The Dose - How Germany’s Approach to COVID-19 Sets the Country Apart

Episode Date: May 1, 2020

Earlier this week, Germany became one of the first countries to start easing COVID-19 restrictions. That’s because its initial response to the pandemic helped keep the death rate low. Germany: Caught the coronavirus early Does lots of testing Has a robust health care system. As the pressure mounts to reopen economies across the globe, other countries may have something to learn. On this episode of The Dose, Michael Laxy, a health economics researcher at the Helmholtz Center in Munich, talks about the German approach.

The Dose is a production of the Commonwealth Fund, a foundation dedicated to affordable, high-quality health care for everyone. I think in the long term, it will still be a little bit of a back and forth, kind of going back step by step, monitoring it closely, and hopefully this will be successful. Hi everyone, welcome to The Dose. That was Michael Loxy, a health economics researcher at the Hemholtz Center in Munich. Like all countries, Germany is grappling with the COVID-19 pandemic.

But experts have observed that some strategies are working really well to keep the death rate low. Germany started testing people early in large numbers. The country has plenty of hospitals and intensive care beds for the severe cases. And it also helps that for the most part, social distancing guidelines are being observed. As the pressure mounts to reopen economies across the globe, other countries may have something to learn from the German approach. So I asked Michael to join me on the show today. Michael is tracking the spread of the disease among households in Munich, as well as the effects of the countermeasures on people's health and economic situation.

Michael, welcome to the show. Hi, Shanna. Great to talk to you today. Great. So let's get started with your research. Tell me what you're working on. Yeah, first, before I start to talk about it in detail, I have to say, in general, I'm doing research more on non-communicable diseases. So my research was pretty much about diabetes and obesity and cardiovascular diseases, etc. But of course, with the start of the pandemic, everyone within the health science tries to contribute little pieces and bits to solve actually the problem and so did i and yeah currently i'm i'm involved in in two studies on uh corbett 19. um the first study is the munich prospective covet 19 study and so this is a study

that um tries to sample a repress representative number of households in the area around Munich. So it will be around 3,000 households. And it will interview these people and also take blood samples. And we will do antibody tests with these samples. And yeah, trying to get a number of how many people already were infected and might have immunity today. And yeah, so in our part in the study as health economic researchers is the assessment of the socioeconomic and also of the psychological impact of the pandemic itself, but also of the countermeasures to tackle the disease.

And I think the specific feature of this study is that these visits will be done repeatedly over a time period of almost 12 months. And so the overall goal is to understand and also monitor the dynamic and spread of the disease, but also trying to evaluate continuously the effectiveness on some of the countermeasures we actually take in place. So tell me what the value is of going to people's houses repeatedly and collecting this data over and over again as we try to look monitor and do kind of an surveillance of what's going on, to understand how the pandemic spreads over time, how its dynamic changes. Yeah, if numbers climbing up again or if, you know, numbers stay constant over time. And by doing that repeatedly over time in a panel of households,

we might also understand the effectiveness and also the side effects, of course, of some of the measures that are already in place or that will be taken possibly in the future. So I think this is the value of the study and that's what the study tries to figure out. So, I mean, all countries are taking countermeasures, but let's talk in some more detail about what Germany has done to control the spread of the pandemic. Yeah, so I think in general, what we did in Germany also followed some of the approaches that other countries did. First of all, we abandoned big mass meetings of more than a thousand people. That was early March. And then the next step was closing down schools and also Kitas, kindergartens, etc. And that was followed by a measure by the end of March of kind of a social distancing measure

and restored also all non-essential shops and had to close at that point. So these, I think, were the first kind of more traditional measures that were taken. And of course, in Germany, we tried to build up a very early high capacity for testing for the disease and for the virus. So already early March, I think in Germany, more than 80,000 tests per week were done. And I think currently we're doing around 400,000 tests a week. And with that, probably much more than some or many other countries currently. Let's talk about the testing infrastructure in more detail. How is Germany able to test so many people?

Yeah, I think that just also has to do with the general healthcare and public health infrastructure here in Germany. I think we have a lot of laboratories across the country that were able to do a lot of tests from the beginning. And due to the political decision quite early that testing is important, that we need to expand the testing capacity, I think these were the two kind of main ingredients also to assure that the testing can be done and will be done. And so lots of testing. You've said a couple of times that Germany started doing things early. So tell me more about that. Was there a crystal ball?

How did you know to do these things? There were two things. First of all, I think we had a little bit more time than some of the other countries that were hit really hard by the pandemic, particularly Italy. So the spread of the pandemic in Italy is probably a couple of weeks happened earlier than in Germany. And I think seeing the massive consequences consequences the pandemic had in northern Italy was really a big warning sign for actually enacting countermeasures. And I think that happened both on a political level, but I think it also happened more of an individual population level where people really realize, okay, we have a problem here and we better should follow maybe the measures that will be enacted now.

You know, we're recording this podcast in the week when Germany is reopening. So what's going on? It's, so first of all, there were a lot of discussions how to do it. And I think there were also some scientific associations who were asked to provide their guidance and their opinion on how to do that, etc. So first of all, I think there was a good exchange between politicians and also between scientists what next steps to do. And I think politicians now made a decision to reopen, but in very small doses and do it with a very low speed. So, for example, we started this week again to reopen schools.

