German coronavirus response rests on early testing and long-term investment

Normally, Berlin’s trade fairground buzzes all year round with food shows, tech conventions and industry gatherings. For April 25th, chancellor Angela Merkel’s ruling Christian Democratic Union (CDU) had booked a hall here to choose a new party leader.

No more: for the first time in the fairground’s history, its entire calendar for April is empty.

Not that the trade fair, on the western fringes of Berlin’s city centre, is a ghost town. On Monday workers began converting Hall 26 into a field hospital with 1,000 beds. Medical equipment and up to 600 staff will follow later in the week in the Berlin city-state government’s latest response to the growing coronavirus crisis.

“With this, Berlin will be a lot better prepared,” said Albrecht Broemme, a former fire service chief back from retirement to oversee the project logistics.

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According to daily figures released on Monday, nearly 57,300 people in Germany are confirmed as infected, up nearly 5,000 from Sunday, giving an infection rate of 69 per 100,000 of the population. The death toll so far, 455, is well below international averages though epidemiologists here insist serious calculations can only be made at the end of a pandemic.

They believe luck has played a part in Germany’s relatively low fatality rate to date. Until now the largest groups affected in Germany have been from the 15-34 and 35-59 age cohorts, people with more robust immune systems. But that could change: over the weekend, some 27 people died in two retirement homes, with many more residents now infected.

German approach

So what, if anything, is Germany doing different in the Covid-19 crisis? Like almost all other countries, Germany is in lockdown. There is no “cocooning” for the over-70s or 2km movement radius, as in Ireland; exercise and walking outdoors is permitted – individually and in twos – and police are patrolling streets and parks to enforce social distancing. All retail is closed besides food stores and pharmacies.

Drive-through test centres are now operational in all cities, including at the trade fairs in Berlin and Hanover and Munich’s sprawling Theresienweise – site of the famous Oktoberfest.

Where Germany differs from many other countries, though, is widespread, early testing and isolation measures by its 16 federal states. Their far-reaching health competences allows states to implement measures best suited to their local situation, without waiting for permission from the Merkel administration in Berlin.

Most states began testing as early as January and, in this country of 82 million, some 200,000 tests are now being carried out weekly. By the end of April, officials expect this to increase to 250,000 a day.

As one official put it: the plan is to get beyond testing to confirm the current situation and to expand testing “to get head of the current situation”.

The current testing regime is open to people who meet two criteria: symptoms such as a temperature or dry cough, as well as contact within the last two weeks with a confirmed coronavirus case. If local test capacities allow it, local health authorities may also conduct tests among people in risk groups with symptoms.

Health service

Beyond testing, Germany has a well-funded health system, paid for by monthly contributions of just over 7 per cent from each employee’s earnings, a premium employers are obliged to match.

Germany’s federal statistics office says the country has 28,000 intensive care beds, or 34 per 100,000 people, one of the highest in the world.

A study for the World Health Organisation in 2015 showed that Germany had 621 critical care beds per 100,000 of population, compared to 275 in Italy and 240 in Ireland.

Already Germany has plans to double its intensive care bed capacity, as part of a €156 billion emergency budget passed last week. As in other countries, however, healthcare worker groups say a greater concern will be finding enough qualified – and healthy – staff.

A federal government paper sees, as a worst-case scenario, up to 70 per cent of the population being infected with Covid-19 but intensive care capacity for only 20 per cent of those presenting at hospitals, which could see the mortality rate top one million.

“To mobilise society’s forbearance,” one government strategy paper says, “keeping quiet about the worst case is not an option.”

Germany’s economic “wise men” on Monday published an emergency study that presents economic contraction scenarios of between 2.8 and 4.5 per cent this year for Europe’s largest economy.