Germany. What are they doing right? - Printable Version
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RE: Germany. What are they doing right? - BostonCard - 03-19-2020
If you are looking for a reason that Germany may be doing better than some other countries, and which would augur well for the US, it is this:
![[Image: United-States-Resource-Availablity-for-C...9-Fig1.jpg]](https://sccm.org/sccm/media/main/United-States-Resource-Availablity-for-COVID-19-Fig1.jpg)
From the society of critical care medicine.
https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19
BC
RE: Germany. What are they doing right? - stupac2 - 03-19-2020
(03-19-2020, 12:27 PM)BostonCard Wrote: If you are looking for a reason that Germany may be doing better than some other countries, and which would augur well for the US, it is this:
From the society of critical care medicine.
https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19
BC
You'd really want to know how many available critical care beds, if the US's are all full all the time while Germany's are mostly empty for a situation like this then it's not helpful.
RE: Germany. What are they doing right? - BostonCard - 03-19-2020
(03-19-2020, 02:21 PM)stupac2 Wrote: You'd really want to know how many available critical care beds, if the US's are all full all the time while Germany's are mostly empty for a situation like this then it's not helpful.
Also, how many critical care beds can be made available by, for example, by postponing elective surgery. Don't know.
BC
RE: Germany. What are they doing right? - BostonCard - 03-19-2020
[tweet]https://twitter.com/lymanstoneky/status/1240837304773562368?s=21[/tweet]
Interesting thoughts. Wonder what the age distribution of infected patients is between Germany and Italy.
BC
RE: Germany. What are they doing right? - 2006alum - 03-20-2020
Here's another great thread about Germany, the tl;dr of which is:
-Germany is doing much more testing, so catching more asymptomatic people, which means that they are using something closer to an IFR rather than a sCFR (symptomatic case fatality rate), which would drive up the overall denominator of cases and therefore drive down the overall CFR;
-The age profile of those affected has so far been younger than that in other countries;
-German hospitals were much better prepared to treat seriously ill patients; and
-Germany is behind Italy in terms of explosion in cases, so CFR is likely to converge closer over time.
[tweet]https://twitter.com/TobiasBuckFT/status/1240915915845353472?s=20[/tweet]
RE: Germany. What are they doing right? - Farm93 - 03-20-2020
Many rules and norms in Germany are just different than USA.
Angela Merkel has been very open about the situation. She has consistently utilized science and statistics to defend her actions.
The population there has a lot of safe guards for health care and employment security. Those benefits have consequences in good times, but look mighty helpful when fighting a global pandemic.
Here in CA, my wife had a co-worker that went to work yesterday with what I will describe as "Flu-like" symptoms. This co-worker appeared at work because she is in her third trimester and does not want to deplete her sick days as she wants them to get some pay during leave. As most of you know, the USA has awful paid maternity leave policies, so that was not a crazy idea. However that would NEVER happen in Germany for so many reasons.
Then that company's CEO decided last night's CA stay at home order does not apply to his business. So even today an employee from Long Beach, which had its own stay at home policy, and the sick pregnant co-worker and dozens of others are there offering administrative support services to the manufacturing team making items that are not exactly on the essential services list.
In the USA that fear of termination, losing health care and relatively limited personal savings will make a lot of people do things that would seem crazy to any other industrialized country.
I informed my wife that she's done. Work from home, save messages that imply anything else, and we will manage. It will only add to the accelerating destruction of 20+ years of retirement planning, but following civic orders should be done by all.
USA will be #1 in both cases and fatalities before end of April. Just sitting at home hoping the "flu-like" co-worker JUST had a normal flu. In Korea or Japan my family would probably be tested with that type of direct exposure, but here in the USA....:(
RE: Germany. What are they doing right? - Crafter Artisan - 03-20-2020
(03-20-2020, 09:21 AM)Farm93 Wrote: Then that company's CEO decided last night's CA stay at home order does not apply to his business.
What a piece of $#%&. Deserves to end up getting sent to jail.
RE: Germany. What are they doing right? - stupac2 - 03-20-2020
(03-20-2020, 07:31 PM)Crafter Artisan Wrote:(03-20-2020, 09:21 AM)Farm93 Wrote: Then that company's CEO decided last night's CA stay at home order does not apply to his business.
What a piece of $#%&. Deserves to end up getting sent to jail.
This is the problem with leaving such massive loopholes in the order. Like, the minimum basic operation provisions should be enough for general businesses, everything else should be an explicit list. Leaving open "suppliers to essential businesses" is just ridiculous, because that's basically everyone. My company supplies places like national labs, but not urgently and not in a way that we need to maintain full coverage. We've gone down to one person in the office at a time just to take care of what arises at the mothership, everyone else is WFH. That seems reasonable and within the spirit of the order, but there would be a very easy argument to make that we could operate at full capacity all the time. It's just poor planning on the counties' part when they crafted the order.
Same thing with the distancing requirements, there's no guidance on how grocery stores etc should enforce them, so many just don't. It's going to eat away the effectiveness of what we're doing which is infuriating.
