James Melville contrasts and compares Britain to the fast testing and community outreach approach of its European neighbour.
Erst denken, dann handeln. – First think, then act.
Although taking action is important, it is of equal importance to take the right action. Determining which one that is requires some deliberate thinking. This proverb reminds us to set the right priorities and make decisions about what we want instead of blindly rushing into the wrong response.
This old German proverb is proving to be particularly apt during the Coronavirus crisis.
The UK government’s Chief Medical Officer, Professor Chris Whitty told the daily government press briefing on Tuesday: “We all know that Germany got ahead in terms of its ability to do testing for the virus, and there’s a lot to learn from that.”
It’s not just about the testing programme, from start to finish, Germany has been ahead of the curve compared to the UK in their strategic approach to the Coronavirus crisis and this is shown in the huge difference of deaths between the two countries.
COMPARE AND CONTRAST AS OF 9 APRIL, 2020
- UK total deaths = 7,097
- Germany total deaths = 2,349
- UK death rate % v total population = 0.01%
- Germany death rate % v total population = 0.003%.
There are a number of tangible reasons why Germany is limiting the mortality rates better than the UK. It’s a mixture of due diligence, proactive delivery and learning from the successes and weakness from the earlier COVID-19 patterns in South East Asia.
A major reason for the relatively low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms – which in turn, increases the number of known cases, but not the overall percentage number of fatalities. More tests automatically lowers the percentage death rate – simply because more people are sampled and confirmed as having the disease versus deaths.
By the time Germany recorded its first case of COVID-19 in February, laboratories across the country had already built up a stock of test kits because of the earlier initial spread of the disease in China. Now, Germany is conducting around 500,000 coronavirus tests a week, far more than any other European country. Early and widespread testing and tracing has allowed Germany to slow the spread of the pandemic by isolating known cases and also from contact tracing of new cases while they are infectious.
This mass testing programme increases the range of early diagnosis and can treat patients early before they deteriorate, therefore reducing the risk of intensive care over demand.
It’s not just testing for COVID-19, it’s also about applying testing to ascertain who has already has the virus. At the end of April, Germany health authorities plan to roll out large-scale antibody studies, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.
In many countries, including the UK, testing is largely limited to the critically ill patients, but wilfully ignoring the benefits of mass testing to identify milder cases – to prevent them from unwittingly spreading the virus. Germany quickly learned and shaped their approach to mass testing and tracking by adopting the strategy that has proved so successful in South Korea where they limited the spread of the virus early on by adopting a huge testing and tracking programme.
But there are also other significant other factors that have kept the number of deaths in Germany relatively low. Germany, compared to any other European nation, has a larger supply of intensive care beds. Germany has more ICU beds per capita than any other country in Europe. Right across Germany, hospitals have expanded their intensive care capacities. And they started from a high level.
According to figures from the Organisation for Economic Co-operation and Development (OECD), Germany now has 34 ICU beds per 100,000 people (an increase from 29% at the start of the pandemic). The UK has just 6.6 ICU beds per 100,000 people. Italy has 12.5 and France has 9.7.
Another reason why Germany has managed to limit the mortality rates is because of huge coordinated community engagement and outreach programme that helps to limit the spread of the disease within the cases of early mild and moderate symptoms. Germany set up a programme of ‘corona taxis’ – where doctors outfitted in protective gear, travel around their local communities to check on patients who are at home, a week into being sick with the coronavirus.
They take a blood test from the patient, looking for signs that the patient is about to go into symptom decline. They then often suggest early hospitalisation, or offer medication to patients who have mild or moderate symptoms; therefore increasing the likelihood of minimising patient deterioration in the earlier stages of symptoms and improving the chances of surviving before any rapid infection decline by being in a hospital when symptoms begin.
Compare and contrast Germany’s holistic approach to curbing the virus with the UK. From the first UK case on 31 January to 23 March lockdown, there were no social distancing measures as sporting events, concerts, pubs, restaurants and travel were all still open for mass social gatherings. The UK also failed to implement any form of mass testing and tracing and many NHS staff were not fully equipped with protective equipment. The outcome? The UK now has a steeper Coronavirus death rate curve than Italy. The UK is now on the steepest mortality trajectory in Europe.
Germany, like many things in life have been proactive in dealing with the Coronavirus. Their mantra of “first think, then act” has been actively applied to their approach in dealing with the Coronavirus. Tragically, it hasn’t been applied by the UK government.