Germany. What are they doing right?

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Germany. What are they doing right? - cardcrimson - 03-16-2020

Thus far, they've 17 deaths and over 7200 cases for a .2% fatality rate according to Johns Hopkins. A client's brother in Munich contracted the disease from a co-worker and after just a day, his fever has broken. What is Germany doing correctly and what can we learn?

RE: Germany. What are they doing right? - 2006alum - 03-16-2020

Well, a simple google search for "germany deaths lower coronavirus why" led to this. And none of the factors are ones a country like ours can replicate:

-Our medical and hospital system, as Cuomo said earlier today, is essentially a haphazard network of private companies.
-We lack medicare for all.
-The vast majority of employees are at will hires with no paid sick leave.

Quote:Germany seems to have weathered the early phase of the coronavirus scare with fewer deaths than many nations, reporting only two fatalities out of 1,457 recorded cases as of Tuesday.
Many health professionals point to a variety of reasons for the results so far, including that Germany, a leader in the 27-nation European Union, has some built-in advantages that could help keep the mortality rate noticeably lower than many countries.
Germany has a widespread network of regional laboratories and was able to do extensive testing for coronavirus when it became known in recent weeks. It has one of the most expensive and extensive public healthcare systems in the world with national healthcare insurance for everyone.
Germany also is considered to have one of the world’s highest concentrations of hospitals — 1,900 for a population of 82 million. And workers, who traditionally see high levels of job security in the country, tend to stay home when they notice symptoms of an illness.

Some medical professionals and political leaders said in recent days that the number of people infected with the coronavirus and the resulting deaths are bound to increase substantially, but that Germany certainly has benefited from preparation and other factors.

Crim, sounds like you should be feeling the Bern if you want to replicate Germany.

RE: Germany. What are they doing right? - cardcrimson - 03-16-2020

(03-16-2020, 09:42 PM)2006alum Wrote: Well, a simple google search for "germany deaths lower coronavirus why" led to this.

Well a simple google search earlier today for "first italian case of coronavirus" led to something you pissed all over. Guess I don't trust Google at the moment.

Thanks for dragging politics into a simple question. I'm curious about solutions and successes, not politics. What specifically has Germany done?

RE: Germany. What are they doing right? - akiddoc - 03-16-2020

(03-16-2020, 09:48 PM)cardcrimson Wrote:
(03-16-2020, 09:42 PM)2006alum Wrote: Well, a simple google search for "germany deaths lower coronavirus why" led to this.

Well a simple google search earlier today for "first italian case of coronavirus" led to something you pissed all over. Guess I don't trust Google at the moment.

Thanks for dragging politics into a simple question. I'm curious about solutions and successes, not politics. What specifically has Germany done?

I don't know exactly what the differences are in Germany, but there are a number of possibilities. Testing is far more extensive there in relationship to the population of the country. If we were testing a lot more people we would realize that there are tens of thousands of Americans with minimally symptomatic disease. Our numbers would look better if we included all of those people. German life expectancy is 2.5 years greater than ours, which tells you that their seniors are healthier. The rates of chronic disease are lower than ours. They might be testing younger patients more than we are since they got their testing off the ground faster. In the USA it is hard to get a test right now if you are under 60. And finally, I expect their death rate to rise over time.

RE: Germany. What are they doing right? - M T - 03-16-2020

Germany has 17 dead, 67 recovered, and 7188 active cases.
If no one else gets the disease, their death rate is between 0.2% and 99.1%, unless you can tell the future.

RE: Germany. What are they doing right? - cardcrimson - 03-17-2020

(03-16-2020, 10:56 PM)M T Wrote: Germany has 17 dead, 67 recovered, and 7188 active cases.
If no one else gets the disease, their death rate is between 0.2% and 99.1%, unless you can tell the future.

I see your point, though by the same measure, all the statistics at this point are similarly marred and irrelevant, right? Why even look at them?

(03-16-2020, 10:12 PM)akiddoc Wrote:
(03-16-2020, 09:48 PM)cardcrimson Wrote:
(03-16-2020, 09:42 PM)2006alum Wrote: Well, a simple google search for "germany deaths lower coronavirus why" led to this.

Well a simple google search earlier today for "first italian case of coronavirus" led to something you pissed all over. Guess I don't trust Google at the moment.

Thanks for dragging politics into a simple question. I'm curious about solutions and successes, not politics. What specifically has Germany done?

I don't know exactly what the differences are in Germany, but there are a number of possibilities. Testing is far more extensive there in relationship to the population of the country. If we were testing a lot more people we would realize that there are tens of thousands of Americans with minimally symptomatic disease. Our numbers would look better if we included all of those people. German life expectancy is 2.5 years greater than ours, which tells you that their seniors are healthier. The rates of chronic disease are lower than ours. They might be testing younger patients more than we are since they got their testing off the ground faster. In the USA it is hard to get a test right now if you are under 60. And finally, I expect their death rate to rise over time.

Thanks. The comparison to Italy is interesting, as per some of the posters here have pointed out, the Italian outbreak has been attributed to a source in Germany. Why so much worse in Italy than Germany? Similar reasons?

