Germany followed the playbook for saving lives. France didn’t.
France and Germany, Europe’s two most powerful countries, have been hit hard by the coronavirus, with each approaching 150,000 confirmed cases. But as of April 17, France is near 18,000 dead from the infection, while Germany’s death toll has passed 4,000.
Which raises the question: How did two similarly sized countries, located right next to each other and with comparable levels of wealth and resources, end up with such starkly different outcomes?
The answer has a lot to do with how their respective governments responded to the crisis.
France had the continent’s first confirmed cases of the novel coronavirus, but the French government failed for weeks to take decisive action to impose strict social distancing measures or promote large-scale testing. Germany, on the other hand, immediately began aggressively testing and tracking people with symptoms.
Now, France is under lockdown and has just extended it until May 11 at least. Meanwhile, Germany plans to reopen part of its economy next week.
The experiences of these two countries show that just having substantial national wealth and high-quality health care systems isn’t enough to keep citizens safe from the deadly coronavirus. Saving lives is also about how quickly, thoroughly, and effectively the government responds to the brewing crisis. Any delay, it seems, is very costly.
“Countries that were slow to respond have, so far, paid the price,” Thomas Bollyky, a global health expert at the Council on Foreign Relations think tank, told me last month.
If there’s a lesson for world governments, then, it’s to be more like Germany — not France.
How Germany kept its coronavirus death rate so low
It’s not surprising that Germany has the world’s fifth-largest coronavirus outbreak. It’s in the middle of Europe and borders Italy, which early on in the crisis became the continent’s epicenter. If the disease was going to spread, Germany was always going to be a likely victim.
What wasn’t predetermined, though, was its low death rate. That result came from a combination of luck and the government’s quick action.
Let’s start with the luck part.
Marieke Degen, the deputy spokesperson of Germany’s Robert Koch Institute, told me that the country’s earliest coronavirus carriers were skiers returning home from Austria and Italy. Health authorities say that older adults, especially those over 60 years old, are at risk of severe complications. Most skiers, however, don’t fit that age demographic. While some still got sick, then, the chance they would die from the disease was low.
That trend continues: The average age of an infected person in Germany is 49 years old, compared to about 62.5 years old in France.
It also helped that the vast majority of early cases were clustered in the western region of Heinsberg. That just happens to be near top German hospitals in Bonn, Düsseldorf, Cologne, and other cities, which means those patients were able to access the best care.
But young carriers in the area, even if they were asymptomatic, could spread the disease around the country to more vulnerable people. Why didn’t that happen on a wide scale?
Two words: testing and tracking.
“The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,” Christian Drosten, the chief virologist at the Charité hospital in Berlin, told the New York Times this month.
Germany has Europe’s best pharmaceutical industry, allowing it to respond quickly to disease outbreaks. In the case of Covid-19, German laboratories started accumulating testing kits as signs of a global spread became more real in early 2020. These labs were well stocked ahead of Germany’s first confirmed coronavirus case in February.
The Robert Koch Institute’s Degen told me that early testing helped the country’s public health officials get a better understanding of where the outbreaks were and how far the disease had spread before things got out of control. “This is probably why we started to see cases very early, and many cases, and also mild ones,” she said.
This also helps explain why the number of confirmed cases is so high but the number of deaths so small: hundreds of thousands are getting tested each week, and the vast majority of them won’t have a life-threatening case. Every subsequent test, then, makes the infection-to-death ratio smaller and smaller.
But that’s not all: Germany has also gone the extra mile to track those with the disease.
In the city of Heidelberg, for example, the New York Times reports that vehicles known locally as “corona taxis” transport physicians to the homes of those who have been sick for five to six days.
“They take a blood test, looking for signs that a patient is about to go into a steep decline. They might suggest hospitalization, even to a patient who has only mild symptoms; the chances of surviving that decline are vastly improved by being in a hospital when it begins,” the New York Times’s Katrin Bennhold wrote.
This not only helps authorities keep tabs on a known patient, but also enables them to intervene at a critical point in the disease’s progression, thereby reducing the chances of death.
“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Hendrik Streeck, who leads the University of Bonn’s virology institute, told the New York Times.
It appears Germany plans to keep up intense tracking for the foreseeable future. “Once…we are down to, let’s say, a couple of hundred cases per day or even better, less than a hundred cases, we will try to follow up on every case and get in touch with everyone who has been in touch with those new cases, quarantine and test them,” Karl Lauterbach, an epidemiologist at the University of Cologne, told CNBC on April 3.
