What are Germany and Switzerland doing right in the fight against the coronavirus?

I want to get right into this one and take a look at some of the numbers behind both Switzerland and Germany’s apparent success in controlling coronavirus fatalities. This has been all over the news lately, with a lot of people trying to figure out what it is that those countries are doing right. Let’s start by taking a look at mortality growth rates for Germany and Switzerland, as well as some of the countries around them, with the United Kingdom and the United States also thrown in for comparison.

Germany

First recorded fatality: March 9th

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 9 13 17 26 28 44 68 84 94 123 159 206

 

As Europe has become the epicenter of the global coronavirus pandemic, Italy’s fatality rate hovers around 10%, France’s is around 5%, and yet right next door, 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 206 deaths and 37,323 cases, representing a fatality rate of .55%. Of course, this number is fairly meaningless, but it’s one being heavily quoted by those trying to figure out what Germany is doing right.

“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.

Drosten reported that Germany’s low fatality rate is because of his country’s ability to test early and often. He was part of a team that developed the first public domain Covid-19 test, and he estimates Germany has been testing around 120,000 people a week during the monthlong period from late February to now. That’s significant. It means that they are testing a significant number of the country’s youth, those much more likely to survive the coronavirus infection.

“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.”

One of the problems with these low numbers is that they are likely to result in false premises and increased infection rates as people ignore lockdown orders because of a lack of awareness of the dangers. Just three days ago, on the 22nd of March, Germany finally implemented a national curfew, well behind those issued by most surrounding countries.

It was President Trump’s travel ban of March 11th that was actually the first wake-up call to Germany, surprising them and putting them into a scramble to catch up. It wasn’t until the 16th of March that the first German state (Bavaria) declared a state of emergency to be put into place for the next 14 days. Restrictions on restaurants began that same day, but were quite lax, just limiting dine-in options to any time after 3pm with five feet required separation between diners.

Bavaria was the first German state again to implement a curfew, this happening on March 20th.

It wasn’t until March 22nd, just three days ago, that Germany began forbidding group gatherings and closing businesses.

 

Switzerland

First recorded fatality: March 5th

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 13 14 19 27 33 43 56 80 98 120 122 153

 

Switzerland has the second-highest rate of coronavirus infection per capita in the world, after Italy. However, this is incredibly misleading as a stand-alone stat because they’re also testing more people than any country except South Korea, the United Arab Emirates, and Norway.

There’s no doubt that they have a very low death count at a current 153, but that is also very misleading. This is the problem with death counts by country. They don’t take into account so many factors, which I’ll go into in just a bit.

What steps has Switzerland taken to control the spread of the virus? The government has issued a recommendation to all citizens to stay at home, especially the sick and the elderly. It has announced a countrywide ban on gatherings of more than five people. An “extraordinary situation” has been declared, resulting in a ban on all private and public events and closing bars, restaurants, sports and cultural spaces; only businesses providing essential goods remain open. Schools are closed nationwide. The measures are in force until April 19. (https://www.swissinfo.ch/eng/covid-19_coronavirus–the-situation-in-switzerland/45592192) Entry into the country was effectively banned starting just today. Only Swiss citizens, Swiss residents, those entering the country for professional reasons (e.g., those who work there and have a permit to prove it), and those transiting through, can enter. Even foreign partners of Swiss citizens, who do not have a right of residence in the country, will be turned away at the point of entry.

Fairly severe for a country that has only 153 fatalities.

One of Switzerland’s biggest problems is that there are only 1000 ventilators in the entire country. At a critical infection rate that is probably 5%, that means with just 20,000 infections, their ventilator capacity will be at maximum. And that’s assuming some aren’t already in use by people with other illnesses, which obviously is not the case. In fact, a large number of their ventilators are likely already in use. Switzerland currently has about 11,000 cases of Covid-19, which means they’re about to be in trouble if they can’t get more ventilators. And those aren’t too easy to find these days.

 

Spain

First recorded fatality: March 3rd

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
#of deaths 196 294 342 533 638 831 1093 1381 1772 2311 2991 3647

 

Most of daily life in Spain was fairly normal from the first fatality on March 3rd, until they reached almost 200 just a week-and-a-half later. On Saturday the 14th, Spain instituted a national quarantine. Everybody was ordered to stay home for the next two weeks. Things started to move quickly. All land borders were closed the next Monday, the 16th. Fines were implemented for quarantine violators. One person was interviewed by NPR about the restrictions. “Starting Monday, starting yesterday, we could face fines of more than $1,000 for not cooperating. And there are already – already seeing police all over the country patrolling streets, telling people to go home, to hurry up and, you know, when their dog does their business, to go back home immediately.” https://www.npr.org/2020/03/17/817021997/spain-hard-hit-by-coronavirus-pandemic-shuts-down

Things are pretty rough already in Spain. There are reports that the Spanish military—who have basically taken over law enforcement duties there—have found older residents of some care homes completely abandoned and even dead in their beds. Defense Minister Margarita Robles told television reporters that soldiers disinfecting homes and providing emergency health care services to residential homes across the country are finding dead bodies. She was unable to give an exact figure for the abandoned dead, but it sounds nightmarish. (https://www.npr.org/sections/coronavirus-live-updates/2020/03/24/820711855/spanish-military-finds-dead-bodies-and-seniors-completely-abandoned-in-care-home)

Here’s a report from Madrid of one elder care home where twenty people were left abandoned and dead by health care workers. It’s not a pretty picture in Spain, and it’s only getting worse.

