On February 27, with a total of 26 confirmed cases, the government set up an inter-ministerial national crisis management group. RKI began issuing daily situation reports for the national and international public health sector on January 23. 10 Risk assessments and technical guidelines for testing, case finding, contact tracing, hygiene, and disease management, as well as various other documents, were made available on January 16. By then, Germany’s public health infrastructure had already mobilized against the disease. The first case in Germany was reported on January 27, 2020, in Bavaria. For example, life expectancy at birth grew from 75 years in 1990 to 81 years in 2018, 8 and the maternal mortality ratio also decreased from 11 deaths per 100,000 live births in 1990 to 7 in 2017. The user-friendliness of the health care system and its ample human resources and physical infrastructure have led to exceptional and continuously improving health indicators. 6 In a Commonwealth Fund survey, Germany has the shortest wait times for both consultations with specialists and elective surgeries. Health insurance is mandatory for all citizens and permanent residents of Germany, with approximately 90 percent of the population covered through nonprofit nongovernmental insurance funds and around 10 percent of the population covered through private insurance. Germany has traditionally held the most restriction-free and consumer-oriented health care system in Europe. 4 As of 2017, it also ranked among the top five countries in the EU for the number of nurses (13.2) and physicians (4.2) per 1,000 people. In the European Union (EU), Germany has the most hospital beds per 1,000 people (8.3) 3 and a robust sector of private and public laboratories, among which nearly 200 have the capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. 1, 2 As a result, the capacity of Germany’s health care system is considered to be very high. Germany has the fourth largest economy in the world and spends approximately 11 percent of its gross domestic product on health care, with US$5,119 spent per capita per year. In the second surge, it has become clear that ICU capacity is lower than initial estimates, because there is a shortage of trained staff to care for the patients in all available beds. Treat: With a large number of hospital beds and careful planning, Germany’s intensive care units (ICUs) were not overly stressed in the first surge, although health care workers had to contend with shortages of personal protective equipment (PPE). In the second surge, however, the country was not able to replicate this success. The relatively low rate of infection among Germany’s population over age 70 was probably one driver of its relatively low case fatality rate in the first surge. Later, Germany became a pioneer in polymerase chain reaction (PCR) testing, which continues to feature prominently in the national strategy.Ĭontain: For a time, Germany maintained relatively limited transmission in long-term care facilities, which kept deaths down, because older people are more likely than younger people to die from the virus. RKI and scientists at other institutions mobilized in early January 2020 to launch a national crisis management effort to understand the epidemiology of the pandemic.ĭetect: One of the first diagnostic tests for COVID-19 was developed at Berlin’s Charité hospital, and the government worked to mobilize the country’s public and private laboratories to rapidly scale up testing capacity. Prevent: Local health authorities, the Robert Koch Institute (RKI)-Germany’s public health institute-and other scientific institutions produce data and analysis to inform Germany’s response. With the surge, however, the disease began to spread among older people, and hospital capacity has been stretched. Germany’s prevention protocols facilitated the country’s rapid response to the outbreak, with the early development of testing capacity and high levels of testing, an effective containment strategy among older people, and efficient use of ample hospital capacity. The country’s strong enabling environment, including a good public health care system and expert scientific institutions, contributed to the early success. However, starting in October 2020, the country experienced a major surge in cases and deaths that has yet to be brought under control as of January 2021. Throughout the COVID-19 pandemic, Germany has demonstrated elements of success across the four phases of our preparedness and response framework: prevent, detect, contain, and treat.
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