The coronavirus crisis has hit Germany with full force. Infections are increasing rapidly, schools, factories and bars have closed across the country, and government measures to slow the outbreak are becoming more draconian by the day.
In one crucial way, however, the country is proving remarkably resilient: relative to known infections, the number of deaths has so far been minuscule.
According to data from Johns Hopkins University, there were 13,979 coronavirus infections in Germany on Thursday afternoon, more than in any other country except China, Italy, Iran and Spain.
At the same time, Germany had only registered 42 deaths. Neighbouring France, by contrast, reported 9,058 infections and 243 deaths. Spain had 17,395 infections and 803 deaths. The US, the UK, Italy and even South Korea all show case fatality rates significantly higher than Germany.
The apparent anomaly has sparked debate in Germany and beyond, though experts warn against drawing sweeping conclusions. They argue that the country’s low fatality rate most likely reflects the fact that the outbreak is still at a relatively early stage, and that the age profile of those affected has so far been younger than that in other countries. Younger patients without previous ailments have a much better chance of surviving Covid-19 than elderly patients.
Another factor that may help explain the variance is the unusually high number of tests being carried out in Germany. According to Lothar Wieler, the president of the Robert Koch Institute, German laboratories are now conducting about 160,000 coronavirus tests every week — more than some European countries have carried out in total since the crisis started. Even South Korea, which is conducting 15,000 tests a day and has been held up by virologists as an example to follow, appears to be testing less than Germany.
“This is about capacity. The capacity in Germany is very, very significant. We can conduct more than 160,000 tests per week, and that can be increased further,” Prof Wieler told journalists this week. Test capabilities would be boosted not least in part by switching laboratories that specialise in animal health towards coronavirus checks. There was no sign that test kits were running low, Prof Wieler added.
In the short term at least, mass testing feeds through into a lower fatality rate because it allows authorities to detect cases of Covid-19 even in patients who suffer few or no symptoms, and who have a much better chance of survival. It also means that Germany is likely to have a lower number of undetected cases than countries where testing is less prevalent. Indeed, one notable feature of the coronavirus outbreak in Germany so far is the high number of relatively young patients: according to data from the Robert Koch Institute, more than 80 per cent of all people infected with the coronavirus are younger than 60.
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“Especially at the beginning of the outbreak in Germany we saw many cases connected to people returning from skiing trips and similar holidays,” said Matthias Stoll, a professor of medicine at the University of Hanover. “These are predominantly people who are younger than 80 and who are fit enough to ski or engage in similar activities. Their risk of dying is comparatively low.”
Hans-Georg Kräusslich, a professor of medicine and the head of virology at the University Hospital in Heidelberg, said: “In most cases the illness is mild and shows few symptoms, and we assume that the detection of such mild cases varies from country to country. In statistical terms that leads to a difference in case fatality rates.”
However, Prof Kräusslich cautioned that the picture in Germany was likely to change in the weeks and months ahead: “We are still at a relatively early stage in the outbreak in Germany. The overwhelming share of patients became infected only in the last week or two, and we will probably see more severe cases in the future as well as a change in the fatality rate.”
That note of caution is echoed by virologists and epidemiologists across the country. Most expect the different national case fatality rates to converge as time passes and more countries uncover the true number of infections. But experts also point out that Germany has at least had the chance to prepare for a surge in serious infections, with hospitals across the country expanding intensive care capacity and boosting staff numbers and the government buying up as much critical equipment as it can.
Last week, the federal government ordered an extra 10,000 life-saving ventilators from a German manufacturer, on top of the 25,000 that are already in place in hospitals across the country. The city state of Berlin, which has so far recorded 391 cases of Covid-19, is converting parts of the local trade fair ground into a 1,000-bed hospital for future coronavirus patients. Similar steps have been taken across the country.
“We are at the beginning, so we can still implement all the measures that have been called for,” said Prof Wieler. “We can still ensure that severely ill people can get treatment in the hospital.”