Germany has stood out during the coronavirus pandemic with an improbably low mortality rate so far – just 92 deaths from the 23,921 cases of infected people recorded as of Sunday. Has the country been just lucky or are there tangible reasons – such as a strong medical care system and extensive early testing – for the strikingly low case fatality rates compared to the other countries battling Covid-19? Are there demographic reasons with fewer elderly Germans afflicted? Or might there even be intangible factors such as the experience of World War II helping to imbue the more vulnerable senior citizens with an instinct to bunker down and stay away from danger? Epidemiologists and medical professionals asked about the intriguing German mortality rate of almost 0.4 per cent compared to 9 per cent in Italy (5,476 deaths and 59,138 cases) say they expect both the confirmed cases and deaths to continue spiralling higher as they have elsewhere in the days and weeks ahead. Even Chancellor Angela Merkel, 65, may have been infected by a doctor who vaccinated her recently, and went into quarantine at her central Berlin flat on Sunday – a stunning announcement that came just after she told a news conference in her offices there would be further public restrictions on the public, limiting the size of groups in public to two. Medical professionals in Germany are generally loath to put too much faith in numbers they see as preliminary and perhaps misleading with the crisis still unfolding worldwide. There is no gloating or backslapping in Germany over the low rates so far. German experts also suspect there could be some statistical factors skewing the data because of more extensive testing from an early date in Germany (now able to test 12,000 per day) compared to lower numbers in Italy and elsewhere. That might be masking higher numbers of confirmed cases with mild symptoms in other countries as well as different testing methods – in Germany, elderly people who die are not necessarily given postmortem examinations for coronavirus, while in Italy reportedly everyone who dies is tested. The Italian doctors fighting death on the coronavirus front line But they also agree there may be some factors unique to Germany and some inherent advantages with its strong and well-funded public health care system that could be helping to keep the case fatality rate in the European Union’s most populous nation low. “We were able to recognise quickly how serious the situation was (when the virus was detected in Europe) and we were at the forefront as far as diagnostics is concerned,” said Christian Drosten, director of virology at Berlin’s Charite Hospital, whose lab devised the coronavirus test that was later ordered by the World Health Organisation. “That’s mainly due to the fact that there are established laboratories spread out across the country and can identify the virus. That is why we had such a big head start compared to other countries.” Trying to explain the low case fatality rate in Germany, he told reporters in Berlin recently that a dense network of independent labs across Germany was able to start administering the tests in large numbers in January when the first few scattered cases appeared in the country. He added that Germany was able to distribute tests to labs and doctors across the country to help them better track the virus. “Other countries lost a month or more because of that,” he said, noting that other national labs often have testing monopolies. Confusion as Chinese face masks bound for Italy end up in Czech Republic One of the world’s richest countries, Germany also has one of the most expensive and extensive public health care systems with universal health care insurance and considerably high job protection for workers, who call in sick an average of 17 times per year without any worry about losing their job. It is believed to have one of the world’s highest concentration of hospitals – 1,900 for a population of 82 million. They were long seen as an expensive luxury and faced budget cuts in recent years but are proving to be a blessing in disguise now. “Our health care system is perhaps one of the best in the world,” Merkel said in a rare prime-time television address to the nation on Wednesday before adding: “But the epidemic is showing us all how vulnerable we actually are and how dependent we are on others.” In perhaps the most critical advantage in the face of the coronavirus challenge, Germany has one of the highest levels of intensive care beds per capita in Europe – 29 per 100,000 residents compared to 13 in Italy, 12 in France, 10 in Spain and seven in Britain. “We also had some advance warning in Germany and were able to better prepare,” said Christoph Specht, a doctor and leading medical expert for the NTV news channel. Germany benefited from an early warning in February with the rapid spread of the disease in Italy. That gave authorities a head start on ramping up the all-important tests and bracing the country for ever-tighter restrictions. The rules limiting and later banning most public gatherings were in general more widely accepted and respected in Germany. UK outbreak ‘accelerating’ amid fears country on same path as Italy “Across the country, hospitals in Germany are well-prepared and ready,” he said. “But even a good system can quickly be pushed to the limits if too many people get really sick at the same time. We’ve got more capacity with intensive care beds than Italy and a lot of other countries. We can only hope there will be enough. We can only hope not everyone gets sick at the same time.” What may also be contributing to Germany’s remarkably low case fatality rate could be factors such as its formidable Gesundheitsamt structure of well-organised public health offices that rigorously enforce rules and regulations on hygiene and health care. There are hundreds of the public health offices spread out across the country with the authority to shut down public life. Karl Lauterbach, a doctor and leader in parliament for the centre-left Social Democrats, said Germany’s crisis management had worked well so far. “We started testing relatively quickly compared to other countries such as Italy, which didn’t,” Lauterbach told German Radio. “That’s how we were able to detect cases quickly. That gave us a relatively good overview at an early phase and that’s important to get better control over it.” Angela Merkel says up to 70 per cent of Germans may get infected That elderly Germans, the most vulnerable to the virus, have so far not been as affected as their counterparts in other countries might also have something to do with the nation’s history, and the senior citizens’ own experience with World War II. “The older people know how to get by with next to nothing,” said Martin Floeter, a 55-year-old electrician in Berlin who helps to take care of his elderly parents. “They know how to take cover and stay away from danger.” Purchase the China AI Report 2020 brought to you by SCMP Research and enjoy a 20% discount (original price US$400). This 60-page all new intelligence report gives you first-hand insights and analysis into the latest industry developments and intelligence about China AI. 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