Germany’s testing success looks real — for now
But statistics that show how many days one country is behind another are humbug
Germany has one of the best healthcare systems in the world — so good that some expats abroad fly home when they get sick.
There is no doubt that the Germans got one big thing right during the early stages of the Covid-19 crisis: they tested, tested and tested again. By doing so, they managed to prevent their own crisis hotspot, the district of Heinsberg to the west of Cologne near the Dutch border, from turning into another Bergamo.
Germany is now conducting Covid-19 tests at a rate of 350,000 a week, having tested close to 1m out of a population of 80m so far. The numbers of tests that have been carried out in France, for example, are only a tenth of that.
But it would be a mistake to conclude from the recorded number of infections that Germany has the virus under control when others do not. Or that Germans are less prone to die from the disease. Its low recorded mortality rate — 15 per 1m people, lower than most of Europe — is influenced by its sheer number of tests. If you test 10 times more people, you will catch many with mild symptoms, or none. Your recorded mortality rate will be lower compared to countries that do not test as much.
In Germany, the virus did not spread from the young to the old as quickly as happened in Italy. My own experience from having lived in Italy is that older Italians are more integrated into their communities than older Germans, most of whom live away from their families, often in care homes. The virus took a while to spread in Germany, but this is now starting to happen too.
Nor can we conclude from the data that Germany is on a different trajectory than other countries. All we know is that it did a good job getting ready. In particular, Germany started the lockdown well before mortality rates shot up. Schools have been transformed into makeshift hospitals for the avalanche of cases they are expecting this month.
Germany also has more critical care units and ventilators than other European countries. I would expect it to be better at maintaining a functioning health system for non-Covid-19-related illnesses and emergencies at the same time. But German doctors are no better at treating the disease than doctors elsewhere and German healthcare workers, too, suffer from a shortage of masks.
A study on the 2009 swine flu epidemic found that real-time mortality estimates were all over the place. It concluded that we still lack agreed methods to measure mortality rates. Given different rates of testing and inconsistent ways of measuring fatalities across countries, we should avoid real-time cross-country comparisons. Statistics purporting to tell us how many days one country is behind another are humbug.
Lothar Wieler, president of the Robert Koch Institute in Berlin, the federal government’s health agency, has said the true mortality rate in Germany is probably higher than the officially recorded number. He reported on some tentative evidence that the number of new infections might be slowing down, but said it was too early to make firm conclusions.
It is possible, but yet to be proved, that Germany has managed to control the spread of the virus better than others through its policy of mass testing. But I would be very surprised if the final German mortality rate turns out to be different from others’. Germany has so far reported a third of France’s absolute level of deaths, despite a bigger population. Yet since the virus affects the old more than the young, one would expect Germany’s eventual mortality rate to be higher than in France, which has a younger population. If this turns out not to be the case, it will either be due to the quality of emergency care or to factors we may not yet fully understand.
In the meantime, be wary of forecasts. Statistics is one of the most potent tools mathematics has made available to other sciences. But like any power tool, it can cause havoc in the wrong hands. We should rely on experts, but the experts in question are not economists and armchair virologists. They are bio-statisticians who understand not only the statistical methods but also the many subtleties behind the data.
Anyone prone to drawing big conclusions from popular online virus data trackers should heed Robert Grant, a British medical statistician who tweeted last week: “I’ve studied this stuff at university, done data analysis for decades, written several NHS guidelines (including one for an infectious disease), and taught it to health professionals. That’s why you don’t see me making any coronavirus forecasts.”
In that spirit, we should take note of the German statistics and resign ourselves to the realisation that their main usefulness at this point is to raise questions, rather than provide answers.