Germany's Coronavirus Death Rate Is Lower Than in Other Countries
npr.org
npr.org
Increasing the denominator by testing lots and lots of people is important only if testing lots and lots of people helps you prevent more people from dying. Germany is doing pretty well on this front compared to its European neighbors. But if you look at its absolute death rate graph it is headed up and to the right, like everywhere else. It'll be a little while before the dust settles and we can actually see whose public health policies were effective.
Four times as many people have already died from COVID-19 as are ever supposed to have died from great recession excess suicides, and we are just getting started with COVID-19. And the effect of recessions on overall mortality is much less clear (fewer die in commuting car accidents during recessions, for example). There's just no plausible way that a recession following this pandemic will kill more folks than the pandemic itself will, not even close.
I'm not arguing that the deaths from the virus won't outnumber deaths related to the quarantine, but they will be significant. They will also be much more likely to involve younger people whereas the virus is mostly killing people who are within a 10 years of reaching the average life expectancy for their country or above.
There is a incredible difference between "I'm taking a month off of work" and "I'm being forced to stay in my home, physically isolated from my friends and forced to be around those I share a home with 24/7, with the possibility of financial hardship in the near or far term."
One is a vacation, the other is prison.
You're unfortunately very far off in that claim about risk as it pertains to economy. Suicides are a small component of economic risk factors.
For example, if you miscalculate what you're doing in India in managing people and the functioning of the economy through this, you could cause famine and kill millions of people.
A story from Bloomberg covering the food supply deprivation beginning in India:
> ‘We Will Starve Here’: India’s Poor Flee Cities in Mass Exodus
Put together the suicides (which could be worse this time with so many people trapped at home), domestic abuse, drug addiction, and worldwide starvation, and it adds up to a lot of lives. That’s just what I’m halfway confident about so far.
If poverty doubles (very probable) and the number of children dying dies as a result, it will take 9.5 years just to reach the death toll in children alone. Once you factor adults as well, I wouldn't be surprised if the economic fallout causes more deaths than this flu in less than 5 years.
These countries will also never catch up to where they otherwise would have been, so the additional incremental deaths due to the economic fallout will persist in perpetuity.
But the impact and knock on effects of this pandemic, will not exactly help poverty related deaths and without a doubt, exacerbate them.
Every day it continues, more are added.
But, there is no up-to-the-minute tracker with bright red body counts. There are no stacks of coffins. There are no sob stories.
Because the people who will die because of the lockdown might not die for years yet. A family that was doing OK, now both parents have lost their jobs, one will remain unemployed for years. The family becomes poor, eats lower-quality food for the next 20+ years.
Kids that would have been healthy now get diabetes in their 30s, heart disease in their 40s, and ultimately die of heart attacks in their early 50s, who otherwise would have loved to 80.
Or, kid that used to have a healthy home environment now does not. Gets involved in gangs and drugs. Overdoses at 26. Or is killed in gang violence. Or ends up in prison. It takes three generations for that family to recover.
Millions of families that were not on this path a month ago are now five steps down it -- and every day, some unknowable number of these tragedies goes from possible to probable, or from probable to all-but-unavoidable.
But in virtually all of the cases, even after the fact, you'll never be able to prove that it wouldn't have happened but for the lockdowns.
So, we get to pretend the number is zero, instead of unknowable masses.
Even without any public health intervention, a death toll like this would spark a major recession most folks withdrew from economic activity out of fear. Even if you ignored it at the governmental level, it would quickly be impossible to ignore at the social level. Pretending that we can just push through that many deaths is a fantasy.
I doubt your prediction of a doubling of extreme poverty would come to pass. The folks we're talking about are already in many cases living at a subsistence level. They are not depending on an export economy to keep their households fed. But even supposing it does, it would take four years of that to make up for the losses due to unchecked COVID-19, and that's assuming that such a scenario caused no economic setbacks, which is just not plausible.
Anyway, none of that is going to happen. No political regime would survive sitting idly by as 2-3% of the population expires. So lockdown and public health intervention will ultimately be the order of the day everywhere. The theory that any other approach would do better will not be tested.
Let’s argue about hypotheticals in a few months when we have more perspective. Both of your lines of reasoning are filament-thin and stitched together using way too many assumptions right now.
In this example country B ultimately had the better outcome, despite having more deaths directly due to the virus.
Died with SARS-CoV-2, not because of it. As far as I know died "because of" isn't tracked or published by any country. And "died with" doesn't mean much (anything?) because coronaviruses of all kinds are so frequently co-present in natural deaths of old age anyway.
