In the reporting on the spread and the effects of Covid-19 globally, Germany has received some attention due to the atypical trajectory of its fatality rate. While the country has one of the highest number of cases recorded globally after the US, Italy, Spain, and France, its death rate is relatively low compared to these countries. This is particularly interesting as the German federal government’s official response was relatively slow and reactive.
Germany recorded its first confirmed case of Covid-19 on 27 January 2020. Despite growing global concern, Germany’s Health Minister, Jens Spahn, assessed the risk of the spread of the disease in Germany as “low”. Spahn revised this assessment on 24 February following the spread of the disease in Italy. This reassessment led to the establishment of a national crisis management unit, reporting measures for air, sea and rail travel, strengthened controls within a 30-kilometre radius of borders, and the establishment of a central point of acquisition for PPE.
On a regional level, a cluster of cases in a district in the federal state of North Rhine-Westphalia (NRW), led to closures of schools, libraries, swimming pools and other public amenities by local authorities at the end of February. On 2 March—the day the European Centre for Disease Prevention and Control raised its threat level for Europe from "moderate" to "high"—the Robert Koch Institut, the German government’s centre for disease control, raised the Covid-19 threat level for Germany to “moderate”.
The first Covid-19 deaths in Germany occurred on 9 March in NRW. By 10 March, the NRW state government banned all mass public events, and on 13 March, after the number of cases in NRW passed 800, all schools and kindergartens were closed.
On 17 March, the German COVID-19 threat level was raised to “high” amid concerns that reported case numbers were lower than actual ones due reporting lags and limits to testing capacity. Six days later and nearly two weeks after other European countries put measures in place, Germany’s national quarantine measures were broadly agreed to by the government and the federal states (broadly because due the nature of the federal system, quarantine measures differ between federal states with some adopting stricter measures than others) on 22 March.
This has raised question why Germany’s death toll is still comparatively low.
A variety of possible factors have been cited for this divergence:
demographic factors: The median age of those infected in Germany was lower than in Italy and France. This is thought to be related to the fact that many of those infected caught the disease on skiing holidays in Austria and northern Italy, thus were relatively young and healthy
- widespread testing; however, while Germany’s rate of testing is high, at the current rate it would take 3 years to test the entire population
- the robust German health system infrastructure; although it needs to be pointed out that hospitals are understaffed—medical students are currently assisting in treating patients— underfunded, and there are concerns regarding the availability of PPE
- concentration of cases in a small number of geographical regions
- the nature of the federal system which allows for more local/regional autonomy with a network of distributed institutions and professionals who are able to initiate targeted measures.
While no clear answer has emerged, the low fatality rate and a basic reproduction number (R0) of below 1 at the time, may have contributed to federal government and the federal state’s 15 April agreement on a limited and gradual lifting of the restrictions on public life from 20 April.
Given the dynamics of the development of the disease and the associated uncertainties, illustrated by the variances in the increases in Germany’s daily new infections, deaths, and the reproduction rate, from 0.7 on 16 April to 0.9 on 21 April, to 1 for a number of days until 27 April and then to 0.9 again on 28 April, it remains to be seen whether Germany’s Covid-19 trajectory will stay atypical or whether it will mirror other European countries albeit with a time lag.
