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Europe Versus Coronavirus - Germany, a Resilient Model

BLOG - 17 April 2020
Key Points
1

Resilience may be defined as a mechanical characteristic that determines a material’s resistance to impact. Germany's ability to withstand the Covid-19 epidemic "shock" is a matter of both long-term investment and strong adaptation capacity. With one of the highest levels of health expenditure per capita in Europe, Germany has a particularly well-prepared healthcare system that can rely on a number of doctors, nurses and hospital beds per capita well above the OECD average. The country’s balanced public accounts have also enabled a massive and appropriate response to the economic consequences of the crisis.

2

Affected by the epidemic later than its French and Italian neighbors, Germany has adopted a targeted screening strategy aimed at slowing the spread of the epidemic to avoid overloading its healthcare system. Combined with less restrictive social distancing measures than in other European countries, the use of mass screening made it possible to identify and isolate individuals carrying the virus, thereby giving German hospitals time to increase their capacity.

3

On April 15, the federal State as well as the Länder presented their post-lockdown strategy, characterized by a gradual resumption of economic activity, along with the obligation to wear masks in public space and the use of a digital tracking application which should be available in mid-June. This crisis recovery strategy is accompanied by an emergency braking mechanism meant to slow down in the most affected areas. While the prospect of a second wave now seems to have been averted, the post-lockdown phase in Germany has been marked by major popular demonstrations accusing the government of excessive restrictions on liberties.  

Timeline

  • January 27: First case of Covid-19 detected in Germany in the state of Bavaria.
  • February 24: Health Minister Jens Spahn announces that the epidemic has reached Germany.
  • March 4: Germany bans the foreign export of medical protective equipment.
  • March 9: The Robert Koch Institute, the federal agency responsible for disease control and prevention, announces the first death linked to Covid-19. Meanwhile, the number of detected cases exceeds the symbolic mark of 1,000 people.
  • March 11: First press conference by the Chancellor since the start of the crisis. Angela Merkel announces that the epidemic could eventually affect 60% of the population and €140 million are released to support vaccine research; recourse to part-time unemployment by firms is facilitated.  
  • March 12: The federal government, in tandem with the Länder, announces the suspension of all non-essential medical operations in order to free up additional hospital beds. Demonstrations with more than 1,000 people are postponed. The Länder gradually decide on the closure of nurseries and schools.
  • March 13: Finance Minister Olaf Scholz and Economic Affairs Minister Peter Altmaier present a package of exceptional measures to support the economy, including loan guarantees and a €600 billion fund for economic stabilisation.
  • March 15: Minister of the Interior Horst Seehofer announces the closure of borders with neighboring countries, though the transfer of goods and the movement of workers across the border are still permitted. On the same day, the newspaper Die Welt reveals that the United States have reportedly tried to obtain exclusive rights to the vaccine on which the German laboratory CureVac is working.
  • March 16: The Chancellor details a list of exceptional measures to curb the spread of the virus including the closure of bars and clubs, cultural institutions, playgrounds and brothels, suspension of religious services and travel abroad. To avoid congestion, food stores and pharmacies may open on Sundays. Bavaria is the first state to declare a state of emergency, Katastrophenfall.    
  • March 18: In her first televised address since she was reelected, the Chancellor calls on Germans to respect instructions of social distancing, to show solidarity and declares that "Germany faces its greatest challenge since the Second World War".   
  • March 20: Bavaria's Minister-President Marcu Söder introduces the country’s strictest measures of confinement.
  • March 22: The federal government and the Länder agree to close down restaurants and hairdressing salons. Meetings of more than two people in public areas are banned and subject to a fine.    
  • March 23: Baden Württemberg becomes the first German state to admit French and Italian patients to its hospitals.  
  • March 25: The Bundestag approves the economic rescue plan and lifts the constitutional debt brake. During the same session, it adopts a law on the protection of the population in the event of an epidemic, which significantly strengthens the powers of the Federal Ministry of Health for managing the crisis.
  • March 30: The Economic Council of German Experts announces the inevitability of a recession.
  • April 1: The federal government and the Länder agree to extend restrictive measures of social distancing and the lockdown of the economy beyond the original date of Easter.
  • April 15: the federal State and the Länder agree on a gradual post-lockdown strategy. 
  • April 27: the government puts forth its new digital tracing application, based on voluntary use and decentralized data storage.
  • May 13: the Chancellor calls on German citizens to remain cautious and disciplined during the reopening phase. 
  • May 15: first demonstrations "anti-restrictions" in Germany
  • May 19: The German Chancellor and the French President introduce a 500 billion euros rescue plan in order to enable the European economy to recover. 
  • May 26: the federal State puts forth a 9 billion euros in order plan to salvage the German aerial company Lufthansa. 
  • June 2: the partners of the ruling grand coalition (CDU-CSU-SPD) met to decide on a new plan to support the economy. 
     

