The author generally does a very good job of sticking to the facts, but there a several things here that are either factually wrong or a matter of opinion which completely muddle the comparison.
First, how is it vaguely possible that you don’t know the difference between the United Kingdom and England? The United Kingdom does not have a centralised public health system, as you state — England does. Scotland has its own, more local, public health system, with its own test and trace capability. In the end, though, a localized response didn’t make that much of a difference when you compare results between England and Scotland.
Second, masks. Everywhere I’ve been in England and France for the past three months, everyone has been wearing masks in all indoor spaces, and they were all in lock down before that. Hasn’t made any difference though. I find it extremely hard to believe that one small territory mandating masks in Germany a little bit earlier could actually explain much of the difference in Covid deaths.
Third, quality of politicians. Really? I can read the FT/Guardian for that.
It would seem that how Germany handled care homes was the key difference. It would be very helpful if that weren’t lost in the fog of nonsense making up much of the rest of the article.
“..Germany handled care homes was the key difference.” As far as i can tell (media reports, I don’t have any secret news source) 1) Germany (as the article points out) took a hard/aggressive position on care homes. 2) Germany healthcare had/has more capacity to deal with serious patients. 3) UK GOV decided to save NHS and it threw the old people to care homes 4) Care homes (professional experience) are on average better in Germany than UK 5) All the points above are (luck aside) byproduct of a competent political class that spends more on healthcare than UK.
P.S. Even loyal Tories (news reporting) think the current government is light on talent.
You’re perpetually going on about the superiority of German politicians, so could you please explain why our incompetent leaders in the UK have been able to reduce per capita carbon emissions by 4x of what Germany has achieved in the past 15 years? Your sixth-form political analysis of Germany good/Britain bad is really not helpful. Germans do somethings well (i.e. financial frauds) but they’re not perfect.
“You’re perpetually going on about the superiority of German politicians…” No I have not!!! I simply pointed out in THIS crisis (details above) that political decision (luck aside) have produced better results. I didn’t say UK bad Germany good – you did. Just like you repeating the same stat (carbon emission).
Big Picture Argument:
We have internationally accepted metrics that measure a country’s performance; human development index and by most metrics Germany outperforms UK. It is beyond argument that since 1950 Germany’s elite (politicians, bureaucrats, business leaders) have performed better than UK’s elite.
Because we outsourced all our manufacturing to China and.. Germany.
I’m not sure that addresses the point. AH’s comment suggests the reductions are relative to a base line of 15 years ago. Unless you’re suggesting that the “outsourcing” all took place since 2005 then it’s irrelevant – and probably makes it even more difficult for UK.
Germans still have a manufacturing base. They export . We import. Anyway the article is about a specific problem not general point-scoring. Disclosure ;have lived in Germany but live in England and am English .
The UK still has a manufacturing base, and is particularly strong in precision engineering, robotics, aerospace, defence, computing, pharmaceuticals, biotech. etc (and is relatively strong in the high-value add parts of the process).
We don’t so very much Big Iron stuff anymore, which creates some strategic/security risks, but isn’t such a big deal economically.
And we are also world class in culture, services, law, finance, etc
“..and is relatively strong in the high-value add parts of the process” It is not actually. The most detailed study about a country’s innovation/competitiveness is the Annual Bloomberg Index. Value added UK is ranked 44th in the world. Total scoring UK is 18th in the world.
P.S. You should visit Hannover Messe, the largest word fair for advanced manufacturing. Check out how many Tier 1/2 (robotics, machinery, industrial automation, industrial sensors) companies are British.
The politicians are nuts in Germany Angie is a physicist .She said in june that she ll decide when this is over !! and just yesterday Söder said that even if there was a vaccine then they would continue with the measures!
Best laugh of the afternoon! Right on, Brother Andrew.
Yes, Mother Superior Angela got religion and nuked Germany’s nukes after the Fukushima business. Germany ended up importing coal-fired electricity from Poland … (sigh …) …
2) Germany healthcare had/has more capacity to deal with serious patients.
Not over the last 6 months it hasn’t. UK hospitals were cleared to make way for Covid patients. UK hospitals were not over-stretched at any stage since March.
5) All the points above are (luck aside) byproduct of a competent political class that spends more on healthcare than UK.
Germany has a distributed multi-layer healthcare system which is funded from both statutory and private health insurance, We have the NHS which is, of course, a far superior system. I know this because we keep getting told that it is.
Is it not simply the case that: – Germany spends 20% more on health. The UK only started to catch up recently. Our rising population requires infrastructure investment, Their falling population means they spend all their money on current requirements, The whole difference can be accounted for by money and the fact that Germans and their insurers are customers not supplicants to their medics
I didn’t say it is simple – I gave a list of fact that has contributed to the current situation. Spending more on healthcare (directly or indirectly) is AGAIN a political decision.
I agree with that but I will say that the care home policy was not a political decision. It was informed almost entirely by scientific advice. It is not even remotely possible that the decision to place people from hospital and into care homes was a political decision – it must have been a SAGE decision or advice of a medical nature – prioritise the hospitals to keep COVID-19 out. Other countries also made that mistake and that is no coincidence. Whether we have an inferior political class or not is a matter of opinion but the care home issue is a matter so basic as not to need statecraft. It wasn’t government’s decision on a whim and cannot be interpreted as such once given some thought.
Agree partly upon part Second: not a strong case with early “successful” mask-wearing in Jena. Perhaps Germans handle their masks in a more hygienic manner, though?
People in England are not wearing masks in all indoor spaces – they are not wearing them in pubs, restaurants or cafes because you cannot eat or drink while wearing them.
Even in shops not everyone wears masks, some shops do not enforce wearing and in many the staff did not wear masks and had a simple face shield.
A better example to compare against would be the Asian countries where mask wearing was much more established from their previous experience of SARS and MERS out-breaks and where it was accepted as effective.
Masks do nothing and are a health hazzard. Which is proven by 40 years of proper science not the rushed through rubbish the lads on the telly are spitting out.
There’s been scientific studies which have demonstrated the effectiveness of masks, and particularly respirators in either stopping or significantly reducing the amount of virus a wearer is exposed to.
That is why medics caring for COVID patients wear FP3 respirator masks as these provide the highest level of protection.
Surgical masks and face coverings do not provide the same level of protection, but still provide some reduction and prevent the projection of droplets and aerosols when people cough, sneeze or talk.
If masks work as advertised, the way they are actually worn is a public health hazard. If they don’t it’s all a waste of time. Mask wearing in general public is nonsensical.
It depends critically on drop-size. And non-clinical masks are good for relatively large droplets but contrary to initial assumptions it seems Covid is being spread through small droplets not large ones, which go through masks and indeed can hang in the air – but are less likely to be passed on via surfaces.
Clinical-quality PPE, worn properly is a completely difference question.
Though perhaps masks discourage hand-face contact and help in other ways.
Masks in Asia are not that common but not rare either. In the winter in Japan maybe 15% are wearing them and those people rotate depending on how they feel.
The Far East Asians also eat with chopstick, could that be significant? I mean the West Experts have thrown away the whole causation/correlation dilemma in favor of correlation.
Yeah you should eat with chopsticks. We don’t wear masks. Ever. Except when there is a pandemic and the whole seems to be trying to do it. Those that do, do fine a little better it seems so far. The US didn’t, and I suppose neither did you. Shame on you Fremic. You could be an asymptomatic carrier and pass it on.
Ummm… there is a plausible causal mechanism relating face masks to infection; not so for chop sticks making.
Unforutnately (?) controlled trials on infecting people with untreatable diseases don’t get past the ethics commitees.
And there is a great deak of basic medicine that has never be trialed. Established and apparently effective treatments don’t get controlled trials vs. neglect – only against potentially superior new treatments
Germans themselves didn’t know why they were “doing better”. They went into “lockdown” 5 days earlier than us. They said things like: ” it must be because we eat pork fat rather than olive oil”, and repeatedly warned of a second wave.
One factor is Germany has a Bismark health system. The UK a Beveridge system, like the US with Obama care. Check out the best health care systems in the world, and they are Bismark systems. Switzerland, Holland etc. The reason they are better is that insurance, supply and regulation are split. In the UK they aren’t.
If you want to see the effect of that, check out what Dr Jane Barton did, and why nothing has happened.
Second the Group think in the NHS is Marxist. It’s a religion. That religion doesn’t like the tories. So what better than inflate the numbers killed. The flip side is that their performance is disasterous.
They claim short falls in cash, and yet in absolute and real terms, spending is at record levels. 100% increases in real terms. Productivity up 5%. That’s the problem
Adminstrators, the root cause, decide that Covid was a great reason to kick out bed blockers and that killed thousands.
Capacity is not an issue. 11 patients used Nightingale hospitals.
Tories have been in power most of the time since NHS came to be. Nothing (political costs aside) is stopping the Tory party from going all Bismarck on NHS.
I hink it was the care homes mistake…which itself arose from the videos of Bergamo and other reports, and the graphic way they illustrted a modern, competent, efficient Health system being over run.
THat focus on the NHS shouldn’t have led to systemic blindness in respect of care homes, and I think that may be a key focus of any inquiry.
Though far be it from anyone to point out our huge, centralised NHS may also not be the most optimal way to organise things in Health care in the 21st century.
Barry Wetherilt
3 years ago
My understanding is that the definition of a Covid death in Germany is very different from that in the UK (and most other countries). That is, in Germany you must have actually died of Covid whereas in the UK you simply have to have tested positive within the last 28 days of dying for any reason (up to recently even longer). Some analysis of this is important and I wouldn’t mind betting explains a lot of the difference between Germany’s Covid death rate and the rest of Europe.
Yes, when a relative died in hospital recently, it was suggested that Covid diagnosis be written up; “you’ll get a quicker funeral”, her daughter was told. They argued the point and the correct diagnosis was put on the death certificate. How many have similar stories?
Could it also be that, in Germany, a lot of deaths are being recorded as due to viral pneumonia rather than Covid? Whether this is a major factor or not (I am not involved in medicine, but learned this from a GP in the NHS), it is clear that differences in death recording methodology vary widely across Europe (and clearly globally – anyone believe the stats from Russia / China / N Korea among others?). A couple of months ago an investigative article appeared in Spain’s El PaÃs, contrasting the official reported death total with the number of deaths where Covid was given as the cause of death on the death certificate. The latter was harvested from over 600 civil registries from across all 17 of the country’s autonomous provinces and regions. The difference was stark: the data revealed an additional +/- 16,000 deaths above the official number, which around the time of publication, was around 32,000 – so a difference of roughly 50%! The Sánchez government denied and rejected the El PaÃs findings, claiming to be following WHO guidelines. But is not as if El PaÃs had / has any partisan axe to grind, being a left of centre national daily. This was roughly contemporaneous with the England revising its death numbers down by 5,000 and adopting the within 28 days of a positive test rule. Despite all its well documented issues, the number in France has seemed suspiciously, stubbornly sticky at c.31-32,000 For several months. Hard to know what to make of it, but it appears every country has its own definition & methodology; what we do know is that ours too probably understates the true total, but whether we are apparently by so far the “worst” (as if it were a competition) in Europe is not so clear-cut in absolute rather than relative terms.
Spot on – I raised this point as above – should have read your post first! The numbers are highly suspect as evidenced by several posts below – I know personally of a relatively young man (41) who suffered from rheumatoid arthritis and died from pulmonary stenosis as a complication of the underlying condition. He tested negative for Covid three times in his last week but Covid still went on the death certificate.
Thank you for posting your comment. By the first paragraph I was nettled by this entirely wrong statement: About one in every 1,600 British people has died of Covid-19 since the first confirmed death in early March. A great many of those deaths – how many we are not told – were death with Covid as you correctly point out. My sister is a nurse of many years experience and she is flabbergasted by what has been going on. If a terminally ill patient of say cancer or some other disease – often age related – tests positive then Covid is put on the death certificate even if no actual symptoms developed. In the early days of this pandemic, doctors in the US were speaking out about this requirement to put Covid on the death certificate even if there were other far more pressing co-morbidities. Knowing this makes it impossible for me to trust the so-called statistics and articles such as this are rendered void.
Some places ask for post-mortems to be done to prove that you really died of Covid. Taking in account the age group I would say that “the definition of Covid death” is the thing that makes some countries different from others. If you compare in the group younger than 60 years the result probably is not so different between different countries.
Exactly. Similarly in America Trump announced early on that the government would pick up the medical tab for people dying of Covid. It would be an act of compassion for hospitals to rack up the covid deaths and save the bereaved a fortune and one which must have massively distorted the deaths there.
Flu and covid spread the same way. What would be interesting is to compare the death rates of both. I suspect huge numbers have been moved from flu to covid
They don’t quite spead in the same way. Covid has an ‘over-dispersed’ pattern (a smaller number of larger clusters rather than a broad even distrubiton of cases). Which require very different tracing and control approaches.
That’s right. Different methods. Not different numbers.
Matthew Powell
3 years ago
Whilst I accept that Germany’s large number of hospital beds and a better system of protecting its care homes could have improved its death rates, nothing cited here is unique in comparison what to other European countries have done.
Personally I believe the virus simply arrived in Western Europe earlier and in greater numbers. Travel numbers are far higher in the West that they are in Central Europe and this seeded outbreaks that were much larger and harder to bring under control. Given that the virus has a large number of asymptomatic carriers and seems to be following a super spreader patter of infection, the timing and initial number of infections introduced is going to be extremely important in how the epidemic develops.
This fits the pattern we see across Europe, where most countries in Central and Eastern have so far had very low numbers of cases and deaths, despite not enjoying the same advantages Germany has, though this may change as the second/first wave hits them.
By ignoring factors outside our control and placing too much faith in our ability to fight the virus, we’re likely to continue to cause as much, or even more harm to our societies than the virus is.
I hope that I am wrong and that Germany and the rest of Europe have found a way to control the virus but epidemiologists at the start of the pandemic told us we could slow the spread of the virus, not stop it. We, and indeed some of them, seem to have forgotten this.
There is not a choice between controlling the virus and stopping it. If a virus doesn’t find a host to use to reproduce itself it dies. The better you can track, trace and isolate the quicker you will slow, then eventually stop, the spread of of Covid19.Tere is no “second wave” incidentally, it is merely the first wave not completely contained.
I recall hearing on the news over the summer that half of all traced Covid cases that had been *imported into* the UK from abroad had arrived from Pakistan alone. (This wasn’t then mentioned again, either because it was deemed inaccurate or too politically sensitive?) If this was indeed true (and I have no idea whether it was!), it would provide another reason why Britain might perhaps have been less ‘lucky’ when compared to Germany, where for historical reasons there is presumably rather less aviation traffic with that part of the world?
Mark Corby
3 years ago
After at least 24 days, UnHerd seems to have finally fixed the reply system. A true miracle, perhaps the Germans are responsible?
There was a disqus disclaimer form to read and approve ““ no approval, no commenting allowed. There was probably a legal issue behind all that disruption.
They were all down here in the basement debating masks and germany.
Mark Cole
3 years ago
Interesting – the different treatment of nursing homes In Germany was a key factor in lower death rates. I also think their airport testing was put inlace very quickly and local TTT systems also worked earlier.
I agree we do have a structural problem in the UK in that we have too many bureaucratic layers in national orgs/quangos largely stuffed with “desk toppers” who write process. We have too few locally responsible and accountable individuals – In fact lack of accountability means few take real responsibility. If you have worked in the private sector and sat in some of these public sector and civil service committees the lack of practicality or focus on the delivery part and whether it passes the small test is unbelievable..We need more of a military approach to the organisation, accountability and responsibility of our civil service and public sector orgs
David Bardell
3 years ago
It’s no mystery We have the British Civil Service and they don’t
John Finn
3 years ago
I take it then that combination of PHE & the NHS had absolutely nothing to do with the failure on Covid?