For example in 2006 there was what appeared to be an outbreak of SARS in an old people's home in Canada:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095096/
It turned out to be false positives on the kits and the real coronavirus was a fairly ordinary strain. Nonetheless the measured death rate was 5%.
When you see things like this it becomes apparent how carefully statistics like death rate must be used (or not used). We have literally no solid data in this epidemic. Every piece of evidence, every anecdote turns out on investigation to have enormous caveats or be misleading.
Just look at say Japan after the tsunami which not only killed people but also destroyed a lot of critical infrastructure.
Ok, lets; because I think the one positive thing that may come out of all of this is that we act with an acute understanding that our current system on this Planet is precarious, unsustainable, and we cannot just go back to it.
Which is what Japan did, and continues to do: they have not addressed the massive out-pour of Nuclear run-off into the Pacific, they have neglected to address the massive displaced population of Fukushima, their contamination programs are insufficient and the testing for their food is still not wide-spread nor taken seriously. They haven't completely phased out Nuclear Energy after all of this, and continue with a political lobbyist perspective whether they will or won't turn them back on.
All while still trying to continue to get the Olympic games to take place; no, I'd say Japan's Government reaction is exactly what we shouldn't be following, its exactly what we need to avoid in order to ensure this doesn't take place.
Wet-Markets re-emerging in China, for example, would be following Japan: simply continuing something because it served some economic function, but carried large consequences and still doing it anyway is not what we should strive for. Those Wet-Markets are thought to be significant contributors to SARS and now CoVid19.
If anything risk-management needs to be a bigger contributor to how we act moving forward; as I see ME and Russia oil refiners play chicken with one another, I wonder if this is what will what finally transitions us to EV in earnest. Continuing to rely on such suicidal actors to carry out best practices for something so critical has to be seen for the folly that it is.
I'm admittedly a petrolhead, but a part of me always knew this was coming and I fully embraced it occurring, I just wished we would have had the good sense for it to be a gradual transition--as it was appearing to be with many Manufactures pushing for EV models being a large part of their lineup based on purchases and legislation requirements--rather than an abrupt shock to the system that made us realize where our priorities should be when thinking about sustainable mass-transport.
The same sentiment goes for things like how UBI, Work From Home and Online Learning being the way many jobs and schools function in order to reduce Greenhouse emissions and help curb climate change. This can be an opportunity in disguise if we have the foresight to see it as one and act as a Planetary Species understanding that our very survival is at stake rather than the petulant children and a voracious appetite for 'what we want, at all costs,' as we've been thus far.
> Economies are surprisingly resilient.
I want to believe in anti-fragile economic models, too; but I've come to the realization that however persuasive intellectually as that argument may be it isn't absolute when the very Environment you're operating in cannot carry on with the practices that make that doctrine possible at scale.
Croatia is ranked number one by Oxford for government responses to the epidemic: https://www.bsg.ox.ac.uk/research/research-projects/oxford-c...
Note: HRV is Hrvatska which means Croatia in Croatian. It is the three letter ISO country code.
The Croatian government website on coronavirus is: https://koronavirus.hr/en
There is an interesting interview by a Croatian epidemiologist here: https://www.total-croatia-news.com/lifestyle/42484-igor-ruda...
It's ranked as number one in stringency of response - they explicitly say it's not to be interpreted as a rating of the appropriateness or effectiveness of a country's response.
I have a friend that lives in Zagreb, and after the earthquake that damaged the town she said an alarming amount of People were outdoors, and were unprotected as they were worried about aftershocks and tremors and just left their homes.
So she went to the countryside with her family, she said she was super lucky because right after she left they closed down all public transportation and issued a mandated lockdown.
Croatia is a really small country with a small population so its far more manageable to contain then the US or China, it also has a high elderly population who are most vulnerable: I spent a lot of time there, and in the South its common to be in a town where the average age is 70+ with them filling as the primary child care takers as the parents are in major cities working or often in other parts of the EU.
So its interesting how the containment measures play out as it has really dire consequences.
Economically speaking, they're screwed if this goes on: its mainly a tourism based economy with little else, they're active like 7 months out of the year in order to survive the other 5 as it comes to a stall.
It's hard to say what's working.
German article with two bar charts (scroll down a bit), the first chart is showing deaths by age group, the second is showing infections by age group: https://www.tagesschau.de/investigativ/swr/datenanalyse-coro... (needs JS enabled)
From https://nos.nl/artikel/2328827-ic-arts-gommers-binnen-een-we...
(by the end)
In totaal zijn 1200 patiënten opgenomen geweest op de intensive care, van wie er 140 zijn overleden. 19 IC-patiënten zijn uit het ziekenhuis ontslagen, meldt Gommers.
