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Covid-19: how to explain the low death rate in Germany?

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At the end of March 2020, while the coronavirus has been rife for two months in Europe, Germany has only 455 fatal cases for 57,298 people infected (as of March 30). How to explain this “low” mortality rate? A look back at the federal government’s strategy to contain the epidemic.

The mortality rate due to Covid-19 is currently 0.69% in Germany. But as the Süddeutsche Zeitung explains, this figure does not mean that the virus is less deadly in Germany than elsewhere. In reality, this is a “statistical distortion”, because different criteria must be taken into account, such as the number of unreported cases, which would be rather low, but also the severity of the symptoms. Numerous people with only mild forms of the disease are thus taken into account in German statistics, while in Italy the opposite occurs, leading to a high mortality rate, which would indicate rather than a large many infected young people have fallen through the cracks.

The weekly Die Zeit deduces that this low death rate is in fact a sign that Germany has a better view of the situation. Assuming that the actual lethality of the virus should be roughly the same everywhere, a high case fatality rate indicates above all that many non-fatal cases have not been reported.

The Süddeutsche Zeitung lists five criteria that can influence the death rate: the age of infected people (in Germany 80% are under 60, in Italy 56% are over 60), lung health, air pollution, antibiotic resistance, and finally the quality and capacity of the health system.

No containment

Last Saturday, March 28, 2020, Angela Merkel thanked the citizens of Germany for following the new rules established to fight against the coronavirus pandemic. Updated on March 22, they aim to reduce travel, so that the number of new infections only doubles every ten days. This repetition currently occurring every 5.5 days, the rules of distancing, which do not come under confinement in the strict sense, are reiterated. You are asked to avoid contact and to keep your distance when going out. You can only go out alone, or accompanied by members of your household, or a single person outside your home but maintaining a distance of two meters. It is allowed to leave your home “when necessary”, namely to go to work, go shopping, go to the doctor, go to very important appointments such as an exam, play sports or take a walk . Parties and all gatherings are prohibited; cafes, bars and restaurants no longer serve customers, but customers can prepare deliveries; personal service businesses (hairdressers, make-up artists, physiotherapy offices, massage and tattoo parlors) are now closed. Only essential shops (food, pharmacies) and the administration remain open.

The German government therefore wished to proceed in stages to restrict the movement of citizens, in particular because it believed it had some control of the situation, and this, since the very beginning of the pandemic.

Germany is ready

On February 24, 2020, Minister of Health Jens Spahn declared: “The coronavirus epidemic has arrived in Europe. So we can expect it to spread to Germany as well. Germany has prepared for it at best. This preparation started at the beginning of January, even before the first infected patient was identified on January 27 in Bavaria. A single procedure was therefore applied to all identified cases, to contact persons and to persons coming from risk areas: immediate quarantine, then tests at the end of quarantine. These measures made it possible to circumscribe the three German clusters (in Bavaria, North Rhine-Westphalia and Baden-Württemberg) from the end of February, with the aim of interrupting the chains of infection as quickly as possible.

In an interview with the weekly Die Zeit on March 20, the director of the Institute of Virology of Charity in Berlin, Christian Drosten, returns to this anticipated management of the epidemic: “I believe that Germany quickly became aware of the start of the epidemic. We did it two or three weeks earlier than some of our neighbors. We got there because we diagnosed a lot, tested a lot. During this first phase we also certainly let cases pass, it is always so. But I don’t think we’ve missed a significant event of the outbreak. The proof is that the infection curve follows the expected trend. But we also see that we have fewer fatal cases than other countries. One might therefore think that we are not too far from having identified all of the cases. We certainly don’t see all of the cases, but we do see relatively more than other countries that test less. “

Tests, an asset for Germany

On Thursday, March 26, during a press conference at the French Ministry of Education and Research, Christian Drosten estimates the number of tests carried out at 500,000 per week. According to a survey carried out by Politico magazine in partnership with the daily Die Welt, France only performs 5,000 tests per day, while Italy has carried out 300,000 since the start of the epidemic.

Christian Drosten, who is also the head of the National Coronavirus Laboratory, participated in the decoding of the SARS virus in 2003 and developed a test to diagnose it; in January 2020 it did the same for the new coronavirus. Germany is thus at the forefront of the fight against the virus before it even arrives on its territory.

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