So why do these bodies exist?
NHS England employs several people who are paid considerably more than most government ministers – including the PM. The same goes for PHE. The sole purpose of PHE is (or was) to prepare for emergency health crises, In 2013, they did produce a document which gave details of preparations for a flu Pandemic but they seemed to get a bit bored with that and decided they needed to focus on how much salt we were putting on our chips.
The NHS completely cleared its decks to prepare for Covid while the never-used Nightingale Hospitals were built to cope with the overspill. Even at peak, the total number of Covid patients in English hospitals was only around 17k.
The NHS can’t continue to take the plaudits for the good stuff but be blameless when things go wrong. The performance of the NHS has been less than stellar during this pandemic.
The way we organise and fund our healthcare may be at fault. Individual health practitioners are not at fault would be my take. It’s a topic that could take up an entire thesis.
NHS isn’t just nurses and doctors. We have created a national structure that , in theory, ought to be better able to respond to emergency health issues. It provides consistent advice and treatment protocols to all hospitals & clinicians across the service.
The NHS failed miserably on 3 key fronts.
1/ Nosocomial (hospital acquired Covid infections [HACI]). This is what created the initial panic in March. You might remember the sudden switch from testing & contact tracing to hospital only testing. Why? Because huge outbreaks were being detected in hospitals. Seven months later – we have the same problem. The proportion of HACIs has been steadily increasing over recent weeks. It’s now up to 18%.
2/ NHS discharged infected patients from near-empty hospitals back to Care Homes.
3/ The survival rate of Covid patients in UK appears worse than in other countries. Germany which has a distributed, mainly private, healthcare system did far better in the early stages. UK is improving but this is an area which should have been a strength for the NHS.
Disappointingly, but not surprised, that no one seems to look into the fact that in Germany Homeopathy is commonly prescribed by medical practitioners, 70% of medical insurances cover homeopathy in their plans and outlay 20million Euros each year. Homeopathic remedies are also readily available at pharmacies which would indicate that individuals are also self prescribing. Please could someone investigate ? How about it Tom ? or are you worried about what you might find about this medical modality ?
D W
3 years ago
I think the major reason is much more simple: the UK artificially balloons its fatality tally up, by counting people as Corona victims purely based on the fact that they tested within the recent last (currently 28 days) positive for Corona. Beyond this I have heard from multiple credible sources that people were classified as Corona victims even though they hadn’t tested positive for Corona in the first place. In contrast to this in Germans are very conservative when it comes to classifying people as Corona fatalities.
Why would the UK want to artificially balloon its fatality rate up? It just makes the government look more fabulously incompetent than it already is – tough Brexit stance thus far aside, of course.
They are not exactly artificially ballooned but there has been great laxity in actual diagnosis – in the early days of the pandemic covid has been put on death certificates even without tests done, terminally ill patients who then tested positive for the virus but died of their primary disease without developing symptoms had covid added to their death certificates. Two members of my family are nurses. One of them is a hospice nurse. They are equally baffled as to why this is happening.
But our excess deaths are way up , and the German excess deaths are not.
david bewick
3 years ago
There is some evidence that differences in the severity of the last flu season may have something to do with it. Italy ,Spain, France and the UK for example had a very mild flu season whereas Denmark, Germany, Austria, Switzerland had a normal season. Therefore there were very many more susceptible people available for covid to attack in the former countries. There is also some recording and reporting anomalies across all European countries that need to be considered.
Germany tested more extensively but the extensive testing found younger and less sick people more often: their median age was given as 47 or 45 years, whereas Italy tested older and sicker people at a median of 63 years. Many early infections happened in skiers returning from Tyrol, who tended to be fit people rather than persons at higher risk of complications, and contributed a negligible mortality. Since Germany has no routine for post-mortem tests, unlike Italy and Belgium it may not have discovered all deaths. In Spain, the first death was also discovered by a test carried out post-mortem.
Nope. Look at https://euromomo.eu and see that the UK, Holland, Belgium, Spain, were hit harder and did not have fewer deaths in previous years. And these excess deaths have zero politics.
Kurt Lauer
3 years ago
Though Chivers is quick to dismiss “immunological dark matter”, a comparison to other countries in Central and Northeastern Europe should also be considered. Poland, Austria, Czech Republic, the Baltic States and Belarus all have death rates similar or even lower than Germany. Though Czech Republic took early precautions, Belarus did nothing – yet there death rate is lower than Germany. Basically all the countries in mainland Europe that border Germany to the East have very similar death rates. Maybe Germany’s policies had very little to do with their outcomes and possibly their death rates is a product of their geographical location.
Simon B
3 years ago
I generally rate Tom Chivers’s stuff, but I think he’s way off the mark here and needs to zoom out of the detail.
All everyone in the world seems to talk about is which interventions work, micro-analysing and comparing responses. Lock down this, test and trace that, mask up the other. In reality, it’s all absolute nonsense, because we humans are not controlling this in any meaningful way at all.
Just go to Our World In Data or similar and pull up a map of the world with cumulative Covid-19 deaths per million. The single determining factor is geography, particularly longitude.
Statistically, the very west of Europe and the Americas are more heavily impacted, with almost all of Asia, Oceania and Africa hardly affected at all. Germany and the rest of Central and Eastern Europe are a transition zone.
Why is this? Geography, climate, different regional levels of pre-existing immunity, or a combination of these or other factors? I don’t know, and perhaps no-one does. But the trend is obviously macro, not micro, yet hardly anyone seems to be talking about it.
https://ourworldindata.org/… shows neither latitude nor longditude as correlations. With places lilke the UK including motorcycle crash fatalities as SARS-CoV2 and other places going the other way and massively under reporting you are right, at the mo we can never know. If we do know in thhe future it could only be through some reckoning via ICC, Nuremburg trial type process.
naillik48
3 years ago
Don’t have any figures but one of the most significant co morbidities of corvid is obesity. Looking around here in the N West I see rather a lot . Just returned from N Italy – the first extremely large person we saw all week was in the Ryanair return queue. I read that we are the most obese nation in Europe ( except Malta GC ).
Pictures from Northern Italy in March showed many very large and mostly old people in hospitals and on ventilators. Yes, the UK is super large though and has a real problem with obesity.
And this was the strongest correlation shown by the Lancet study on all the available world wide data – the link between rates of obesity and numbers of deaths in different countries, regardless of lock down policies. Lockdown policies did appear to have some positive impact on recovery times, but I saw no explanation as to why that might be the case. It is also interesting that it is a German lawyer, Reiner Füllmich, who is now suing the German government for the collateral damage and death caused by their lockdown policies.
Writing from inside Germany, and having followed the handling here very closely, I ask permission to disagree on several key points.
Sure, there are differences in the death toll. But lockdown is not (as has been shown frequently) a factor in this. Otherwise the swedish curve would have a different shape than the German. It doesn’t. The measures came quite late (Carnival needed to be celebrated first), and had little effect (as can be seen when looking at the smooth German curve alone).
Here a few thoughts as to why Germany may have had a rather mild Covid toll:
Few factors do have such an impact as air quality. Germany has been investing heavily into environmental technology. Emissions are fewer than in most European countries. Definitely fewer than in England or the UK (even though there are huge differences within the UK, too). Harvard and the University of Bologna have shown that outcomes in Covid patients was directly linked to pollution. Northern Italy, New York, as well as Wuhan, are famous for their poor quality, too. Maybe Germany earned a dividend from thirty years of investment in reducing emissions?
Of course the Health System has had some impact, with Germany having three or four times the amount of ICU beds per capita than most European countries.
It seems, however, to have had a huge impact. Our World in Data reports that by late May, only 19% of Covid cases in Germany were among the over-70s, compared to 36% in Spain and 39% in Italy. And that meant that fewer people died: just 4.6% of those tested positive by May in Germany, compared to 14.1% and 12% in Spain and Italy respectively. Younger people are at much lower risk from the disease.
The demographics depend heavily on testing. Here Germany has tested many times more than most countries. They have tested many asymptomatic which accounts primarily for the differences in cases by age and country, don’t you think? Deaths by age on the other hand is very similar in Germany and the rest of Europe, or the rest of the World. Why do you think this is? Case-Fataliy-Rate is not a good indicator for Covid, especially if testing and definition of what a case is vary greatly, as they do even within Europe.
Germany has been ill-prepared for what happened, as have most countries. PPE shortages for hospital staff has been a problem here too. Why is that, many Germans ask? Mr Spahn should take more care in answering these questions rather than bragging about questionable “successes”. The German strategy failed, even though the death toll was smaller than elsewhere. It failed because the way Germany reacted set her up for the Casedemic it is now finding herself in.
Sweden has no Casedemic, no mandatory masks, no lockdown. Yet German politicians including Mr Spahn keep warning against the Swedish strategy. They should know better!
Well said about lockdown. But regarding air quality; I would say Sweden have very similar air quality as Norway and Finland, and about equal in the hard hit Stockholm-region as small Denmark. And the infection outcome is not comparable (so far).
greg waggett
3 years ago
Surprisingly, you don’t mention two other important factors: The Germans eat more sensibly and have a better diet, and there is less of a problem with obesity and other underlying health issues.
I think that study or studies showed that smokers were less likely to be infected by the virus but if they were infected they would more likely have a worse outcome. I think that message being a tad complicated may be why it’s been forgotten.
Jeff Andrews
3 years ago
The main difference was the handling of care homes and hygiene in hospitals. Other than that, the writer has been played along with most other people just as planned relying on people’s idea that Germany is always more efficient, therefore follow them, although they haven’t gone bankrupt, have they? I’ve yet to see any proof that so called Covid19 is any different from seasonal flu or SARS and until then I’ll stick to Klaus Schwabs books to see what our future holds.
And our panic over Covid will go down in history as the worst self inflicted wound of all time – Sweden got it right much to the eternal and increasing frustration of all other governments who so wish Sweden had lost their nerve – Meanwhile who would make the more chilling Bond Villain Klaus Schwab or George Soros?
Euan Ballantyne
3 years ago
The article could have just said “protected care homes better” and finished there. Concerning the rest, I understand the temptation, but its still too early to be calling winners and losers. The prematurity is probably eagerness to confirm some biases.
juliandodds
3 years ago
A couple of things to note re Germany. I have no way of knowing if they are true or not. Prospect magazine carried an article in about May saying that the first area to get the virus decided they could not send recovering elderly covid patients back into care homes so they created separate facilities. Given 40% of our deaths have come from Care homes that is a fairly major difference (if true). Secondly the Test Track Trace System in Germany is a conundrum for me. At the end of April Andrew Marr interviewed Anders Michaelis who was to be the next German Ambassador to UK. He said very clearly that in the great state of Bavaria, they had NO track and tracers and that it would take another 2 months or so to set the required teams up properly. You can see it on YouTube.
The more you read the less you know!
Ifor Humphreys
3 years ago
Bit soon to jump to conclusions. We’ve a long way to go…..
Bruno Lucy
3 years ago
This decentralised state is however running amok with Minister Presidents in various Länder, to request tests ( try to take one …) and quarantine from people wanting to vacation in their region. Mrs Merkel has summoned them to the chancellery….virtual or in the flesh to try to resolve this. But….as all these mini kings depend on local votes, they do what so far every populist and clueless country has done…..doing a lot of useless things to show they are doing something. Same in France…..where one single guy will announce tonight what spell he is going to have us under. So far only one country has managed this health crisis in a very factual and pragmatic way……Sweden…..and the reason is that politicians cannot take part in it. Measures are taken purely on the merit of their efficacy…..not a coming general election…….and the proof is in the pudding. Germany has done well…..it is now getting over the top making people s lives totally miserable and worst……dividing the country……..Back to before Bismarck times.
Dominic Straiton
3 years ago
The Germans don’t have to put up with a centralised, crappy, health service elevated to a religious icon.
Lots of things wrong with the German health service. I have said this before on these pages and no doubt will say it again. I live here so it frustrates me when people who haven’t experienced it say this. Yes, they do have more intensive care stations but the UK was able to put these together at short notice. It seems to me that track and trace was the key factor, but what someone else said earlier on about the geographical factor may also be significant.
Fran Martinez
3 years ago
Germany and the UK report covid deaths in very different ways. Germany reports deaths BECAUSE of covid. The UK reports deaths of anyone who ‘tested positive within 28 days of dying’. That’s the main difference. Nothing strange.
By the way this makes me wonder, how many people die within 28 days of drinking water…
Stu White
3 years ago
“but, I think most of us would agree now, they were worth it” We bloody well do not agree
Emma Miller
3 years ago
I have heard differently: Germany and a couple of other countries had been hit by a severe flu wave last winter (2019/20) with a large number of deaths. The theory is that all those countries that were hit hard then have now the fewest covid deaths: people in danger died then.
The UK in contrast had a mild flu year and so those vulnerable people who survived then have now been hit by covid.
Yep. The very old, sick and the vulnerable can’t die twice but as an exasperated Tory MP said recently amidst the ongoing economic carnage, ‘it’s almost like this government is trying to legislate against dying’.
Death figures like these can only be fully ascertained and understood over the fullness time rather than as an immediate, media friendly snapshot so it will be interesting to see what happens in Germany and elsewhere over the coming winter months and even in the next year and beyond in terms of death rates.
We know that Germans are extremely diligent, hardworking and on occasion fiendishly clever so perhaps their politicians have indeed uniquely and secretly managed to legislate against the one inevitable fate that we apparently falsely believed faced us all?
Nicholas Ridiculous
3 years ago
I’m not convinced, or rather, I’m willing to be more convinced. The author states that devolved decision making has been critical in Germany. Wouldn’t this have led to a patchwork of good versus bad responses in Germany, with some states and regions within states having had a ‘good’ coronavirus while some were less successful? Here in the UK we have at least four devolved set-ups, one for each nation – does this mean we’ve just been unlucky that none of them has been a great success? I wonder if population density has something to offer us. The UK is very densely populated and highly urbanised. The author quickly dismisses ‘immunological dark matter’ but it’s becoming clearer all the time that some populations appear to be more susceptible than others.
Christopher Barclay
3 years ago
No discussion of the differing health systems in Germany and Britain? The NHS appears to be inflexible and unable to learn simple lessons such as the importance of hygiene in hospitals. A reflection on its senior management more than on its courageous front line staff.
It appears that the transfer of temporary staff from one care home to another was a key transmission mechanism in the UK. The Germans treat more jobs as worthy of training. My guess is that there were fewer temporary staff in German care homes and that those staff see their work as a profession and source of pride.
Johnson is intellectually incapable of clear and logical thought. Even if he and his colleagues had asked for strategic plans to deal with the virus in early 2020, the question remains whether they would have received anything worthwhile from the Civil Service. Merkel could count on the backing of her government officials. Johnson could not. The British Civil Service was more interested in bringing down a government they didn’t want.
Media reporting of Covid in the UK has ignored what is obvious to many people who don’t live in the media/political bubble: that a large proportion of the population ignored the rules/laws from the start. On housing estates, it was easy to slip from one flat into another. In south London, a full month before lockdown was ‘lifted’, on sunny days social life had largely returned to normal. The media and political class can’t bear to face reality because they can’t deal with the total disrespect being shown them by a substantial proportion of the country.
Jeremy Smith
3 years ago
I would like to point out a cultural/political difference. Germans accepts that the state exist, must function well and it must be properly financed. Someone (who?) once said that the British want European levels of welfare with American levels of taxation. UK (and USA) are intellectually dishonest about state, its role and its funding.