Dead yesterday 1039 https://www.rivm.nl/actuele-informatie-over-coronavirus
Fellow falls hits his head, dies from head trauma -- but because he had COVID, he "succumbed to the virus"
Good grief
but
The median fatal case in Italy is an 81-year old with 2 comorbidities (typically two of: heart disease, COPD, diabetes, obesity).
An 81-year-old has a ~10% chance of dying in any given year, and an 81-year-old with serious underlying medical conditions is even likelier to die.
If you're an 81-year-old with serious underlying health issues, you have a material chance of death generally in a 2-month period (which the coronavirus has been there). On top of that, for those folks, every illness is a high-risk occurrence (even a simple cold).
The situation in Italy now is bad enough that there are definitely many COVID deaths that wouldn't have happened without COVID. But it is almost certainly the case that a meaningful number of these patients would have died in those two months anyway. (Roughly 2% of all 80+ population would have died in that time if the virus didn't exist; it seems very likely that that 2% would be disproportionately inclusive of those with serious underlying health issues -- which are the people most killed with COVID.
Normal european death rates seem to be ~10 death/1000 people/year; for example in 2018 Germany had 954874 deaths or ~2600 per day. Multiply that with a ~0.1% coronavirus rate and only 2 people who would have died anyway would get overcounted for coronavirus.
In Italy, for example, all in-hospital deaths of COVID-positive patients are recorded as COVID deaths.
If you're 85 years old, with emphysema, heart disease, diabetes, and COVID, and you die of acute respiratory distress... did COVID kill you?
In Italy, it did, 100%
In New York, it is up to the doctor who declares you dead, but it probably did.
In Germany, it most likely didn't.
That is not to say that Germany isn't doing a good job -- they are. They are doing a lot of testing, isolating, and contact tracing. They are also going full-speed-ahead with the experimental hydroxychloroquine/azithromycin treatment, offering it everyone without contraindications, starting almost from the beginning of the outbreak.
Both of those things contribute to the low death rate.
They are also detecting a higher percentage of cases, which automatically lowers the apparent mortality (since every country detects most of the hospitalizations, more testing means finding more inherently non-lethal cases, meaning more detected recoveries)
I check the worldometers numbers everyday, and already Germany is up about half a percent from when that article was written, but I'm not totally sure that site's numbers are trustworthy.
So far among nations in Western Europe, 1.08% is extraordinary. France is at 6.6% at a similar point in recovered cases vs positive tests. And Germany is the second oldest nation at the median, behind Japan, among major nations. That mortality rate is a remarkable achievement so far.
And note that the real number of recovered patients is certainly higher than reported in those dashboards, because while reporting infections and deaths is mandatory, some municipalities report recoveries, others don't, and on the whole, reporting recoveries is low priority, even for those who do report them.
So it is one of those things when we won't be able to compare until down the line, and able to compare like for like.
If you think or raise so, then you're measuring wrong; and to me, it feels everybody is measuring death rates wrong.
Let me elaborate. Let's say you're a teacher and you do a "test-type" exam (the true/false ones whose score you can verify with a machine, real quick) to 100 students. If after 30minutes of ongoing examination, 10 students have finished already, and let's say you check how many have passed: 9. The way the world is measuring, as an analogy, is saying that the "fail rate" of the exam is 1%, while it's actually "10% so far". When you measure success/failure, you have to take in account only people that finished.
Therefore it's crucial to compare recovered vs death cases, and not take the "current cases" into account.
Still, if we correct the death rates numbers to use this method, it'll be not accurate, because there are many cases which are untested and therefore many recoveries that are not taken in account (although some deaths too).
I do not know where you got this bullshit from; as someone living here, it makes me wonder, how anybody could call the Merkel Passiveness to "having startet extensively"
???
Source, please.
Note that the German numbers are a week out of date compared to other countries and Germany has been doing 200,000 tests in addition last week.
Wikipedia has a very interesting table with testing stats: https://en.wikipedia.org/wiki/COVID-19_testing#National_stat...
Many countries or regions have extremely high positive test ratios, for example Lombardy is at 37% positive, France at 20% while Germany is at 7.4% and South Korea at 2.4%.
If Lombardy tested more people they would find many many more cases and their reported death rate would decrease.
The fact that areas with high infection counts like New York and Northern Italy are reporting high positive test ratios is terrifying. It means that they are doing worse than the numbers indicate and they're limited by testing capacity.
Just as a thought experiment: The same metric would give herpes a 100% death rate.
