The world is in a state of emergency because of the coronavirus pandemic. The Sars-CoV-2 virus stops at no limit. Governments from Australia through Asia, Europe, Africa and America are preparing for the worst. And yet there are striking differences in the number of deaths.
Germany stands out with a relatively low number of deaths compared to the total number of registered cases – the so-called case mortality rate. Until Tuesday, Italy had more than twice as many cases as Germany, according to the Johns Hopkins University, but the case mortality rate there was more than 20 times higher than in Germany. Why?
“To be honest, we still don’t know enough,” said Richard Pebody, an expert with the World Health Organization (WHO). “The case mortality rate is puzzling.” He warns against comparing countries because the framework conditions are different in each country. “It’s like comparing apples to pears.” But there are several explanations that all play a role.
The time of the epidemic
“Italy, Spain, these countries are likely to be further into the epidemic than Germany,” says Pebody. There, the first cases should have appeared undetected much earlier and the virus had probably spread unnoticed to the population. It takes a while after the infection for complications to appear. Many patients are in the intensive care unit for weeks before they die.
Because very little is tested in many countries, only the average age of the demonstrably infected is known. But there are likely to be many younger people who have also had the virus and have had no or only mild symptoms.
Among the demonstrably infected, the average age in Italy is much higher than in other countries, including Germany. “Average age of corona cases in Germany: 45 years, Italy: 63 years,” tweeted the German population researcher Andreas Backhaus earlier this week. On the online platform Medium, he compares South Korea and Italy on key dates on which both had about the same number of cases. In South Korea, just under nine percent of the confirmed infections were over 70, in Italy more than 40 percent. The infection is rather easy for younger people.
The Robert Koch Institute (RKI) only names the age group from 60, not from 70 years. Even there the proportion in Germany is clearly below the Italian values: At the beginning of the week 19 percent of the demonstrably infected in Germany were over 60, more than half were between 35 and 59. Especially with regard to Italy it is important to emphasize: It is about proven cases.
Coronavirus: Experts agree that rigorous testing can slow the epidemic. (Source: Sebastian Gollnow / dpa)
The given age structure of the cases in different countries mainly says something about testing in one country. If more young people were tested in Italy, the case mortality would probably be very different. WHO emergency coordinator, Michael Ryan, points to the high number of unreported infections: “There is a very aggressive test strategy in Germany, so there should be more mild cases among the total number of confirmed cases.”
Pebody says that in some countries a test is carried out on the deceased, in others not. That also changes the statistics. And: The more advanced an epidemic is, the more difficult it is for a country to test a lot because the health system is simply overwhelmed. WHO chief Tedros Adhanom Ghebreyesus’ call: “Test, test, test.” The countries should know what the situation is. “You can’t put out a fire blindly,” he said.
The quality of healthcare
The better hospitals are prepared, the more lives can be saved, says WHO coordinator Ryan. “When hospitals are overwhelmed by the number of patients, it is a simple question of the extent to which adequate care can be provided and whether one can respond to any change in the patient’s condition in the intensive care unit.” Pebody says three factors are crucial: the number of intensive care beds, adequate protective clothing and well-trained staff in the intensive care units.
According to the authorities, Italy with around 60 million inhabitants had 5,000 intensive care beds before the crisis. More have been created in the meantime. Britain, with 66 million inhabitants, had 4,100 intensive care beds, according to the National Health Service. There are around 28,000 in Germany with around 80 million inhabitants, and the number is now to be doubled.
Overall, experts agree that rigorous testing, isolation of infected people, and quarantine for people who have been in contact with infected people will slow the epidemic. South Korea and Singapore have consistently implemented this. In some countries, exit restrictions are needed to slow the spread, the WHO said. The case mortality rate – currently around 0.4 percent in Germany – is a good one percent in South Korea and around 0.3 percent in Singapore.
Asian surveillance methods are blatant for Europeans: In Singapore there is now a state app for smartphones that can be used to find out via Bluetooth who has been away from an infected person for more than 30 minutes less than two meters away.