RE: Germany. What are they doing right? - Mick - 03-21-2020
(03-20-2020, 09:21 AM)Farm93 Wrote: USA will be #1 in both cases and fatalities before end of April.
Well, the USA has the third largest population in the world after China and India. And China doesn't appear to be reporting accurately -- or at all. After a slow start, India's rapidly adding cases, but still about 1% of what the USA reports.
So...yes, I agree. USA will be #1 in both before end of April. End of year, not so certain, but I would imagine top three.
(03-20-2020, 08:52 PM)stupac2 Wrote:(03-20-2020, 07:31 PM)Crafter Artisan Wrote:(03-20-2020, 09:21 AM)Farm93 Wrote: Then that company's CEO decided last night's CA stay at home order does not apply to his business.
What a piece of $#%&. Deserves to end up getting sent to jail.
This is the problem with leaving such massive loopholes in the order. Like, the minimum basic operation provisions should be enough for general businesses, everything else should be an explicit list. Leaving open "suppliers to essential businesses" is just ridiculous, because that's basically everyone. My company supplies places like national labs, but not urgently and not in a way that we need to maintain full coverage. We've gone down to one person in the office at a time just to take care of what arises at the mothership, everyone else is WFH. That seems reasonable and within the spirit of the order, but there would be a very easy argument to make that we could operate at full capacity all the time. It's just poor planning on the counties' part when they crafted the order.
Same thing with the distancing requirements, there's no guidance on how grocery stores etc should enforce them, so many just don't. It's going to eat away the effectiveness of what we're doing which is infuriating.
It's because everyone who runs a business is desperately trying to hold onto their business, feed themselves and feed their employees. It's why nail salons stay open until the police tell them to shut down. Two months off, and those businesses vanish, along with the life savings of the owners and the salaries of their employees. Apparently some people find that difficult to understand.
RE: Germany. What are they doing right? - stupac2 - 03-21-2020
(03-21-2020, 07:51 AM)Mick Wrote: It's because everyone who runs a business is desperately trying to hold onto their business, feed themselves and feed their employees. It's why nail salons stay open until the police tell them to shut down. Two months off, and those businesses vanish, along with the life savings of the owners and the salaries of their employees. Apparently some people find that difficult to understand.
There's no need to be condescending. The store I was talking about could easily take measures to dramatically reduce the potential for contagion (which basically every other store I'm aware of near here is doing), but they're choosing not to. They'd still make money, they just don't care. I actually had an employee of that store respond to me elsewhere saying that they were glad they're on vacation this week because management just doesn't care.
At some point you stop being able to assign reasonable motives to these things.
RE: Germany. What are they doing right? - Goose - 03-21-2020
(03-21-2020, 07:51 AM)Mick Wrote: It's because everyone who runs a business is desperately trying to hold onto their business, feed themselves and feed their employees. It's why nail salons stay open until the police tell them to shut down. Two months off, and those businesses vanish, along with the life savings of the owners and the salaries of their employees. Apparently some people find that difficult to understand.Probably not applicable to "everyone". The impact undoubtedly varies quite widely among businesses. It isn't good for anybody. That is why I believe the government, Federal, State, and local needs to put in place some system to propagate the losses up the food chain to organizations whose existence in general will not be threatened or can more easily be sustained by intervention (i.e banks).
That said, this situation isn't "fair", and never will be, no matter who does what. Businesses that are not "essential" should, in fact must, (nail salons) shut down. Yes, it sucks. Yes, you may lose your shirt. However, that is part of the social contract. If many people chose not to honor that contract, society fails. In this, there is no "free lunch". It is true society has obligations to the individual. We hear about that all the time, way too much IMHO. However, it works the other way too. Individuals have an obligation to society, even when it is difficult and not evenly distributed. We as a society hear about that way too little, IMHO.
RE: Germany. What are they doing right? - baymeadows3408 - 03-21-2020
(03-20-2020, 09:21 AM)Farm93 Wrote: Many rules and norms in Germany are just different than USA.
Angela Merkel has been very open about the situation. She has consistently utilized science and statistics to defend her actions.
The population there has a lot of safe guards for health care and employment security. Those benefits have consequences in good times, but look mighty helpful when fighting a global pandemic.
If/when we get through this, I wonder if this pandemic will cause a leftward shift in American politics, like how the Great Depression ushered in the New Deal. The fact that health insurance is tied to employment for most Americans is going to make navigating the pandemic more difficult.
RE: Germany. What are they doing right? - BostonCard - 03-26-2020
Update:
Germany reported 47 deaths yesterday to bring their total to 206. That has pushed their naive CFR to 0.6%, which while lower than what has been seen overall, is no longer an outlier. On the other side, among cases with an outcome 4% have been fatal.