I have lived in Germany, France and the Netherlands. And the fact is that levels of welfare in terms of benefits etc tend to be lower in Germany, the Netherlands, and the Scandinavian countries than they are in the UK. (Of course, if you are a fraudulent asylum seeker you will get everything, but that’s another story). The Scandinavian countries and others worked out some years ago that the absurdly generous levels of welfare were not sustainable.
As for the state existing and functioning, we would be much better off if the eternally grasping and incompetent British state did not exist at all.
Also, taxation levels are actually pretty high in the US, especially in failing Democrat-run states such as California and New York.
UK GOV spending as % of GDP is c.40%, in Germany is c.45%. Scandinavian (51% and higher) countries even higher. That “extra” spending (all those countries have higher GDP per capita) must go somewhere?!
There is a difference between ‘government spending’ and the ‘welfare’ to which you refer above. These countries do indeed have a larger state. Thus they spend more on, for instance, sports facilities. However, they have become quite tough on ‘welfare’ i.e. giving people free money for no reason.
I have no objection to a larger state if the money is spent wisely. But do you really think that any British government, or any area of the British state, will ever spend money wisely?
But better public space does contribute indirectly to “richer” population. In relation to payment to unemployed my understanding is that the German (European) system is based on personal contribution to the welfare state? More you put in more you get out?
Yes, in other countries, the more you put in the more you get out. Which is as it should be. (Of course, this doesn’t apply to fraudulent and criminal asylum seekers, but that’s another story). When you tell people from other countries that the British government literally pays the rent for people who have never worked they can’t believe it. Then they try to move to the UK – and who can blame them?
Hmmm….Maybe that is the problem in the US. Here it seems that if you have a long history of working to make a good living you will have almost no chance of getting any public benefits should some catastrophe derail your career after having paid taxes for decades….much easier if you have never had a job at all…and even easier if you are not even from the USA.
When you say that what one gets from welfare systems should depend on what you put in, are you suggesting that when some people cannot afford to put as much in as others, it is their own fault and that they didn’t try hard enough?
(Sometimes, as above where you introduced the idea of asylum seekers when it wasn’t part of the point, I cannot tell if you are being blunt or sharp.)
Possibly for this topic it’s more important to look at levels of spend on health rather than on welfare overall. The German health model has more money spent on it per capita than the UK health model but at the same time has lower levels of state expenditure going into health. The reason being that they adopt a different way of funding. It is a mix of private and state whilst we are funding almost wholly from taxation. This results in under-funding and the health service being far too politicised. In Germany the health service is not in the same league as the NHS is as a political football. The other thing mentioned in this article as favourable for Germany is the way its health care is organised ie by region. If you tried that here in the UK you would immediately be faced by howls of postcode lottery.
Pat Davers
3 years ago
I read recently that in Switzerland, French- and Italian-speaking cantons have much higher death rates than German-speaking ones. I don’t want to start speculating why this might be, but it would appear at the very least that national policy in Germany might not be the only factor contributing to their relatively low death rates.
Perhaps it has to do with Germanic culture which emphasizes respect for rules and compliance with public policies versus the more individualistic happy-go-my-way of Latin cultures and the don’t tread on my rights attitude of Anglo countries?
Plus the fact that the German medical system is far better (and more expensive). I live in Brandenburg and am very happy with the available treatment options. Like I said though, it’s not cheap.
So businesses in Milan and Turin never posted their important letters over the border in Switzerland then? Because obviously the postal service in the hairy latin quarter of Switzerland would be equally inefficient, and there’d be no point. Funnily enough they did though, maybe they still do. Alternatively there isn’t really much regional variation in Swiss efficiency and the reason for the higher covid rates in South Switzerland is simple geographical proximity to the covid mother lode of Lombardy. Maybe they got infected from handling all that contaminated mail.
mike otter
3 years ago
What exactly is this test the Germans have gotten hold of and why can’t UK get it? UK is using the PCR test acknowledged as useless to test for SARS-Cov2 by its inventor. It is known Class 5 & 6 viruses have distinct RNA genomes, but its by no means clear that SARS CoV2 has only one variant.Until this issue is addressed the UK will continue to wallow in its self sabotaging, self interest driven political point scoring whilst its people die of cancer, heart failure and a few fom SARS Cov2. This washed down with a large chaser of economic, social and mental health blight. Considering the choice of party leaders in Dec 2019 this is surely no surprise?
Kenneth MacKillop
3 years ago
Looking across the entirety of national and regional policy responses worldwide, there appears to be very little consistent and sustained effect to any of it. Lockdowns (voluntary or involuntary) do work to temporarily reduce transmission of course. IMO this simply delays the buildup of immunity and is a disadvantage over the longer term.
There is a conceit that the epidemic(s) can be “managed”. Almost all of the data, however, is inconsistent with this notion. Epidemiologists experienced with respiratory pathogens like flu all knew this was not possible too.
A ratio of 6:1 in fatalities between two quite similar countries really does require explanation. I do not believe that ANY behavioral factors are remotely possible to generate such a stark difference. A difference in immunological and general metabolic health IS.
It is interesting how the apparently large majority of those in modern societies expect a solution from government and medicine and point the finger at others, rather than looking to their own endogenous resources. For viral infection especially, this is naive and ineffective.
Kenneth MacKillop
3 years ago
The steep slope of risk vs. age for CoVID-19 is really remarkable, and unique as far as I know. I recently learned that the median length of time between admission to a “care” home in US (here we tend to call them “nursing” homes — same thing) is 5 mo! Average age of death from CoVid-19 is in the 80s, and deaths have been predominantly in care homes.
It should go without saying that people in care homes are near end of life. They cannot fight off infection by SARS-CoV-2, for the most part, and that has a lot to do with being already irrecoverably enfeebled.
In the US there is a “laboratory” of 50 different states. The individual states regulate medicine, care homes, and pretty much everything — not the federal gov’t. Florida, for example, has had an order of magntude lower deaths in care homes any way it might be measured (e.g. per capita), despite having one of the highest percentages of elderly in these homes in the country, in comparison to northeastern states like NY, NJ and MA which have been disasters for care home deaths and policy. Florida’s governor took the issue seriously and did something to protect care homes early on, while northeastern states generally returned still-sick CoVID-19 patients from hospitals back into care homes to infect the other residents. This all has to do with lobby groups, political corruption and bribery here in the northeast, all of which are longstanding and entrenched.
I recommend a comparative study amongst the US states in addition to those of Europe. One will have to dig deep, however, rather than reading almost any mainstream press which is simply propaganda and misinfo and politically biased nonsense. The states do report CoVID-19 data, usually with daily updates.
Sidney Falco
3 years ago
German doctors are very meticulous in attributing Covid deaths to people who actually died OF Covid as opposed to WITH Covid.
William Cameron
3 years ago
Two fundamental differences -in addition to the far better health services (not state run of course unlike the centralised NHS) – Much bigger land mass so lower density of population-and the NHS decanting untested carriers into care homes accounting for much of the 20,000 care home deaths. It didnt occur to German to “Save the NHS” they saved patients.
alan.higham100
3 years ago
There is such a huge difference in Covid19 outcomes between someone who is frail with other ailments and someone who isn’t. You therefore need to look beyond the high level similarities at general population levels and go to the older more vulnerable parts of the population.
A big difference between Germany and UK is prior years mortality. UK mortality in 2019 was abnormally low. Germany in contrast has had heavy winter deaths in recent years.
So yes Germany looks far better April to October 2020 but how about looking across the last two years and see how the two countries compare then?
Many of the factors in the article are also relevant but it is striking that this factor was omitted. Did the author not know about it or did he choose to ignore it?
Fraser Bailey
3 years ago
‘We should note that “lockdown” in Germany meant something very different from what it meant here: Spahn said that it was closer to a Swedish model…’
Well there you go, the Swedish model. Even better would be the Florida model. They opened up completely a few weeks, ago and had a very good record of protecting the old relative to, say, New York and New Jersey. This is probably because Florida is run by Republicans, while the Democrat-run NY was shoving people with Covid into care homes, killing 12,000 in care homes alone.
That said, we have all known for years that all arms of the British state are rotten and incompetent to the core. it’s almost as though uselessness is their mission statement.
If you judge Sweden by its own gov goals (protect the old, testing) it failed. Its economic hit (vs. death rate) is far worst than Germany, Denmark, Norway, Finland.
There is currently one death a day in Sweden and life there is back to normal. Indeed, it never ceased to be normal for most Swedish people. Yes, they could and should have done a better job with care homes, but Sweden has been a massive success relative to the UK and most other European countries.
Italy and Spain got hit early (bad luck?) if you compare Sweden to its Scandi neighbors (as it is always done about everything) Sweden has performed very poorly. I don’t see how a “lighter” regime in UK would have delivered a lowered death rate. When it comes to economic hit I can only testify that even before the close down London was empty. Public space (Islington where i live and Mayfair where i work) was empty.
Sweden have admitted that they were too slow to react to the care homes. In addition their care home system is vastly different to their Nordic neighbours – care homes are very large and many privatised.
I wouldn´t say normal – the psychological toll is big here in Sweden too. But, yes, life goes on to a large extent as usual. And no compulsary masking! I miss the culture/sports events though.
Helen Barbara Doyle
3 years ago
Our difficulty came from the sheer volume of people who went on skiing holidays to Italy in February, brought the virus back with them and seeded it everywhere in the country all at once. Germans don’t go skiing in Italy as much.
Rickard Gardell
3 years ago
Isn’t germany then an example that Focussed Protection works?? Why are the lockdown junkies saying that strategy is not possible? 95% of people dying from this is 65+. Germany managed to execute this strategy recommended by the great Barrington declaration. The other, potentially important difference overlooked by the article is death classifications. Did Germany record every death with or just from covid(or somewhere in between). Sweden’s post mortem analysis showed that only 15% of with covid actually died from covid.
neilyboy.forsythe
3 years ago
I heard that the difference in numbers was because VW were in charge of the Covid-19 statistics. Was that not correct?
G Harris
3 years ago
This is all turning into an unseemly, pointless willy waving contest when it comes to the media frenzy surrounding cases and death rates.
The, ‘which country and its government has needlessly and heartlessly killed the most number of its citizens, what demographic are they from and what can we apparently simplistically deduce from that in order to beat them over the head with it in future?’ competition.
If that’s the case, then here comes my ‘willy’ when it comes to Germany’s handling of the covid debacle in the specific examplar cited here.
Legally locking vast swathes of the seriously sick and old people, a large number of who could most kindly be described as in the very twilight of their lives, essentially against some of their wills and away from their nearest and dearest indefinitely and at great mental and emotional costs to everyone involved doesn’t seem like the most compassionate course of action to me either.
J StJohn
3 years ago
Germany spends 20% more on health. The UK only started to catch up recently. Our rising population requires infrastructure investment, Their falling population means they spend all their money on current requirements, The whole difference can be accounted for by money and the fact that Germans are customers not supplicants to their medics
Again, I live in Germany. Believe me, we are not customers in the German health service. We are also not customers of the Krankenkasse – the insurance companies who run the payment side of things. We do what we are told.
So. Why do you think you are doing so much better than the UK? Or is it merely an illusion? If you ‘do what we are told’ then could you please inform us what that is; in particular , in relation to the coronavirus. Thanks
Their falling population means they spend all their money on current requirements,
For the last 10 years population has grown in Germany (total). Only in 2019/2020 the population has declined. Also, you don’t just build extra capacity in 3 months.
Why? There are lots of theories on this page and I wouldn’t pretend to know better than anyone else. But no-one will know for a very long time, just the same as no-one really knows whether lockdowns work and the fact is that many scientists have very different views on their effectiveness. My favourite theories about Germany are test and trace was well implemented and that the spread was originally mainly among the young. Also, as someone said earlier, the geographic position. Fewer obese people, Germans are basically healthier, enjoying more time outdoors despite a similar climate. Others theories I have come across: less use of antibiotics in Germany for other conditions, resulting in people with better immune systems and less use of ventilators early on. I don’t know how these last two compare with the UK but we do know that worldwide, overuse of antibiotics is a big problem. Anyway, despite better numbers, Germany seems to be panicking now.
I forgot to add, putting sick people into care homes seems also to have been a big mistake made in the UK and some other countries.
Derrick Byford
3 years ago
The real takeaways – A far more effective and less bureaucratic, localised National Health Service, a stronger tradition of disease control and better prepared, kept infected people as far as possible out of hospitals by treating them in GP surgeries (and no doubt better infection control in hospitals), and by far the most effective in reducing deaths – protected the vulnerable in care homes and avoided sending infected patients into them. NB their general early lockdown was soft – closer to the Swedish model (and the point about masks being effective is very flaky).
Lucy Lock
3 years ago
” most Covid-19 patients were not treated in hospital at all, but by community GPs. That prevented the hospitals getting overrun, and reduced hospital transmissions.” A telling statement. Our primary healthcare quickly closed down to anyone with symptoms of Coronavirus.
Lizzie J
3 years ago
I’m in Berlin for a few days. Everyone (yes, everyone) is courteous and considerate. No crowds, no raucous groups in bars or restaurants, no one is loud or pushy,100% mask wearing. It’s all so much more peaceful and measured.
A sample of one, but I suspect it makes a difference. I don’t think Germans are more cautious or law abiding, they’re just, on the whole, more sensible than us Brits.
No doubt someone will have the opposite view but I felt it was worth saying.
I have been at Oktoberfest (3 times) and I can never remember drunken violence. Germans are happy drunk. If you can get that many people in UK drunk at the same place you would have fistfights everywhere. Anecdotal story I know.
YouGov polling (across countries and over time) shows 64% of Germans stating, as of early October, that they wear a face mask when in public places. The German response has been essentially static at that level since early May.
That number is lower than the latest polling figure on that question for the UK (76%). The German percent stating that they wear masks is also lower than the figure for other large European countries (France, Italy, and Spain) as well as for the U.S. Mask wearing in most of these countries heavily increased in the time period from late March to early May, with the exception of the UK (where the big increase was in July to early August). The countries I’ve listed other than the UK, however – France, Italy, Spain, and the U.S. – have consistently had greater % stating they wear masks than Germany in this YouGov polling, with mask-wearing in those other countries also increasing before Germany in March, April, and May. (Germans have worn masks more than those in the limited number of smaller European countries polled by YouGov. The four smaller countries with such polling are Denmark, Finland, Norway, and Sweden.)
It’s a somewhat similar story on “avoiding public places”, except that there the Germans even *more* consistently rank as the lowest percentage answering affirmatively, often 8th to 10th out of the countries that I’ve listed.
Perhaps Germans generally answer these questions more honestly than those in other countries, which could change the relative comparisons among these countries, but an experience of “100% mask wearing” seems to be a big outlier in Germany.
(I’ll post a link to this poll in a separate comment, but it’s probably easiest to search for it as “YouGov COVID-19 polling”. Links apparently trigger automatic moderation by Unherd and therefore sometimes never show up.)
Germany has 25000 ITU beds!! The hospitals were empty as were Drs Practices. 420,000 medical staff were furloughed during this pandemic.Germany would normally have an influenza rate of between 7 to 25,000 deaths a year. There was 12000 influenza infections recorded but just 417 Deaths recorded.The countries ie Bayern with the hardest lockdowns had the hightest death rates.Masks and lockdownds do no good had have caused and will cause way more hardship illness and death .No lives has been saved with this rubbish.