The mortality is not increased [1], the number of acute respiratory illnesses is not increased [2]. German hospitals are not overwhelmed, indeed we gave away hundreds of respirators and treat a large number of patients from neighboring countries right now.
There are single cases of overwhelmed medical systems, but those are few and in places where this has happened before [3] and frankly those places have not been in great shape before.
I can't see the justification for these draconian measures with so little evidence. What I do see however is a perverse dynamic between sensationalist media and power hungry politicians. It's infuriating how critics are defamed by newspapers [4] and even high-profile experts ignored [5]. The economic and social downfall from these measures will be insurmountable I fear and dwarf any risk now or even in the foreseeable future from sars-cov-2.
[1] https://www.euromomo.eu/ [2] https://image.jimcdn.com/app/cms/image/transf/none/path/s56f... [3] https://milano.corriere.it/notizie/cronaca/18_gennaio_10/mil... [4] https://www.welt.de/gesundheit/article206667595/Wolfgang-Wod... [5] https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-a...
Milan was not overwhelmed by influenza, that is just an Italian title, which is full of energy/exaggeration as usual. The article talks of 48 cases, which is a far cry from the 40,000+ they have in that region now.
Frankly, anybody peddling that a crushing blow to the world economy is conspiracy to get a little more funding for one sector should be discredited whoever they are. That is ludicrous. There is far to much avarice in too many competing sectors, just for starters. And scientists are not that cutthroat as a group.
I think you misinterpret the last link you posted. He does not advocate for doing nothing, but for quickly gathering data and changing our tactics as new information comes in, since there are risks both in quarantine and in not quarantining. I think everyone agrees with this and it is actually what all countries are doing. Even Italy is reevaluating their quarantine measures weekly, etc.
I do agree with you that the economic risk is enormous, and I am unconvinced that my business will exist when I can work again. But at the same time there is nothing to say what we did in the face of illness before this quarantine was human or correct. I think we are too callous about "normal" annual deaths from other causes and if anything comes from this massive effort, I hope it is an awareness of these other causes of death and funding and concrete action going towards them. It's no conspiracy to recognize that investing in better health of the population by effective, concrete steps to guarantee and promote diet, exercise, etc would be a worthwhile item to invest far more resources to than we currently do.
What would be enough evidence in a month or two that you would agree that this was fantastically overblown? I fear that even after this is over, the numbers will be be same same but still misrepresented by everyone to say that it was all necessary.
Solidarity and group effort are important parts of what it means to be human.
I think we both weight our rights, the medical risk and economic danger differently but I can see your reasoning.
German researchers want to send out hundreds of thousands of coronavirus-antibody tests over the coming weeks, Der Spiegel reported.
People who test positive for the antibodies could be given an "immunity certificate" that would allow them to leave their coronavirus lockdown early.
Other countries, including the United Kingdom, are planning mass testing to ease lockdowns.
https://www.businessinsider.com/coronavirus-germany-covid-19...
CNN just ran an article highly critical of decentralized approaches. (They were advocating top-down, unified actions on a country-wide basis.)
Here, NPR tells us Germany is doing well because the regions are able to act autonomously.
Hard for us armchair quarterbacks.
A lot of states, not just the US have highly unequal public infrastructure. France being one of the bigger examples, but the UK too.
There's a very basic Hayekian argument about the problems of concentrating so much knowledge and capacity in the capital alone. It simply impedes flow of information, it creates distrust and simply put dysfunction.
People in the anglosphere don't just ask these questions about Germany when it comes to healthcare, they also often ask them when they see regions like the Rustbelt or North England and compare it to the German Mittelstand. In many ways the centralised model is broken.
Is it better? I really don’t know, all I heard about this are the complaints about rural areas being underserved by doctors, especially GPs
It's also worth noting that in the 5 days since that article, the number of deaths in Germany appears to have quadrupled. There's also:
https://www.dw.com/en/coronavirus-germany-to-centralize-supp...
b) I don't see how the decentralized system entails more testing. Canada is decentralized and has more testing by the US, but it's because the respective authorities 'just did it'. The logic of 'some labs blocking others' makes no sense. If S. Korea wanted to do 'the most testing' it might be in their self-interest to 'centrally plan' thereby ensuring that it's also pointed in the right direction.
c) Canada has 1/3 the per-capita cases of Germany.
Whilst on site you see nothing much, as you won't get tested if you cannot prove contact and risk or symptoms. Only symptoms will not get you tested, even in Germany. Only Korea is able to do that. So anecdotes are appreciated.
Maybe manifacturing and PCR sequencer availability and how these tests are now prepared automatically should have been mentioned also. But nobody went that far. Only the recent Atlantic article on Quest touches that a bit.