Success:
" A 22-year-old man who had no symptoms but
whose employer — a school — had asked him to take a test after learning
that he had taken part in a carnival event where someone else had
tested positive.
In most countries,
including the United States, testing is largely limited to the sickest
patients, so the man probably would have been refused a test."
WHO does not recommend testing. Only those with symptoms, and even Malaysian official policy is to test those that have symptoms. Fortunately, Malaysia has many exceptions, such as the Tablig clusters.
Admission of failure:
"All those who had returned to Germany from Ischgl, an Austrian ski
resort that had an outbreak, for example, should have been tracked down
and tested, Professor Streeck said."
He should have mentioned the very first case. Wuhan should have been quarantined, at least self-quarantine the moment the disease was known, not when it was confirmed that it can transmit from human to human, which was too late anyway.
Patient zero in Germany visited Wuhan. She caught it from her parents who were not without any symptoms at that time.
A German Exception? Why the Country’s Coronavirus Death Rate Is Low
The
pandemic has hit Germany hard, with more than 100,000 people infected.
But the percentage of fatal cases has been remarkably low compared to
those in many neighboring countries.
In the heart of Berlin, Potsdamer Platz was nearly empty on Saturday, as people heeded orders to stay at home. Credit...Emile Ducke for The New York Times
They
call them corona taxis: Medics outfitted in protective gear, driving
around the empty streets of Heidelberg to check on patients who are at
home, five or six days into being sick with the coronavirus.
They
take a blood test, looking for signs that a patient is about to go into
a steep decline. They might suggest hospitalization, even to a patient
who has only mild symptoms; the chances of surviving that decline are
vastly improved by being in a hospital when it begins.
“There
is this tipping point at the end of the first week,” said Prof.
Hans-Georg Kräusslich, the head of virology at University Hospital in
Heidelberg, one of Germany’s leading research hospitals. “If you are a
person whose lungs might fail, that’s when you will start
deteriorating.”
Heidelberg’s
corona taxis are only one initiative in one city. But they illustrate a
level of engagement and a commitment of public resources in fighting
the epidemic that help explain one of the most intriguing puzzles of the
pandemic: Why is Germany’s death rate so low?
The virus and the resulting disease, Covid-19, have hit Germany with force: According to Johns Hopkins University,
the country had more than 100,000 laboratory-confirmed infections as of
Monday morning, more than any other country except the United States,
Italy and Spain.
But
with 1,584 deaths, Germany’s fatality rate stood at 1.6 percent,
compared with 12 percent in Italy, around 10 percent in Spain, France
and Britain, 4 percent in China and nearly 3 percent in the United
States. Even South Korea, a model of flattening the curve, has a higher
fatality rate, 1.8 percent.
“There
has been talk of a German anomaly,” said Hendrik Streeck, director of
the Institute of virology at the University Hospital Bonn. Professor
Streeck has been getting calls from colleagues in the United States and
elsewhere.
“‘What are you doing differently?’ they ask me,” he said. “‘Why is your death rate so low?’”
There
are several answers experts say, a mix of statistical distortions and
very real differences in how the country has taken on the epidemic.
The average
age of those infected is lower in Germany than in many other countries.
Many of the early patients caught the virus in Austrian and Italian ski
resorts and were relatively young and healthy, Professor Kräusslich
said.
“It started as an epidemic of skiers,” he said.
As
infections have spread, more older people have been hit and the death
rate, only 0.2 percent two weeks ago, has risen, too. But the average
age of contracting the disease remains relatively low, at 49. In France,
it is 62.5 and in Italy 62, according to their latest national reports.
Another
explanation for the 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, increasing the number of known cases, but not
the number of fatalities.
“That automatically lowers the death rate on paper,” said Professor Kräusslich.
But
there are also significant medical factors that have kept the number of
deaths in Germany relatively low, epidemiologists and virologists say,
chief among them early and widespread testing and treatment, plenty of
intensive care beds and a trusted government whose social distancing
guidelines are widely observed.
