The mystery of low German COVID-19 fatality rates-THE HINDU-06-04-2020


High engagement:

“There has been talk of a German anomaly,” said Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn. Streeck has been getting calls from colleagues in the United States and elsewhere. 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, Dr. Kräusslich said.

Another explanation 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.

More ICU units:

By the time Germany recorded its first case of COVID-19 in February, laboratories had built up a stock of test kits. By now, Germany is conducting around 3,50,000 coronavirus tests a week, far more than any other European country. Early and widespread testing has allowed authorities to slow the spread of the pandemic by isolating known cases while they are infectious. Kräusslich said.

Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 10,0,000 people across Germany every week to gauge where immunity is building up. One key to ensuring broad-based testing is that patients pay nothing for it, said Dr. Streeck. “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.

Not in Germany. Streeck 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, Streeck said. 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%. “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. Further, all across Germany, hospitals have expanded their intensive care capacities.

In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 1,00,000 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,” Streeck said. 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, Herold said, the models suggest that triage could be avoided. 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. “Maybe our biggest strength in Germany,” said Dr. Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.

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