly the message that Lothar Wieler, President of the Robert Koch Institute (RKI), has been spreading for weeks. The institute is responsible for fighting epidemics in Germany. Wieler regularly informs the population about the situation, wrestling with handy formulas for the intangible virus at his press conferences. Probably the very nature of the reserved Rhinelander speaks against the fact that he would celebrate something like a “German Exception”. He always avoids questions about this regarding the data situation.
A few weeks ago, however, Wieler let through what he believes could be the reason why the death rate in Germany is so low. And there is a reason for which he and the government cannot do anything: the infected people in Germany are on average younger than in Italy, for example. According to the RKI, the average age of the sick is currently 50 years (as of April 15). In Italy, it is more than 62 years old. This could be since among the first people infected in Germany were many young people who became infected during their ski vacation. Wieler pointed out that the average age of those infected had gradually increased in Germany as well, and homes for the elderly reported more infections.
What is definitely on Wieler’s account is the high number of corona tests. Since the beginning of the crisis, the RKI has had more than 1.7 million tests carried out – only South Korea has carried out extensive tests across the board. At the end of February, the daily laboratory capacity in Germany was still a good 7,000 tests. In the meantime, the laboratories are evaluating around 100,000 tests per day – and the German government wants to significantly expand its capacities again.
If people are tested very early after infection and with only mild symptoms, they can be quarantined early and better monitored for their health. However, Leidl warns of a statistical bias: A higher volume of tests could be associated with the fact that the infections are observed earlier than in other countries. This could mean that in early test countries, the mortality rate rose later in the course of the epidemic than in the late test countries.
“We didn’t have to be taught to wash our hands with soap”
But all the tests, all the hospital beds would probably be in vain without measures such as contact restrictions and without a population that adheres to them. Political scientist Uwe Jun, therefore, draws attention to the mentality of the Germans, who play a role in the crisis that should not be underestimated. “The Germans follow the rules set by the state more than some other nation,” says Jun. This can now also be seen in the Corona period. While there were occasional reports of bars that violated the rules, the police have now concluded that the population largely abides by the rules. Even after the Easter weekend, the authorities reported hardly any violations.
Health economist Rychlik also observes that Germans have a more pronounced sense of health and hygiene than people in other countries. “We didn’t have to be taught to wash our hands with soap.” Yes, the toilet paper was not the first item sold out in Germany – it was the disinfectant.
Now and then the Germans even tend to overdo it with a sense of duty. “Sometimes we also play senior teachers,” says Rychlik. In pandemic times, it looks like this: The neighbor has the Corona party dissolved by the police, photos of small groups of people who gather in parks end up on the Internet, customers are asked to go to the supermarket, but please do so exactly on the distance strip in to stand in line. This is often not nice. However, it is precisely this mixture of a sense of duty and the tendency to play the senior teacher that proves to be helpful in the corona crisis, says Rychlik.
The master in time-saving
Despite the far-reaching restrictions on public life, the population stands behind the government’s measures. The approval ratings of the grand coalition have been high for weeks – after there was even talk of early elections before the crisis. Chancellor Angela Merkel regulates the crisis in a calculated and evidence-based manner, Jun says. It looks credible because as a physicist, she already has the image of a fact-based approach. “Nothing appears to be shot from the hip.” And Merkel is a master at winning time. What you have not always interpreted well in the past makes sense in Corona times.
A look at the USA, which is badly affected by the coronavirus, shows how important the government’s crisis management is. There, President Trump first downplayed the problem, ignoring the opinions of experts. Now he is arguing with the governors over exit scenarios. In Germany, too, there were initially debates about the responsibilities of the federal and state governments. The Chancellor and the Prime Minister avoided the public exchange of blows as in the USA. Jun believes it is an advantage that the federal states in Germany have scope for their own rules: “”Central states like France seem to be at a disadvantage.” There are significant differences in the hotspots there, but French President Emmanuel Macron still directs everything uniformly from Paris, says Jun.
The spirit of the black zero
There is one more thing that Germany benefits from the upturn that has been going on for years and the fact that it is sticking to the black zero means that the Federal Government can make full use of Corona aid for the economy. The Federal Government has mobilized more than a trillion euros in emergency aid and loans. That also increased the acceptance of the measures taken by the population, says Jun.
This week, however, there was growing evidence that the quiet location in Germany is fragile. The exit plan presented by the federal government no longer met with the same broad approval as the measures of the past few weeks. The road ahead of the government will be more difficult to master. Nothing forgives people less than being disappointed after a victory that was already believed to be certain.
