Two French coronavirus patients were transferred to Germany, at the Essen university hospital at the end of March 2020. - AFP

  • According to some reports, the fatality rate of coronavirus in Germany is around 0.7%, while it reaches around 4% in France and 8% in Italy. Figures that change every day.
  • Even if the comparison between countries which do not have the same health system, and especially screening and strategy, is difficult, these figures raise questions.
  • Will Germany manage to keep Covid-19 deaths so low? With great care, 20 Minutes tries to answer them.

This is a question that comes up often. How have our German neighbors done so far to limit the fatality rate, a real cornerstone of this fight against the coronavirus? On March 30, Germany had only 455 deaths for 57,298 people infected. And this while this country bordering on France has not chosen the strategy of strict confinement, but rather that of a social distancing with ban on meetings, but authorization to go out to do shopping, sports, work ...

What is the case fatality rate?

Importantly, we are talking here about the fatality rate and not the mortality rate. The difference ? The coronavirus mortality rate is the number of deaths from this disease compared to the total population. It is said, for example, that 0.25% of French people die each year from a disease or cardiovascular accident. However, the case fatality rate is the number of people who die from Covid-19 compared to the number of people infected.

However, this case fatality rate is extremely complicated to compare. To obtain this figure, it would still be necessary to be sure of the number of people infected. Which is far from the case. "Depending on the country, we will not necessarily verify that the person died from Covid-19 and not from influenza and another pneumonia", nuances Michèle Legeas, teacher at the School of Advanced Studies in Public Health (EHESP). But also because a lot of sick people go under the radars because they have little or no symptoms with this particular disease.

Another bias: some countries test their populations on a large scale, which is the case of Germany and South Korea. One of the hypotheses which could explain this particularly low German fatality rate compared to its European neighbors, it is therefore its policy of massive screening: the more one tests, the more cases, and therefore the more the number of deaths is put into perspective. However, at the end of March, Germany carried out around 500,000 tests per week… But does this magnifying glass effect explain everything?

A delay effect?

Not necessarily. "It is very difficult to find explanations, we can only evoke a set of hypotheses, cautiously suggests Michèle Legeas, specialist in the analysis and management of situations with health risks. For the moment, we can see that Portugal and Germany are two countries where the case fatality rate is lower. For the moment I am wondering about this heterogeneity… ”

If the curve of coronavirus cases continues to explode, as observed in most of the affected countries, this fatality rate is likely to increase. This is already the case, but slightly. If so far, we mentioned a case fatality rate of 0.7%, it has risen to 0.8% in recent days. "It is possible that we are facing a delay phenomenon," specifies the researcher.

More capacity in hospitals…

"The argument often put forward to try to explain this fatality rate is that Germany has many more beds in intensive care units compared to most European countries", continues Michèle Legeas. In fact, there are 28,000 intensive care beds in Germany, compared to 5,500 in France and 5,100 in Italy. Compared to the population, there would be two to three times more places in sheave with our Germanic neighbors. Figures that date from before the health crisis, since France, like Italy, have increased their capacity.

An explanatory factor to put in perspective for Michèle Legeas: “We don't have the number of people hospitalized. This would allow us to say if hospitalized patients are better cared for in Germany than elsewhere, or if these patients do not require hospitalization. "

Germany has other strengths in the healthcare system. According to OECD comparisons, it had 4.3 doctors per 1,000 inhabitants in 2018, compared to 3.4 in France. The same slight superiority for nurses: with 12.9 nurses per 1,000 inhabitants, compared to 10.8 in France. This does not prevent some concerns across the Rhine. Germany may be blessed with an "excellent healthcare system, perhaps one of the best in the world", according to Angela Merkel, the pandemic indeed reveals the evils of the German healthcare system.

"In recent months, some intensive care beds have been closed because there were not enough qualified staff available," Reinhard Busse, a specialist in health economics at the Technical University of Berlin, told AFP. . In addition, for several years there have been some 17,000 unfilled nursing positions.

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… And industrial resources

Nevertheless, Germany seems better equipped to face the crisis. In particular thanks to a robust industry. “In a very clear way, it has kept a lot of productions on its territory, recognizes Michèle Legeas. On equipment such as respirators or access to the reagent for testing, they are better placed than France. We are one of the countries that have relocated their industrial sector to other parts of the world. Except that when this region is itself quarantined, we find ourselves stuck. "

In fact, the German government has ordered 10,000 respirators from Dräger. No doubt our neighbors had immediately available more masks, tests and respirators, essential tools to fight against the virus today, and even more in the weeks to come.


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