 

This article was updated on June 4.

Chancellor Angela Merkel (CDU) described the coronavirus epidemic as the greatest challenge facing Germany since the Second World War. Merkel, who had remained in the background of the political stage since she announced she would not seek a fifth term in office, regains a leading political role as the  crisis unfolds. The "Krisenkanzlerin" (Crisis Chancellor) enjoys a high level of endorsement by German public opinion. According to the latest ZDF political barometer, 89% of those polled are satisfied with the way the government is handling the crisis, and the CDU-CSU alliance has achieved its highest popularity score since the last elections. Although she has multiplied her public statements, Merkel has not changed her style, characterized by pragmatism, moderation and a call for responsibility on everyone's part. Since the beginning of the crisis, her message has remained focused on a single objective: to flatten the contamination curve in order to avoid a saturation of the healthcare system.

A German exception?

On Monday June 1, 2020, the number of people infected in Germany almost reached 184,000 and the number of deaths due to Covid-19 was 8,722, a mortality rate close to 4.7%. On the same day, in France there were 189,000 people contaminated and more than 28,830 deaths linked to the virus, i.e. a mortality rate close to 15.2%, while Italy had 233,300 people contaminated and more than 33,400 deaths, i.e. a mortality rate close to 14.3%.

The low mortality rate in Germany, that some have called a "German exception", can be explained by two factors. With nearly 350,000 tests per week since March 16, the number of tests carried out in the country is one of the highest in the world. This helps to paint a more realistic picture of the spread of the virus than in other European countries. The underestimation of the number of people infected in countries such as France and Italy leads to a significant overestimation of their mortality rates and, as the German weekly Der Spiegel reveals, only the evolution of the number of deaths can, in fact, give a realistic picture of the evolution of the epidemic country by country.

The underestimation of the number of people infected in countries such as France and Italy leads to a significant overestimation of their mortality rates.

The other factor behind the especially low mortality rate in Germany is the temporality of the pandemic. As shown in Der Spiegel with a graph describing the evolution of the number of deaths linked to Covid-19 after the first ten deaths, Germany was affected by the epidemic 8 days later than France and 14 days later than Italy. The curve of deaths in Germany in the first 10 days follows a pattern comparable to the French and Italian curves; it would therefore be wrong to see the low mortality rates as a sign of a German exception.

On the other hand, the evolution of the German curve of infections and deaths related to the epidemic is characterized by a faster inflection than in other European countries. While acknowledging that Germany was still at the "beginning of the epidemic", the Robert Koch Institute, the federal agency responsible for disease control and prevention, announced on April 3 that the measures put in place in Germany in mid-March were beginning to produce their first effects.

Three pillars, one strategy

In order to combat the epidemic, Germany has put in place measures to limit physical contact across the territory, to identify individuals carrying the virus by increasing the number of tests, and to strengthen the healthcare system’s capacity.

1. Limiting physical contact

Taking into account the "delay" in the spread of the epidemic in Germany, social distancing measures were adopted earlier than in other European states. Long before any political intervention in the crisis, the population was made aware of the importance of barrier measures by the Robert Koch Institute, the federal health agency, which was a reference point and whose recommendations were largely taken into account by the Germans. As early as March 11, when the first deaths linked to Covid-19 had just been identified, the Chancellor called on Germans to avoid gatherings and to follow "barrier gestures" recommended by the Robert Koch Institute. As shown by studies on the role of social contacts in the spread of epidemics, the lower intensity of social contacts in Germany compared to that of other European states may have helped to limit the spread of the virus. Images of crowded German parks broadcast on the following weekends, however, put into perspective the idea of a distinctly German "discipline" that would have helped to contain the spread of the virus.

