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Why is Germany's COVID-1 death rate so much lower than other countries?

A man walks at the Marienplatz square in Munich, Germany, normally a magnet for tourists, on March 21, 2020, the first day of a dawn-to-dusk curfew in Bavaria during the coronavirus pandemic.
A man walks at the Marienplatz square in Munich, Germany, normally a magnet for tourists, on March 21, 2020, the first day of a dawn-to-dusk curfew in Bavaria during the coronavirus pandemic.
(Image: © Alexander Hassenstein/Getty Images)

Germany has confirmed nearly 34,000 cases of COVID-19 as of Tuesday morning (March 25), but just 171 deaths total. That number — about a 0.5% death rate — suggests the death rate of the novel coronavirus causing COVID-19 is way, way lower in Germany than it is in other countries, such as France, where about 4.3% of cases have ended in death or the United States with a 1.3% mortality rate from the coronavirus. 

Why does Germany seem to be spared lethal cases of the new coronavirus? Early in the infection spread, Germany began to try to test and quarantine all of those who tested positive, at a time when numbers weren't overwhelming, The Washington Post reported

"At the beginning, when we had relatively few cases, when it came to finding them and isolating them, we did quite well in Germany," Reinhard Busse, head of the department of health care management at the Berlin University of Technology, told the Post. "That's the major reason."

Related: Coronavirus in the US: Map & cases 

Some epidemiologists told the Journal that high testing rates in Germany might partly explain the lower death rate, as more testing would catch even the mildest cases. However, Germany didn't do mass testing at the highest rates — as was seen in South Korea where 10,000 tests were run a day — but Germany was meticulous about the process, the Post reported. Once an individual tested positive, officials then tracked every one of their contacts and proceeded to test and quarantine those individuals, essentially breaking "infection chains," the Post reported.

In addition, the virus is known to have more severe impacts on the elderly, and to date, most of the diagnosed cases in Germany are in younger individuals: The median age for confirmed cases of COVID-19 is 47 in Germany, compared with 63 years old in Italy (where the death rate from the coronavirus is the highest globally, at 9.5%), according to the Robert Koch Institute, as reported by the Wall Street Journal. (The median means half of the individuals are above and half are below that number.)

Related: Should you wear a face mask to prevent COVID-19? Experts disagree.

In the United States, about 8 in 10 of the coronavirus-related deaths have been in individuals 65 and older, according to the Centers for Disease Control and Prevention (CDC). And a study published online March 18 found that the majority of COVID-19 deaths in China were in the age group 60 and over.

Coronavirus science and news

Originally published on Live Science. 

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  • Nehmo
    Don't wear facemasks, little people. We, medical people, want them for ourselves!
    Reply
  • R.G.
    Oh, you missed the most significant reason...treatment for the sick. Early on in the spread in Italy, they recognized the need for ventilators to treat the severe pneumonia cases and requested help from their European Union neighbor, Germany. Germany refused. So, the high death rate in Italy has a lot to due with the fact that there are more patients with severe pneumonia and respiratory failure than there are ventilators. You can imagine what happens when a patient needs a ventilator and none are available...the patient dies. THAT is the reason for the high death rate in Italy. Too few ventilators for too many patients. But Germany has enough ventilators and, consequently, more patients in Germany survive. It really isn't a mystery. This story has been reported in news outlets.
    Reply
  • djr12
    I've been very fascinated by this question myself. I'm not sure either the article or the respirator issue really explains it. https://www.worldometers.info/coronavirus/ When you look at stats there, Germany is listed as having almost no serious cases. So it's not that they have serious cases and people are saved by medical technology. It's that they're not having as many serious cases — not even close.
    Reply
  • Addy Adderson
    Isn't it possible that Germany's death rate for covid 19 is simply more accurate than Italy's or the US's? Italy freely admits that their reported number of cases is likely 10X higher than what they reported. If that's the case, Italy's death rate would be only 1%, not 10%. Could it be, because of more disciplined testing, that Germany is actually showing us the real death rate of Covid-19 at around .5%? If that death rate is really that low, what would be the implications for the economic impact of drastic actions the world is taking?
    Reply
  • Vivek
    At this crucial moment of time, all countries irrespective of their political,military,religious and economical affliations should come togother to constrain this epidemic.
    Reply
  • jiw71
    admin said:
    Why does Germany seem to be spared lethal cases of the new coronavirus?

