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Why Germany's Coronavirus Death Rate Is Far Lower Than In Other Countries

Mar 25, 2020
Originally published on March 25, 2020 5:10 pm

As confirmed cases of the coronavirus in Germany soared past 10,000 last week, hundreds of Berliners crowded Volkspark am Friedrichshain to play soccer and basketball, and to let their kids loose on the park's many jungle gyms.

The conditions seemed ideal for the spread of a virus that has killed thousands. Indeed, as of Wednesday, Germany had the fifth-highest number of cases.

Yet Germany's fatality rate so far — just 0.5% — is the world's lowest, by a long shot.

"I believe that we are just testing much more than in other countries, and we are detecting our outbreak early," said Christian Drosten, director of the institute of virology at Berlin's Charité hospital.

As Europe has become the epicenter of the global coronavirus pandemic, Italy's fatality rate hovers around 10%. France's is around 5%. Yet Germany's fatality rate from COVID-19 has remained remarkably low since cases started showing up there more than a month ago. As of March 25, there were 175 deaths and 34,055 cases.

Drosten, whose team of researchers developed the first COVID-19 test used in the public domain, said Germany's low fatality rate is because of his country's ability to test early and often. He estimates Germany has been testing around 120,000 people a week for COVID-19 during the monthlong period from late February to now, when it's reached epidemic proportions in the country, the most extensive testing regimen in the world.

And that means Germany is more likely to have a lower number of undetected cases than other countries where testing is less prevalent, which raises the question: Why is Germany testing so much?

"We have a culture here in Germany that is actually not supporting a centralized diagnostic system," said Drosten, "so Germany does not have a public health laboratory that would restrict other labs from doing the tests. So we had an open market from the beginning."

In other words, Germany's equivalent to the U.S. Centers for Disease Control and Prevention — the Robert Koch Institute — makes recommendations but does not call the shots on testing for the entire country. Germany's 16 federal states make their own decisions on coronavirus testing because each of them is responsible for their own health care systems.

When Drosten's university medical center developed what became the test recommended by the World Health Organization, they rolled these tests out to their colleagues throughout Germany in January.

"And they of course rolled this out to labs they know in the periphery and to hospital labs in the area where they are situated," Drosten said. "This created a situation where, let's say, by the beginning or middle of February, testing was already in place, broadly."

Drosten said that has meant quicker, earlier and more widespread testing for COVID-19 in Germany than in other countries.

Lothar Wieler, head of the Robert Koch Institute, Germany's federal agency responsible for disease control and prevention, said at a news conference last week that Germany's testing infrastructure means authorities have a more accurate read of confirmed cases of the virus.

"We don't know exactly how many unknown cases there are, but we estimate that this unknown number is not very high," Wieler said. "The reason is simple. We issued recommendations in mid-January about who should be tested and who shouldn't be tested."

But some Berlin residents aren't as confident as Wieler. Nizana Nizzi Brautmann said she was worried when a teacher at her son's school tested positive for COVID-19 and a day later she and her son woke up with fevers and persistent coughing. She said she couldn't get through to Berlin's coronavirus hotline, which was continuously busy.

She finally got through to the city's emergency medical service number, "and I told her I think we need to be checked because we have some symptoms," Brautmann recalled. "The lady was just saying, 'We make no tests here. I can't help you. I would advise you to stay home and drink tea.' "

When she finally was able to speak to a doctor on the phone, the doctor told her to wait in line outside a local hospital to get tested, but she didn't have a mask for her or her son, and she didn't want to infect others in line, so she stayed home. She and her son are now in good health, but she said the episode left her wondering how prepared German society is for this pandemic.

Drosten said such experiences are probably an exception, not the rule.

"I know the diagnostics community in Germany a bit," Drosten said. "My feeling is that actually the supply of tests is still good. And of course, our epidemic is now also very much up-ramping and we will lose track here, too."

Drosten said the growing number of cases in Germany will soon exceed testing capacities. But for the time being, he thinks the country has had a robust response to the coronavirus pandemic. He's most worried about countries in Africa that aren't well set up for this — countries that, once the crisis comes to them, will find it more difficult to flatten the curve.

NPR Berlin bureau producer Esme Nicholson contributed to this story.

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