As the rest of Europe, Germany took exceptional restrictive measures. On March 15, yielding to pressure from the Länder bordering France and Austria, the federal government announced the closure of land borders with most of its European neighbors and introduced screening measures for new entrants. The following day, the Chancellor detailed, in a sober and restrained style, a list of measures to curb the spread of the virus including the closure of bars and clubs, cultural institutions, playgrounds and brothels, suspension of religious services and travel abroad. She also called on states that had not already done so to close their nurseries and schools. These social distancing measures were reinforced on March 22, when the federal government and the Länder agreed on the closure of restaurants and hairdressing salons, and on the prohibition of gatherings of more than two people in public spaces, except for families or people of the same household.

As studies on the contribution of social contacts to the spread of epidemics have shown, the lower intensity of social contacts in Germany compared to other European states may have helped to limit the spread of the virus.

Justified by the health emergency and seemingly well accepted by the population, the implementation of these measures has given rise to two important debates in Germany.

  • The first relates to Germany’s federal system. Since disease control falls within the competence of the Länder, the federal government must agree with the various states’ governments on which  protective measures to be implemented, while leaving the Länder considerable room for manoeuvre in enforcing them. As the fight against the epidemic calls for a rapid and coordinated response, this federal structure may have hindered an optimal crisis management. In response to this situation, the Bundestag passed the Infection Protection Act (Infektionsschutzgesetz) on March 25, which gives the Federal Minister of Health greater powers in times of epidemic. This strengthening of the central state, which results in a concentration of powers in the hands of the ambitious Minister of Health Jens Spahn, is calling into question the principle of federalism enshrined in the Constitution.
     
  • The second debate arising from the adoption of these measures pits advocates of a contact ban (Kontaktverbot) against advocates of lockdown (Ausgangsperre). In the end, the more moderate form of contact ban prevailed in Germany, although various Länder, such as Bavaria, Saarland and Saxony, chose to impose stricter confinement measures than those prevailing at the national level. To understand Germany's reluctance to impose strict lockdown measures, reference should be made to the Chancellor’s speech on March 18 when she stated: "We are a democracy: we do not live by compulsion, but by informing and involving everyone". Experiences of dictatorship that have marked German history thus seem to encourage the country to promote a method of crisis management far less coercive than the ones that proved valuable in several Asian countries and towards which France is currently turning.

However, Germans' expectations with regards to firm leadership in times of crisis are reflected by the renewed popularity of the Bavarian Minister-President Marcus Söder (CSU). Söder has been advocating stricter measures than those decided at the federal level since the beginning of the epidemic, and is already emerging as one of the epidemic’s great political winners.

2. Identify carriers of the virus   

Social distancing measures adopted by Germany are complemented by a more extensive use of tests than in other European states. The country’s strategy of mass screening is, according to Christian Drosten, Director of Virology at the Charité Hospital in Berlin, "the primary reason for the low number of deaths in Germany".

Although the strategy is not to test the entire population, the facilitated use of tests makes it possible to treat fragile patients before complications arise and to isolate asymptomatic carriers to avoid new infections. The Robert Koch Institute specified on April 3 that Germany's testing capacity had increased considerably in recent weeks, reaching 350,000 in the last week of March and confirming the government's target of 500,000 tests per week for the month of April. On March 26, the German company Bosch also announced the imminent market launch of a "rapid test", making it possible to process a sample taken from a patient's nose or throat in two and a half hours without the need to go through a laboratory.

Germany's testing capacity had increased considerably in recent weeks, reaching 350,000 in the last week of March and confirming the government's target of 500,000 tests per week for the month of April.

The mobilisation of Germany’s industrial sector in the fight against the epidemic is one of the strongest elements of the country’s strategy to deal with the crisis. The pharmaceutical industry is being financially supported to accelerate vaccine research, and the German company CureVac hopes to succeed in developing a vaccine against Covid-19 as early as fall 2020. Many factories, particularly in the automobile sector, have reoriented their production towards masks, artificial respirators and laboratory equipment. The Green Minister-President of Baden Württemberg, Winfried Kretschmann, sent a letter on March 23 to the industrial players in his state encouraging them to redirect their production towards a genuine "war economy".

