How exemplary a covid-19 patient is Germany (now)? (Version 0.9)
There was a time — around the time when cases soared and spun out of control during the first wave in Italy, Spain, and neighboring Belgium and France, for example — when Germany was celebrated for its ability to keep the pandemic under control, meaning that hospitals were nowhere near capacity and that deaths per million were a fraction of most other European countries including Sweden but excluding countries such as Denmark, Norway, Austria, and Czechia.
As recent as August 21, Germany had place of prominence, next to Vietnam and South Korea, in the OurWorldInData series, Exemplars in Global Health: Learning from the most successful countries in the world. The success of what was considered as late as early October a gold-standard country was attributed, by admittedly partisan writers, to its “strong enabling environment”.
As recent as late September, Germany’s most prominent epidemiologist/virologist (and prominent advisor to the government), Christian Drosten was hopeful that this enabling environment in Germany would allow for the virus to be managed successfully and without a devastating second wave.
Indeed, several large-scale eruptions, including (in)famously an outbreak involving more than 1,000 workers in a meat-processing plants near Bielefeld were brought under control relatively quickly through tracing and quarantining and testing that seemed up to snuff.
Not any longer. With about 3 out of 4 new infections not longer traceable to known cases, and new cases for this past weekend predicted to hit four times the highest numbers from the first wave (5k vs 20 k), last week Merkel and the premiers of the 16 German states that constitute the federal state — a national cabinet similar to the key decision-making group in Australia — agreed, in an attempt to once again bend the wave, on yet another partial shutdown in the hope to be able to relax restrictions well before Christmas.
Starting November 2, the restrictions for the remainder of the month will include closed restaurants and bars, except for take-away, closed theaters, cinemas, public recreation centers of various kinds, and cancelled large events (including amateur sports events, with professional soccer allowed to continue without spectators watching live), suggestions to forgo unnecessary travel and to work from home where possible, with business trips allowed but overnight stays in hotels for tourist purposes banned.
However, schools and kindergartens will remain open, church services and protests will be allowed due to constitutional concerns (courts having already intervened in earlier attempts to outlaw protest), nursing home residents will be allowed to receive visitors, and shops will remain open, with one customer allowed per 10 square meters. Importantly, borders remain open.
There is guarded optimism, and certainly considerable evidence, that these measures will allow to bend the curve before the end of the month to a level where tracing efforts are again on top of things, as they have been since the loosening of restrictions in May.
The situation is volatile though. As also in Australia, state premiers — and Merkel — have learned that fighting covid-19 can be good for approval ratings (and apparently even for re-election campaigns). Also as in Australia, questions have increasingly been asked about the legitimacy of the measures that have been implemented and the decision process that led to these decisions. Recent debates in the national parliament have made it clear that parties not represented in the national cabinet are not willing to accept the current state of affair, and their own marginalization, much longer. Indeed, protests against various restrictions have become something of a regular event in most parts of Germany, with courts having shot down attempts to outlaw protests.
It also became quickly clear that the alleged consensus of the national cabinet making the decisions was not quite as unanimous as initially announced. Specifically the premier of Thuringia, Bodo Ramelow — the only premier from Germany’s leftist party Die Linke (The Left), made it clear that he would implement the restrictions only if the Thuringia state parliament would support them. Given the much lower infection numbers in the east of Germany, that seems a sensible stand.
What Germany has going for it is, quite sensibly given its location at the center of Europe, that it never went for an unsustainable eradication strategy and that its suppression strategy tried to trade-off sensibly, lives today with lives and livelihoods in the future. It had specifically not to deal with very vocal academics that denied that there were trade-offs. And in Merkel it had a leader that the majority of citizens trust to various degrees, her scientific background having come in handy especially early in the pandemic. It also seems fair to say that the enabling environment was indeed reasonably well-established and that in particular testing and processing of tests were ramped up quickly.
This enabling environment, and the — as of yet — relatively calm public debate, certainly by Australian standards, about the best approach makes it likely that relative to countries such as France, Belgium, Spain, Italy, and England/the UK Germany will do o.k.. It also makes it likely that Germany, in terms of deaths per million will continue to report a fraction of deaths of those countries forward going although calling it an exemplar on par with Taiwan, South Korea, Vietnam, or Japan is clearly no longer justified.
Germany, has become — as have also it neighbors Austria and in particular Czechia — , a victim of its initial success in dealing with the virus. All of which goes to show that containing the virus is not just about epidemiology but at least as importantly about the psychological and behavioral implications (“prevention paradox”) of movement restrictions.
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Comments on this version very welcome.
Brief update about three weeks after the partial lockdown (on November 22):
Worldometer’s seven-day-moving average suggests that Germany has managed to bend the curve just below 20k new cases a day. (It’s been there for several days now.)
Number of deaths, lagging as it is, is still increasing sharply but should level off next week, maybe just in time for the health system being able to manage.
It seems to hit its limits in some areas: https://edition.cnn.com/2020/11/21/europe/germany-icu-beds-covid-intl/index.html
Update November 28: As it is, the curve has been bent and for the last couple of weeks the number of new cases has kept steady at under 20,000 a day, the effective reproduction rate fluctuating around 1. (The number of deaths keeps climbing though and the 7-day moving average is now above the max of the first wave in mid-April. The health system seems to manage so far.)
The hope was, of course, that the restrictions imposed in early November would drive the reproduction rate clearly under 1. That has not happened, partially because there has been considerable resistance to the restrictions, some of it quite pathetic. Hence Merkel and the premiers have hence decided to extend the partial lockdown (restaurants and bars closed, no private hotel stays, etc.) through December 20. In fact, they have attempted to tighten the restrictions: Private gatherings with friends and families were to be restricted to maximally five people from one’s own and one other household. The hope was that these added restrictions would reduce the effective reproduction rate to 0.7 and bring Germany back, in time for the Christmas holidays, to around 5,000 new cases a day which is considered manageable.
Several states have made it clear already that they will not implement some such tightening of restrictions (and in fact want to losen the restrictions that are in place). If you look at the heatmap, since the reproduction rate is quite low in parts of the country (e.g,, the north and northeast), that refusal is quite understandable.
Update December 9: The numbers have not gone down since the curve got bent. In fact, they are creeping up ever so slightly albeit regionally quite differently with hot zones along the borders to Czechia (no surprise there) and Austria and stretching through much of Bavaria. In contrast, on the coasts in the north infection numbers are rather low. Merkel, and her advisors, seem concerned about the numbers and ponder further action. As does a group of well-known scientists (from epidemiology, medicine, pschology, public health, etc., with economists unfortunately mostly excluded) who advocate a harder lockdown.
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