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Homeland Security

Germany Staggers World With Low COVID-19 Death Rate

By Leonie Kijewski April 18, 2020

While countries around the world struggle with a lack of hospital beds and equipment for coronavirus patients, German cities such as Bremen have taken in patients from neighboring countries.

On a recent Saturday, Bremen received its first two French coronavirus patients from Strasbourg as Germany's neighbor France struggles with hospitals at their limits.

The city could theoretically take more patients from abroad, hospital group Gesundheit Nord spokeswoman Karen Matiszick told local news outlet Buten un Binnen – although the situation could rapidly change. Bremen currently has had 567 cases and 24 deaths, according to official statistics.

The capacity to take in patients has been attributed to the lower number of cases that need intensive care, and Germany's comparatively low death rate has caught the world's attention.

Of the more than 130,000 diagnosed cases in Germany, about 3,900 people have died as of Friday. In contrast, the U.S., Italy, Spain and France have each recorded more than 10,000 deaths linked to the disease. In Italy alone, more than 20,000 deaths have been registered – among 160,000 cases.

Susanne Glasmacher, a spokesperson for government's Robert Koch Institute, pointed to multiple factors.

"At the beginning, the majority of affected people in Germany didn't belong to a risk group, as many of the transmission paths happened during ski holidays, on international travels, carnival, and other festivities," she told VOA.

The median age of diagnosed cases is comparatively low in Germany at 49, compared to Italy's 62.

The average age of those who have died from the virus in Germany is about 80, and 87% of the deceased patients were older than 70. Similarly, 83.7% of those in Italy who died were older than 70, according to the Italian National Institute of Health.

In recent weeks, though, an increasing number of cases in German nursing homes have raised concern. Forty-one people have died in a single nursing home in the north German city of Wolfsburg as of Thursday. Hundreds of nursing homes across the country have found their first cases.

"If more transmissions take place in homes for elderly people or hospitals, it's to be feared that the rate increases," Glasmacher said.

The current low median age of German cases can to an extent be explained because of the number of tests conducted. Glasmacher said that Germany had tested on a much larger scale than other countries.

"Infections get recognized in more people with mild symptoms than in other countries where sometimes only severely ill people in hospitals are tested," she said.

With a current weekly capacity of about 500,000 tests, Germany is also testing those only showing mild symptoms and those who have not been in known contact with coronavirus cases.

Last month, Germany ordered closure of all nonessential shops to prevent the spread of the disease. Groups of more than two people who don't live in the same household are not allowed in public.

However, the number of deaths has also depended on how strained the health system is, Glasmacher said.

"If the hospitals become overcrowded, the ratio of those who cannot be helped will increase," she said. "The number of deaths can, therefore, change dramatically in the future."

Making similar assessments, Dietrich Rothenbacher, director of the Institute of Epidemiology and Medical Biometry at Ulm University, said the number of deaths depends on how many hospital beds are available for intensive care.

He said a 2012 study found that the number of intensive care beds per 100,000 inhabitants was 29.2 in Germany, 12.5 in Italy, 11.6 in France, and 6.6 in England.

"This has a positive effect on the treatment options for severe cases and the lethality," he said.

Yet, he, cautioned against comparing death rates among countries, as he said the numbers in different countries were highly distorted and not representative of the true picture.

"Based on representative numbers, the Covid-19 pandemic would look less deadly also in Italy," he said.

However, all experts warned that death rates would rise in coming weeks as Germany is still at the beginning of the epidemic. Severe cases often lead to death only after a prolonged period of illness.

"In two to three weeks (or in later phases of the pandemic) the numbers might look differently in Germany," Rothenbacher said.

Bremen itself has a lower infection rate than the German average. The national average is about 161 cases per 100,000 inhabitants; Bremen has only 81 cases per 100,000 inhabitants, according to the Robert Koch Institute.

While Andreas Dotzauer, a University of Bremen virologist, said that reasons for this difference were still unclear, he speculated that the character of the city's population – known for being reserved – might play a role.

"In general … it seems that the population [in Bremen] has implemented all rules and restrictions in a very disciplined manner," he said.

"Perhaps the typically more distanced, northern German, Bremen character also contributes to this."

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