How Germany was able to flatten the curve

When Germany’s federal minister of health appeared on major US television channels twice last week, one local media outlet went so far as to describe Jens Spahn as a ‘star’.

It’s all about testing and tracking contacts whenever an infection is suspected, a smug Spahn explained the secret of Germany’s success in the country’s fight against Covid-19 to eager Americans. Germany still has a relatively low mortality rate – around 3% – and the country’s hospitals are coping well. The virus can be controlled, Spahn told local journalists just a day later, at the regular Berlin press conference about the pandemic’s progress.

Around the same time, also last week, one 36-year-old Berlin local was listening to Spahn anxiously. She had lost her sense of smell and taste, was exhausted and her throat tickled with a dry cough – all symptoms of a potential Covid-19 infection. A work colleague had recently been hospitalised with the virus. The Berliner, who works as an art gallery assistant, wasn’t feeling debilitatingly sick but she did feel a sense of social responsibility, so made her way to a public health clinic to get tested. There was nobody else there at all, she reported afterwards, and she went straight through to see a doctor.

‘About 90% of people don’t show any symptoms at all,’ the doctor told her. ‘But you don’t seem very sick. A lot of the people who come here are really sick. And these tests are expensive, you know. You might have something. You probably do. But you should probably go and see your GP.’ She left, and only realised afterwards that the clinician had not even bothered to take her temperature.

It was strange, the wannabe patient conceded later, because it was almost the exact opposite of what all the politicians say is happening. She has since started to feel better but has no idea at all whether she was infected, or if she infected others. Certainly, nobody traced her contacts. And hers is not the only such story.

From the very start of the pandemic up until now, Germans have taken to social media to express confusion and anger at the disconnect between what they are being told was happening, and what actually seems to be. That includes testing appointments that were never kept, coronavirus hotlines nobody could get through on (the line busy for hours), infection data being processed too slowly (and sent by fax), contacts that were never traced and family doctors who told patients, ‘I’m just as puzzled as you. We get different information every day’.

In fact, in the domestic press, Germany’s would-be hero health minister has been criticised for not taking the virus seriously enough early on, for the testing chaos, for not distributing protective equipment to medical staff quickly enough and for an inability to make a definitive decision about face masks, among other things. As several commentators have said, much of the ‘Germany is so good’ commentary is political, likely based on the ‘US/UK is so bad’ dichotomy. But if overseas impressions of this country’s clever leadership, relentless testing and obedient, social-distancing citizenry are incorrect, then why is the country doing so well?

Covid-19 is stress-testing every nation’s pre-existing conditions – social, economic and cultural fractures that were there long before the zoonotic virus even left the animal world. Factors such as different healthcare models, income inequality, populist and political divisions, demography and cultural traditions all play a part in how the pandemic is being handled and how locals react. For example, Germany’s health care model is universal and de-centralised but has also often been described as inefficient, with a surfeit of capacity and a deficit of personnel.

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Health insurance is compulsory and on average, Germans pay around 14.6% of their monthly salary towards it. Over the years, this has seen the health system bloat and increasingly driven by profit; it has regularly been criticised for conducting unnecessary procedures and underwriting too many prescriptions. On the other hand, this has also meant that Germany was over-prepared for this pandemic, with around 29 intensive care beds per head of population, the most in Europe, and much capacity for testing – up to around 650,000 tests a week, at last count.

France, Spain and Italy have less than half the number of critical care beds and the European average is thought to be around 11.5 beds. In fact, last week, there were still 150,000 empty hospital beds and around 13,000 vacant critical care beds . Local doctors have started complaining that patients who need care for other health issues are simply not showing up.

And then there’s German finance ministers’ years-long adherence to austerity, in the interests of minimising of public debt. In the context of European unity, Germany has been roundly criticised for that. But years of fiscal conservatism also meant that Europe’s largest economy had financial room to move on a new national budget to cope with Covid-19.

With a 1.2 trillion-euro rescue package, the IMF says Germany is one of the world’s biggest spenders on Covid-19. And it only had to borrow around 156 billion euros, selling government bonds, to do so. The two most recent finance ministers – Wolfgang Schäuble and Olaf Scholz – are having something of a ‘told you so’ moment.

What has been most controversial in Germany, as elsewhere, is the question of when to end the lockdown, and how much economic growth (and how many senior citizens) to sacrifice. Germany’s prosperity – and its generous social welfare and health system – depends on exports, manufacturing and ongoing growth.