France

First recorded fatality: February 15th (This seems to be an anomaly though, so we should use the date of their second fatality, February 26th for comparison purposes.)

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 91 127 148 175 264 372 450 562 674 860 1100 1333

 

On Saturday, March 7th, 3550 people in France set the Guinness World Record for largest gathering of Smurfs. Yeah, those Smurfs, the blue little creatures from the old cartoons. While the rest of the world looked on in shock, French Smurfs were being interviewed at the gathering.

“We figured we wouldn’t worry and that as French people we wouldn’t give up on our attempt to break the record, and now we’re champions of the world!” One attendee told the AFP news agency.

“There’s no risk — we’re Smurfs! Yes, we’re going to Smurfize the coronavirus!” said another.

“(This) was more important. The coronavirus is no big deal, it’s nothing,” another said.

Some people in France finally got it when the first actual lockdown and movement restrictions were put into place on Saturday, March 14th. Unfortunately, some people—probably the same ones from the Smurf gathering—decided to flood social media with videos of themselves out and about in parks and squares and plazas on Sunday the 15th. That forced the French government to institute even stricter rules starting Monday the 16th. Today, anybody outside their home must have a signed document detailing their reasons for being out. French police drones fly overhead monitoring the quarantine orders. Exercise is allowed only as long as you remain within one kilometer of your home and you only do it for one hour maximum, one time per day. Many southern French cities have curfews in place that completely restrict movement during hours of darkness. Fines are progressive, starting at €135 and going up to €3700, with 4-time violators heading to prison for up to six months.

Sound severe enough? These restrictions are quite an upgrade from just a week or so prior when 3500 alleged adults put on blue paint and danced in a square. You think maybe, just maybe, France is regretting their flagrant little Smurfcapade? How many people will die in the chain-reaction of Smurfpidity that led to that gathering? Why didn’t anybody listen to any of the hundreds of Papa Smurfs, who surely could have told them all what an abso-smurf-ly stupid endeavor this world record attempt was? I know I’m being tough on them for this, but there’s no nice way to put it. And this is not hindsight. I tweeted about it and I talked about how dumb it was in an article the day after it happened. This was stupidity on the highest level possible.

If they held this rally today, I have a feeling there would be a disproportionate representation of Sneezy Smurf and Respiratory Failure Smurf in the group.

 

Italy

First recorded fatality: February 21st

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 1441 1809 2158 2503 2979 3405 4032 4825 5476 6077 6820 7503

 

A lot has been written about Italy, so I’m not going to go into detail here. They are immersed in an absolute disaster right now, the worst in the world. Unfortunately, I think the rest of the world isn’t too far behind.

 

United Kingdom

First recorded fatality: March 5th

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 21 35 55 71 104 144 177 233 281 335 422 466

 

In the UK, fatality rates are increasing at an alarming rate in relation to their population. Prime Minister Boris Johnson has only recently come to this realization, just a few days ago taking steps to close all of the UK’s bars, restaurants, cafes, gyms, cinemas, and schools. Why did it take so long for him to act, with the very obvious troubles the world was facing? According to this article in BuzzFeed, there were dayslong “heated” and “extremely difficult” arguments between top British scientists and high ranking members of the government over what steps needed to be taken to get control of the infection.

While the scientific debate raged between experts, officials, and ministers, Johnson’s government was publicly insisting that the scientific advice showed the UK did not yet have to bring in more stringent measures to fight the virus. They realized how wrong they were when this chart was published showing a comparison of the path of infections in the UK and the very obviously hellish conditions in Italy:

This is pretty unequivocal evidence that the UK is headed right into an Italian-level crisis and Johnson finally took steps to stop it. Within the next few days, we’ll see if those steps are going to be successful. It’s almost certain they won’t be.

United States

First recorded fatality: March 1st

Date 3/14 3/15 3/16 3/17 3/18 3/19 3/20 3/21 3/22 3/23 3/24 3/25
# of deaths 57 69 87 110 150 206 255 301 414 555 780 1042

 

The United States hit 4-digit death numbers today and is clearly following a doubling path that is three days or fewer. I had somebody ask me today what I thought of the over/under on maximum number of U.S. deaths in any one day would be, with the total being set at 1947 deaths. I would never bet on such a thing, but, if I was going to, over. Way over. I’ve written plenty about the state of the coronavirus in the U.S., and don’t want to rehash it, but with 362 deaths yesterday, it seems we are only two weeks away from days of 5000 or more deaths, and we are nowhere near reaching the peak of our mortality rate curve.