RE: Germany. What are they doing right? - BostonCard - 03-17-2020

(03-17-2020, 08:13 AM)cardcrimson Wrote:
(03-16-2020, 10:56 PM)M T Wrote: Germany has 17 dead, 67 recovered, and 7188 active cases.
If no one else gets the disease, their death rate is between 0.2% and 99.1%, unless you can tell the future.

I see your point, though by the same measure, all the statistics at this point are similarly marred and irrelevant, right? Why even look at them?

Isn't this always the case. Even with the benefit of hindsight, we will always have issues like misdiagnoses in statistics. That doesn't mean that they are, by definition, invalid. You just have to take the limitations of what you are measuring into account, and you have to ask yourself if measurement errors account for your observations. So, what are the possible reasons for Germany's apparent lower mortality?

1) Germany's healthcare system is somehow better equipped to treat patients with Covid-19. Reasons may include the healthcare system being intrinsically better equipped to handle the epidemic or that, so far, it has not become overwhelmed, or that they have learned something from other countries and are applying it systemically.

2) Germany's population is somehow better able to withstand the pandemic. The biggest risk factor for death right now appears to be age, and Germany is not all that much younger than other countries in the pandemic. Or, they are somehow more able to shield their vulnerable populations. I find that explanation a bit doubtful.

3) Either the deaths attributed to Covid-19 are an underestimate or other countries have an undercount of total cases.

4) Deaths in Germany are lagging.

Germany isn't the only country with an apparently low death rate. There have been 3 deaths in Norway out of 1437 cases (0.2%), Austria has 4 deaths out of 1332 cases (0.3%), Portugal has reported one death out of 448 cases (0.2%), Malaysia has 2 deaths in 673 cases (0.3%), and Brazil has 1 death in 301 cases (0.3%). For most of these, it is an issue of small numbers. If two more people in Brazil die in the next day, you would get up to 1%.

I think at the end of the day we may never know, but a lot of people will study the question and try to come to conclusions, but I think the issue is hard to tease out at this point of the pandemic.

BC

RE: Germany. What are they doing right? - cardcrimson - 03-17-2020

An interesting perspective:

https://www.cnn.com/2020/03/16/opinions/south-korea-italy-coronavirus-survivability-sepkowitz/index.html

RE: Germany. What are they doing right? - 2006alum - 03-17-2020

One other thing to note is that each country classifies its deaths differently, in terms of what the cause of death is attributed to, how quickly a cause is attributed, etc. Here's another piece on this:

Quote:Meanwhile, an Italian virologist said the low number in German deaths "is a question no one can really answer".
Giovanni Maga from CNR told Euronews that in Italy a person who tested positive while alive or post-mortem is counted as a coronavirus-death. "I don't know if Germany or France follow the same criteria," he noted.
Maga also stated that healthcare structures are rather similar in northern Italy, France and Germany, making it harder to justify such discrepancies in numbers.

It's possible, for example, that Germany requires autopsies before legally attributing a cause of death - if so, that would put its CFR significantly behind countries like Italy that treat any death of a patient with a positive diagnosis as a COVID-19 death.

But insofar as the death rates in France, Spain, and the UK are all surging now in a way Italy's began to a week ago, if Germany continues to have such a lagging indicator, I would assume it's due to something other than uniformly better patient outcomes.

RE: Germany. What are they doing right? - akiddoc - 03-17-2020

The Chinese have identified several mutations of Covid-19. I do not know if they have studied whether one is more deadly than another.

RE: Germany. What are they doing right? - OutsiderFan - 03-17-2020

Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

RE: Germany. What are they doing right? - Mick - 03-17-2020

(03-17-2020, 06:40 PM)OutsiderFan Wrote: Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

Can we throw in their educational system as well?

RE: Germany. What are they doing right? - pefloresjr - 03-17-2020

(03-17-2020, 06:42 PM)Mick Wrote:
(03-17-2020, 06:40 PM)OutsiderFan Wrote: Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

Can we throw in their educational system as well?

Well, if we're going create wish lists, can we add currywurst from Berlin? ;-)

Cheers,
Pete F.

RE: Germany. What are they doing right? - cardcrimson - 03-17-2020

(03-17-2020, 06:40 PM)OutsiderFan Wrote: Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

Are you sure? Sent to me from a client who runs the US operation for a German company:

"In Germany and rest of EU we are seeing most places shutting down. We expect the same wave to hit the US with a 1-3 week delay.

At this moment the German healthcare system is crumbling. A diagnosed person doesn’t have access to a doctor for at least 3 days (that is the current backlog). Average wait to contact the health care system is >5hrs, some people never get thru.

The two key symptoms to watch out for are fever and throwing up along with impaired vision. They come quickly. My brother was exposed to an infected person (sitting next to the person in a meeting room and sharing a pen) Thursday and is showing a quick rise in temp, and all symptoms today."

FWIW, the brother is recovering quickly after a couple of days. Thankfully he's 42 and fit.