In addition to respirators, the need for protective masks is currently the greatest challenge facing German industry. While the city of Jena has now imposed the use of masks in public spaces, most political actors consider that this obligation will represent a central element of the German strategy of lockdown exit. Large German companies are called upon to support the government's project to buy protective masks from China – at the beginning of April, the Ministry of Health announced the arrival of 20 million masks in Germany, not without some conflict with the United States – while the government is calling for the development of industrial production on German territory.        

3. Strengthening the healthcare system’s capacity   

The German strategy’s central objective is to avoid a saturation of the healthcare system, which would result in an exponential increase in deaths linked to the epidemic. Characterized by one of Europe’s oldest populations, Germany is particularly vulnerable to Covid-19. According to a joint report by the OECD and the European Commission, Germany is, after France, the second EU country with the highest health expenditure as a percentage of GDP and the first EU country in terms of per capita health expenditure. The consequences of this investment are visible, considering its healthcare system is one of the best prepared to deal with the epidemic in Europe.

Before the crisis’ outbreak, Germany had 28,000 intensive care beds, 20,000 of which were equipped with ventilators. According to the German hospital trade association, this capacity was rapidly scaled up to 40,000 intensive care beds and 30,000 ventilators by early April. In addition, a digital platform (DIVI-Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) was set up to coordinate the availability of hospital spaces throughout the country. The federal government has also launched a "hackathon" under the title #WirVsVirus (We vs. the virus) to promote initiatives combating hospital overcrowding. For example, the city of Heidelberg has set up "Corona-Taxis" to visit Covid-19 patients and organize transfer to hospitals, while the start-up Recare gmbh offers solutions to hospitals for at-home patient care in order to free up as many places as possible for Covid-19 patients. 

Germany is, after France, the second EU country with the highest health expenditure as a proportion of GDP and the first EU country in terms of per capita health expenditure.

The German healthcare system is characterised by long-term investment and a strong capacity to adapt. By way of comparison, Italy has 5,000 beds in intensive care and France, the leading country in terms of health expenditure as percentage of GDP, currently has 7,000. In order to relieve overcrowded French and Italian hospitals, hospitals in the various German Länder began, as of March 23, to take in patients from these two countries. Though, initially, Germany was reluctant to adopt a European response, the country has now coordinated its recovery policy with that of the continent.        

Defining an exit strategy  

A rescue package for the economy worth several hundred billion euros was adopted by the German Parliament, the Bundestag, on March 25. This rescue plan provides in particular for massive aid to companies and employees, as well as the possibility for the state to partially nationalize strategic industrial groups if threatened by bankruptcy. Breaking away from the budgetary orthodoxy that has determined German political life until now, this rescue plan has largely helped to reassure experts and economic players across the Rhine.

On June 2, the main partners of the ruling coalition met to agree on a new plan to support the German economy, which could again exceed 100 billion euros. Two weeks prior to this, the Chancellor Angela Merkel supported the Franco-German idea of a 500 billion euro fund made up of subsidies in order to help the economic sectors and regions of Europe most affected by the crisis. As the economist Jean Pisani-Ferry explained in Le Monde: "the main lesson from the crisis is German: in order to capitalize on Keynesianism in the face of financial, health or ecological shocks, one should ensure a degree of flexibility".

On March 30, the Council of German Economic Experts nevertheless acknowledged that a recession in 2020 was inevitable and presented three scenarios for the evolution of the economic situation, depending on the duration of restrictions in the country. In the so-called "basic" scenario, which foresees a return to normal before the summer, the Council of Experts foresees a 2.8% contraction of GDP in 2020 and 3.7% growth in 2021. In this publication, the experts call on the federal government and the Länder to present an early strategy to exit lockdown.

Given the average age of victims – 82 years old in Germany – the ethical debate on whether or not to limit lockdown measures to the oldest people seems inevitable, in Germany as in many other countries.