Quentin Dark
3 years ago
Excellent article, but there is one additional point. Germany has a comprehensive infrastructure of diagnostic testing facilities, both independent laboratories and the “laborgemeinschaften” owned by groups of GPs. German GPs typically use diagnostic testing far more frequently than GPs in the UK, so the volume of tests is higher in normal times. German medical practice in diagnostics was supported by the German, world leading, diagnostics company Boehringer Mannheim (later acquired by Roche). So in Germany, testing for COVID was a normal familiar process, but for a new pathogen, with local sampling, local testing, and test results in less than 24 hours, not the two days plus in the ludicrous test “system” cobbled together by Matt Hancock. (Are we still counting it as a test when a sample kit is posted out?) Testing availability in Germany supports an effective tracing system – evidently far from the situation in the UK.
Kenneth MacKillop
3 years ago
Can’t remember where I read this recently, but I was really quite surprised to read that the average (or maybe median ??) serum calcifediol level is well over 30ng/mL which is generally considered a minimum for adequacy of hepatic vit D stores, in Germany. That is really excellent — I had never heard of a country at such a latitude so high.
Vit D is important to maintaining efficacy of the innate immune defense called AMPs (antimicrobial peptides) in lung. It may be the AMPs layer which is one of the “innate” factors Prof. Gupta hypothesizes as suggested by the epidemiological data patterns. This would be my #1 guess.
I wonder if anyone can tell me how the Germans have been apparently so successful in educating their populace to supplement vit D orally. As a single case, I have a severe humoral immune deficiency (CVID, a polygenic condition) for which I produce absolutely no antibodies to protein or polysaccharide antigens, and so my B cells essentially have no function at all wrt any virus including flu.
This would put me in one of the highest-risk categories for CoVID-19. And yet I was infected early (mid Feb.) with such minor symptoms that I felt it could not be CoV at the time. I had less than a day of sore throat followed by about ten days of very mild dry cough, both of which were notable. But nothing else — no fever, no nasal congestion, etc. as always with flu, etc.
I am 62 but do supplement 5000IU of vit D daily and run 8-16 mi in woods twice weekly. I have been tested for lung function (this being the most common cause of death in CVID) and am higher than average rather than lower.
I had made a deliberate decision not to change my daily routine at all to isolate myself. My routine included spending a lot of time in the morning in a crowded restaurant drinking coffee and chatting with other regulars (dining room is now closed).
My reasoning had to do with the fact that I am so unusually susceptible to flu and yet recover without any B-cell function or antibodies, and I have thought a lot about viral immunology due to my condition. I was confident I would recover from CoV similarly as I told my brother. But I did NOT expect it to be so minor — essentially, although I had two of the classic symptoms, I was not sick. One of the big problems with modern clinical research is the loss of most case studies in favor of biomarkers in large anonymous cohorts.
Anyway, I have had T-cell immunity (all that I can muster for almost any pathogen) since Feb. This seems to be quite adequate, and I continue to be liberal with my daily exposure to others unconstrained.
graewells
3 years ago
Is our multi-ethnic population partly to blame as some seem more susceptible poss as a result of social norms, rates of diabetes, obesity, vit D levels etc. Belgium, US similarly tho perhaps not northern Italy or Spain? We know BAME people had a higher death rate per capita. During the stringent lockdown it was noticeable to me that the large groups of people congregating on Bournemouth beaches were of E European or Middle Eastern extraction, tho young so not susceptible to severe disease. Was the message getting out to migrant workers well enough? Is it harder to communicate effectively with a more diverse population, v likely. Germany is more homogenous apart from a large Turkish pop which again is homogenous.
rosie mackenzie
3 years ago
“Then there were manual forms that were given straight to the doctor, who had to get numbers and call everyone up, find out the symptoms, get them to isolate,” says one senior German public health expert”
” also important ““ most Covid-19 patients were not treated in hospital at all, but by community GPs. That prevented the hospitals getting overrun, and reduced hospital transmissions. “
The author doesn’t seem to have noticed the big difference here: our doctors became unobtainable, as did our dentists. Theirs went on practising throughout, and obtained their own PPE too.
And Cummings did not break the guidelines or the law. Our very PC, left wing, politicised police “service” confirmed that. If they could have got him prosecuted, they would have done.
I totally agree with your points re. health serevices and totally disagree re. police.
john_h_eve
3 years ago
You suggest that decentralisation in Germany was a strength. The article in the Lancet about Spain suggests that decentralisation has been a weakness of the Spanish system. It seems unlikely that both of these claims are true.
David Bell
3 years ago
There are a number of other caveats to consider:
1. There is reason to believe that the strain of the virus in Germany is less deadly than the strain in the UK. This is because the German strain looks like it was imported directly from China and the UK strain came out of Italy where it had mutated into something that kills more people 2. The UK is now testing more people than in Germany but is not changing the death rates, so something else is going on. Testing, tracing and tracking help contain but they do not stop local spreading, which appears to be the big issue 3. The article states there were and are very sever mental health and other medial issues caused by lockdown. We still have no idea on how many deaths that will cause. When all is added together we will probably find deaths caused by the lockdowns are greater in Germany than in UK
That seems to be a very likely reason . I have heard, although I don’t know if it is true, that there are eight forms of the virus attacking different parts of the body. Which would tie in with a less virulent strain.
Lesley van Reenen
3 years ago
Fewer overweight and obese people in Germany, if I can rely on Google. This of course begs the question with regard to other co-morbidity stats.
John Stone
3 years ago
Germany had five and a half times the ICU beds before the crisis started. UK had only 40% of beds per capita of population compared to 30 years ago. They had much more room to manoeuvre than we did. I am also outraged that back in 2017 Jonathan Van-Tam was appointed as Deputy Chief Medical Officer for emergency planning and pandemic preparedness, a fact which has never been identified by mainstream reporting. Without wishing to be vindictive it is puzzling how we could be so little prepared.
Andrew Baldwin
3 years ago
Tangential to the article, but the statement: “They’re the 16th richest country in the world by GDP per capita; we’re the 21st” would seem to be based on unreliable exchange-rate adjusted nominal GDP estimates. The estimates of GDP on a purchasing power parity (PPP) basis by the IMF and the World Bank generally give the same rankings of the top countries in the world, but, as one would expect, they differ more in their GDP per capita rankings. The IMF estimates for GDP per capita on a PPP basis for 2020 put Germany in 15th place and the UK in 25th place. The World Bank estimates for 2019 also put Germany in 15th place but put the UK in 24th place. Both sets of estimates put the UK further down the rankings than the exchange-rate adjusted estimates, and further behind Germany. The 2020 IMF estimates show Germany in 15th place and the UK in 21st place. Perhaps Tom was using the corresponding 2019 estimates, which I couldn’t easily find. Anyway, it’s not good practice to use exchange-rate adjusted estimates. As American economists Michelle A. Vachris and James Thomas have written: “To accurately compare GDP data across countries, one must express the data in a common currency and value it at the same price level. These problems are similar to those encountered in comparisons of GDP across time for one country. Of course in the case of comparison across time, the data are already expressed in one national currency, but the figures must accommodate changes in the price level for the comparisons to have any meaning. Purchasing power parities are estimates derived from the relative price levels in different countries and reflect the rate at which currencies can be converted to purchase equivalent goods and services. Therefore, a PPP is the rate of currency conversion that equalizes purchasing power of different currencies and so has the dimensions of an exchange rate as well as a price index. PPPs are preferable to exchange rates for converting national expenditure data into a common currency because they also adjust for differences in price levels and reflect only differences in the volume of goods and services purchased between countries.”
David Waring
3 years ago
Surely the Main reason is Westminster is infested with corrupt Politicians while our civil servants have been successfully infantilised by our politicians love of Brussels.
klauskroy
3 years ago
This is certainly the story the German government wants to hear (or could have released). But, honestly, I don’t buy it. It mixes a compilation of verbatim and indirect quotes taken from the official narrative with some superficial judgements that are in conflict with a considerable body of what I consider very respectable scientific evidence. I don’t think most readers here crave for such simplistic answers to complex questions. Disappointing.
“This is certainly the story the German government wants to hear (or could have released).” Another conspiracy theory? German gov (and the population) really “cares” what Unherd publishes. Large testing capacity (day 1), ICU beds, etc. are not “simplistic” answers – are facts that can be easily verified.
Iliya Kuryakin
3 years ago
A very narrow comparison that misses a wide picture. Death rates from around the world reveal an interesting picture: western European countries and large Latin American countries have the highest per capita death rates; Eastern European and Scandinavian countries death rates are lower (apart from Sweden’s which are nearly on a par with Italy); Africa (bar South Africa and the north coast) are low; but the best countries are the advanced Asian economies. Japan has 13 deaths per million, against Germany’s 112 and the UK c660. We should be discussing Japan, South Korea, Singapore, Hong Kong and Taiwan instead of engaging in this Eurocentric analysis.
UK is a European country not an Asian country. In many of those countries (korea being the perfect example) the GOV has no respect about privacy and personal data. Singapore is a semi-authoritarian city state that can do things no liberal democracy can dream of.
7882 fremic
3 years ago
“but, I think most of us would agree now, they were worth it.” The writer glibly says on our behalf.
If you want to know what’s been gong on in Germany take read of the book written by Karina Reiss and Sucharit Bhakdi, both eminent German scientists. Translated into English. Corona, False Alarm?: Facts and Figures
Peter KE
3 years ago
The U.K. failures are directly attributable to PHE, department of health, Sage. All pathetic and should be disbanded.
SUSAN GRAHAM
3 years ago
Another factor regarding the death toll – deaths here were recorded as due to Covid even if the crucial factor was an underlying cause, as opposed to the German system where a death – even if Covid was a side factor was recorded as due to the main cause. I know of two cases where Covid was stated on the death certificate because it was ‘easier’ when the actual cause of death was unrelated to Covid. Also there is a vast difference between the German character and the British – being methodical and obeying instruction is part of German DNA – in total contrast to the British, many of whom hold guidance and rules in contempt. I wonder how many mass gatherings and protest meetings with no masks or social distancing have been allowed in Germany?
There were in fact a series of protests against the whole Covid bureaucracy in Berlin and elsewhere during the summer.
Rob Alka
3 years ago
Germany has become over the last few decades one of the most efficient, resourceful and well organised countries in Europe, while Britain has become increasingly something of a basket case. What makes matters worse in that Britain today has delusions of superiority which hark to its days of empire when it was a back when it had more red blobs on the map of the world) and is unable or unwilling to take a cool hard look at itself in these present times. Britain imagines it is making progress by analysing and debating everyting to distraction, may well be a displacement activity to avoid making decisions. It is not just coronavirus that afflicts Britain but the virus of the Peter Principle (idiots rising to the top), which mutates into Parkinson’s Law (bloated bureacracy, data pollution, endless debate), which mutates into Heath Robinson solutions (botch-ups), which mutates into Murphy’s Law (inevitable dramatic failures). I see little or no evidence of Germany sharing those characteristics.
Nicholas Taylor
3 years ago
I fear this article is already out of date. The imbalance in the first wave appears not to be repeated in the second (or is it already the third?). According to WHO figures the current rate of new cases is about the same in Germany as here but their death rate exceeds ours and is still rising. No information about age distribution or other circumstances but maybe the data exist somewhere. The virus seems to respond very non-linearly to circumstances, or opportunities offered by people’s behaviour – after all it is people that carry and transmit it. I would like to think there must be a crucial insight just around the corner, but after nearly a year hope wears thin. It’s like being in a ship where some kind of ‘demon’ has interposed itself between helm and throttles and the engines and steering. Every time the captain and crew think it’s answering, it may be no more than coincidence.
John Chestwig
3 years ago
I’m afraid this is a case of the author seeing what he wants to see.
There are only two fundamental differences I’m aware of, between Germany and UK, which will lead to a different overall outcome in terms of deaths:
– Germany does better testing, with repeat tests of +ve results, to avoid the ridiculous overcounting of false positive deaths we get in the UK (estimated at 50-70 per week in UK care homes and hospitals alone https://lockdownsceptics.or… )
– better initial management of care home residents, not booting them out of hospitals and back into their care homes where they were clearly likely to cause real outbreaks and deaths.
Other than the above, the claims about better test and trace, treatment by community docs etc, will have made hardly any difference. There is no reason to assume that overall actual covid deaths will be any different (though UK false positives deaths will be impressively high).
Gary Taylor
3 years ago
No need to speculate. The results of the multi-country multivariate academic analyses are in:
“Increasing COVID-19 caseloads were associated with countries with higher obesity, median population age and longer time to border closures from the first reported case.
Increased mortality per million was significantly associated with higher obesity prevalence and per capita GDP.
Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns and reduced country vulnerability to biological threats were significantly associated with increased patient recovery rates.”
The German Landers system is historic and has been in place as an evolving form of Federalism for well over a hundred years. https://en.m.wikipedia.org/…
This gives Germany many well defined resilience characteristics, polycentrism being one. https://www.stockholmresili…
Fiscally Germany has been running a surplus for many years, an advantage that it has gained through structural advantages afforded by the eurozone which enables its export industries.
Lastly, Germany has a societal health ethic whereby people will self isolate if feeling sick, including with the cold and flu. Unlike here where we trot off to work no matter how bad we feel.
The new tier system obviously seeks to mimic the Landers system but of course there is more Federalism and decentralisation to do.
Saphié Ashtiany
3 years ago
We seem to have unsuccessfully set up a parallel, outsourced system and bypassed GPs as well as local public health services. So while our hospitals have made good progress in handling the disease once a patient is admitted, we have made little or no progress in managing its spread in the community.
bob thrasher
3 years ago
Another way to look at it is in terms of case fatality rate – which is not what this article describes. UK has roughly 2x the CFR compare with Germany (and USA).
Chauncey Gardiner
3 years ago
Tom! You may have solved the mystery!
That bit about Germany doing a much better job than Spain and Italy (and likely, Magna Brittania) at protecting “vulnerable communities” may balance the balance sheet. You report that 19% of cases were among folks 70 and older in Germany. You report that the figure in Italy is 39%. So, a 20% differential. Perhaps that 20% differential accounts for most of the difference in per capita fatalities.
If you are sitting on top of the numbers, can you sort out whether or not that differential solves the mystery?
Many thanks from your loyal reader Chauncey Gardiner. All will be well in the garden.
Dennis Boylon
3 years ago
The entire article is nothing but conjecture. It is less than useless. Shouldn’t everybody in Belarus be dead by now? Lol. https://www.rt.com/op-ed/50…
ilaajonline
3 years ago
I don’t understand this article’s main focus. If it is about a comparison between the two countries then I think that’s rather a broad topic but if it is about the healthcare system and taking into consideration the health of the whole population then that would make sense. Healthy behaviour and common sense will perhaps matter more than anything else in this second wave of rising numbers . Hopefully the science and the world are much wiser now than 8 months ago. As a healthcare professional I can only say that the NHS may even do much better if it was not starved by chronic underfunding. A piece of advice to our politicians- LISTEN TO THE SCIENCTIFIC EVIDENCE AND DON’T MESS IT UP AGAIN.
connieperkins9999
3 years ago
None of these explanations account for a six-fold differential. As others have mentioned, deaths per million are far more likely related to the ‘dry tinder’ per million.
Jonathan Bagley
3 years ago
Their death rate isn’t massively lower and Germany’s track and trace isn’t an unqualified success. The ratio of their June minimum 7 day rolling average to their current new cases per day RA is 26.15. Ours is 33.45; and our June minimum was more likely than theirs to be an underestimate. Our current RA of deaths is 135. Our RA new cases a day 25 days ago was 5709: a ratio of 0.0236. Their ratio is 31:1780, or 0.0174. Lower, but not massively. They aren’t quite as fat and they eat better.
Mark Corby
3 years ago
A nation that managed to exterminate upwards of six million undesirables, under wartime conditions is hardly likely to find dealing with C-19 a major problem.