Image
Drive-through testing in Halle, Germany. The country has done far more testing than any other in Europe.Credit...Ronny Hartmann/Agence France-Presse — Getty Images
Testing
In
mid-January, long before most Germans had given the virus much thought,
Charité hospital in Berlin had already developed a test and posted the
formula online.
By
the time Germany recorded its first case of Covid-19 in February,
laboratories across the country had built up a stock of test kits.
“The
reason why we in Germany have so few deaths at the moment compared to
the number of infected can be largely explained by the fact that we are
doing an extremely large number of lab diagnoses,” said Dr. Christian
Drosten, chief virologist at Charité, whose team developed the first
test.
By now, Germany is conducting
around 350,000 coronavirus tests a week, far more than any other
European country. Early and widespread testing has allowed the
authorities to slow the spread of the pandemic by isolating known cases
while they are infectious. It has also enabled lifesaving treatment to
be administered in a more timely way.
“When
I have an early diagnosis and can treat patients early — for example
put them on a ventilator before they deteriorate — the chance of
survival is much higher,” Professor Kräusslich said.
Medical
staff, at particular risk of contracting and spreading the virus, are
regularly tested. To streamline the procedure, some hospitals have
started doing block tests, using the swabs of 10 employees, and
following up with individual tests only if there is a positive result.
At
the end of April, health authorities also plan to roll out a
large-scale antibody study, testing random samples of 100,000 people
across Germany every week to gauge where immunity is building up.
One
key to ensuring broad-based testing is that patients pay nothing for
it, said Professor Streeck. This, he said, was one notable difference
with the United States in the first several weeks of the outbreak. The
coronavirus relief bill passed by Congress last month does provide for
free testing.
“A
young person with no health insurance and an itchy throat is unlikely
to go to the doctor and therefore risks infecting more people,” he said.
Image
German
hospitals, whose workers are checked regularly for coronavirus, have
withstood the epidemic better than those in many other countries.Credit...Sascha Schuermann/Getty Images
Tracking
On
a Friday in late February, Professor Streeck received news that for the
first time, a patient at his hospital in Bonn had tested positive for
the coronavirus: A 22-year-old man who had no symptoms but whose
employer — a school — had asked him to take a test after learning that
he had taken part in a carnival event where someone else had tested
positive.
In most countries, including
the United States, testing is largely limited to the sickest patients,
so the man probably would have been refused a test.
Not
in Germany. As soon as the test results were in, the school was shut,
and all children and staff were ordered to stay at home with their
families for two weeks. Some 235 people were tested.
“Testing
and tracking is the strategy that was successful in South Korea and we
have tried to learn from that,” Professor Streeck said.
Germany
also learned from getting it wrong early on: The strategy of contact
tracing should have been used even more aggressively, he said.
All
those who had returned to Germany from Ischgl, an Austrian ski resort
that had an outbreak, for example, should have been tracked down and
tested, Professor Streeck said.
Image
Construction workers beginning to prepare an exhibition hall in Berlin to become a treatment center for coronavirus patients. Credit...Pool photo by Clemens Bilan/EPA, via Shutterstock
A Robust Public Health Care System
Before
the coronavirus pandemic swept across Germany, University Hospital in
Giessen had 173 intensive care beds equipped with ventilators. In recent
weeks, the hospital scrambled to create an additional 40 beds and
increased the staff that was on standby to work in intensive care by as
much as 50 percent.
“We have so much
capacity now we are accepting patients from Italy, Spain and France,”
said Susanne Herold, a specialist in lung infections at the hospital who
has overseen the restructuring. “We are very strong in the intensive
care area.”
All across Germany,
hospitals have expanded their intensive care capacities. And they
started from a high level. In January, Germany had some 28,000 intensive
care beds equipped with ventilators, or 34 per 100,000 people. By
comparison, that rate is 12 in Italy and 7 in the Netherlands.
