We are far from the end of the Covid-19 pandemic, but Germany’s fatality rate from the disease is at this point far below that of the United States and most other countries. Let’s take a look at some possible reasons for this. (Also see our comparison chart for Germany and the USA below.)

Erin’s previous German Way blog post detailed how Covid-19 pandemic has impacted her own family in Berlin. In this post I want to offer an overview of the coronavirus fight in the United States and Germany at the current time.

Coronavirus structure IMAGE: Wikimedia Commons

Testing Problems

Dr. Stephen Hahn, the commissioner of the Food and Drug Administration (FDA) is largely blamed for making it difficult for hospitals, private clinics, and companies to deploy widespread Covid-19 testing as had happened in many other countries. In the early days of the pandemic, while other nations were performing tests in the tens of thousands, the US had conducted fewer than 100 tests in the same period.

In the first weeks of the outbreak, the World Health Organization (WHO) had distributed effective Covid-19 test kits to any country that wanted them. The WHO coronavirus test kit had been developed at Berlin’s Charité hospital, but the FDA had stringent rules for approving such tests. Under Dr. Hahn’s leadership, the FDA refused to relax those rules, despite the fact that in February it became obvious that the test kits developed by the CDC were seriously flawed, delaying rapid early testing in the United States.

It is ironic that Dr. Hahn, whose German surname means “rooster,” would end up with the blame for delaying a German-made test that was already in worldwide use. But the FDA stubbornly refused to relax the approval rules, even after the CDC had restricted Covid-19 testing because of the limited amount of kits available. The opportunity to rapidly test for the virus, a step that had allowed South Korea, Taiwan, and other countries to limit the spread of the contagion in its early stages, was lost. Three weeks (21 days) were wasted in the US testing race because of the flawed CDC test kits.

But it was also a lack of interest or any sense of urgency from the Trump administration that led to a lost month. (Trump: “It’s going to disappear. One day – it’s like a miracle – it will disappear.”) It would be early March before federal officials announced plans to increase testing. But it was too late to slow the spread of Covid-19, and to this day, as I write this, the US is failing to adequately test. My own state of Nevada still has to make its own test kits, having received little or no help from the federal government. Nevada’s latest Covid-19 case count is 1,836 with 46 deaths. Most of the cases and deaths are in southern Nevada (Las Vegas area). The US now reports over 325,000 Covid-19 cases with over 9,200 deaths (5 April), but the lack of widespread testing means those figures may be misleading.

Which brings us to “lies, damned lies, and statistics.”

Mixed Protocols

Today’s editions of both The Washington Post and The New York Times feature articles about the lack of testing and how coronavirus cases and deaths are being undercounted in the United States and elsewhere. Many hospital officials, medical examiners, and public health experts are casting doubts on the official tallies in the US. Many factors have contributed to the undercounting of Covid-19 cases and the resulting deaths. The lack of test kits (and the difficulty of obtaining valid results), inconsistent death reporting criteria, and different testing protocols from state to state, mean that we may not know the true extent of the pandemic in the US and elsewhere for months, if ever.

Some US states only count Covid-19 deaths that are indicated on official death certificates. Other states have broader criteria. Some states do not count deaths at home or even in senior living facilities, while others do. Even within the same state not all counties follow the same reporting protocols.

Even testing reports are problematic. The COVID Tracking Project grades each state on its reporting methods in a “data report card.” States with a B grade, for instance, fail to distinguish between the number of tests administered versus the number of patients tested.

A pandemic means a certain degree of confusion and disorganization, but a lack of good leadership at the federal level in the US has made matters worse than they needed to be. President Trump seems unaware of the need for FEMA and other federal agencies to help the states, acting like we are still under the Articles of Confederation before the creation of the United States of America. Seventy days (70!) passed between the date when the White House was officially notified of the outbreak in China (January 3) and the day President Trump began to treat the coronavirus with the seriousness it deserves.

Even as late as March 20, the president was making statements that indicated he might be more concerned with the economic impact than the death toll. That day he told reporters, “We can’t have the cure be worse than the problem.” President Trump has refused to ask for a nationwide lockdown. Ten US states still have no statewide stay-at-home orders.