That’s a very despicable comment both anti semitic and anti German. The 6 million were European Jews not undesirable as you callously state. Secondly modern day Covid-19 German containment policies have nothing to do with the National Socialist policies of ethnic genocide carried out 75 years ago. Only a narrow minded bigot would post such a comment.
It is a fact that the Jews were considered undesirable by the Nazis. It is also a fact that the Germans are remarkably efficient and effective – hence their superb engineering industries. I’m less sure about their sense of humour.
Honestly, I’m disappointed in this article.
The author generally does a very good job of sticking to the facts, but there a several things here that are either factually wrong or a matter of opinion which completely muddle the comparison.
First, how is it vaguely possible that you don’t know the difference between the United Kingdom and England? The United Kingdom does not have a centralised public health system, as you state — England does. Scotland has its own, more local, public health system, with its own test and trace capability. In the end, though, a localized response didn’t make that much of a difference when you compare results between England and Scotland.
Second, masks. Everywhere I’ve been in England and France for the past three months, everyone has been wearing masks in all indoor spaces, and they were all in lock down before that. Hasn’t made any difference though. I find it extremely hard to believe that one small territory mandating masks in Germany a little bit earlier could actually explain much of the difference in Covid deaths.
Third, quality of politicians. Really? I can read the FT/Guardian for that.
It would seem that how Germany handled care homes was the key difference. It would be very helpful if that weren’t lost in the fog of nonsense making up much of the rest of the article.
“..Germany handled care homes was the key difference.”
As far as i can tell (media reports, I don’t have any secret news source)
1) Germany (as the article points out) took a hard/aggressive position on care homes.
2) Germany healthcare had/has more capacity to deal with serious patients.
3) UK GOV decided to save NHS and it threw the old people to care homes
4) Care homes (professional experience) are on average better in Germany than UK
5) All the points above are (luck aside) byproduct of a competent political class that spends more on healthcare than UK.
P.S. Even loyal Tories (news reporting) think the current government is light on talent.
You’re perpetually going on about the superiority of German politicians, so could you please explain why our incompetent leaders in the UK have been able to reduce per capita carbon emissions by 4x of what Germany has achieved in the past 15 years? Your sixth-form political analysis of Germany good/Britain bad is really not helpful. Germans do somethings well (i.e. financial frauds) but they’re not perfect.
“You’re perpetually going on about the superiority of German politicians…”
No I have not!!!
I simply pointed out in THIS crisis (details above) that political decision (luck aside) have produced better results.
I didn’t say UK bad Germany good – you did. Just like you repeating the same stat (carbon emission).
Big Picture Argument:
We have internationally accepted metrics that measure a country’s performance; human development index and by most metrics Germany outperforms UK.
It is beyond argument that since 1950 Germany’s elite (politicians, bureaucrats, business leaders) have performed better than UK’s elite.
Because we outsourced all our manufacturing to China and.. Germany.
Don’t see what bearing that has on Covid infections though.
Because we outsourced all our manufacturing to China and.. Germany.
I’m not sure that addresses the point. AH’s comment suggests the reductions are relative to a base line of 15 years ago. Unless you’re suggesting that the “outsourcing” all took place since 2005 then it’s irrelevant – and probably makes it even more difficult for UK.
Germans still have a manufacturing base. They export . We import. Anyway the article is about a specific problem not general point-scoring. Disclosure ;have lived in Germany but live in England and am English .
The UK still has a manufacturing base, and is particularly strong in precision engineering, robotics, aerospace, defence, computing, pharmaceuticals, biotech. etc (and is relatively strong in the high-value add parts of the process).
We don’t so very much Big Iron stuff anymore, which creates some strategic/security risks, but isn’t such a big deal economically.
And we are also world class in culture, services, law, finance, etc
Not bad, not bad.
“..and is relatively strong in the high-value add parts of the process”
It is not actually. The most detailed study about a country’s innovation/competitiveness is the Annual Bloomberg Index.
Value added UK is ranked 44th in the world. Total scoring UK is 18th in the world.
P.S. You should visit Hannover Messe, the largest word fair for advanced manufacturing. Check out how many Tier 1/2 (robotics, machinery, industrial automation, industrial sensors) companies are British.
The politicians are nuts in Germany Angie is a physicist .She said in june that she ll decide when this is over !! and just yesterday Söder said that even if there was a vaccine then they would continue with the measures!
They follow rules really well no matter how ridiculus they are.
Best laugh of the afternoon! Right on, Brother Andrew.
Yes, Mother Superior Angela got religion and nuked Germany’s nukes after the Fukushima business. Germany ended up importing coal-fired electricity from Poland … (sigh …) …
2) Germany healthcare had/has more capacity to deal with serious patients.
Not over the last 6 months it hasn’t. UK hospitals were cleared to make way for Covid patients. UK hospitals were not over-stretched at any stage since March.
5) All the points above are (luck aside) byproduct of a competent political class that spends more on healthcare than UK.
Germany has a distributed multi-layer healthcare system which is funded from both statutory and private health insurance, We have the NHS which is, of course, a far superior system. I know this because we keep getting told that it is.
Is it not simply the case that: – Germany spends 20% more on health. The UK only started to catch up recently. Our rising population requires infrastructure investment, Their falling population means they spend all their money on current requirements, The whole difference can be accounted for by money and the fact that Germans and their insurers are customers not supplicants to their medics
I didn’t say it is simple – I gave a list of fact that has contributed to the current situation. Spending more on healthcare (directly or indirectly) is AGAIN a political decision.
I agree with that but I will say that the care home policy was not a political decision. It was informed almost entirely by scientific advice. It is not even remotely possible that the decision to place people from hospital and into care homes was a political decision – it must have been a SAGE decision or advice of a medical nature – prioritise the hospitals to keep COVID-19 out. Other countries also made that mistake and that is no coincidence. Whether we have an inferior political class or not is a matter of opinion but the care home issue is a matter so basic as not to need statecraft. It wasn’t government’s decision on a whim and cannot be interpreted as such once given some thought.
Agree partly upon part Second: not a strong case with early “successful” mask-wearing in Jena. Perhaps Germans handle their masks in a more hygienic manner, though?
People in England are not wearing masks in all indoor spaces – they are not wearing them in pubs, restaurants or cafes because you cannot eat or drink while wearing them.
Even in shops not everyone wears masks, some shops do not enforce wearing and in many the staff did not wear masks and had a simple face shield.
A better example to compare against would be the Asian countries where mask wearing was much more established from their previous experience of SARS and MERS out-breaks and where it was accepted as effective.
Masks do nothing and are a health hazzard. Which is proven by 40 years of proper science not the rushed through rubbish the lads on the telly are spitting out.
There’s been scientific studies which have demonstrated the effectiveness of masks, and particularly respirators in either stopping or significantly reducing the amount of virus a wearer is exposed to.
That is why medics caring for COVID patients wear FP3 respirator masks as these provide the highest level of protection.
Surgical masks and face coverings do not provide the same level of protection, but still provide some reduction and prevent the projection of droplets and aerosols when people cough, sneeze or talk.
Still, it has been proven personal protection like masks do not have any significant effect on infection
If masks work as advertised, the way they are actually worn is a public health hazard. If they don’t it’s all a waste of time. Mask wearing in general public is nonsensical.
It depends critically on drop-size. And non-clinical masks are good for relatively large droplets but contrary to initial assumptions it seems Covid is being spread through small droplets not large ones, which go through masks and indeed can hang in the air – but are less likely to be passed on via surfaces.
Clinical-quality PPE, worn properly is a completely difference question.
Though perhaps masks discourage hand-face contact and help in other ways.
Indeed, wearing masks on city streets was very common in Asia before hang, for hygene and air quality isues, even pre-SARS
Masks in Asia are not that common but not rare either. In the winter in Japan maybe 15% are wearing them and those people rotate depending on how they feel.
The Far East Asians also eat with chopstick, could that be significant? I mean the West Experts have thrown away the whole causation/correlation dilemma in favor of correlation.
Yeah you should eat with chopsticks. We don’t wear masks. Ever. Except when there is a pandemic and the whole seems to be trying to do it. Those that do, do fine a little better it seems so far. The US didn’t, and I suppose neither did you. Shame on you Fremic. You could be an asymptomatic carrier and pass it on.
Ummm… there is a plausible causal mechanism relating face masks to infection; not so for chop sticks making.
Unforutnately (?) controlled trials on infecting people with untreatable diseases don’t get past the ethics commitees.
And there is a great deak of basic medicine that has never be trialed. Established and apparently effective treatments don’t get controlled trials vs. neglect – only against potentially superior new treatments
Germans themselves didn’t know why they were “doing better”. They went into “lockdown” 5 days earlier than us. They said things like: ” it must be because we eat pork fat rather than olive oil”, and repeatedly warned of a second wave.
They went into lockdown at the same time. perhaps you mean, compared to the progress of their epidemic, which is true?
One factor is Germany has a Bismark health system. The UK a Beveridge system, like the US with Obama care. Check out the best health care systems in the world, and they are Bismark systems. Switzerland, Holland etc. The reason they are better is that insurance, supply and regulation are split. In the UK they aren’t.
If you want to see the effect of that, check out what Dr Jane Barton did, and why nothing has happened.
Second the Group think in the NHS is Marxist. It’s a religion. That religion doesn’t like the tories. So what better than inflate the numbers killed. The flip side is that their performance is disasterous.
They claim short falls in cash, and yet in absolute and real terms, spending is at record levels. 100% increases in real terms. Productivity up 5%. That’s the problem
Adminstrators, the root cause, decide that Covid was a great reason to kick out bed blockers and that killed thousands.
Capacity is not an issue. 11 patients used Nightingale hospitals.
Tories have been in power most of the time since NHS came to be. Nothing (political costs aside) is stopping the Tory party from going all Bismarck on NHS.
I hink it was the care homes mistake…which itself arose from the videos of Bergamo and other reports, and the graphic way they illustrted a modern, competent, efficient Health system being over run.
THat focus on the NHS shouldn’t have led to systemic blindness in respect of care homes, and I think that may be a key focus of any inquiry.
Though far be it from anyone to point out our huge, centralised NHS may also not be the most optimal way to organise things in Health care in the 21st century.
My understanding is that the definition of a Covid death in Germany is very different from that in the UK (and most other countries). That is, in Germany you must have actually died of Covid whereas in the UK you simply have to have tested positive within the last 28 days of dying for any reason (up to recently even longer). Some analysis of this is important and I wouldn’t mind betting explains a lot of the difference between Germany’s Covid death rate and the rest of Europe.
Yes, when a relative died in hospital recently, it was suggested that Covid diagnosis be written up; “you’ll get a quicker funeral”, her daughter was told. They argued the point and the correct diagnosis was put on the death certificate. How many have similar stories?
Thousands I should think.
I’ve heard it from a paramedic. It avoids a post mortem, apparently.
Could it also be that, in Germany, a lot of deaths are being recorded as due to viral pneumonia rather than Covid?
Whether this is a major factor or not (I am not involved in medicine, but learned this from a GP in the NHS), it is clear that differences in death recording methodology vary widely across Europe (and clearly globally – anyone believe the stats from Russia / China / N Korea among others?).
A couple of months ago an investigative article appeared in Spain’s El PaÃs, contrasting the official reported death total with the number of deaths where Covid was given as the cause of death on the death certificate. The latter was harvested from over 600 civil registries from across all 17 of the country’s autonomous provinces and regions. The difference was stark: the data revealed an additional +/- 16,000 deaths above the official number, which around the time of publication, was around 32,000 – so a difference of roughly 50%!
The Sánchez government denied and rejected the El PaÃs findings, claiming to be following WHO guidelines. But is not as if El PaÃs had / has any partisan axe to grind, being a left of centre national daily.
This was roughly contemporaneous with the England revising its death numbers down by 5,000 and adopting the within 28 days of a positive test rule.
Despite all its well documented issues, the number in France has seemed suspiciously, stubbornly sticky at c.31-32,000 For several months.
Hard to know what to make of it, but it appears every country has its own definition & methodology; what we do know is that ours too probably understates the true total, but whether we are apparently by so far the “worst” (as if it were a competition) in Europe is not so clear-cut in absolute rather than relative terms.
Spot on – I raised this point as above – should have read your post first! The numbers are highly suspect as evidenced by several posts below – I know personally of a relatively young man (41) who suffered from rheumatoid arthritis and died from pulmonary stenosis as a complication of the underlying condition. He tested negative for Covid three times in his last week but Covid still went on the death certificate.
Infection ratio and deaths together points in the same direction though. Same with Sweden´s poor outcome (so far…)
Thank you for posting your comment. By the first paragraph I was nettled by this entirely wrong statement: About one in every 1,600 British people has died of Covid-19 since the first confirmed death in early March.
A great many of those deaths – how many we are not told – were death with Covid as you correctly point out.
My sister is a nurse of many years experience and she is flabbergasted by what has been going on. If a terminally ill patient of say cancer or some other disease – often age related – tests positive then Covid is put on the death certificate even if no actual symptoms developed. In the early days of this pandemic, doctors in the US were speaking out about this requirement to put Covid on the death certificate even if there were other far more pressing co-morbidities.
Knowing this makes it impossible for me to trust the so-called statistics and articles such as this are rendered void.
Some places ask for post-mortems to be done to prove that you really died of Covid. Taking in account the age group I would say that “the definition of Covid death” is the thing that makes some countries different from others. If you compare in the group younger than 60 years the result probably is not so different between different countries.
Exactly. Similarly in America Trump announced early on that the government would pick up the medical tab for people dying of Covid.
It would be an act of compassion for hospitals to rack up the covid deaths and save the bereaved a fortune and one which must have massively distorted the deaths there.
Flu and covid spread the same way.
What would be interesting is to compare the death rates of both. I suspect huge numbers have been moved from flu to covid
They don’t quite spead in the same way. Covid has an ‘over-dispersed’ pattern (a smaller number of larger clusters rather than a broad even distrubiton of cases). Which require very different tracing and control approaches.
this old chesnut again. We (as in UK) count different than Germany?
That’s right. Different methods. Not different numbers.
Whilst I accept that Germany’s large number of hospital beds and a better system of protecting its care homes could have improved its death rates, nothing cited here is unique in comparison what to other European countries have done.
Personally I believe the virus simply arrived in Western Europe earlier and in greater numbers. Travel numbers are far higher in the West that they are in Central Europe and this seeded outbreaks that were much larger and harder to bring under control. Given that the virus has a large number of asymptomatic carriers and seems to be following a super spreader patter of infection, the timing and initial number of infections introduced is going to be extremely important in how the epidemic develops.
This fits the pattern we see across Europe, where most countries in Central and Eastern have so far had very low numbers of cases and deaths, despite not enjoying the same advantages Germany has, though this may change as the second/first wave hits them.
By ignoring factors outside our control and placing too much faith in our ability to fight the virus, we’re likely to continue to cause as much, or even more harm to our societies than the virus is.
I hope that I am wrong and that Germany and the rest of Europe have found a way to control the virus but epidemiologists at the start of the pandemic told us we could slow the spread of the virus, not stop it. We, and indeed some of them, seem to have forgotten this.
There is not a choice between controlling the virus and stopping it. If a virus doesn’t find a host to use to reproduce itself it dies. The better you can track, trace and isolate the quicker you will slow, then eventually stop, the spread of of Covid19.Tere is no “second wave” incidentally, it is merely the first wave not completely contained.
Track, trace and isolate? In my country you would need to deploy the army to find those I was in contact with over a two week period.