The debate was characterised by bickering between two senior politicians from Angela Merkel’s ruling Christian Democratic, or CDU, party last week. They were arguing about the newly created rule on easing the lockdown, that says only shops up to 800 square meters may re-open this week. According to observers, German economy minister, Peter Altmaier, was opposed to letting larger stores open. That would be equivalent to opening inner cities up again and risking a rise in infections, he argued. ‘With all respect, Peter,’ countered his colleague and North Rhine Westphalia’s state premier, Armin Laschet. ‘If we don’t let them open, maybe we won’t have those kinds of stores anymore.’

Despite those little tiffs, and despite rising populist sentiment on the far-right, German society is far from divided. There’s no Brexit, no Fox News and no longer any truly divisive topic to spark a rancourous ‘culture war’, now that the refugee issue has faded into the background somewhat.

Most Germans still like Angela Merkel, a constant at the top for 15 years. Her popularity has risen along with Covid-19 infections, with around 80% of Germans now saying she’s doing a good job. And Merkel was admired by voters anyway – even five weeks ago, 68% of voters thought she was doing well. Merkel’s party, the CDU, is also feeling the love. On April 19, the national weekly survey of voters had the CDU at 39%, its best result in around four years, while the far-right contrarians in the Alternative for Germany party lost points.

There’s no doubt, Merkel – who’s often fondly described as the mother, or Mutti, of the nation – has been a calm, consensus-building, technocratic leader with a clear message. But whether she, and Germany, deserve as much credit as the international community is giving them is another question. Christian Odendahl, chief economist at the Centre for European Reform in Berlin, put it like this: The ‘Anglo-Saxon idolising of Merkel is a bit pathetic, but understandable,’ Odendahl’s scathing comment on Twitter went: ‘The political leadership of both the US and the UK is a parody, and so you are naturally drawn to the polar opposite – which is Merkel.’

In fact, thanks to German laws on infectious diseases, the federal government – that is Merkel and her ministers – can only give advice about what should be done. Each of the country’s 16 states makes their own decisions, the argument being that a local authority is best equipped to judge what’s happening at home. At the beginning of the crisis, this sort of federalism was seen as a handicap, preventing a unified national response. Five weeks later, decentralised decision-making is being lauded as an asset.

As a result of the federal system, there’s been some disparity between Germany’s states as to how strict lockdown measures should be. A ban on gatherings of more than two people, as recommended by Berlin, was widely implemented. But Germany’s lockdown has actually never been as tough as those in other European countries. While schools and non-essential shops were closed, hardware stores stayed open, construction workers carried on and people could leave their homes without permission slips. You were even allowed to travel around the country if your mission was work-related. Google mobility tracking, which uses anonymous phone location tracking, shows that the Germans didn’t stay at home as much as other Europeans either.

There was no change in how much they went to supermarkets and pharmacies. That’s compared to France and Italy, where there was 40% and 42% less movement to grocery stores respectively. In terms of parks, beaches and recreational areas, 35% more Germans went to these places. That’s in stark opposition to France and Italy, where there was a 74% and 83% decrease in people going to parks, respectively.

Police and other municipal officials have been more visible on Berlin and other city streets. But up until this weekend, when some Berliners mistook the easing of the lockdown as permission to party, most infringements in the German capital apparently involved stores or bars opening illegally. Given that Berlin has almost four million inhabitants, a total of 2,048 coronavirus-related misdemeanours and 1,136 crimes since mid-March, constitutes a fairly low rate of offending.

It’s hard to know exactly what that means. Germany’s government trusted its citizens to behave well and didn’t institute strict measures. Police reports suggest they did behave, while Google’s mobility reports insinuate they didn’t stay at home quite as much as they possibly should have. Maybe Germans were busy social distancing in parks. Maybe they weren’t.

All of which brings us to the final, and possibly even most important factor in Germany’s much praised pandemic progress: Plain, dumb luck.

Italy was the first European country to see exponential contagion, resulting in overcrowded hospitals and tens of thousands of deaths. The country was an estimated three to four weeks further ahead in infections than other EU members, which gave other nations, including Germany, more time to prepare. Additionally, the first Germans to be infected were far younger on average, around 40 years old at first, than other countries. Simply put, Germany got lucky.

And instead of congratulating ourselves on how clever and well organised we are, we should realise that, the German chancellor and various experts seemed to be saying this week, as the country prepared to ease its lockdown and start opening businesses.

‘I have the impression that since last Wednesday, there’s been a discussion that insinuates a sense of security, that is not accurate today,’ Merkel told local media, before coining a charming new German word, ‘oeffnungsdiskussionsorgien’, or an orgy of discussion about opening up. ‘It would be a shame if we walked into a relapse, with our eyes open,’ she concluded, a reminder that, as with all good fortune, it rather depends on what you do with it.