The current Covid 19 statistics for Germany recorded more than 220 deaths. That is more than 220 tragedies. And yet this number is surprisingly small compared to the approximately 40,000 people infected. In mathematical terms, this results in a lethality – that is the technical term for the death rate – of around 0.5 percent; the value is significantly smaller than in many other countries. Meanwhile, people are also asking themselves outside of the Federal Republic: What is different in Germany than, for example, in Italy, which is badly affected?
In fact, there are enormous differences when you divide the number of deaths by the number of cases. According to this calculation, Bangladesh and San Marino have a lethality of more than ten percent, Italy is just under ten percent. In contrast, the calculation for Australia, the Czech Republic and Israel results in a death rate of less than 0.4 percent.
Part of the phenomenon is that simple division is not a very reliable method. It must be taken into account how long the outbreak has persisted, that illness and death do not occur at the same time, and how reliably deaths and infected people are recorded. There are large – and above all: differently sized – undisclosed numbers, especially when registering infections.
The number of undetected cases in Germany is likely to be lower than in many other countries. A comparatively large number of people are tested here, as Lothar Wieler, President of the Robert Koch Institute, regularly emphasizes. Many infected people with mild or no symptoms were also recorded. Italy, on the other hand, tests a lot, but mostly in clinics where the seriously ill struggle for breath. Light cases are hardly registered anymore, wrote scientists from Rome a few days ago in the journal Jama.
In Germany it is mainly younger people who get sick, in Italy and Spain the older ones
But beyond statistical bias there are explanations for the geographical differences. This includes the age of the sick. In Germany, Sars-CoV-2 has so far met younger people, in Italy and Spain, however, the older ones who are at greater risk of death.
Smoking is believed to be another factor. The damaged lungs of cigarette users could favor severe courses of Covid-19. This connection could explain why men, among whom smoking is more common, are infected more often and die more often than women. However, differences between Italy and Germany cannot be explained in general, the smoking rates in both countries are roughly the same.
The influence of air pollution is also being discussed. The fine dust concentration is particularly high in northern Italy. The dirt particles can exacerbate chronic lung diseases, making it harder for patients to fight pneumonia, says Sara De Matteis, an environmental physician at the University of Cagliari: “This is probably also the case with Covid-19”.
Even a good health system is not immune to dramatic developments
Oxford University scientists also hypothesize that antibiotic resistance could explain some of the deaths in Italy. Antibiotics do not help against the coronavirus, but are used in those patients who also develop an accompanying bacterial infection. But Italy has been struggling with pathogens that have become resistant for years.
Differences in the capacity and quality of the health system can also be an influencing factor. It is likely to be particularly effective in poorer countries. Which of these factors ultimately has which influence is currently extremely uncertain. What is certain is that Germany, despite its good health system, is not immune to more dramatic developments. “We are only at the beginning of the epidemic,” says Wieler.
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