I recall hearing on the news over the summer that half of all traced Covid cases that had been *imported into* the UK from abroad had arrived from Pakistan alone. (This wasn’t then mentioned again, either because it was deemed inaccurate or too politically sensitive?) If this was indeed true (and I have no idea whether it was!), it would provide another reason why Britain might perhaps have been less ‘lucky’ when compared to Germany, where for historical reasons there is presumably rather less aviation traffic with that part of the world?
After at least 24 days, UnHerd seems to have finally fixed the reply system.
A true miracle, perhaps the Germans are responsible?
LOL
There was a disqus disclaimer form to read and approve ““ no approval, no commenting allowed. There was probably a legal issue behind all that disruption.
Gosh, and there I was making productive use of all the time I wasn’t spending commenting on UnHerd. Damn…
Glad to see you back Basil!
Well, thank you!
They were all down here in the basement debating masks and germany.
Interesting – the different treatment of nursing homes In Germany was a key factor in lower death rates. I also think their airport testing was put inlace very quickly and local TTT systems also worked earlier.
I agree we do have a structural problem in the UK in that we have too many bureaucratic layers in national orgs/quangos largely stuffed with “desk toppers” who write process. We have too few locally responsible and accountable individuals – In fact lack of accountability means few take real responsibility. If you have worked in the private sector and sat in some of these public sector and civil service committees the lack of practicality or focus on the delivery part and whether it passes the small test is unbelievable..We need more of a military approach to the organisation, accountability and responsibility of our civil service and public sector orgs
It’s no mystery
We have the British Civil Service and they don’t
I take it then that combination of PHE & the NHS had absolutely nothing to do with the failure on Covid?
So why do these bodies exist?
NHS England employs several people who are paid considerably more than most government ministers – including the PM. The same goes for PHE. The sole purpose of PHE is (or was) to prepare for emergency health crises, In 2013, they did produce a document which gave details of preparations for a flu Pandemic but they seemed to get a bit bored with that and decided they needed to focus on how much salt we were putting on our chips.
The NHS completely cleared its decks to prepare for Covid while the never-used Nightingale Hospitals were built to cope with the overspill. Even at peak, the total number of Covid patients in English hospitals was only around 17k.
The NHS can’t continue to take the plaudits for the good stuff but be blameless when things go wrong. The performance of the NHS has been less than stellar during this pandemic.
You haven’t really clarified why you think the NHS is at fault. It’s not the same as PHE. More detail please,
The way we organise and fund our healthcare may be at fault. Individual health practitioners are not at fault would be my take. It’s a topic that could take up an entire thesis.
NHS isn’t just nurses and doctors. We have created a national structure that , in theory, ought to be better able to respond to emergency health issues. It provides consistent advice and treatment protocols to all hospitals & clinicians across the service.
The NHS failed miserably on 3 key fronts.
1/ Nosocomial (hospital acquired Covid infections [HACI]). This is what created the initial panic in March. You might remember the sudden switch from testing & contact tracing to hospital only testing. Why? Because huge outbreaks were being detected in hospitals. Seven months later – we have the same problem. The proportion of HACIs has been steadily increasing over recent weeks. It’s now up to 18%.
2/ NHS discharged infected patients from near-empty hospitals back to Care Homes.
3/ The survival rate of Covid patients in UK appears worse than in other countries. Germany which has a distributed, mainly private, healthcare system did far better in the early stages. UK is improving but this is an area which should have been a strength for the NHS.
Disappointingly, but not surprised, that no one seems to look into the fact that in Germany Homeopathy is commonly prescribed by medical practitioners, 70% of medical insurances cover homeopathy in their plans and outlay 20million Euros each year. Homeopathic remedies are also readily available at pharmacies which would indicate that individuals are also self prescribing. Please could someone investigate ? How about it Tom ? or are you worried about what you might find about this
medical modality ?
I think the major reason is much more simple: the UK artificially balloons its fatality tally up, by counting people as Corona victims purely based on the fact that they tested within the recent last (currently 28 days) positive for Corona. Beyond this I have heard from multiple credible sources that people were classified as Corona victims even though they hadn’t tested positive for Corona in the first place. In contrast to this in Germans are very conservative when it comes to classifying people as Corona fatalities.
Why would the UK want to artificially balloon its fatality rate up? It just makes the government look more fabulously incompetent than it already is – tough Brexit stance thus far aside, of course.
A very good question. This is without doubt what is happening though.
They are not exactly artificially ballooned but there has been great laxity in actual diagnosis – in the early days of the pandemic covid has been put on death certificates even without tests done, terminally ill patients who then tested positive for the virus but died of their primary disease without developing symptoms had covid added to their death certificates. Two members of my family are nurses. One of them is a hospice nurse.
They are equally baffled as to why this is happening.
But our excess deaths are way up , and the German excess deaths are not.
There is some evidence that differences in the severity of the last flu season may have something to do with it. Italy ,Spain, France and the UK for example had a very mild flu season whereas Denmark, Germany, Austria, Switzerland had a normal season. Therefore there were very many more susceptible people available for covid to attack in the former countries. There is also some recording and reporting anomalies across all European countries that need to be considered.
Germany tested more extensively but the extensive testing found younger and less sick people more often: their median age was given as 47 or 45 years, whereas Italy tested older and sicker people at a median of 63 years. Many early infections happened in skiers returning from Tyrol, who tended to be fit people rather than persons at higher risk of complications, and contributed a negligible mortality.
Since Germany has no routine for post-mortem tests, unlike Italy and Belgium it may not have discovered all deaths. In Spain, the first death was also discovered by a test carried out post-mortem.
Nope. Look at https://euromomo.eu and see that the UK, Holland, Belgium, Spain, were hit harder and did not have fewer deaths in previous years. And these excess deaths have zero politics.
Though Chivers is quick to dismiss “immunological dark matter”, a comparison to other countries in Central and Northeastern Europe should also be considered. Poland, Austria, Czech Republic, the Baltic States and Belarus all have death rates similar or even lower than Germany. Though Czech Republic took early precautions, Belarus did nothing – yet there death rate is lower than Germany. Basically all the countries in mainland Europe that border Germany to the East have very similar death rates. Maybe Germany’s policies had very little to do with their outcomes and possibly their death rates is a product of their geographical location.
I generally rate Tom Chivers’s stuff, but I think he’s way off the mark here and needs to zoom out of the detail.
All everyone in the world seems to talk about is which interventions work, micro-analysing and comparing responses. Lock down this, test and trace that, mask up the other. In reality, it’s all absolute nonsense, because we humans are not controlling this in any meaningful way at all.
Just go to Our World In Data or similar and pull up a map of the world with cumulative Covid-19 deaths per million. The single determining factor is geography, particularly longitude.
Statistically, the very west of Europe and the Americas are more heavily impacted, with almost all of Asia, Oceania and Africa hardly affected at all. Germany and the rest of Central and Eastern Europe are a transition zone.
Why is this? Geography, climate, different regional levels of pre-existing immunity, or a combination of these or other factors? I don’t know, and perhaps no-one does. But the trend is obviously macro, not micro, yet hardly anyone seems to be talking about it.
https://ourworldindata.org/… shows neither latitude nor longditude as correlations. With places lilke the UK including motorcycle crash fatalities as SARS-CoV2 and other places going the other way and massively under reporting you are right, at the mo we can never know. If we do know in thhe future it could only be through some reckoning via ICC, Nuremburg trial type process.
Don’t have any figures but one of the most significant co morbidities of corvid is obesity. Looking around here in the N West I see rather a lot .
Just returned from N Italy – the first extremely large person we saw all week was in the Ryanair return queue.
I read that we are the most obese nation in Europe ( except Malta GC ).
Pictures from Northern Italy in March showed many very large and mostly old people in hospitals and on ventilators. Yes, the UK is super large though and has a real problem with obesity.
And this was the strongest correlation shown by the Lancet study on all the available world wide data – the link between rates of obesity and numbers of deaths in different countries, regardless of lock down policies. Lockdown policies did appear to have some positive impact on recovery times, but I saw no explanation as to why that might be the case. It is also interesting that it is a German lawyer, Reiner Füllmich, who is now suing the German government for the collateral damage and death caused by their lockdown policies.
Upvoted for remembering the GC
Writing from inside Germany, and having followed the handling here very closely, I ask permission to disagree on several key points.
Sure, there are differences in the death toll. But lockdown is not (as has been shown frequently) a factor in this. Otherwise the swedish curve would have a different shape than the German. It doesn’t. The measures came quite late (Carnival needed to be celebrated first), and had little effect (as can be seen when looking at the smooth German curve alone).
Here a few thoughts as to why Germany may have had a rather mild Covid toll:
Few factors do have such an impact as air quality. Germany has been investing heavily into environmental technology. Emissions are fewer than in most European countries. Definitely fewer than in England or the UK (even though there are huge differences within the UK, too). Harvard and the University of Bologna have shown that outcomes in Covid patients was directly linked to pollution. Northern Italy, New York, as well as Wuhan, are famous for their poor quality, too. Maybe Germany earned a dividend from thirty years of investment in reducing emissions?
Of course the Health System has had some impact, with Germany having three or four times the amount of ICU beds per capita than most European countries.
The demographics depend heavily on testing. Here Germany has tested many times more than most countries. They have tested many asymptomatic which accounts primarily for the differences in cases by age and country, don’t you think? Deaths by age on the other hand is very similar in Germany and the rest of Europe, or the rest of the World. Why do you think this is? Case-Fataliy-Rate is not a good indicator for Covid, especially if testing and definition of what a case is vary greatly, as they do even within Europe.
Germany has been ill-prepared for what happened, as have most countries. PPE shortages for hospital staff has been a problem here too. Why is that, many Germans ask? Mr Spahn should take more care in answering these questions rather than bragging about questionable “successes”. The German strategy failed, even though the death toll was smaller than elsewhere. It failed because the way Germany reacted set her up for the Casedemic it is now finding herself in.
Sweden has no Casedemic, no mandatory masks, no lockdown. Yet German politicians including Mr Spahn keep warning against the Swedish strategy. They should know better!
Well said about lockdown. But regarding air quality; I would say Sweden have very similar air quality as Norway and Finland, and about equal in the hard hit Stockholm-region as small Denmark. And the infection outcome is not comparable (so far).
Surprisingly, you don’t mention two other important factors: The Germans eat more sensibly and have a better diet, and there is less of a problem with obesity and other underlying health issues.
I think they smoke more as well. It has been forgotten now but early on this was shown to have a positive impact
I think that study or studies showed that smokers were less likely to be infected by the virus but if they were infected they would more likely have a worse outcome. I think that message being a tad complicated may be why it’s been forgotten.
The main difference was the handling of care homes and hygiene in hospitals. Other than that, the writer has been played along with most other people just as planned relying on people’s idea that Germany is always more efficient, therefore follow them, although they haven’t gone bankrupt, have they?
I’ve yet to see any proof that so called Covid19 is any different from seasonal flu or SARS and until then I’ll stick to Klaus Schwabs books to see what our future holds.
Well said
And our panic over Covid will go down in history as the worst self inflicted wound of all time – Sweden got it right much to the eternal and increasing frustration of all other governments who so wish Sweden had lost their nerve – Meanwhile who would make the more chilling Bond Villain Klaus Schwab or George Soros?
The article could have just said “protected care homes better” and finished there.
Concerning the rest, I understand the temptation, but its still too early to be calling winners and losers. The prematurity is probably eagerness to confirm some biases.
A couple of things to note re Germany. I have no way of knowing if they are true or not. Prospect magazine carried an article in about May saying that the first area to get the virus decided they could not send recovering elderly covid patients back into care homes so they created separate facilities. Given 40% of our deaths have come from Care homes that is a fairly major difference (if true). Secondly the Test Track Trace System in Germany is a conundrum for me. At the end of April Andrew Marr interviewed Anders Michaelis who was to be the next German Ambassador to UK. He said very clearly that in the great state of Bavaria, they had NO track and tracers and that it would take another 2 months or so to set the required teams up properly. You can see it on YouTube.
The more you read the less you know!
Bit soon to jump to conclusions. We’ve a long way to go…..
This decentralised state is however running amok with Minister Presidents in various Länder, to request tests ( try to take one …) and quarantine from people wanting to vacation in their region.
Mrs Merkel has summoned them to the chancellery….virtual or in the flesh to try to resolve this.
But….as all these mini kings depend on local votes, they do what so far every populist and clueless country has done…..doing a lot of useless things to show they are doing something.
Same in France…..where one single guy will announce tonight what spell he is going to have us under.
So far only one country has managed this health crisis in a very factual and pragmatic way……Sweden…..and the reason is that politicians cannot take part in it.
Measures are taken purely on the merit of their efficacy…..not a coming general election…….and the proof is in the pudding.
Germany has done well…..it is now getting over the top making people s lives totally miserable and worst……dividing the country……..Back to before Bismarck times.
The Germans don’t have to put up with a centralised, crappy, health service elevated to a religious icon.
Lots of things wrong with the German health service. I have said this before on these pages and no doubt will say it again. I live here so it frustrates me when people who haven’t experienced it say this. Yes, they do have more intensive care stations but the UK was able to put these together at short notice. It seems to me that track and trace was the key factor, but what someone else said earlier on about the geographical factor may also be significant.
Germany and the UK report covid deaths in very different ways. Germany reports deaths BECAUSE of covid. The UK reports deaths of anyone who ‘tested positive within 28 days of dying’. That’s the main difference. Nothing strange.
By the way this makes me wonder, how many people die within 28 days of drinking water…
“but, I think most of us would agree now, they were worth it” We bloody well do not agree
I have heard differently: Germany and a couple of other countries had been hit by a severe flu wave last winter (2019/20) with a large number of deaths.
The theory is that all those countries that were hit hard then have now the fewest covid deaths: people in danger died then.
The UK in contrast had a mild flu year and so those vulnerable people who survived then have now been hit by covid.
Yep. The very old, sick and the vulnerable can’t die twice but as an exasperated Tory MP said recently amidst the ongoing economic carnage, ‘it’s almost like this government is trying to legislate against dying’.
Death figures like these can only be fully ascertained and understood over the fullness time rather than as an immediate, media friendly snapshot so it will be interesting to see what happens in Germany and elsewhere over the coming winter months and even in the next year and beyond in terms of death rates.
We know that Germans are extremely diligent, hardworking and on occasion fiendishly clever so perhaps their politicians have indeed uniquely and secretly managed to legislate against the one inevitable fate that we apparently falsely believed faced us all?
I’m not convinced, or rather, I’m willing to be more convinced. The author states that devolved decision making has been critical in Germany. Wouldn’t this have led to a patchwork of good versus bad responses in Germany, with some states and regions within states having had a ‘good’ coronavirus while some were less successful? Here in the UK we have at least four devolved set-ups, one for each nation – does this mean we’ve just been unlucky that none of them has been a great success? I wonder if population density has something to offer us. The UK is very densely populated and highly urbanised. The author quickly dismisses ‘immunological dark matter’ but it’s becoming clearer all the time that some populations appear to be more susceptible than others.
No discussion of the differing health systems in Germany and Britain? The NHS appears to be inflexible and unable to learn simple lessons such as the importance of hygiene in hospitals. A reflection on its senior management more than on its courageous front line staff.
It appears that the transfer of temporary staff from one care home to another was a key transmission mechanism in the UK. The Germans treat more jobs as worthy of training. My guess is that there were fewer temporary staff in German care homes and that those staff see their work as a profession and source of pride.
Johnson is intellectually incapable of clear and logical thought. Even if he and his colleagues had asked for strategic plans to deal with the virus in early 2020, the question remains whether they would have received anything worthwhile from the Civil Service. Merkel could count on the backing of her government officials. Johnson could not. The British Civil Service was more interested in bringing down a government they didn’t want.