    Why is Germany's COVID-1 death rate so much lower than other countries? : Read more
    First and foremost: no country knows with certainty how many have the virus. Stats therefore are always in error. It is a guessing game at present............ similar to stats posted on influenza. Many people get the flu and do not seek medical attention. There are presently those who probably have the virus now and/or had the virus without being aware. Those with underlying health issues are the first to seek medical attention and are the ones counted. And there are those who are voluntarily tested. Not an accurate count at all.
    Reply
  • susanin76
    djr12 said:
    I've been very fascinated by this question myself. I'm not sure either the article or the respirator issue really explains it. https://www.worldometers.info/coronavirus/ When you look at stats there, Germany is listed as having almost no serious cases. So it's not that they have serious cases and people are saved by medical technology. It's that they're not having as many serious cases — not even close.
    That's the point, once you have far less cases filed as 'mimimal symptoms' to 'mild', no further measure has to be taken than having you avoid contacts with elderly. Maybe enough to fulfill the curiosity of many but not of whom is used to dive deeper below the surface for more convincing explanations, especially if figures delivered in Germany are BY FAR lower than any other industrialized country. Germans claims that they were able to prevent the virus making its way to the most vulnerable group of people, and this comes down, they say, to a mix of timeliness and medical equipment/capacity in better supply. They were more capable to deploy a great deal of swabs in very short time to random test people close to the first reported cases, detect a lot of younger infected people with very mild/no symptoms, stop the propagation in its early stages. This would also explain the unbalance to younger age classes in the distribution graph, compared to countries with a pretty heavy infection history so far but roughly similar age structure. No doubt Germany can count on a higher number of beds in units equipped for this kind of treatments, swabs were distributed very rapidly and in great number, we could also guess the sampling methods adopted in Germany were more effective than anywhere else. That could partly explain why the contry is apparently yielding amazing success in its early efforts to contain the spread of the contagion while neighbouring countries are struggling to cope. But we may argue on their timeliness, since most counties made their move a week or more after Italy, so at this stage we cannot afford any serious discussion if and how long it will take to countries that started later to catch up with Italy and fill the gap, so this part of the story could probably casts a first major doubt on how Germany managed to keep figures so dramatically lower. Time will possibily raise the tally and thus letality rate to a much more reliable level (?).
    Second point of discussion is the count of the number of fatalties. Until recently, Italian media (I guess none of the readers will argue we're using Italy as the strongest benchmark in this affair) made a big fuss about the way medical authorities are handling and delivering data so far, especially about how Covid-19 cases with fatal outcome should be best classified. Were they 'caused by' or 'with' corona virus infection? No matter the presence of a number of concurrent factors or contributing causes (other serious illnesses, secondary infections, even causalties from therapy mishandling) I assume that if the death was direct consequence of Covid-19 infection, the same should be linked with the virus, just as italian hospitals actually do. I think it makes no sense to quibble weather the case would not have turned out fatal were there no other serious underlying illnesses of whatsoever severity.
    So far so good for Italy, but are we sure Germany is applying the same counting criteria? To my knowledge there is no international standard to comply with or sort of common reviewing mechanism, and even if there was any, WHO and other third party institutions do not seem much concerned about how countries are now recording data that are feeding the official reports on a daily basis, although they should be much concerned given the magnitude of the issue.... We all see how Iran's leaders are using their powers to tweak figures, lest the real magnitude the epidemics would not be discovered and exploited against the establishment. Iran has a long tradition in and deceiving its own public opinion and international community, but as any countries are left a great leeway to present figures to the wide audience as they prefer, I don't see any reason for anyone should not elaborate some form of cover-up to promote a different story-telling.
    Reply
  • Mxyzptlk
    ...You can imagine what happens when a patient needs a ventilator and none are available...the patient dies. ....