BC
RE: Germany. What are they doing right? - 2006alum - 03-26-2020
On this note, a fascinating chart showing that CFR rates have varied in Switzerland quite dramatically from Canton to Canton depending on whether they are predominantly German-speaking, French-speaking, or Italian-speaking:
[tweet]https://twitter.com/TrevorSutcliffe/status/1243098835036979200?s=20/[/tweet]
Unless there are dramatically different healthcare systems among those Cantons that is nearly perfectly correlated with the Canton's predominant language, this may be further evidence that it may be difficult to calculate the virus's "native" CFR due to how much it may vary depending on social practices, and especially if exposure to higher viral loads leads to worse outcomes. As some of the lay reactions to this correlation suggest, some joke that "Germans are natural social distancers," whereas Italians like to hug and kiss, with the French somewhere in the middle.
This also makes me think of Japan, where bowing rather than handshakes and hugs are the more standard social greetings. Japan has seemed to have been hit early but not badly without as many imposed social distancing measures and the same degree of testing, contact tracing and isolation that other East Asian countries have implemented.
RE: Germany. What are they doing right? - JustAnotherFan - 03-26-2020
Seems like their proximity to and their traveling to and from the affected countries might be a big driver, especially if the fatality rate is a function of capacity. I'd be interested to see the amount of travel between Italian-Switzerland and Northern Italy vs. Italian-Switzerland and German-Switzerland.
(03-26-2020, 09:50 AM)2006alum Wrote: On this note, a fascinating chart showing that CFR rates have varied in Switzerland quite dramatically from Canton to Canton depending on whether they are predominantly German-speaking, French-speaking, or Italian-speaking:
[tweet]https://twitter.com/TrevorSutcliffe/status/1243098835036979200?s=20/[/tweet]
Unless there are dramatically different healthcare systems among those Cantons that is nearly perfectly correlated with the Canton's predominant language, this may be further evidence that it may be difficult to calculate the virus's "native" CFR due to how much it may vary depending on social practices, and especially if exposure to higher viral loads leads to worse outcomes. As some of the lay reactions to this correlation suggest, some joke that "Germans are natural social distancers," whereas Italians like to hug and kiss, with the French somewhere in the middle.
This also makes me think of Japan, where bowing rather than handshakes and hugs are the more standard social greetings. Japan has seemed to have been hit early but not badly without as many imposed social distancing measures and the same degree of testing, contact tracing and isolation that other East Asian countries have implemented.
RE: Germany. What are they doing right? - Hurlburt88 - 03-26-2020
Winflop and I have a mutual friend from b-school who now lives in Germany where his wife is a physician. He sent an email Monday stating that his wife feels that because of privacy laws and practices to this point the # of deaths and also critical cases has been grossly under reported in Germany. Data point of one, yet interesting.
RE: Germany. What are they doing right? - BostonCard - 03-26-2020
(03-26-2020, 10:09 AM)JustAnotherFan Wrote: Seems like their proximity to and their traveling to and from the affected countries might be a big driver, especially if the fatality rate is a function of capacity. I'd be interested to see the amount of travel between Italian-Switzerland and Northern Italy vs. Italian-Switzerland and German-Switzerland.Unless the hospitals are overwhelmed and it is leading to insufficient capacity to keep critical (but survivable) cases alive, I'm not sure about the death rate being affected.
BC
RE: Germany. What are they doing right? - JustAnotherFan - 03-26-2020
(03-26-2020, 01:50 PM)BostonCard Wrote:(03-26-2020, 10:09 AM)JustAnotherFan Wrote: Seems like their proximity to and their traveling to and from the affected countries might be a big driver, especially if the fatality rate is a function of capacity. I'd be interested to see the amount of travel between Italian-Switzerland and Northern Italy vs. Italian-Switzerland and German-Switzerland.Unless the hospitals are overwhelmed and it is leading to insufficient capacity to keep critical (but survivable) cases alive, I'm not sure about the death rate being affected.
BC
I just assumed that the hospitals were being overwhelmed to the degree / relative to where their cases were coming from, Italy > France > Germany. A baseless assumption, I admit.
RE: Germany. What are they doing right? - M T - 03-26-2020
(03-26-2020, 09:50 AM)2006alum Wrote: On this note, a fascinating chart showing that CFR rates have varied in Switzerland quite dramatically from Canton to Canton depending on whether they are predominantly German-speaking, French-speaking, or Italian-speaking:
Social actions (cheek kissing, hugging, gathering, sharing objects) might explain a different number of people getting infected, but I don't see how that changes the percentage of people who test positive and then later die.
Demographics could play a role. Whether through events or genetics, the different language groups might also have different distribution of ages which could explain the different CFRs. For instance, if you took the number of people in Florida that speak with a NY accent, they probably have a higher CFR than those that speak with an Alabama accent. The difference would be from their ages.
RE: Germany. What are they doing right? - Mick - 03-27-2020
(03-26-2020, 03:36 PM)M T Wrote: Demographics could play a role. Whether through events or genetics, the different language groups might also have different distribution of ages which could explain the different CFRs. For instance, if you took the number of people in Florida that speak with a NY accent, they probably have a higher CFR than those that speak with an Alabama accent. The difference would be from their ages.
Lots of different accents in Silicon Valley, the hardest-hit of the CA counties on a per capita basis:
https://projects.sfchronicle.com/2020/coronavirus-map/