Of course, many experts I spoke to warned that the situation could still worsen in Germany.
Degen told me that “the [death] rate has been steadily rising” — it’s roughly at 3 percent now — “and we expect it to further do so.” She added that it’s “very important to stress that Germany is still at the beginning of the epidemic” and that more and more elderly people in the country are getting sick.
That means Germany isn’t out of the woods yet. But it’s in a better position than most because it had good fortune and the good sense to start testing early and often.
France, on the other hand, had none of that.
How France bungled its coronavirus response
France, like Germany, is a wealthy country with a great healthcare system. It doesn’t have the pharmaceutical prowess of its neighbor, experts tell me, but still has good hospitals with thousands of ICU beds and well-trained physicians.
If you were to list the countries best prepared, at least in theory, to weather the coronavirus outbreak, France would surely be near the top.
And yet that’s not what happened.
That’s in large part because French President Emmanuel Macron and his team completely missed their chance to quash the disease early on.
Macron even admitted as much. “Were we prepared for this crisis? On the face of it, not enough. But we coped,” he said in a televised national address in which he announced an extension of the nation’s lockdown to May 11.
To understand just how badly Macron’s government bungled the country’s coronavirus response, it helps to go back to the beginning.
On January 24, France’s then-Health Minister Agnès Buzyn announced that two people in the country tested positive for the coronavirus, becoming the first known cases in all of Europe. They had just been to China, Buzyn said, adding, “We will probably have other cases.”
But if Macron’s government felt a sense of urgency, it didn’t show it.
February came and went with little action. Health officials advised citizens to wash their hands, keep a safe distance from others, cover their mouths when sneezing, and stay away from retirement homes. And even as Macron held video conference calls on the virus and inspected hospitals and clinics to see how his country was coping, few concrete actions were taken to impose strict social distancing measures or promote large-scale testing.
In fact, in early March, the government still allowed gatherings of up to 1,000 people to proceed. Macron, for his part, attended a theater performance on March 6, partly to show that life could continue unperturbed. He also visited a retirement home that same day, even as the number of coronavirus infections in the country was at least doubling.
To make matters worse, France couldn’t get a clear picture of the growing problem due to a lack of tests. As Politico reported last week, the country doesn’t manufacture its own testing kits, but rather “relies on China for their main components.” With China paralyzed by its coronavirus outbreak at the time, France was unable to quickly get more tests. That severely limited the country’s ability to do widespread testing early on, which public health experts say is critical to slowing an outbreak.
Macron, in effect, seemed to be sleepwalking toward disaster. Two events finally woke him from his slumber, experts say.
The first was Italy’s coronavirus situation. In late February, Italy had just three confirmed cases; by mid-March, that number had skyrocketed to around 15,000. That got Macron’s attention and caused him and his leadership team to worry that perhaps the disease was worse than China had let on.
The second was the discovery of some 2,500 coronavirus cases in the country that could all be traced back to a single week-long religious gathering that had taken place in mid-February.
As Reuters reports, during the week of February 17, hundreds of worshippers from around the world attended an annual celebration at the Christian Open Door evangelical megachurch in Mulhouse, a city in eastern France near the country’s border with Germany. One of the congregants carried the disease.
The first case linked to the church was identified on February 29. Over the following weeks, experts traced some 2,500 infections back to the event. “Worshippers at the church [had] unwittingly taken the disease caused by the virus home to the West African state of Burkina Faso, to the Mediterranean island of Corsica, to Guyana in Latin America, to Switzerland, to a French nuclear power plant, and into the workshops of one of Europe’s biggest automakers,” Reuters reports.
By the time researchers understood the extent of the outbreak, they knew bigger problems lay ahead. “We realized that we had a time bomb in front of us,” Michel Vernay, an epidemiologist with France’s national public health agency, told Reuters in March.
Put it all together, and it becomes clear that in addition to its early luck with younger carriers, Germany’s ability to test early, track often, and treat patients thoroughly has kept its death toll down despite a large number of confirmed infections. France, meanwhile, dawdled on implementing significant measures, especially testing, for weeks.
The contrast shows how vital swift, aggressive measures are for combating the disease. The hope is that other nations learn that lesson as the virus continues to sweep across the globe.
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Author: Alex Ward
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