By now, there are 40,000 intensive care beds available in Germany.
Some
experts are cautiously optimistic that social distancing measures might
be flattening the curve enough for Germany’s health care system to
weather the pandemic without producing a scarcity of lifesaving
equipment like ventilators.
“It is
important that we have guidelines for doctors on how to practice triage
between patients if they have to,” Professor Streeck said. “But I hope
we will never need to use them.”
The
time it takes for the number of infections to double has slowed to
about nine days. If it slows a little more, to between 12 and 14 days,
Professor Herold said, the models suggest that triage could be avoided.
“The curve is beginning to flatten,” she said.
Image
Streets around the Siegestor, or Victory Arch, in Munich are empty. Credit...Laetitia Vancon for The New York Times
Trust in Government
Beyond
mass testing and the preparedness of the health care system, many also
see Chancellor Angela Merkel’s leadership as one reason the fatality
rate has been kept low.
Ms. Merkel, a
trained scientist, has communicated clearly, calmly and regularly
throughout the crisis, as she imposed ever-stricter social distancing
measures on the country. The restrictions, which have been crucial to
slowing the spread of the pandemic, met with little political opposition
and are broadly followed.
The chancellor’s approval ratings have soared.
“Maybe
our biggest strength in Germany,” said Professor Kräusslich, “is the
rational decision-making at the highest level of government combined
with the trust the government enjoys in the population.”
Katrin
Bennhold is The New York Times's Berlin bureau chief. Previously she
reported from London and Paris, covering a range of topics from the rise
of populism to gender. @kbennhold•Facebook
A version of this article appears in print on , Section A, Page 9 of the New York edition with the headline: Testing, Tracking and Trust Help to Lower a Death Rate. Order Reprints | Today’s Paper | Subscribe
Tracking U.S. COVID-19 Vaccine Donations Published: Sep 22, 2021 https://www.kff.org/coronavirus-covid-19/issue-brief/tracking-u-s-covid-19-vaccine-donations/ Facebook Twitter LinkedIn Email Print There remains a significant gap in vaccine access across the world, with only 2% of the population in low-income countries (LICs) receiving at least one vaccine dose, compared to 30% in lower-middle-income countries (LMICs), 54% in upper-middle-income countries (UMICs), and nearly two-thirds in high-income countries (HICs). One way to address this gap is for countries that have vaccines to donate them to countries in need, either via the multilateral COVAX mechanism or directly to countries and/or regions via bilateral donations. For its part, the U.S. government has pledged to donate at least 1.1 billion doses of COVID-19 vaccine for global use by 2022 and has been delivering doses to countries around the world since June. 1 To understand more abo...
KKM hide cases in PPV. There are 2 more cases at PPV in Sabah, but not reported by KKM. Only investigate. We must sue KKM for being reckless. One in Telupid was reported in the news but KKM did not even investigate. Another case in Kota Kinabalu, was posted in facebook, even with test result, but KKM only investigate but so far no news. KKM only denied asking people to get tested, which I suspect was issued by one of KKM staff unofficially. If it can happen to 2 cases in Sabah, imagine the situations in Selangor. I suspect many of them catch Covid at the PPV, but no record of any cluster, just as KKM hid the clusters at factories to the point that Azmin presented the fake data to Parliament. As is normal in Malaysia, authorities never learned that hiding one or two cases means that the cases are widespread and to be safe, we must assume that it happens to all places. All PPV in Malaysia are infected with the Delta variant. Notice that the Delta variant only needs 15 seconds of exposure...
https://www.nature.com/articles/d41586-020-00974-w https://www.asianscientist.com/2020/04/in-the-lab/sars-cov2-rna-aerosols-air-droplets-wuhan-china/ Is the coronavirus airborne? Experts can’t agree The World Health Organization says the evidence is not compelling, but scientists warn that gathering sufficient data could take years and cost lives. Dyani Lewis A Nature Research Journal Subscribe Search ...
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