Media reporting of Covid in the UK has ignored what is obvious to many people who don’t live in the media/political bubble: that a large proportion of the population ignored the rules/laws from the start. On housing estates, it was easy to slip from one flat into another. In south London, a full month before lockdown was ‘lifted’, on sunny days social life had largely returned to normal. The media and political class can’t bear to face reality because they can’t deal with the total disrespect being shown them by a substantial proportion of the country.
I would like to point out a cultural/political difference. Germans accepts that the state exist, must function well and it must be properly financed. Someone (who?) once said that the British want European levels of welfare with American levels of taxation.
UK (and USA) are intellectually dishonest about state, its role and its funding.
I have lived in Germany, France and the Netherlands. And the fact is that levels of welfare in terms of benefits etc tend to be lower in Germany, the Netherlands, and the Scandinavian countries than they are in the UK. (Of course, if you are a fraudulent asylum seeker you will get everything, but that’s another story). The Scandinavian countries and others worked out some years ago that the absurdly generous levels of welfare were not sustainable.
As for the state existing and functioning, we would be much better off if the eternally grasping and incompetent British state did not exist at all.
Also, taxation levels are actually pretty high in the US, especially in failing Democrat-run states such as California and New York.
UK GOV spending as % of GDP is c.40%, in Germany is c.45%. Scandinavian (51% and higher) countries even higher. That “extra” spending (all those countries have higher GDP per capita) must go somewhere?!
There is a difference between ‘government spending’ and the ‘welfare’ to which you refer above. These countries do indeed have a larger state. Thus they spend more on, for instance, sports facilities. However, they have become quite tough on ‘welfare’ i.e. giving people free money for no reason.
I have no objection to a larger state if the money is spent wisely. But do you really think that any British government, or any area of the British state, will ever spend money wisely?
But better public space does contribute indirectly to “richer” population.
In relation to payment to unemployed my understanding is that the German (European) system is based on personal contribution to the welfare state? More you put in more you get out?
Yes, in other countries, the more you put in the more you get out. Which is as it should be. (Of course, this doesn’t apply to fraudulent and criminal asylum seekers, but that’s another story). When you tell people from other countries that the British government literally pays the rent for people who have never worked they can’t believe it. Then they try to move to the UK – and who can blame them?
Hmmm….Maybe that is the problem in the US. Here it seems that if you have a long history of working to make a good living you will have almost no chance of getting any public benefits should some catastrophe derail your career after having paid taxes for decades….much easier if you have never had a job at all…and even easier if you are not even from the USA.
When you say that what one gets from welfare systems should depend on what you put in, are you suggesting that when some people cannot afford to put as much in as others, it is their own fault and that they didn’t try hard enough?
(Sometimes, as above where you introduced the idea of asylum seekers when it wasn’t part of the point, I cannot tell if you are being blunt or sharp.)
Possibly for this topic it’s more important to look at levels of spend on health rather than on welfare overall.
The German health model has more money spent on it per capita than the UK health model but at the same time has lower levels of state expenditure going into health. The reason being that they adopt a different way of funding. It is a mix of private and state whilst we are funding almost wholly from taxation. This results in under-funding and the health service being far too politicised. In Germany the health service is not in the same league as the NHS is as a political football.
The other thing mentioned in this article as favourable for Germany is the way its health care is organised ie by region. If you tried that here in the UK you would immediately be faced by howls of postcode lottery.
I read recently that in Switzerland, French- and Italian-speaking cantons have much higher death rates than German-speaking ones. I don’t want to start speculating why this might be, but it would appear at the very least that national policy in Germany might not be the only factor contributing to their relatively low death rates.
Perhaps it has to do with Germanic culture which emphasizes respect for rules and compliance with public policies versus the more individualistic happy-go-my-way of Latin cultures and the don’t tread on my rights attitude of Anglo countries?
Plus the fact that the German medical system is far better (and more expensive). I live in Brandenburg and am very happy with the available treatment options. Like I said though, it’s not cheap.
So businesses in Milan and Turin never posted their important letters over the border in Switzerland then? Because obviously the postal service in the hairy latin quarter of Switzerland would be equally inefficient, and there’d be no point. Funnily enough they did though, maybe they still do.
Alternatively there isn’t really much regional variation in Swiss efficiency and the reason for the higher covid rates in South Switzerland is simple geographical proximity to the covid mother lode of Lombardy. Maybe they got infected from handling all that contaminated mail.
What exactly is this test the Germans have gotten hold of and why can’t UK get it? UK is using the PCR test acknowledged as useless to test for SARS-Cov2 by its inventor. It is known Class 5 & 6 viruses have distinct RNA genomes, but its by no means clear that SARS CoV2 has only one variant.Until this issue is addressed the UK will continue to wallow in its self sabotaging, self interest driven political point scoring whilst its people die of cancer, heart failure and a few fom SARS Cov2. This washed down with a large chaser of economic, social and mental health blight. Considering the choice of party leaders in Dec 2019 this is surely no surprise?
Looking across the entirety of national and regional policy responses worldwide, there appears to be very little consistent and sustained effect to any of it. Lockdowns (voluntary or involuntary) do work to temporarily reduce transmission of course. IMO this simply delays the buildup of immunity and is a disadvantage over the longer term.
There is a conceit that the epidemic(s) can be “managed”. Almost all of the data, however, is inconsistent with this notion. Epidemiologists experienced with respiratory pathogens like flu all knew this was not possible too.
A ratio of 6:1 in fatalities between two quite similar countries really does require explanation. I do not believe that ANY behavioral factors are remotely possible to generate such a stark difference. A difference in immunological and general metabolic health IS.
It is interesting how the apparently large majority of those in modern societies expect a solution from government and medicine and point the finger at others, rather than looking to their own endogenous resources. For viral infection especially, this is naive and ineffective.
The steep slope of risk vs. age for CoVID-19 is really remarkable, and unique as far as I know. I recently learned that the median length of time between admission to a “care” home in US (here we tend to call them “nursing” homes — same thing) is 5 mo! Average age of death from CoVid-19 is in the 80s, and deaths have been predominantly in care homes.
It should go without saying that people in care homes are near end of life. They cannot fight off infection by SARS-CoV-2, for the most part, and that has a lot to do with being already irrecoverably enfeebled.
In the US there is a “laboratory” of 50 different states. The individual states regulate medicine, care homes, and pretty much everything — not the federal gov’t. Florida, for example, has had an order of magntude lower deaths in care homes any way it might be measured (e.g. per capita), despite having one of the highest percentages of elderly in these homes in the country, in comparison to northeastern states like NY, NJ and MA which have been disasters for care home deaths and policy. Florida’s governor took the issue seriously and did something to protect care homes early on, while northeastern states generally returned still-sick CoVID-19 patients from hospitals back into care homes to infect the other residents. This all has to do with lobby groups, political corruption and bribery here in the northeast, all of which are longstanding and entrenched.
I recommend a comparative study amongst the US states in addition to those of Europe. One will have to dig deep, however, rather than reading almost any mainstream press which is simply propaganda and misinfo and politically biased nonsense. The states do report CoVID-19 data, usually with daily updates.
German doctors are very meticulous in attributing Covid deaths to people who actually died OF Covid as opposed to WITH Covid.
Two fundamental differences -in addition to the far better health services (not state run of course unlike the centralised NHS) – Much bigger land mass so lower density of population-and the NHS decanting untested carriers into care homes accounting for much of the 20,000 care home deaths. It didnt occur to German to “Save the NHS” they saved patients.
There is such a huge difference in Covid19 outcomes between someone who is frail with other ailments and someone who isn’t. You therefore need to look beyond the high level similarities at general population levels and go to the older more vulnerable parts of the population.
A big difference between Germany and UK is prior years mortality. UK mortality in 2019 was abnormally low. Germany in contrast has had heavy winter deaths in recent years.
So yes Germany looks far better April to October 2020 but how about looking across the last two years and see how the two countries compare then?
Many of the factors in the article are also relevant but it is striking that this factor was omitted. Did the author not know about it or did he choose to ignore it?
‘We should note that “lockdown” in Germany meant something very different from what it meant here: Spahn said that it was closer to a Swedish model…’
Well there you go, the Swedish model. Even better would be the Florida model. They opened up completely a few weeks, ago and had a very good record of protecting the old relative to, say, New York and New Jersey. This is probably because Florida is run by Republicans, while the Democrat-run NY was shoving people with Covid into care homes, killing 12,000 in care homes alone.
That said, we have all known for years that all arms of the British state are rotten and incompetent to the core. it’s almost as though uselessness is their mission statement.
If you judge Sweden by its own gov goals (protect the old, testing) it failed.
Its economic hit (vs. death rate) is far worst than Germany, Denmark, Norway, Finland.
There is currently one death a day in Sweden and life there is back to normal. Indeed, it never ceased to be normal for most Swedish people. Yes, they could and should have done a better job with care homes, but Sweden has been a massive success relative to the UK and most other European countries.
..
Italy and Spain got hit early (bad luck?)
if you compare Sweden to its Scandi neighbors (as it is always done about everything) Sweden has performed very poorly.
I don’t see how a “lighter” regime in UK would have delivered a lowered death rate. When it comes to economic hit I can only testify that even before the close down London was empty. Public space (Islington where i live and Mayfair where i work) was empty.
Sweden have admitted that they were too slow to react to the care homes. In addition their care home system is vastly different to their Nordic neighbours – care homes are very large and many privatised.
I wouldn´t say normal – the psychological toll is big here in Sweden too. But, yes, life goes on to a large extent as usual. And no compulsary masking! I miss the culture/sports events though.
Our difficulty came from the sheer volume of people who went on skiing holidays to Italy in February, brought the virus back with them and seeded it everywhere in the country all at once. Germans don’t go skiing in Italy as much.
Isn’t germany then an example that Focussed Protection works?? Why are the lockdown junkies saying that strategy is not possible? 95% of people dying from this is 65+. Germany managed to execute this strategy recommended by the great Barrington declaration. The other, potentially important difference overlooked by the article is death classifications. Did Germany record every death with or just from covid(or somewhere in between). Sweden’s post mortem analysis showed that only 15% of with covid actually died from covid.
I heard that the difference in numbers was because VW were in charge of the Covid-19 statistics. Was that not correct?
This is all turning into an unseemly, pointless willy waving contest when it comes to the media frenzy surrounding cases and death rates.
The, ‘which country and its government has needlessly and heartlessly killed the most number of its citizens, what demographic are they from and what can we apparently simplistically deduce from that in order to beat them over the head with it in future?’ competition.
If that’s the case, then here comes my ‘willy’ when it comes to Germany’s handling of the covid debacle in the specific examplar cited here.
Legally locking vast swathes of the seriously sick and old people, a large number of who could most kindly be described as in the very twilight of their lives, essentially against some of their wills and away from their nearest and dearest indefinitely and at great mental and emotional costs to everyone involved doesn’t seem like the most compassionate course of action to me either.
Germany spends 20% more on health. The UK only started to catch up recently. Our rising population requires infrastructure investment, Their falling population means they spend all their money on current requirements, The whole difference can be accounted for by money and the fact that Germans are customers not supplicants to their medics
Again, I live in Germany. Believe me, we are not customers in the German health service. We are also not customers of the Krankenkasse – the insurance companies who run the payment side of things. We do what we are told.
So. Why do you think you are doing so much better than the UK? Or is it merely an illusion? If you ‘do what we are told’ then could you please inform us what that is; in particular , in relation to the coronavirus.
Thanks
Their falling population means they spend all their money on current requirements,
For the last 10 years population has grown in Germany (total). Only in 2019/2020 the population has declined.
Also, you don’t just build extra capacity in 3 months.
Why? There are lots of theories on this page and I wouldn’t pretend to know better than anyone else. But no-one will know for a very long time, just the same as no-one really knows whether lockdowns work and the fact is that many scientists have very different views on their effectiveness. My favourite theories about Germany are test and trace was well implemented and that the spread was originally mainly among the young. Also, as someone said earlier, the geographic position. Fewer obese people, Germans are basically healthier, enjoying more time outdoors despite a similar climate. Others theories I have come across: less use of antibiotics in Germany for other conditions, resulting in people with better immune systems and less use of ventilators early on. I don’t know how these last two compare with the UK but we do know that worldwide, overuse of antibiotics is a big problem. Anyway, despite better numbers, Germany seems to be panicking now.
But I do agree, the extra money that Germany puts in must also be helpful in providing those extra intensive care beds.
I forgot to add, putting sick people into care homes seems also to have been a big mistake made in the UK and some other countries.
The real takeaways – A far more effective and less bureaucratic, localised National Health Service, a stronger tradition of disease control and better prepared, kept infected people as far as possible out of hospitals by treating them in GP surgeries (and no doubt better infection control in hospitals), and by far the most effective in reducing deaths – protected the vulnerable in care homes and avoided sending infected patients into them. NB their general early lockdown was soft – closer to the Swedish model (and the point about masks being effective is very flaky).
” most Covid-19 patients were not treated in hospital at all, but by community GPs. That prevented the hospitals getting overrun, and reduced hospital transmissions.” A telling statement. Our primary healthcare quickly closed down to anyone with symptoms of Coronavirus.
I’m in Berlin for a few days. Everyone (yes, everyone) is courteous and considerate. No crowds, no raucous groups in bars or restaurants, no one is loud or pushy,100% mask wearing. It’s all so much more peaceful and measured.
A sample of one, but I suspect it makes a difference. I don’t think Germans are more cautious or law abiding, they’re just, on the whole, more sensible than us Brits.
No doubt someone will have the opposite view but I felt it was worth saying.
I have been at Oktoberfest (3 times) and I can never remember drunken violence. Germans are happy drunk. If you can get that many people in UK drunk at the same place you would have fistfights everywhere. Anecdotal story I know.
YouGov polling (across countries and over time) shows 64% of Germans stating, as of early October, that they wear a face mask when in public places. The German response has been essentially static at that level since early May.
That number is lower than the latest polling figure on that question for the UK (76%). The German percent stating that they wear masks is also lower than the figure for other large European countries (France, Italy, and Spain) as well as for the U.S. Mask wearing in most of these countries heavily increased in the time period from late March to early May, with the exception of the UK (where the big increase was in July to early August). The countries I’ve listed other than the UK, however – France, Italy, Spain, and the U.S. – have consistently had greater % stating they wear masks than Germany in this YouGov polling, with mask-wearing in those other countries also increasing before Germany in March, April, and May. (Germans have worn masks more than those in the limited number of smaller European countries polled by YouGov. The four smaller countries with such polling are Denmark, Finland, Norway, and Sweden.)
It’s a somewhat similar story on “avoiding public places”, except that there the Germans even *more* consistently rank as the lowest percentage answering affirmatively, often 8th to 10th out of the countries that I’ve listed.
Perhaps Germans generally answer these questions more honestly than those in other countries, which could change the relative comparisons among these countries, but an experience of “100% mask wearing” seems to be a big outlier in Germany.
(I’ll post a link to this poll in a separate comment, but it’s probably easiest to search for it as “YouGov COVID-19 polling”. Links apparently trigger automatic moderation by Unherd and therefore sometimes never show up.)
https://today.yougov.com/to…
Germany has 25000 ITU beds!! The hospitals were empty as were Drs Practices. 420,000 medical staff were furloughed during this pandemic.Germany would normally have an influenza rate of between 7 to 25,000 deaths a year. There was 12000 influenza infections recorded but just 417 Deaths recorded.The countries ie Bayern with the hardest lockdowns had the hightest death rates.Masks and lockdownds do no good had have caused and will cause way more hardship illness and death .No lives has been saved with this rubbish.
