Pandemic diary: The successful German approach

The case of the response and approach that Germany has taken in this pandemic has been interesting to follow. Many of my scientist friends, and people to whom I speak, have indicated scepticism about the reliability of the death rate due to Covid19 in Germany. It did initially seem odd to me that the death rate in Germany was substantially lower compared to many other major European nations including the UK, which at one point had a death rate of over 4% of confirmed cases. At the early stages of its epidemic, Germany had a death rate as low as 0.3% despite its very high number of confirmed cases. However, this death rate has been steadily increasing to the current rate of almost 0.8%. This is much closer to what other areas and countries with similar approaches (e.g. extensive testing, tracing and isolation of confirmed cases) are reporting.

Germany has been more successful in their testing approach than any other country. It carries out over half a million tests every week compared to 56 000 tests per week in the UK (89% fewer than in Germany). This lack of extensive testing might indicate that many more infected people are currently undetected in the UK. Therefore, the death rate compared to confirmed cases in the UK would seem much higher than in Germany. How much higher is the actual number of cases in the UK is unknown. In any case, it is quite worthy to note that many countries that have been successful in keeping a comparatively low death rate have implemented testing, tracing and isolation, as well as being equipped with a high capacity of ICU beds. The death rate in these countries is just below or around 1%. Apart from Germany these countries include South Korea, areas of China outside Wuhan or Hubei province, and Singapore.

A number of articles and news reports have suggested that Germany might be under-reporting their number of deaths by Covid19. They especially put in doubt whether they take into account all cases that die from and die with SARS-Cov-2. Others dismiss such suspicions and argue that all cases are included in its death rate. What can be said for certain is that Germany’s death rate by Covid-19 is close to a 35% daily increase, a figure that is typical for most developed countries. This indicates that the case for under-reporting is not strong, unless most developed nations affected by Covid-19 are under-reporting deaths in a similar way.

How does this compare to the situation in the UK? A number of people are attacking the austerity measures and under-funding of the NHS from recent governments, and there are many voices calling for higher expenditure on the NHS to keep it sustainable and efficient over the long term. Others are calling for clarity on how this could be funded and whether there will be an increase in taxation.

The case of Germany's health care expenditure is quite a good example of how a dramatic increase in expenditure could be achieved over a medium to long term. Germany has one of the highest expenditures in health in Europe at 11% of GDP, compared to 9.8% in the UK. This difference may not seem like much but a 1.2% extra yearly expenditure amounts to an extra year of funding into the health budget over a period of 9 to 10 years compared to the UK, which is a huge amount. This has resulted in impressive results: Germany’s response to Covid19, its almost non-existent waiting times, ease of access to a doctor and much lower visits to A&E. Additionally, Germany has been able to implement measures to prevent people from visiting hospitals in the first place, which will be crucial in the near future, especially due to its ageing population problem that is afflicting many developed nations. 

The case for extra funding on its own as a way to improve the NHS is not so clear and we should be cautious. For instance, many countries around Europe have lower budgets than the UK as a percentage of GDP, such as Spain and Italy, and they are able to show similar results. Moreover, Germany’s health care system is not without its problems. Life expectancy in Germany is slightly lower than the life expectancy in the UK, and in the future it will also face a strain in its funding due to its ageing population. Therefore, how the NHS uses its extra funding, its health strategies, and policies would be another important area to consider. The NHS could benefit from a 1-2% increase in its budget, which implemented over a long and consistent period of time could bring results similar to Germany’s system in the future. Additionally, many lessons could be learnt from other countries around the world where their public health care systems produce similar results but on a lower budget.