Three Possible Explanations for Low Coronavirus Mortality Rate in Germany

RIO DE JANEIRO, BRAZIL – The coronavirus figures in Germany hide a conundrum: the country currently counts 19,000 confirmed cases but only 68 dead. This results in a mortality rate of 0.36 percent, much lower than in France (two percent), Spain (four percent) and Italy (eight percent).

We know that this difference is influenced by Germany’s ability to perform thousands of tests. But there must be something more. The German mortality rate is also exceptionally low compared to South Korea (one percent), whose diagnostic capacity is also considered high.

So how to explain the German case? On Friday, Spanish Health Ministry spokesperson Fernando Simón said they do not know. And the German authorities also do not have a conclusive explanation. But there are at least three scenarios:

1. It is possible that the virus outbreak occurred later in Germany. The first local outbreak of contagion within Europe was detected in Italy and was very advanced when it emerged: so the dead quickly emerged there. Only a week passed between infected number 20 and dead number 20. This suggests that the outbreak had been active for weeks because the disease takes two to three weeks to kill.

The alarm in Italy caused European countries to double their detection efforts. In Spain, the number of detected cases has multiplied from an outbreak that was in fact already in the country.

The first cases were also detected in Germany, but their outbreak was undoubtedly at an early stage. “Germany recognized its outbreak very early on. Two or three weeks earlier than some neighboring countries,” virologist Christian Drosten told Zeit magazine.

“That’s because we diagnosed and tested extensively. We certainly lost cases in that first stage. But I don’t think we missed a major outbreak”.

That may explain its lower mortality rate. For two reasons. First, because if Germany detected the cases from the outset, it would have detected more infected youths, who are the first to become infected (they travel more and have more contact with foreigners). Youths are better able to withstand the virus. Deaths are more common when the virus spreads and older people become infected.

The other reason is that deaths take some time to occur. In many countries we have seen that mortality rates have increased over time. This happened in South Korea, where the tests are more exhaustive and mortality doubled: from 0.5 to 1.1 percent between March 1st and 20th.

If the outbreak in Germany is more recent than in Spain and Italy, its mortality rates could increase.

2. The German patients are younger. In Germany a sample of those infected is published daily, so we know that their average age is 47 and that only 20 percent are over 60. These figures are similar to those in Korea, but very different from those in Italy, where the average age of those infected -detected- is 66 and 58 percent are over 60.

Older Covid-19 patients are at higher risk. The population pyramid of each country may also influence. Italy is the European country with the highest number of inhabitants aged over 65 (26 percent), while in Korea there are only 14 percent. But this does not help to explain the German case, where 25 percent of people are 65 or older.

Cultural factors can also weigh in. China’s data says that between 75 and 80 percent of Covid-19 infections occurred in family groups, as Bruce Aylward of the WHO told The New York Times. But daily contact between the young and the elderly is not the same in all societies.

As Moritz Kuhn of the University of Bonn (Germany) suggests, people aged 30 to 49 living with their parents exceed 20 percent in Italy, China, and Japan, while in Germany they are just over ten percent.

3. The tests are behind it all. Germany has said through the Robert Koch Institute, the center in charge of disease control, that it can perform 160,000 tests per week. The country may have conducted as many as 4,000 tests per million people, well above the 625 per million conducted by Spain.

Clearly, better detection reduces gross mortality rates to bring them closer to reality: if all infections are accounted for – including the milder ones – the proportion of deaths among infected people will be lower.

This is also suggested by South Korea’s figures. It is the country that has conducted the most tests (more than 5,000 per million inhabitants), and even though its outbreak is several weeks old, it is still one of the countries with the lowest mortality rate, 1.1 percent, which is often used as a benchmark.

It is likely that the low mortality of the virus in Germany is due to a combination of several factors. On Saturday, the Brazilian Ministry of Health suggested another possibility for success in the death rate of Angela Merkel’s country: having more ICUs than her European neighbors. Its numbers will likely remain far from those in Spain and Italy, as long as the country continues to be able to test massively.

But if another factor is that its outbreak is at an early stage, its death toll will rise and mortality will increase. The question is by how much.

Source: El País

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