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Germany’s Response to the pandemic of COVID-19 caused by SARS-COV-2: Initial Confusion, Organization, Successful Control

2020-05-01

Brandenberger Tor photo by ArtTower courtesy of pixabay.com

Germany is a federal republic, superficially similar to the way the US government is organized.  The federation has been officially this way since the reunification of the country after the communist eastern half collapsed in 1990.  German federal republics have substantial autonomy but the whole country has universal health care insurance (run by agreement among private companies rather than the government) and a highly organized economy with important worker protections that don’t exist in the US.  These refinements have substantially eased the impact of the pandemic in Germany.

Early on, German response to the pandemic was confused and slow.  With growing case numbers and deaths, reactions and federal response peaked in mid to late March, around the same time as the response in the US and the rest of Europe (with Italy in the lead).  Since early April, multiple effective measures have been taken in Germany– as described below.

According to the Wall Street Journal (subscription required): “Germany’s success in battling the coronavirus pandemic has drawn international attention. The main lessons: Fight the virus locally, and keep politics out of it.”

The Worldometer says that Germany has had 163,331 confirmed cases of COVID-19, with 6,632 deaths and 126,900 recoveries.  This would represent a raw case fatality rate of 4%, but there are many un-ascertained victims, despite intensive efforts at case-finding.  The number of cases, including those without symptoms, could be ten times the number confirmed by testing.  According to charts in the Wikipedia article (cited below), the number of new cases per day peaked in early April.

Bloomberg wrote yesterday:

[German Chancellor Angela] Merkel has identified the reproduction factor — known by epidemiologists as R-naught — as a means of gauging how successfully countries have kept the virus in check and how much stress it could place on health services.

Germany’s latest R0 declined to 0.75 on Wednesday from 0.9 the previous day, according to the latest situation report from the country’s public health authority. That means that each person with the virus infects an average of 0.75 other people.

Wikipedia’s article on the outbreak in Germany is unusually specific about where the cases came from.  The first known case was found January 27, and most cases early on “originated from the headquarters of a car parts manufacturer there [Munich]” and clusters were found “linked to a carnival event ” and related to the Italian outbreak.  The specifics are due to careful contact tracing, an important feature of the German response to the pandemic.  “New clusters were introduced in other regions via Heinsberg as well as via people arriving from China, Iran and Italy… from where non-Germans could arrive by plane until 17–18 March.”

The German response is organized according to a national plan “advised” by the Robert Koch Institute.  In order to have an effective response, a plan had been previously developed which detailed a containment phase, a protection phase, and a mitigation phase.  In the protection stage, curfews, home isolation, and restrictions on visitors to nursing homes and other vulnerable sites were instituted.  Some of the federal republics had more restrictions than others.  The third phase, mitigation, responded to widespread infections.

On April 1, plans for a smartphone app for Europe were announced that would provide users with information about contacts and keep track of movements to determine whether the user had been near someone who tested positive for the virus.  On April 2, The Robert Koch Institute recommended that all persons, whether symptomatic or not, should wear face masks in public; this response was hobbled by a shortage of masks.  “On 7 April, the Robert Koch Institute, in partnership with healthtech startup Thryve, launched the app Corona-Datenspende (Corona Data Donation) for voluntary consensual use by the German public to help monitor the spread of COVID-19 and analyse the effectiveness of measures taken against the pandemic. ” (Wikipedia)

A rapid antigen-testing kit which could report results in 2.5 hours was developed and implemented all over Germany in early April.  With this kit, infection data and isolations could be quickly updated; previously results were not available for five to ten days.

Numerous problems were reported.  Controversies over mask shortages, treatment of refugees, and other issues abounded.  Details are available on the Wikipedia page for the pandemic in Germany.  Notwithstanding all the problems, the hospital system in Germany was not overwhelmed (partly because the intensive care unit bed capacity was much higher in Germany than in Italy).  The R0 (“R-naught”, the rate of passing on the infection from one person to another) has decreased to 0.75, meaning the pandemic is easing in Germany.

A contact-tracing system for smartphones, a rapid antigen-testing kit, and effective self-isolation have led to control of the pandemic in Germany.  Universal health care insurance and a well-organized system of work furloughs have helped to reduce the economic impact.  Our country would do well to emulate these features of the response to the pandemic.  As things stand here, massive contraction of our GDP (gross domestic product) and a disproportionate economic and medical impact on the most vulnerable people in our society have impaired our country’s well-being.

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