The contrast between what’s happening in the US and Germany in the coronavirus battle is stark.

Comparing Germany and the USA

LEADERSHIP
Germany: Chancellor Angela Merkel, even from recent self-quarantine (negative test results) in her Berlin apartment, has presented a calm, steady message to all Germans, calling for solidarity and a nationwide lockdown to overcome Covid-19. At the state level, Germany’s state governors (Ministerpräsidenten/Ministerpräsidentinnen) have also shown strong leadership. Bavaria’s governor, Markus Söder, was one of the first in Germany to shut down non-essential businesses and to call for a stay-at-home order in his state. See our Coronavirus in Germany: Information page.
USA: President Trump has presented a confusing, contradictory, mostly partisan message concerning the coronavirus pandemic, seemingly changing his position from day to day. At first dismissive, calling the virus a hoax designed to damage his presidency, he has since become more serious concerning Covid-19, with only occasional lapses into delusional talk (e.g., opening up the country by Easter). His coronavirus “press conferences” usually offer a distracted, “fake news” approach, in which he rails against reporters who ask him questions he doesn’t like, and attacks governors who dare question his federal response. The real leadership in the US has come from Democratic state governors such as Andrew Cuomo in New York and Gavin Newsom in California, who were both early proponents of testing and lockdowns.

COVID-19 TESTING PER CAPITA (NPR, as of 2 April)
Germany (pop. 83 million): 1 in 90 people (918,460 tests); now 500,000 tests per week
USA (pop. 327 million): 1 in 273 people (1.2 million tests*); the testing rate varies greatly by state; California and other states have been hampered by a lack of tests and test results.
* The total testing figure may not accurately reflect the number of patients tested versus the number of tests administered.

FATALITY RATE (CFR) (5 April)
Germany: 100,024 cases, 1576 deaths = 1.58 percent**
USA: 334,735 cases, 9,533 deaths = 2.85 percent**
See the note on calculating CFR below.**

HOTSPOTS
Germany: Coronavirus hotspots currently in three states: Bavaria (Bayern), Baden-Württemberg, and Nordrhein-Westfalen (NRW) – in the west and southern parts of Germany – but the fatality rate remains low.
USA: Coronavirus hotspots currently in a few states (California, New York, New Jersey, Louisiana, etc.) with higher fatality rates than in Germany.

HOSPITAL BEDS (OECD, most recent figures)
Germany: 8 per 1,000 population
USA: 2.8 per 1,000 population

PATIENTS PER NURSE (lower is better)
Germany: 13
USA: 5.3
This is one of the few areas in which Germany lags behind the US and some European nations. For comparison: Switzerland 7.9, United Kingdom 8.6

INTENSIVE CARE BEDS (most with ventilators)
Germany: 34 per 100,000 inhabitants
USA: 35 per 100,000 inhabitants

PERSONAL PROTECTIVE EQUIPMENT (PPE) (for medical personnel)
Germany: Some shortages of N95/FFP2 masks and gloves
USA: Serious, almost criminal shortages of N95 masks and other protective equipment in New York and other hotspots

** The Case Fatality Rate (CFR, the number of infected people who die from a disease) is calculated by dividing the number of dead by the number of recovered plus dead. Most recent CFRs have been a crude version of this: deaths divided by total cases. The problem with these crude calculations is that the cases counted aren’t all resolved at this time, making the CFR look artificially low. The reporting requirements for recovered cases are not consistent from place to place, making current figures unreliable.

While neither country has done everything right and mistakes have been made, I think Germany has done a far better job than the US in protecting its citizens from the dangers of Covid-19. As the next few weeks and months pass, we can only hope that all countries will improve their efforts in the pandemic battle. The doctors, nurses, and medical staff everywhere deserve our highest respect and support. Our deepest sympathy goes out to those who have suffered a loss to Covid-19. We at the German Way wish our readers all the best as we look forward to the end of this crisis. Stay safe!

– HF