The discipline of Germans helps them comply with all regulations and rules during the quarantine
Indeed, as Deutsche Welle notes, as of April 9, Germany's nearly 111,000 officially registered coronavirus cases correspond to about 2,200 deaths. Approximately the same number have died, for example, in neighboring Netherlands and Belgium. Only there the population is 17 and 11.5 million respectively, while in Germany it is 83 million.
In Italy, about 17,700 deaths occurred among 140,000 officially infected; in Spain, 15,200 among 152,000; in France, with 82,000 detected cases, the number of fatalities is approaching 11,000. In the most recent days, about 2,000 people have been dying per day in the United States—roughly the same number as in Germany over the entire epidemic.
How to explain the "German exception"? One could, of course, assume that the government in Berlin is deliberately underreporting data, which, for instance, half of Russians suspect their own authorities of doing. However, in democratic countries with a strong opposition, independent media, and active civil society, this is a very unpromising endeavor. Such attempts would quickly become public knowledge. Especially in a federal state like Germany, where statistics are compiled and published by regional authorities and only summarized at the center.
So we will immediately set aside such an explanation. Especially since it is easier to underreport the number of infected (which in Germany is actually one of the highest in Europe) than to hide a sharp increase in deaths, especially in the era of social networks. In Germany, in any case, coffins are not transported on military trucks as in Italian Bergamo, temporary morgues are not set up in front of hospitals as in American New York, and bodies certainly do not lie on the streets as in Ecuadorian Guayaquil.
Summarizing numerous publications in German media, both earlier and the most recent, three key factors can be identified that contribute to the relatively low mortality from coronavirus in Germany: the specifics of the virus's spread, the level of the German healthcare system, and the discipline of the population.
1. Average age of infected
"It all started as an epidemic among skiers." That is how Professor Hans-Georg Kräusslich, head of the virology department at Heidelberg University Hospital, explained to The New York Times the low average age of infected people in Germany. According to the Robert Koch Institute (RKI), which coordinates the fight against the epidemic as a government agency, the absolute majority of COVID-19 patients in Germany (70 percent) are between 15 and 59 years old, with an average age of 49.
Thus, the specificity of the virus's spread in Germany is that at the first stage, before radical quarantine and restrictive measures were adopted, it was mainly contracted by young and middle-aged people, who generally have stronger immune systems than the elderly. Among them were many vacationers who became infected in bars and discos at Italian and especially Austrian ski resorts, such as the popular party spot Ischgl, and upon return infected people in their social circles.
Two other practically proven major coronavirus hotspots in Germany were a large carnival party in the Heinsberg district in the west of the country (resulting in 15 percent of the population becoming infected) and a beer festival in the Bavarian town of Mitterteich—again, events that elderly and chronically ill people usually do not attend.
In Italy, apparently, at an early stage, unrecognized virus carriers brought it into hospitals, where soon many patients became its victims. When in late March in a nursing home in Wolfsburg, Germany, 72 residents were infected and 17 died, Christian Drosten, director of the Institute of Virology at Berlin's Charité hospital, assessed this as the beginning of a new phase of the epidemic in the country, which would be accompanied by an increasing number of deaths. This forecast was confirmed by the RKI on April 9.
2. German healthcare system
However, by the end of March, quarantine and self-isolation measures were already in full effect in Germany, and the German healthcare system, already considered one of the best in the world, had managed to prepare specifically for the fight against COVID-19. Hospitals freed up additional beds for infected patients, drew up emergency schedules for doctors and nursing staff, and stocked up as much as possible on increasingly scarce masks, protective suits, and medications.
The German Ministry of Health ordered 10,000 ventilators from the German company Drägerwerk, which invented them over a hundred years ago, as early as March 12. This was in addition to the 25,000 ventilators already available in Germany at the start of the epidemic. The order is now being fulfilled at full speed, so that, for example, Berlin hospitals, which had 1,100 ventilators at the beginning of March, can now provide ventilation for 1,600 patients, according to the Tagesspiegel newspaper. By the end of April, this number should grow to 1,800, and by summer to 2,200.
Therefore, there is hope that German doctors, unlike their colleagues in other countries, will not have to make the difficult ethical decision of which patients to connect to scarce ventilators and which to essentially condemn to death. German Health Minister Jens Spahn reported on April 9 that currently, 10,000 intensive care beds are available nationwide.
The fact that Germany has free capacity to save coronavirus patients is also evidenced by the following: German clinics have admitted almost 200 COVID-19 patients from France, Italy and the Netherlands, and the Bundeswehr, according to Der Spiegel, has provided NATO partner Great Britain with 60 mobile ventilators.
3. Discipline of Germans
Almost all publications about the reasons for the low mortality rate in Germany from SARS-CoV-2 point out that the population is being actively tested for the virus. However, tests themselves do not save lives. They allow identifying infected individuals, but six out of seven people who fall ill with COVID-19, as Minister Spahn reported on April 9, are treated on an outpatient basis in Germany.
And here, the decisive factor for preventing possible life-threatening infection of risk groups is how strictly the infected observe quarantine at home, in other words, self-isolate, and to what extent those around them help and demand this from them.
Apparently, the majority of Germans heeded the call of German Chancellor Angela Merkel, who on March 18 in her televised address to the nation urgently asked everyone to reduce social contacts as much as possible: “We must reduce the risk of infecting each other as much as possible.” Many other German politicians also constantly appealed to their voters to stop meeting each other for a while, especially with elderly people.
German President Frank-Walter Steinmeier, for example, found these words in his address to his fellow citizens: “We have to give up meetings with parents, grandparents, meetings with friends, going to restaurants with them, celebrations, and even just sitting together in the sun after a long winter. It is hard for all of us to give this up, and for me too. But only refusal will prevent the irrevocable loss of what we love.”
All these appeals, backed by large-scale but less strict quarantine measures than in some other countries, clearly contributed to the fact that the number of irrevocable losses so far is much lower than it could have been in a pandemic. Thus, one of the explanations for the low mortality from coronavirus in Germany should be considered precisely the conscientiousness and discipline of its residents.