Thread by @Gurdur

A really bugging question at this time is, just how come Germany is keeping #COVID19 patients alive so well? Conversely, why are similar countries doing badly at that?
nytimes.com/2020/04/04/wor…

We know that *other* respiratory infections have dramatically fallen, because of #SocialDistancing; but so too have heart-attacks and strokes, which raises a ton of questions. But that's separate.
nytimes.com/2020/04/06/wel…

On "Daily New Confirmed #COVID19 Cases", Germany *isn't* doing well. Above France, just below Italy, not all that much below the UK, way above Belgium and the Netherlands. So it's not a matter of daily new cases, i.e. gross scale of the epidemic.

It's not a matter of "Total Number Of Confirmed #COVID19 Cases", again gross scale of epidemic, either. Germany's way above the UK, above France, way way above Belgium and the Netherlands.

It's a matter of staying half a step in front of #COVID19; Germany, in many ways, *didn't* stay a full step in front. I was shocked to find out that Germany only ceased all direct flights to Iran a few days ago. Germany's neighbours almost all closed their borders before it did

But refer back to the tweet above with "Daily New Confirmed #COVID19 Cases (Rolling 3-Day Average)". Germany was in the middle there. Now compare that with this: ""Daily New Confirmed #COVID19 Deaths (Rolling 3-Day Average)". And suddenly Germany is near the bottom.

Just to drive that point home, from the above graph, "Daily New Confirmed #COVID19 Deaths (Rolling 3-Day Average)". That's a glaring difference, when you compare that with daily new confirmed cases.

And now we come to the second biggie: Case-Fatality Rate, CFR, percentage of death-rate of confirmed cases. Yes, CFR is lowered by mass-testing of asymptomatics, but the difference in "Daily New Confirmed #COVID19 Deaths" was astounding. So too is the CFR here.

Part of it has to be number of ICU beds, intensive-care beds (a number that inherently also includes ICU stadd) per population. Fine, Germany did well here, like too the USA; Germany's also *increased* its ICU beds from 28,000 to 40,000, for #COVID19.

To put the just-above a slightly different way:
Numbers of critical care beds per 100,000 inhabitants for selected countries, worldwide (& now Germany's increased that 29.2 to 40; I don't know yet how much the USA has increased)
forbes.com/sites/niallmcc…

From the NYT article cited in the first tweet: so another part of this is constant *in-person* checking-up of people ill at home with #COVID19, constantly rechecking to see if they may be going into the typical fast decline:

OK, here's one big piece of the puzzle (from the NYT piece):
average age of catching #COVID19:
Germany: 49.
France: 62.5.
Italy: 62.
BUT: all three countries have much the same base demographics as to age. So.... that means Germany partially suppressed transmission.

The NYT moots other reasons too. Note, "a trusted government whose... guidelines are widely observed". But that only works as far *as the guidelines are good*. Sweden's govt is trusted by its people too, maybe more than in Germany.
CFR:
Sweden: 6.62%
Germany: 1.62%
USA: 2.98%

As of the moment, on the Our World In Data site, CFR rates of selected countries. Note that Norway has a CFR even lower than Germany's, at 1.03%, but it's very early days as yet in Norway, the real climb in deaths hasn't even started. Note the Netherlands, up with the UK & Spain

Sure! Testing, #testing, mass-testing! It helps, it's *vital*. And in Germany, getting yourself tested for #COVID19 #SARSCoV2 is free, which means no-one hesitates. But even testing doesn't explain that low *gross* daily death-rate. Remember?

https://twitter.com/Gurdur/status/1247594831955800067

Sooooo: ICU/population %, Germany & the USA right up there. But then so was Belgium, & Belgium currently has a CFR of 7.84% (average for the world is 5.62%). So unless Belgium markedly reduced ICU capacity in the last few years (as France did), then that's not all of it at all

Soooo: constant rechecking **in person** of those ill w/ #COVID19 at home. Financial support for workers whose work hours were greatly reduced. Financial support for those in need. Social distancing, partial quarantines (there are only scattered, few actual lockdowns in Germany)

Trust in government, except that can go wonky (see Sweden, CFR 6.62%). Good guidelines, except face-masks in public are only coming in now, & Germany can be inconsistent. Bonn has only just now put up roadblocks to stop the crowds of cherry-blossom viewers

https://twitter.com/Gurdur/status/1247593261591678977

While Germany is half a step in front of the #COVID19 epidemic, maybe even a full step, on the issue of ICU beds compared to population, when you look at how *unoccupied* German ICU beds are as yet, then that's not the whole story.

From @ghoeberx:

Reporting? #COVID19 reporting from Germany is very reliable. More comprehensive than France & the UK, far more than Spain & Italy. Proxemics? I don't know, I suspect no big difference. Quality of healthcare inside ICU? I suspect no different to the USA.

https://twitter.com/nerissimo/status/1247611678683992066

End result: Germany has a bigger epidemic than it needed to at this time. Had it closed its borders fast, like Poland did, it'd have lost vital supplies, like Poland did, but have started the real epidemic much later. Same w/ quarantines. Some answers won't come till much later.

Austria is on only 12,633 confirmed #SARSCoV2 #COVID19 cases so far, 243 deaths, CFR 1.79%. At such a low number (Germany is on 107,458 and 1,983 and CFR 1.62%), it's difficult to say much as yet.

https://twitter.com/nerissimo/status/1247626715192582145

But to stress again: despite inconsistencies and delays, Germany's success in keeping down transmission of #COVID19 to the elderly and invalid is a key element here in the keeping its CFR low.

https://twitter.com/Gurdur/status/1247607528013418499