Germany ‘is still at the beginning of the epidemic’ despite low death rate, health body warns

Medical volunteers dressed in protective suits, masks, gloves and goggles wait to take blood samples from visitors with symptoms to test them for Covid-19 infection at a tent set up next to a doctor’s office on March 27, 2020 in Berlin, Germany.

Sean Gallup

Germany, like other European countries such as Spain, Italy and France, has a high number of confirmed cases of the coronavirus. But unlike others, it has a much lower death toll so far.

Germany has 100,123 confirmed cases of the virus and has recorded 1,584 deaths from the virus, according to the Johns Hopkins University, putting the mortality rate at around 1.5%. In comparison, Italy has 128,948 cases of the virus, and has recorded 15,887 deaths, making the case fatality rate nearer to 12%. Spain’s case fatality rate is around 9.5% currently.

Germany has been lauded for appearing to be on top of its coronavirus epidemic, and there are reasons to be hopeful; the daily number of new infections in Germany dropped for the fourth day in a row on Monday.

But Germany’s public health body, the Richard Koch Institute for infectious diseases, is cautious, telling CNBC that the country’s comparatively low mortality rate (the case fatality rate) should not be taken as a measure of the country’s success in combating the virus just yet.

“First of all, it is far too early to speak of a success story here. Germany — at least at the moment — sees a lower case fatality rate than other countries,” Marieke Degen, a deputy spokeswoman at the RKI, told CNBC.

“There might be many factors contributing to this, one is the affected age groups (so far, older people haven’t been affected that much in Germany, more younger who came back from skiing; however, we see this changing at the moment),” she said.

“Also, we know that it takes a while until patients who fall seriously ill finally die, and we are just at the beginning of events here.”

The RKI’s recommendation of early widespread testing to detect cases and slow the spread of the outbreak has been widely seen as a factor that has helped Germany to keep its death toll low. Germany is estimated to be conducting around 500,000 tests a week, far more than countries like the U.K. where the lack of national testing, and a small testing regime for health workers, has been called a fiasco.

Degen said the early testing strategy enabled Germany “to see cases very early, and many cases, and also mild ones (which in other circumstances might have been missed). This might be why the sheer number of those who have died, referring to the number of all known cases, is then of course lower” so far, she said.

But, she cautioned again, Germany is not out of the woods.

“It is again very important to stress that Germany is still at the beginning of the epidemic. We see more and more deaths now and we can’t predict how everything develops. The case fatality rate is increasing. And of course everything is done to further slow the spread at the moment in order to save medical capacities,” she said.

As with most other European countries, Germany has gone into lockdown, advising the public to stay at home and closing all but the most essential businesses, allowing only food stores and pharmacies to remain open. The measures are expected to remain in place at least until April 19.

Imprecise science

Global fatality rates from the coronavirus are an imprecise science, it must be stressed, and making comparisons between nations is not actually that helpful. 

If the number of cases of the virus is under reported, for example, it can exaggerate the fatality rate. There is also a time-lag factor between those that are ill with the virus, and potential future deaths. There are also, simply, so many unconfirmed cases of the coronavirus that a correct death rate is hard to determine.

The amount of people being tested by each country, which varies wildly at the moment, skews mortality rate data.  If a smaller amount of people are tested in a nation, the death rate can appear much higher than in countries where a much wider number of people, say, both symptomatic and asymptomatic cases, are being tested. 

How coronavirus deaths are recorded can also differ between countries too. In Germany, if an individual dies and was infected with coronavirus, this is registered as a death caused by the virus, even if it is not clear if it was exactly the virus that lead to the death. In other words, Germany counts among its coronavirus death toll people that “died from,” as well as “died with,” the virus.

The RKI acknowledges that there are complexities in the recording of deaths. “In cases when people suffer from other severe diseases, you can’t always define (the cause of death) easily … If there is suspicion that a patient died of COVID-19 but hadn’t been tested before, of course post-mortem tests are conducted, but …  not every person dying in this country is generally tested for COVID-19,” she said.

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