And I seem to remember praise for the Chinese system, as well. Read these:

https://www.nationalreview.com/corner/coronavirus-crisis-caused-by-decisions-chinese-government/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=first

https://www.nationalreview.com/2020/03/coronavirus-china-response-will-weaken-it-on-world-stage/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=second

RE: Germany. What are they doing right? - akiddoc - 03-17-2020

(03-17-2020, 08:30 PM)cardcrimson Wrote:
(03-17-2020, 06:40 PM)OutsiderFan Wrote: Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

Are you sure? Sent to me from a client who runs the US operation for a German company:

"In Germany and rest of EU we are seeing most places shutting down. We expect the same wave to hit the US with a 1-3 week delay.

At this moment the German healthcare system is crumbling. A diagnosed person doesn’t have access to a doctor for at least 3 days (that is the current backlog). Average wait to contact the health care system is >5hrs, some people never get thru.

The two key symptoms to watch out for are fever and throwing up along with impaired vision. They come quickly. My brother was exposed to an infected person (sitting next to the person in a meeting room and sharing a pen) Thursday and is showing a quick rise in temp, and all symptoms today."

FWIW, the brother is recovering quickly after a couple of days. Thankfully he's 42 and fit.

And I seem to remember praise for the Chinese system, as well. Read these:

https://www.nationalreview.com/corner/coronavirus-crisis-caused-by-decisions-chinese-government/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=first

https://www.nationalreview.com/2020/03/coronavirus-china-response-will-weaken-it-on-world-stage/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=second

The US health care system is crumbling as well by your definitions. We are not ready for this wave. The ER wait at most hospitals in the Bay Area is 8-12 hours right now. One of my patients just got admitted after a 20 hour stay in the ER (I just got the call). It is going to get A LOT worse. There is no healthcare system that is ready for what is about to hit or has hit in Italy and China. By the way, impaired vision and vomiting are not prominent presentations of this illness. He probably has Influenza or an Enterovirus, especially if he is recovering quickly.

RE: Germany. What are they doing right? - cardcrimson - 03-18-2020

(03-17-2020, 11:46 PM)akiddoc Wrote:
(03-17-2020, 08:30 PM)cardcrimson Wrote:
(03-17-2020, 06:40 PM)OutsiderFan Wrote: Germany's health care system is the one I want for the U.S. and that is not just something I recently concluded.

Are you sure? Sent to me from a client who runs the US operation for a German company:

"In Germany and rest of EU we are seeing most places shutting down. We expect the same wave to hit the US with a 1-3 week delay.

At this moment the German healthcare system is crumbling. A diagnosed person doesn’t have access to a doctor for at least 3 days (that is the current backlog). Average wait to contact the health care system is >5hrs, some people never get thru.

The two key symptoms to watch out for are fever and throwing up along with impaired vision. They come quickly. My brother was exposed to an infected person (sitting next to the person in a meeting room and sharing a pen) Thursday and is showing a quick rise in temp, and all symptoms today."

FWIW, the brother is recovering quickly after a couple of days. Thankfully he's 42 and fit.

And I seem to remember praise for the Chinese system, as well. Read these:

https://www.nationalreview.com/corner/coronavirus-crisis-caused-by-decisions-chinese-government/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=first

https://www.nationalreview.com/2020/03/coronavirus-china-response-will-weaken-it-on-world-stage/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=right-rail&utm_content=top-stories&utm_term=second

The US health care system is crumbling as well by your definitions. We are not ready for this wave. The ER wait at most hospitals in the Bay Area is 8-12 hours right now. One of my patients just got admitted after a 20 hour stay in the ER (I just got the call). It is going to get A LOT worse. There is no healthcare system that is ready for what is about to hit or has hit in Italy and China. By the way, impaired vision and vomiting are not prominent presentations of this illness. He probably has Influenza or an Enterovirus, especially if he is recovering quickly.

I wondered about that too--supposedly he was tested. . . .

RE: Germany. What are they doing right? - OutsiderFan - 03-18-2020

Yeah, no health care system can handle what is facing humanity right now. In ordinary times, I prefer the German system to the U.S. because it covers everyone, gives some room for insurance companies to compete, and is regulated so individual health is prioritized over profits.

Just be glad you don't have Ethiopia's healthcare system. I think it's 1 doctor per 5,000 people.

RE: Germany. What are they doing right? - 2006alum - 03-18-2020

Some more interesting info on this:

[tweet]https://twitter.com/kaibaumgartner/status/1240141447900336129?s=20[/tweet]

RE: Germany. What are they doing right? - Mick - 03-18-2020

(03-17-2020, 11:46 PM)akiddoc Wrote: By the way, impaired vision and vomiting are not prominent presentations of this illness. He probably has Influenza or an Enterovirus, especially if he is recovering quickly.

CDC site says fever, cough, shortness of breath are the most common symptoms.

RE: Germany. What are they doing right? - BostonCard - 03-19-2020

14 new deaths in Germany overnight, which increased the total by 50% (now 42). Maybe the answer is simply that they started identifying patients earlier in the pandemic. Or maybe some reversion to the mean. Note the crude fatality rate is still about .4%, which is still much better than other places.

BC