Is Germany's low death rate a statistical distortion?

Germany’s death rate from the deadly coronavirus pandemic has been relatively lower than many other countries, driving experts and pundits to question what lies behind it all. 

While some have suggested that it’s related to a statistical distortion based on the enormous number of tests conducted on people with mild symptoms, others have pointed to the country’s robust health system with its strong social security coverage. 

A country’s virus fatality rate is calculated by dividing the total deaths by the number of confirmed cases, which could differ in different places depending on testing capability and several other factors (locations where tests are conducted, average age of people, who are tested and the transparency of governments). 

Germany clearly has an edge when it comes to testing. The country has tested nearly a million people in total — only the US, which has four times as many people, has conducted more tests — increasing its testing capacity over time and hitting 350,000 tests per week. 

Even people with mild symptoms and asymptomatics, who are less likely to die from the virus, have been tested, adding to the tally of the country’s confirmed cases. As a result, Germany’s confirmed cases are going up disportionately as those with mild to no symptoms aren’t in danger, keeping the country’s death rate quite low.

“That automatically lowers the death rate on paper,” said Hans-Georg Kräusslich, the leading academic of virology at University Hospital in Germany’s Heidelberg. 

But countries like Italy and Spain have less testing capability, and end up having much higher death rates touching two digits. Germany’s death rate stands at 1.6 percent now. However, it has also significantly increased from two weeks ago when it was only 0.2 percent. 

Experts are advising caution during deadly pandemics warning that pure statistics could lead to misguided conclusions which dismiss various factors in the rates of death tolls. 

“We should rely on experts, but the experts in question are not economists and armchair virologists. They are bio-statisticians who understand not only the statistical methods but also the many subtleties behind the data,” wrote Wolfgang Münchau, an editor at the Financial Times. 

According to Lothar Wieler, the president of the Robert Koch Institute in Berlin, which is the federal government’s health agency, the real death rate in Germany is possibly higher. 

But that could also be a case in other countries. 

In Italy, the hardest-hit country in Europe, where more people are dying than in any other region, according to local officials and experts, the country’s death toll is much higher than the official numbers reveal. 

Another reason for Germany’s unusually low death rate is that the average age of someone with coronavirus in the country is just 49.

That’s a pretty low number compared to Italy and France, where the average age of the infectedis over 60.The virus mostly kills people older than 65 - the risk increases with age. As a result, experts warn that the worst could be on the way for Germany, where the country has been able to keep the virus away from the older generation up until now. 

As the virus spreads with time, reaching old people, the death rates could increase exponentially as has been seen in Italy, Spain and the US.  

A close examination of the death tolls over time exposes the chilling fact that several European countries have similar numbers. 

Once each country had reported its 10th death, the figures then listed 18 days later were similar, with Italy recording 1,441 deaths, while France had 1,331. Spain stood at a staggering 3,647 and in the UK the deaths hit 1,408.

Germany’s deaths, 1,107, are not much lower than the countries above as the statistical data seems to suggest. 

But, despite all the problems with statistics, it is difficult to belittle Germany’s health system’s success in the wake of the epidemic. 

Germany’s rational strategy

Germany has an enormous advantage in terms of bed capacity and intensive care units, which makes a huge difference in death and recovery rates in the fight against the pandemic. 

In a world where the pandemic has made ventilators a scarce commodity, Germany has three times more ventilators than Italy and nearly five times more than the Netherlands. 

Since the beginning of the outbreak, what Germans are effectively doing is trying to keep the curve under control by playing to their strengths. Constant testing and the implementation of a suppression strategy with strict quarantine guidelines across the country in a timely manner have made the difference. 

While the wide-range testing might contribute to statistical distortions in terms of Germany’s death rates, it also helps track the disease’s routes across the country. 

“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,” said Dr Christian Drosten, chief virologist at Berlin’s Charite hospital, where the doctor’s team developed country’s first test. 

The German government's take on the pandemic resembles a guideline a lot of medical experts across the world, ranging from the US to the UK and other countries, have strongly urged since the virus was identified. 

“At the beginning, when we had relatively few cases, when it came to finding them and isolating them, we did quite well in Germany. That’s the major reason,” said Reinhard Busse, head of the department of health care management at the Berlin University of Technology. 

To Germany’s credit, while countries like the US and the UK with populist governments have been dismissive of data and expert advice, initially resorting to some policies like “herd immunity”, Berlin with its powerful social security and public health system has followed the scientific path, limiting its own death tallies.  

“Maybe our biggest strength in Germany is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population,” Krausslich concluded.