BERLIN – OCTOBER 12: A dentist and her assistant prepare to clean a patient’s teeth in this photo illustration at a dentist’s office on October 12, 2009 in Berlin, Germany. German political parties currently involved in federal government coalition negotiations, including the Christian Democratic Union (CDU), its Bavarian sister party, the Christian Social Union (CSU), and the business-oriented German Free Democrats (FDP), are currently haggling over a restructuring of Germanys’ Health Fund, or Gesundheitsfonds, the fund that provides the basis for Germany’s state health care system. The CSU is pushing for more flexibilty in how the system is funded in order to allow for freer competition between the 180 different health insurance companies within the state health care system. The health care negotiations are part of broader negotiations between the CDU/CSU and the FDP in the creation of a new coalition government following nationwide elections in Germany last September. (Photo Illustration by Sean Gallup/Getty Images)

BERLIN (CBS News) — Compared to other countries, the number of deaths caused by the novel coronavirus in Germany has been surprisingly low.

According to the country’s federal health agency, The Robert Koch Institute (RKI), the mortality rate is currently at less than 0.5%. It’s remarkable when compared to the grim numbers in Italy or Spain. Italy has reported more than 86,000 confirmed cases and over 9,000 deaths, which would seem to work out to a mortality rate of roughly 10%. Meanwhile Germany has reported over 49,000 cases but only 342 deaths, according to data compiled by Johns Hopkins University.

But how reliable are the figures?

The statistics of individual countries can only be compared to a certain extent, and the simple division of the number of deaths by the number of reported cases is not a very reliable method, according to Jonas Schmidt-Chanasit, professor of virology at the University of Hamburg.

“In each country the number of unreported cases varies because of the different diagnostic capacities,” he told CBS News.

As RKI’s research data shows, many mild cases were detected from the beginning and included in Germany’s statistics, hence the mortality rate fell proportionally.

However, more people who are currently ill could die in the coming days or weeks. Even if the number of new infections is halted at some point, the death rate will continue to rise until all of the infected people have either recovered or passed away.

Another difference between Italy and Germany is that Italy conducts postmortem tests for COVID-19, which Germany doesn’t. It is therefore possible that some coronavirus-related deaths will remain undiscovered in Germany.

Professor Karl Lauterbach, an epidemiologist and member of the German parliament, tells CBS News that we will only be able to determine how deadly the SARS-CoV-2 virus really is, and how the death rates differ from country to country, some time after the pandemic.

Widespread testing

One explanation for the lower number of deaths in Germany is the fact that the country started widespread testing comparatively early and therefore managed to respond at an early stage of the outbreak.

More than half a million coronavirus tests have been done in the country to date. Lauterbach told CBS News that Germany wants to expand its testing capacities to up to 200,000 tests per day.

Widespread testing allows Germany to follow South Korea’s approach to containing the outbreak. Along with the implementation of social distancing measures, leading scientists say massive testing plays a key role in getting the pandemic under control.

Virologist Christian Drosten, who developed the first coronavirus test available in Germany, told various news outlets that the country recognized its outbreak early and therefore gained time to enact measures to help “flatten the curve” and prepare the health care system for a growing number of seriously ill patients.

Another difference between nations is the average age of the population.

“Italy has always been a model of how people can live longer in good health. But in this situation, this may lead to a higher death rate there,” said Michael Ryan of the World Health Organization. The median age in Germany is 45, versus 63 in Italy.

As Lauterbach pointed out, it is far too early to calculate the death rate accurately as the outbreak is still at an early stage and the disease has not yet progressed far in the vast majority of people.

In Italy, the outbreak started spreading earlier, which also helps account for the fact that more people there have died, as many had already been battling COVID-19 for three or four weeks.

Germany is at an earlier stage of the pandemic, about 18 days behind Italy, and health experts have warned repeatedly that the death rate will climb.

Well-equipped health care system

The capacity of health care systems in different communities also has an influence on death rates. When the number of severely ill patients exceeds the number of available intensive care beds and ventilators, not all critically ill people can receive adequate treatment and the number of deaths will increase.

This is evident in some regions in Italy, where doctors reported that they’ve had to decide which patients with the best chance of recovery can be put on a ventilator and who is left to die.

Germany is better equipped to treat seriously ill patients, with 28,000 intensive care beds, while in Italy there are only 5,000. In total, there are about 450,000 beds in all general hospitals in Germany. About 100,000 of these are currently empty.

The later beginning to the outbreak in Germany, as well as the early testing, gave hospitals in the country time to ramp up capacity. Separate areas are currently being set up in hospitals for coronavirus patients, and work is underway to double the number of intensive care beds. Non-urgent operations are being postponed and hospital staff from other areas are being trained to care for COVID-19 patients.

In Italy, at least initially, it was reported that hospitals did not always have special areas for coronavirus patients. This allowed the virus to spread further in hospitals and infect already weakened patients.

RKI president Lothar Wieler emphasized that Germany is still at the beginning of the pandemic. The number of deaths will undoubtedly increase, and there are still many uncertainties about how the situation will develop. Hospitals in Germany may also reach their limits in the coming weeks or months.

The situation in Italy is “the reality that will also come our way if we don’t do something now to reduce the number of cases” said Christian Drosten in the podcast “Corona-Update,” produced by German public broadcaster NDR.

First published on March 27, 2020 / 7:50 PM

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