An expert group chaired by economist Clemens Fuest, director of the IFO Institute in Munich, published on April 3 an exit strategy aimed at strengthening the population’s immunity by allowing economic sectors with high added value and those where the risk of infection is lowest to gradually resume their activity. A rapid reopening of schools and universities and a resumption of activity in the regions least affected by the epidemic would represent the first steps in this exit from lockdown, which would seek to reconcile the imperative of economic recovery with the need to protect the most vulnerable people. Given the average age of victims – 82 years old in Germany – the ethical debate on whether or not to limit lockdown measures to the oldest people  seems inevitable, in Germany as in many other countries.

The National Academy of Sciences Leopoldina has also proposed progressive lockdown exit measures that would include a widespread use of protective masks in public spaces and the adoption of digital tracing to track infected persons, making it possible to anonymously alert persons at risk of contamination. Despite the sensitivity of German public opinion about the issue of data protection, it is now likely that this application, developed by the Fraunhofer Heinrich-Hertz Institute on the model of an application used by Singapore, will be a central tenet of the lockdown exit process. A considerable advantage of this device is that an individual’s personal data is never shared: the information relating to people you cross paths with is linked to an anonymous identifier, changed regularly, and is stored locally on your phone rather than on a server. If a person is tested positive, they may decide to share this information voluntarily so that people with whom they have crossed paths are informed and encouraged to get tested. 

On April 15, at a press conference with the Mayor of Hamburg and the Bavarian Minister-President, Chancellor Angela Merkel presented the first step of Germany's post-lockdown strategy. She made a point of recalling that the containment of the epidemic in Germany represented a "particularly fragile success story" (ein zerbrechlicher Zwischenerfolg), underlining that the rules of social distancing would be enforced until the end of April and strongly recommending to wear masks in public transport and shops. The Chancellor also insisted on the need to follow the chain of contamination, referring to the tracing application being developed and the increased use of tests.

In parallel, several policies are paving the way for a gradual recovery, including the reopening of bookshops, car dealerships and shops smaller than 800 square metres since April 20, while hairdressers will only be able to reopen on May 4. The Chancellor further announced a gradual reopening of schools, starting with classes preparing for an exam. From May 4, schools will be able to reopen gradually, provided that they set up a "hygiene concept" specific to each establishment. From May 15, hotels, bars and restaurants may reopen as well, provided that the 1.5 metre distance between customers is respected; however, all major events are suspended until August 31. On April 21, the Minister-President of Bavaria and the Mayor of Munich also announced the cancellation of the Oktoberfest, one of the country's largest beer festivals.  

Faced with the risk of a "headlong rush," virologist Christian Drosten, one of Germany's most influential scientists, warned against reopening too quickly, which could foster a second wave. But as only the Länder have the ability to decide on lockdown measures, significant differences emerge from one region to another, making the constraints that continue to be imposed in some areas difficult to sustain. Stepping away from lockdown inevitably gives rise to an increasingly aggressive debate on the legitimacy and effectiveness of the restrictive measures still in place. From May 13 onwards, demonstrations in Germany's major cities brought together opponents of the restrictive measures imposed by the government and gave rise to a new protest movement, while a debate emerged on the possibility of requiring a population-wide vaccination campaign once the Covid-19 vaccine is available. In early June, the general feeling in Germany was that the country had successfully managed a crisis that now belonged to the past. 

From federalism to budgetary discipline and data privacy, the crisis has called into question fundamentals of German political life. Germany, on the other hand, is revealing that  both its healthcare system and its economy are capable of absorbing this unprecedented shock.

Resilience is also a key feature of the German political system. By showing that she remained in control of the situation and that the country was relatively well-prepared to deal with the epidemic, the Chancellor is regaining an aura that had tarnished in the last few years. Renouncing any martial rhetoric, the Chancellor intends to demonstrate that state preparedness and individual responsibility are capable of providing a response to the health crisis that is as effective as that of authoritarian regimes. As shown in the latest opinion polls, the populist AfD party is the first collateral victim of the Chancellor's success. This crisis could help reshuffle the cards in the struggle for her succession. In the midst of this crisis, Health Minister Jens Spahn and Bavaria's Minister-President Marcus Söder are undeniably the new "strong men" of German conservatism.  



COPYRIGHT : CORINA FASSBENDER / AFP

 

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