***

As you can see in the above charts, both Germany and Switzerland would seem at first glance to be doing something correctly. There have been many explanations for this, from a younger population, better quarantine procedures, better and more readily available testing, and better medical care. The problem with just looking at the total fatality numbers though, is that they don’t tell the whole story. We really need to look at a bunch more numbers in order to determine if the fatalities in these countries are truly better than they are in others.

One of the things that many people point to when they laud Germany and Switzerland for impressively low fatality rates, is the actual Case Fatality Rate (CFR). This does indeed appear to be very low in these two countries when compared with Italy, for example. In Germany, the CFR is just under .5%, whereas in Italy it is over 10%. This number is basically meaningless though, without knowing the demographics of everyone being tested. If you want a good primer on CFR, check out this article. Obviously, if Germany is testing a huge percentage of the youth of their country, and they’re finding a large number of people who are positive for Covid-19, those people are going to have a low fatality rate and it will skew the number downward. Conversely, perhaps Italy is testing an inordinate number of elderly people, or an inordinate number of people (as a percentage of the whole number of tests given) who are checking themselves into the hospital, already sick. This would cause their number to skew upward in an inaccurate manner.

There’s just not enough accurate information regarding the demographics behind testing metrics for us to make any valid assumptions. For that reason, I think all numbers regarding testing and positive case numbers should basically just be ignored. Even if those numbers are accurate, they’re fairly inconsequential without knowing exactly what percentage of the population has actually been tested, and then comparing countries using those numbers.

Although we don’t have accurate information for that, we do have mostly accurate information on fatality numbers, and we have completely accurate information on country-specific demographics, so let’s take a look at those numbers.

 

  United States United Kingdom Germany Spain France Italy Switzerland
Total population 331 million 67.8 million 83.7 million 46.7 million 65.2 million 60.5 million 8,600,000
Density (per sq mi) 94 727 623 243 309 532 567
Median Age 38.3  years 40.5  years 45.7  years 44.9 years 42.3 years 47.3 years 43.1 years
Percent urban population 82.8 83.2 76.3 80.3 81.5 69.5 74.0
Percent of world’s total fatalities 4.47 2.20 0.97 17.21 6.30 35.40 0.72
Fatalities per 1 million population 2.86 6.87 2.46 78.09 20.44 124.02 17.79

 

 

It’s fairly obvious from this chart that Switzerland at least, is not doing as well as it might appear by looking only at fatality numbers. The number of fatalities is certainly low, (currently at 153) but as a percentage of their entire population, with 17.79 deaths per million citizens, they are significantly ahead of the UK, the U.S., and Germany.

Germany, however, is doing well, the lowest mortality rate on this chart while having one of the higher population median ages, and the highest total population in Europe. If one of the given reasons for Italy’s high mortality rate is their aging population at a median of 47.3 years, then Germany at 45.7 years ought to be doing nearly as bad as Italy. A year-and-a-half isn’t too far off with regard to median age. So, what is the reason for their low mortality numbers?

Germany has a fairly high density rate, and we know the virus thrives on high population densities, so that would again indicate they’re doing something right. The U.S. has a very low density rate, but that number is very misleading because huge states with small populations like Alaska, Texas, and Montana really skew those numbers. If you look a little closer at some of the worst-hit states in the U.S., New York has a population density of 421 per square mile, with New York City at a staggering 26,400 per. California is at 251 per square mile, and Washington State, the original U.S. viral epicenter has an average density of 750 per square mile in its three most populous counties where the virus has hit the hardest. Earlier, I mentioned evidence of the trajectory that the UK was on, matching Italy’s fatality chart, and so, with a population density nearly as high as the UK, and a median age even higher, why has Germany been so successful?

I don’t think they actually are. I think they’re just behind most of their neighbors through nothing more than pure variance or luck. And, I think they’re going to catch up quickly.

Germany didn’t hit 30 coronavirus deaths until March 19th. France and Spain both hit that number on March 9th, ten days earlier. A week after hitting the 30-death mark, France had 148 deaths, and Spain had 342. Today, on the 25th, a week after hitting the 30-death mark, Germany has 206 deaths, putting them right near the middle between France and Spain. The worst hit country in the world, Italy, had 30 deaths on February 29th. A week later, March 7th, they had 233 deaths. That’s very close to Germany’s 206 deaths.

Germany doesn’t seem to actually be far behind Italy or Spain, and they’re well ahead of France when looking at first coronavirus fatality to total deaths a week later, the most recent comparable figure for Germany. In the next week or so, we’ll be able to track this line further. If Germany is going to see a mortality explosion, it’s going to start happening early next week, and their fatality line will project upwards at the same rate as the countries around them. With the lack of isolation efforts and the lackadaisical attitude of a population that has been convinced by the media that they have some kind of special immunity, it’s likely that Germany is going to actually end up being the hotspot of Europe in about two weeks.

This Covid-19 virus is the same virus everywhere. The people in Germany are sick with the exact same virus as the people in Italy, as the people in China, as the people in the United States. If you see CFR numbers that don’t seem to match, it has nothing to do with arbitrary land borders. There’s usually going to be a reasonable explanation if you just look at the math and analyze the situation.

Maybe with the exception of France. Their numbers are going to be off the Smurfing charts before this is over.

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