Excellent article, but there is one additional point. Germany has a comprehensive infrastructure of diagnostic testing facilities, both independent laboratories and the “laborgemeinschaften” owned by groups of GPs. German GPs typically use diagnostic testing far more frequently than GPs in the UK, so the volume of tests is higher in normal times. German medical practice in diagnostics was supported by the German, world leading, diagnostics company Boehringer Mannheim (later acquired by Roche). So in Germany, testing for COVID was a normal familiar process, but for a new pathogen, with local sampling, local testing, and test results in less than 24 hours, not the two days plus in the ludicrous test “system” cobbled together by Matt Hancock. (Are we still counting it as a test when a sample kit is posted out?) Testing availability in Germany supports an effective tracing system – evidently far from the situation in the UK.
Can’t remember where I read this recently, but I was really quite surprised to read that the average (or maybe median ??) serum calcifediol level is well over 30ng/mL which is generally considered a minimum for adequacy of hepatic vit D stores, in Germany. That is really excellent — I had never heard of a country at such a latitude so high.
Vit D is important to maintaining efficacy of the innate immune defense called AMPs (antimicrobial peptides) in lung.
It may be the AMPs layer which is one of the “innate” factors Prof. Gupta hypothesizes as suggested by the epidemiological data patterns. This would be my #1 guess.
I wonder if anyone can tell me how the Germans have been apparently so successful in educating their populace to supplement vit D orally.
As a single case, I have a severe humoral immune deficiency (CVID, a polygenic condition) for which I produce absolutely no antibodies to protein or polysaccharide antigens, and so my B cells essentially have no function at all wrt any virus including flu.
This would put me in one of the highest-risk categories for CoVID-19. And yet I was infected early (mid Feb.) with such minor symptoms that I felt it could not be CoV at the time. I had less than a day of sore throat followed by about ten days of very mild dry cough, both of which were notable. But nothing else — no fever, no nasal congestion, etc. as always with flu, etc.
I am 62 but do supplement 5000IU of vit D daily and run 8-16 mi in woods twice weekly. I have been tested for lung function (this being the most common cause of death in CVID) and am higher than average rather than lower.
I had made a deliberate decision not to change my daily routine at all to isolate myself. My routine included spending a lot of time in the morning in a crowded restaurant drinking coffee and chatting with other regulars (dining room is now closed).
My reasoning had to do with the fact that I am so unusually susceptible to flu and yet recover without any B-cell function or antibodies, and I have thought a lot about viral immunology due to my condition. I was confident I would recover from CoV similarly as I told my brother. But I did NOT expect it to be so minor — essentially, although I had two of the classic symptoms, I was not sick.
One of the big problems with modern clinical research is the loss of most case studies in favor of biomarkers in large anonymous cohorts.
Anyway, I have had T-cell immunity (all that I can muster for almost any pathogen) since Feb. This seems to be quite adequate, and I continue to be liberal with my daily exposure to others unconstrained.
Is our multi-ethnic population partly to blame as some seem more susceptible poss as a result of social norms, rates of diabetes, obesity, vit D levels etc. Belgium, US similarly tho perhaps not northern Italy or Spain? We know BAME people had a higher death rate per capita.
During the stringent lockdown it was noticeable to me that the large groups of people congregating on Bournemouth beaches were of E European or Middle Eastern extraction, tho young so not susceptible to severe disease. Was the message getting out to migrant workers well enough? Is it harder to communicate effectively with a more diverse population, v likely. Germany is more homogenous apart from a large Turkish pop which again is homogenous.
“Then there were manual forms that were given straight to the doctor, who had to get numbers and call everyone up, find out the symptoms, get them to isolate,” says one senior German public health expert”
” also important ““ most Covid-19 patients were not treated in hospital at all, but by community GPs. That prevented the hospitals getting overrun, and reduced hospital transmissions. “
The author doesn’t seem to have noticed the big difference here: our doctors became unobtainable, as did our dentists. Theirs went on practising throughout, and obtained their own PPE too.
And Cummings did not break the guidelines or the law. Our very PC, left wing, politicised police “service” confirmed that. If they could have got him prosecuted, they would have done.
I totally agree with your points re. health serevices and totally disagree re. police.
You suggest that decentralisation in Germany was a strength. The article in the Lancet about Spain suggests that decentralisation has been a weakness of the Spanish system. It seems unlikely that both of these claims are true.
There are a number of other caveats to consider:
1. There is reason to believe that the strain of the virus in Germany is less deadly than the strain in the UK. This is because the German strain looks like it was imported directly from China and the UK strain came out of Italy where it had mutated into something that kills more people
2. The UK is now testing more people than in Germany but is not changing the death rates, so something else is going on. Testing, tracing and tracking help contain but they do not stop local spreading, which appears to be the big issue
3. The article states there were and are very sever mental health and other medial issues caused by lockdown. We still have no idea on how many deaths that will cause. When all is added together we will probably find deaths caused by the lockdowns are greater in Germany than in UK
That seems to be a very likely reason .
I have heard, although I don’t know if it is true, that there are eight forms of the virus attacking different parts of the body.
Which would tie in with a less virulent strain.
Fewer overweight and obese people in Germany, if I can rely on Google. This of course begs the question with regard to other co-morbidity stats.
Germany had five and a half times the ICU beds before the crisis started. UK had only 40% of beds per capita of population compared to 30 years ago. They had much more room to manoeuvre than we did. I am also outraged that back in 2017 Jonathan Van-Tam was appointed as Deputy Chief Medical Officer for emergency planning and pandemic preparedness, a fact which has never been identified by mainstream reporting. Without wishing to be vindictive it is puzzling how we could be so little prepared.
Tangential to the article, but the statement: “They’re the 16th richest country in the world by GDP per capita; we’re the 21st” would seem to be based on unreliable exchange-rate adjusted nominal GDP estimates. The estimates of GDP on a purchasing power parity (PPP) basis by the IMF and the World Bank generally give the same rankings of the top countries in the world, but, as one would expect, they differ more in their GDP per capita rankings. The IMF estimates for GDP per capita on a PPP basis for 2020 put Germany in 15th place and the UK in 25th place. The World Bank estimates for 2019 also put Germany in 15th place but put the UK in 24th place. Both sets of estimates put the UK further down the rankings than the exchange-rate adjusted estimates, and further behind Germany. The 2020 IMF estimates show Germany in 15th place and the UK in 21st place. Perhaps Tom was using the corresponding 2019 estimates, which I couldn’t easily find. Anyway, it’s not good practice to use exchange-rate adjusted estimates.
As American economists Michelle A. Vachris and James Thomas have written: “To accurately compare GDP data across countries, one must express the data in a common currency and value it at the same price level. These problems are similar to those encountered in comparisons of GDP across time for one country. Of course in the case of comparison across time, the data are already expressed in one national currency, but the figures must accommodate changes in the price level for the comparisons to have any meaning. Purchasing power parities are estimates derived from the relative price levels in different countries and reflect the rate at which currencies can be converted to purchase equivalent goods and services. Therefore, a PPP is the rate of currency conversion that equalizes purchasing power of different currencies and so has the dimensions of an exchange rate as well as a price index. PPPs are preferable to exchange rates for converting national expenditure data into a common currency because they also adjust for differences in price levels and reflect only differences in the volume of goods and services purchased between countries.”
Surely the Main reason is Westminster is infested with corrupt Politicians while our civil servants have been successfully infantilised by our politicians love of Brussels.
This is certainly the story the German government wants to hear (or could have released). But, honestly, I don’t buy it. It mixes a compilation of verbatim and indirect quotes taken from the official narrative with some superficial judgements that are in conflict with a considerable body of what I consider very respectable scientific evidence. I don’t think most readers here crave for such simplistic answers to complex questions. Disappointing.
“This is certainly the story the German government wants to hear (or could have released).”
Another conspiracy theory?
German gov (and the population) really “cares” what Unherd publishes.
Large testing capacity (day 1), ICU beds, etc. are not “simplistic” answers – are facts that can be easily verified.
A very narrow comparison that misses a wide picture. Death rates from around the world reveal an interesting picture: western European countries and large Latin American countries have the highest per capita death rates; Eastern European and Scandinavian countries death rates are lower (apart from Sweden’s which are nearly on a par with Italy); Africa (bar South Africa and the north coast) are low; but the best countries are the advanced Asian economies. Japan has 13 deaths per million, against Germany’s 112 and the UK c660. We should be discussing Japan, South Korea, Singapore, Hong Kong and Taiwan instead of engaging in this Eurocentric analysis.
UK is a European country not an Asian country.
In many of those countries (korea being the perfect example) the GOV has no respect about privacy and personal data.
Singapore is a semi-authoritarian city state that can do things no liberal democracy can dream of.
“but, I think most of us would agree now, they were worth it.” The writer glibly says on our behalf.
My eyebrow was raised.
If you want to know what’s been gong on in Germany take read of the book written by Karina Reiss and Sucharit Bhakdi, both eminent German scientists. Translated into English.
Corona, False Alarm?: Facts and Figures
The U.K. failures are directly attributable to PHE, department of health, Sage. All pathetic and should be disbanded.
Another factor regarding the death toll – deaths here were recorded as due to Covid even if the crucial factor was an underlying cause, as opposed to the German system where a death – even if Covid was a side factor was recorded as due to the main cause. I know of two cases where Covid was stated on the death certificate because it was ‘easier’ when the actual cause of death was unrelated to Covid. Also there is a vast difference between the German character and the British – being methodical and obeying instruction is part of German DNA – in total contrast to the British, many of whom hold guidance and rules in contempt. I wonder how many mass gatherings and protest meetings with no masks or social distancing have been allowed in Germany?
There were in fact a series of protests against the whole Covid bureaucracy in Berlin and elsewhere during the summer.
Germany has become over the last few decades one of the most efficient, resourceful and well organised countries in Europe, while Britain has become increasingly something of a basket case. What makes matters worse in that Britain today has delusions of superiority which hark to its days of empire when it was a back when it had more red blobs on the map of the world) and is unable or unwilling to take a cool hard look at itself in these present times. Britain imagines it is making progress by analysing and debating everyting to distraction, may well be a displacement activity to avoid making decisions. It is not just coronavirus that afflicts Britain but the virus of the Peter Principle (idiots rising to the top), which mutates into Parkinson’s Law (bloated bureacracy, data pollution, endless debate), which mutates into Heath Robinson solutions (botch-ups), which mutates into Murphy’s Law (inevitable dramatic failures). I see little or no evidence of Germany sharing those characteristics.
I fear this article is already out of date. The imbalance in the first wave appears not to be repeated in the second (or is it already the third?). According to WHO figures the current rate of new cases is about the same in Germany as here but their death rate exceeds ours and is still rising. No information about age distribution or other circumstances but maybe the data exist somewhere. The virus seems to respond very non-linearly to circumstances, or opportunities offered by people’s behaviour – after all it is people that carry and transmit it. I would like to think there must be a crucial insight just around the corner, but after nearly a year hope wears thin. It’s like being in a ship where some kind of ‘demon’ has interposed itself between helm and throttles and the engines and steering. Every time the captain and crew think it’s answering, it may be no more than coincidence.
I’m afraid this is a case of the author seeing what he wants to see.
There are only two fundamental differences I’m aware of, between Germany and UK, which will lead to a different overall outcome in terms of deaths:
– Germany does better testing, with repeat tests of +ve results, to avoid the ridiculous overcounting of false positive deaths we get in the UK (estimated at 50-70 per week in UK care homes and hospitals alone https://lockdownsceptics.or… )
– better initial management of care home residents, not booting them out of hospitals and back into their care homes where they were clearly likely to cause real outbreaks and deaths.
Other than the above, the claims about better test and trace, treatment by community docs etc, will have made hardly any difference. There is no reason to assume that overall actual covid deaths will be any different (though UK false positives deaths will be impressively high).
No need to speculate. The results of the multi-country multivariate academic analyses are in:
“Increasing COVID-19 caseloads were associated with countries with higher obesity, median population age and longer time to border closures from the first reported case.
Increased mortality per million was significantly associated with higher obesity prevalence and per capita GDP.
Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns and reduced country vulnerability to biological threats were significantly associated with increased patient recovery rates.”
https://www.thelancet.com/j…
The German Landers system is historic and has been in place as an evolving form of Federalism for well over a hundred years.
https://en.m.wikipedia.org/…
This gives Germany many well defined resilience characteristics, polycentrism being one.
https://www.stockholmresili…
Fiscally Germany has been running a surplus for many years, an advantage that it has gained through structural advantages afforded by the eurozone which enables its export industries.
Lastly, Germany has a societal health ethic whereby people will self isolate if feeling sick, including with the cold and flu. Unlike here where we trot off to work no matter how bad we feel.
The new tier system obviously seeks to mimic the Landers system but of course there is more Federalism and decentralisation to do.
We seem to have unsuccessfully set up a parallel, outsourced system and bypassed GPs as well as local public health services.
So while our hospitals have made good progress in handling the disease once a patient is admitted, we have made little or no progress in managing its spread in the community.
Another way to look at it is in terms of case fatality rate – which is not what this article describes. UK has roughly 2x the CFR compare with Germany (and USA).
Tom! You may have solved the mystery!
That bit about Germany doing a much better job than Spain and Italy (and likely, Magna Brittania) at protecting “vulnerable communities” may balance the balance sheet. You report that 19% of cases were among folks 70 and older in Germany. You report that the figure in Italy is 39%. So, a 20% differential. Perhaps that 20% differential accounts for most of the difference in per capita fatalities.
If you are sitting on top of the numbers, can you sort out whether or not that differential solves the mystery?
Many thanks from your loyal reader Chauncey Gardiner. All will be well in the garden.
The entire article is nothing but conjecture. It is less than useless. Shouldn’t everybody in Belarus be dead by now? Lol. https://www.rt.com/op-ed/50…
I don’t understand this article’s main focus. If it is about a comparison between the two countries then I think that’s rather a broad topic but if it is about the healthcare system and taking into consideration the health of the whole population then that would make sense. Healthy behaviour and common sense will perhaps matter more than anything else in this second wave of rising numbers . Hopefully the science and the world are much wiser now than 8 months ago. As a healthcare professional I can only say that the NHS may even do much better if it was not starved by chronic underfunding. A piece of advice to our politicians- LISTEN TO THE SCIENCTIFIC EVIDENCE AND DON’T MESS IT UP AGAIN.
None of these explanations account for a six-fold differential. As others have mentioned, deaths per million are far more likely related to the ‘dry tinder’ per million.
Their death rate isn’t massively lower and Germany’s track and trace isn’t an unqualified success. The ratio of their June minimum 7 day rolling average to their current new cases per day RA is 26.15. Ours is 33.45; and our June minimum was more likely than theirs to be an underestimate. Our current RA of deaths is 135. Our RA new cases a day 25 days ago was 5709: a ratio of 0.0236. Their ratio is 31:1780, or 0.0174. Lower, but not massively. They aren’t quite as fat and they eat better.
A nation that managed to exterminate upwards of six million undesirables, under wartime conditions is hardly likely to find dealing with C-19 a major problem.
That’s a very despicable comment both anti semitic and anti German. The 6 million were European Jews not undesirable as you callously state. Secondly modern day Covid-19 German containment policies have nothing to do with the National Socialist policies of ethnic genocide carried out 75 years ago. Only a narrow minded bigot would post such a comment.
It is a fact that the Jews were considered undesirable by the Nazis. It is also a fact that the Germans are remarkably efficient and effective – hence their superb engineering industries. I’m less sure about their sense of humour.
Tut tut Herr Verner, you can do better than that?
Bi*ches are gonna bi*ch!
The truth always hurts.
No, is just bi*ching.