When comparing how countries around the world are coping with COVID-19, one country immediately stands out.

In Germany, just 0.6% of their confirmed coronavirus cases have so far ended up being fatal - the lowest figure amongst any of the most affected countries.

The next best case fatality rate is 1.4%, which can be found in the United States, Switzerland, Portugal and South Korea, while in some countries the death rate is substantially higher.

In Italy, 10.1% of confirmed cases have ended up proving fatal.

The answer to why Germany's figure is so much better partly lies in the way the case fatality rate is calculated.


The figure is produced by dividing the number of deaths by the total number of confirmed cases.

This means if a country only tests seriously ill patients they will have a higher case fatality rate, as a higher proportion of these patients will die.

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Whereas, if a country carries out more tests, and also identifies people with mild forms of the disease, their figure will be much lower.

In the early stages of the disease Germany carried out thousands of tests and implemented rigorous contact tracing.

This allowed it to identify substantially more cases of the disease than other countries - as the more tests you do, the more cases you identify, as the chart below shows.

Germany's low case fatality rate is therefore partly caused by the fact it has tested more people and, as a result, has identified more mild instances of the disease.

In comparison, in the UK, only people who need medical assistance are being tested and as a result the UK's case fatality rate is much higher, at 4.8%.

However, carrying out more tests will not just have made Germany's case fatality rate look low compared to other places, it will also have helped reduce it even further.

By testing people who might have been exposed to the disease, Germany has been able to identify cases of coronavirus quicker and isolate people who have been infected.

This has helped prevent the disease from being spread to vulnerable groups - as the charts below illustrate.

The charts show how long it took after cases were first reported in Italy, the UK and Germany before somebody died of the disease.

In Italy, deaths were reported as soon as the case numbers began to increase, while in Germany hundreds of cases were confirmed before the first death was recorded.

Another key reason for Germany's low death rate is that fewer older people were initially infected with the disease.

In Germany, just 20% of patients confirmed to have the disease are aged over 60 - compared to around 50% in Spain.

This difference is important as older people are one of the groups most at risk from the disease (as the chart below shows).

The fewer old people infected, therefore, the lower the case fatality rate will be.

The initial concentration of the disease among younger people in Germany appears to have been because many of those infected were people returning from skiing holidays in Italy.

They therefore tended to be relatively young and fit and passed the disease on to other people of a similar age.

Subsequently, more of this group were able to recover from the disease than if the virus had been spread evenly across all ages.

One final factor that may have helped keep the case fatality rate low in Germany is the number of acute care hospital beds available.

Germany has 621 acute care hospital beds available per 100,000 people, the second highest number in the whole of Europe (and beaten only by Lithuania, which has a small total population).

This means that they will have been more able to cope with an influx of additional patients compared to other countries and will have been able to provide better medical support to those who need it.

So will Germany maintain their low death rate?

Health experts in Germany say their social distancing measures have been effective and they hope the increase in number of cases will begin to slow next week.

Image: Parents are warned not to use a playground in Berlin because of COVID-19

However, that does not mean the death rate will stay the same.

"The death rate in Germany is likely to increase as more older people become infected", says Keith Neal, emeritus professor of epidemiology of infectious diseases at the University of Nottingham.

"The true death rate is probably going to be in the order of 1%.

"On the Diamond Princess, passengers were regularly tested so cases would have been unlikely to be missed, and there eight out of 712 people died.

"We will have a much better idea of the true figure when antibody testing is rolled out across the population."