Is Germany Handling the Coronavirus Crisis Better Than France?

While Covid-19 has been ravaging Europe for almost two months now, the mortality rate in Germany is considerably less than that of France, two similarly sized, highly developed western European countries.

According to the Robert Koch Institute, as of Friday, April 3rd 1,017 Germans had died of the virus out of 79,696 confirmed cases (a mortality rate of 1.3%) compared to 4,503 French out of 59,105 confirmed cases (a mortality rate of 7.6%), according to data made public in that country.

The strain on healthcare infrastructure is being felt more keenly in France than in its cross-Rhine neighbour. German hospitals are a long way from saturation point, so much so, in fact, that Berlin has been accepting patients from Eastern France since mid-March, in addition to those it has accepted from Lombardy.

Highly divergent strategies

In Germany, testing for Covid-19 began at a very early stage, and it was methodical and orderly. A widespread testing programme was integral to German strategy from the get go. The parameters of the screening programme were swiftly drawn up by the pre-eminent Robert-Koch Institute, and the plan was then sent out to the country’s extensive network of independent laboratories, which are well versed in screening for infectious diseases.

“I think that Germany had a handle on this thing from the very beginning,” stressed Christian Drosten, director of the institute of virology at Berlin’s Charité university hospital, “we took decisive action two or three weeks before neighboring countries. We have been successful in battling coronavirus so far because of the vast programme of screening that has taken place in this country.”

Each week, between 300,000 and 500,000 people are tested in Germany, exceeding the Merkel government’s target of 200,000 per day. Those tested are primarily in one of two categories; people showing symptoms of the virus, however benign, and those who have been in contact with the sick.

These tests are being carried out in hospitals, GP surgeries and even in people’s own cars. The objective is to isolate the sick as soon as possible. In Germany there are no explicit confinement measures in place, “the fact that we moved quickly to limit infected people’s contact with others limited the amount of deaths in this country,” explained Hanover-based virologist Thomas Schulz.    

In France, the rate of testing pales in comparison. There are a number of reasons for this, including a shortage of nasal PCR kits, a type of test which allows for rapid detection of the virus. Since these types of products typically need to be imported by France, this has led to a rationing of kits in some instances, with people exhibiting serious symptoms getting priority. Since the middle of March, the WHO has recommended that countries test as much as humanly possible, which has forced France to rethink its strategy, since the country had only been carrying out 10,000 tests per day at that stage. The new objective outlined by the French health minister Olivier Véran, is to ratchet up the rate from 30,000 tests per day at the start of April to 100,000 by June. To boost the number of people that can be screened for Covid-19, German style ‘drive-through’ tests have begun to take place in several French cities.   

Chinks in the healthcare armour  

Germany has 28,000 intensive care beds, 25,000 of which are equipped with a ventilator. With six intensive care beds for every thousand people, it is one of the best equipped OECD member-states in this category. The widespread availability of this equipment in Germany can be explained by the fact that two of the world’s largest manufacturers, Draeger and Löwenstein, are German companies.

The crisis has exposed certain weaknesses of the German healthcare system too however, chief among them it’s reliance on non-national nurses. The government did not anticipate the amount nursing staff from Poland, the Ukraine and the Baltic states that would return to their countries of origin in March, with an estimated 200,000 doing just that. The country has been forced to call up student nurses and bring back retired ones, but the shortfall in medical staff could prove disastrous if the coronavirus crisis in Germany deepens.

France, a nation reputed for the strength of its healthcare system, has nevertheless seen covid-19 stretch hospital capacity to the limit, putting additional pressure on an already creaking service.

France is slightly below the OECD average in terms of hospital-bed capacity, with 3.1 beds per thousand inhabitants. That is half of what Germany has, according to Eurostat figures. French capacity has decreased by around 10% over the last decade, due to factors including prioritizing in-ambulance treatment as well as budget cuts.

The Macron government has in recent weeks pledged to increase the number of intensive-care beds from the pre-Covid-19 total of 5,000 to over 14,000, but it is a race against time as hospitals in some French regions near saturation point.

2019 OECD statistics indicate France has the third largest healthcare budget in the world, but only the twelfth largest per-capita healthcare spend. According to the French newspaper, Le Monde Diplomatique, in 2019 healthcare spending per head of population was €5,200 in Germany and €4,300 in France, with the former home to 18 million more people than the latter.

R&D investment as a key element

Maintaining a high level of scientific and medical research is essential if a country is to in be in any way prepared for an outbreak of the speed and magnitude of Covid-19. After a spike in virology research in France in at the time of the Sars outbreak, funding into coronavirus research had tailed off in recent years. If Germany has been more fleet of foot in terms of testing than France this time round, it is due on no small part to fact that the first viable test for Covid-19 was discovered in Germany by Olfert Landt, with the WHO approving the test for use in mid-January, a week before widespread coronavirus testing in Wuhan even began.

Although France is no slouch, Germany is a world leader in research and development funding, with €90 billion invested annually in R&D, as against €50 billion in France.   

One final feather in the Tirolerhut - German had already simulated the most probable post-coronavirus scenarios last month, while France is only now beginning to sketch them out.          

Edited by Aude Ghespière