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What's your first thought when you see this headline?
https://www.nytimes.com/2020/04/04/worl ... -rate.html
A German Exception? Why the Country’s Coronavirus Death Rate Is Low
The pandemic has hit Germany hard, with more than 92,000 people infected. But the percentage of fatal cases has been remarkably low compared to those in many neighboring countries.
By Katrin Bennhold
April 4, 2020
Updated 3:34 p.m. ET
Mine was this, although in the article it took until paragraph 13 to appear:
Another explanation for the low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities.
“That automatically lowers the death rate on paper,” said Professor Kräusslich.
Widespread testing, including of people without symptoms, would also explain the first reason given for Germany's so-far low death rate, an anomaly described in an earlier paragraph:
The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.
“It started as an epidemic of skiers,” he said.
As infections have spread, more older people have been hit and the death rate, only 0.2 percent two weeks ago, has risen, too. But the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.
The combination suggests not that Germans are younger than people in the other countries mentioned (they are not, or barely), or that the German strain of the virus hits younger people more often, but that the apparent higher occurrence in younger people is artifactual.
More testing, early and widespread, means more asymptomatic cases (positives) are detected, and thus more of the total number of positives are young, relatively more are asymptomatic and relatively fewer die.
Now see what the initial outbreak in Germany was:
The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.
“It started as an epidemic of skiers,” he said.
So it seems the initial group was relatively younger and suffered relatively mild or asymptomatic cases. The state responded swiftly to implement relatively broad testing -- again yielding a group of positives on average younger than in other places, where testing had not been as initially broad and had to catch up with cases where they actually manifested most dramatically (i.e., among older people).
It seems that in Germany, the testing initially outpaced the spread of the virus.
As of the time of the article:
According to Johns Hopkins University, the country had more than 92,000 laboratory-confirmed infections as of midday Saturday, more than any other country except the United States, Italy and Spain.
But with 1,295 deaths, Germany’s fatality rate stood at 1.4 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.
So the spread of the virus and the resulting emergence of an increased number of serious cases is catching up with the testing. Therefore the mortality rate (correct usage, I believe, not "fatality") -- meaning the number of those who die diagnosed with the virus divided by the total number of those who test positive -- rises accordingly from the initial 0.2 to the current 1.4.
Sounds like a point may be reached soon wherein the German Covid mortality rate (by the definition of deaths of those "diagnosed with" divided by total positives tested) and the average age of positives ("cases") rise to the level of the other countries (Germany having a similar population distribution by age).
It will probably remain a bit lower, given that this is Germany, as opposed to countries with underdeveloped and unprepared health care systems and/or governments and ruling classes less diligent about the welfare of the general population.
The likely rise in the death rate sounds dire, and may be, but still doesn't answer what the number of positives who are asymptomatic (or who show the antigens, now that antigen tests are also being conducted) will be, once the number of tests goes into the millions.
At that point, the recorded death rate following infection may again be revised downward, perhaps radically, and not just in Germany.
Note that none of this considers the matter of strains, which we haven't considered much on this thread either. These suckers evolve, and while selection generally favors the less deadly, mutation doesn't care: it can produce more deadly strains and these can run wild. This appears to have happened in 1918, when the second wave in the fall killed many more people than the first.
The further reasons given for the low German Covid mortality so far, not at all surprising, would seem more significant than the currently low average age of tested positives:
But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.
The rest of the article elaborates upon and confirms the reading I'd have considered obvious:
Testing
In mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.
By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.
“The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,” said Dr. Christian Drosten, chief virologist at Charité, whose team developed the first test.
By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country. Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.
“When I have an early diagnosis and can treat patients early — for example put them on a ventilator before they deteriorate — the chance of survival is much higher,” Professor Kräusslich said.
Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. To streamline the procedure, some hospitals have started doing block tests, using the swabs of 10 employees, and following up with individual tests only if there is a positive result.
At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.
This is the first I'm hearing of anyone
finally doing this (or being in a position to do this). Large random samples. Hello, science.
Stop me if I'm getting this wrong, and forgive any imprecision in the language if I'm basically right, but only two procedures can measure actual contagion rates in the population, and death rates among the infected. One is to preemptively test large random samples of people for antibodies in cross-sections of all age groups and all conditions of health, regardless of whether they display symptoms. The other is to allow the virus to run its course, uncontrolled, until infection reaches 60 or 70 percent or whatever the level of herd immunity will be in this case, and then hold up mirrors to everyone's faces and see who's still alive.
One key to ensuring broad-based testing is that patients pay nothing for it, said Professor Streeck. This, he said, was one notable difference with the United States in the first several weeks of the outbreak.
Duh! Duh! Duh, motherfucking stupid heartless ultra-capitalist underdeveloped reckless incompetent country! Duh!
The coronavirus relief bill passed by Congress last month does provide for free testing.
“A young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people,” he said.
Tracking
On a Friday in late February, Professor Streeck received news that for the first time, a patient at his hospital in Bonn had tested positive for the coronavirus: A 22-year-old man who had no symptoms but whose employer — a school — had asked him to take a test after learning that he had taken part in a carnival event where someone else had tested positive.
In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.
Not in Germany. As soon as the test results were in, the school was shut, and all children and staff were ordered to stay at home with their families for two weeks. Some 235 people were tested.
“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.
Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.
All those who had returned to Germany from Ischgl, an Austrian ski resort that had an outbreak, for example, should have been tracked down and tested, Professor Streeck said.
Image
Construction workers beginning to prepare an exhibition hall in Berlin to become a treatment center for coronavirus patients. Construction workers beginning to prepare an exhibition hall in Berlin to become a treatment center for coronavirus patients. Credit...Pool photo by Clemens Bilan/EPA, via Shutterstock
A Robust Public Health Care System
Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.
Giessen, pop. 83,628 (2015), town in central Germany, north of Frankfurt.
“We have so much capacity now we are accepting patients from Italy, Spain and France,” said Susanne Herold, a specialist in lung infections at the hospital who has overseen the restructuring. “We are very strong in the intensive care area.”
All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people. By comparison, that rate is 12 in Italy and 7 in the Netherlands.
By now, there are 40,000 intensive care beds available in Germany.
Some experts are cautiously optimistic that social distancing measures might be flattening the curve enough for Germany’s health care system to weather the pandemic without producing a scarcity of lifesaving equipment like ventilators.
“It is important that we have guidelines for doctors on how to practice triage between patients if they have to,” Professor Streeck said. “But I hope we will never need to use them.”
The time it takes for the number of infections to double has slowed to about eight days. If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.
“The curve is beginning to flatten,” she said.
Trust in Government
Beyond mass testing and the preparedness of the health care system, many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.
Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country. The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.
The chancellor’s approval ratings have soared.
“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”
Christopher F. Schuetze contributed reporting.
It's not Merkel per se, although she is competent and now becomes the beneficiary of incumbency during a competent response, at least so far. A minoirty may hate their government in Germany, much like elsewhere, a few may even want to overthrow it for some of the same reasons people do anywhere, but they don't doubt that, regardless of its political makeup at a given time, it takes public health seriously, proceeds from scientific findings in its public health policy, and has the high expertise and competence available for this. That's a function of investing enough in the education and infrastructure over decades.
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