    My understanding is that 80% or so of ventilated patients die despite the heroics. If that is correct, having more ventilators will definitely change the mortality rate. But not by much.
    Reply
  • Accuracy of Testing
    susanin76 said:
    That's the point, once you have far less cases filed as 'mimimal symptoms' to 'mild', no further measure has to be taken than having you avoid contacts with elderly. Maybe enough to fulfill the curiosity of many but not of whom is used to dive deeper below the surface for more convincing explanations, especially if figures delivered in Germany are BY FAR lower than any other industrialized country. Germans claims that they were able to prevent the virus making its way to the most vulnerable group of people, and this comes down, they say, to a mix of timeliness and medical equipment/capacity in better supply. They were more capable to deploy a great deal of swabs in very short time to random test people close to the first reported cases, detect a lot of younger infected people with very mild/no symptoms, stop the propagation in its early stages. This would also explain the unbalance to younger age classes in the distribution graph, compared to countries with a pretty heavy infection history so far but roughly similar age structure. No doubt Germany can count on a higher number of beds in units equipped for this kind of treatments, swabs were distributed very rapidly and in great number, we could also guess the sampling methods adopted in Germany were more effective than anywhere else. That could partly explain why the contry is apparently yielding amazing success in its early efforts to contain the spread of the contagion while neighbouring countries are struggling to cope. But we may argue on their timeliness, since most counties made their move a week or more after Italy, so at this stage we cannot afford any serious discussion if and how long it will take to countries that started later to catch up with Italy and fill the gap, so this part of the story could probably casts a first major doubt on how Germany managed to keep figures so dramatically lower. Time will possibily raise the tally and thus letality rate to a much more reliable level (?).
    Second point of discussion is the count of the number of fatalties. Until recently, Italian media (I guess none of the readers will argue we're using Italy as the strongest benchmark in this affair) made a big fuss about the way medical authorities are handling and delivering data so far, especially about how Covid-19 cases with fatal outcome should be best classified. Were they 'caused by' or 'with' corona virus infection? No matter the presence of a number of concurrent factors or contributing causes (other serious illnesses, secondary infections, even causalties from therapy mishandling) I assume that if the death was direct consequence of Covid-19 infection, the same should be linked with the virus, just as italian hospitals actually do. I think it makes no sense to quibble weather the case would not have turned out fatal were there no other serious underlying illnesses of whatsoever severity.
    So far so good for Italy, but are we sure Germany is applying the same counting criteria? To my knowledge there is no international standard to comply with or sort of common reviewing mechanism, and even if there was any, WHO and other third party institutions do not seem much concerned about how countries are now recording data that are feeding the official reports on a daily basis, although they should be much concerned given the magnitude of the issue.... We all see how Iran's leaders are using their powers to tweak figures, lest the real magnitude the epidemics would not be discovered and exploited against the establishment. Iran has a long tradition in and deceiving its own public opinion and international community, but as any countries are left a great leeway to present figures to the wide audience as they prefer, I don't see any reason for anyone should not elaborate some form of cover-up to promote a different story-telling.

    An informative update on the test method:

    https://www.livescience.com/coronavirus-tests-available.html
    It appears that the reagent gave inaccurate results:

    “The CDC's original failed test for the coronavirus was a PCR test. It did successfully detect SARS-CoV-2, said David Kroll, a professor of pharmacology at the University of Colorado Anschutz Medical Campus. But one of the chemicals used in the test also responded to non-coronavirus genetic material as if the virus were present — returning false positive results. After this failure, the Food and Drug Administration issued Emergency Use Authorizations for private labs and hospitals to develop their own coronavirus PCR tests. These tests still have to meet the CDC's bar for accuracy, but they don't have to go through the long process of typical FDA approval. As of March 30, 20 emergency authorizations had been granted for different tests.”

    What test method did the Germans use? Did it also result in many false positives but they tracked them all down with an abundance of caution?
    Reply