But just, for example, the classes in most states who will graduate this year and have to prepare for their final examinations, etc. Also, there's now an upper limit in terms of the space shops need to provide that they're allowed to reopen. And so I think it's going now step by step. And what is also clear, and it has been emphasized by politicians as well. The spread of the pandemic will be monitored quite closely during this process and probably if we see now the numbers skyrocket again as they did a couple of weeks ago, this might be also a bad message and some of these things might be done backwards I don't hope so but at the current stage no one really knows and that's the current situation here in Germany. So what about people in Germany who have chronic conditions what what about somebody with heart disease or hypertension diabetes diabetes? Yeah, so probably for them, they might have the biggest problems with that.

Young, healthy people don't need routine care that often. But of course, if I have hypertension or diabetes, I need routine care checkups every few weeks. I need to get prescriptions regularly to take my medications, et cetera, et cetera. So probably, yeah, the older people who, of course, are more likely to have chronic conditions, et cetera, they're probably more burdened if there is actually a big effect. And we still don't have hard data on that yet, so we might speculate that this is a problem. We know that isolation might have an impact on mental health,

on physical health, so this might be a problem. Particularly if that's the case we might also expect uh bigger impacts on elderly who are more often living alone who are more often depending on on visits by by by friends and family members etc and i think we see the same thing right now. So kindergartens and Kitas are still closed. I think also kids are actually desperately looking forward to meeting again friends and peers, etc. So we need to also consider the potential side effects of the things that are in place. So it makes sense that the people who are most likely to have side effects on their health are the people who are already struggling with health conditions. But then there's a whole

other aspect of the countermeasures, and those are economic, because with social distancing, so many people are confined to their homes, can't go to work. So who are the people who are worst impacted economically by the crisis in Germany? Yeah this is kind of a complex question. I'm trying to answer it the best I can. I think we also need to differentiate between two levels. So there's like direct consequences of the pandemic. And of course, this is a little bit more simple. It affects elderly people,

those with chronic conditions are at highest risk. And of course, those who still work in system relevant jobs, like for example, healthcare workers, but maybe also people working in grocery stores, bus drivers, the police workforce, etc. They still are kind of in the front and most exposed to actually get infected by the virus itself. So this is more like a direct effect, and this is a little bit more easier to quantify. And then the indirect consequences of the countermeasures, they're a little bit more complex, I guess. So I think that the largest immediate economic impact we will see in people who do not have

system relevant jobs, but who cannot work from home. And here I particularly think about people, like first of all small business owners, but also employees working in hotels and restaurants, etc. These things that are closed right now. We might expect the hardest economic hit in these people. When we talk about the professions and intersectors where probably the economic crisis hits the hardest, we are probably

in a population segment of people who already make less money than the average. So we probably will see a disproportionate negative economic effect on people who have a low socioeconomic status. What is the German government doing to help these people who are hardest hit economically? There are different measures that they're trying to enact. I think the most important one is a measure that is called Kurzarbeit. So this tries to prevent losses of jobs. And so the mechanism works that when companies actually cut down the working hours of their employees, the employees will be compensated from the Federal Institute of Employment in Germany to kind of level off the income losses they see.

And so this is a scheme or a model that actually worked also quite well in the economic crisis here in Germany 10 years ago. And I think there are some, yeah, also some scientific evidence from economics that says or that is hypothesizing that this measure was also successful in preventing that unemployment rates go up a lot. So of course, these are measures that are more in the short term. Government will not be able to subsidize salaries over years. And I think the things are in place right now. And as soon as the economy recovers, of course, these things will also be taken back step by step.

The thing that strikes me about this is that it means that people haven't lost their jobs. So when the economy is ready to reopen, as it sounds like Germany is right now, people can just go straight back to work. They don't have to look for a new job because they lost their job. Right. So I think this is the underlying intention of this measure, trying to prevent losses of job that first of all of course you know cause a lot of distress for the for the people that get fired and are unemployed then and of course then also I'm trying to keep the economy as stable as possible and when we now or maybe also in a couple of weeks, go back to a kind of normal business

or kind of normal business, that these employees actually are still like in place and can be productive again. Well, this is a good note to end on, actually. Let's talk about going back to normal, because I know that here in the U.S., people are getting restless. People want to go back to normal. Germany has started that a little bit, as we talked about earlier. But before you can go back to normal, so many things need to be done to make sure that the country is prepared for that.

So what are some of these things that people are really paying attention to in Germany? Yeah, I mean, so, of course, one really big issue people were talking about a lot was also how are we going back to kind of normality in schools and in kindergartens? Because as long as, you know, schools are closed and Kitas and kindergartens are closed, there's for many employees, there's not even the question about going back to work. Because as long as they have to do homeschooling their kids. So this is one thing where there's really a discussion currently ongoing because I think we need smart concepts,

making sure kids can go back to school, but that is also in a safe environment. And I think a lot of people are working on concepts to assure that right now. And then I think the overall premise is to further adhere to hygiene and to the measures that are in place, to keep the distance in daily life. This is still a very important thing to do. And this is independently if it's at schools or at workplace or in a supermarket, et cetera. So I think these are essential things. We haven't paid a lot of attention in the past,

and I think we do that now, and we will need to continue to do that in the future. And I think on top of that, there's also a little bit of hope that with the digital contact tracing that is aimed to be implemented soon, that we might also have another measure for actually having, yeah, an early kind of detection

where we can maybe also isolate people who might be infected but don't have symptoms, etc. So this is very difficult right now when we do that kind of the old way in an analog way and phoning the contacts of people that got infected. And of course, last, we as a scientific community also hope to do like, or to provide our support or impact on that, providing data data that actually inform politicians to make informed choices. And I think in the long term it will still be a little bit of a back and forth, kind of going back step by step, monitoring it closely, and then hopefully this will be successful but I think we need to wait a couple of more weeks to evaluate if the way we are doing that currently in Germany is actually

successful and sustainable or not. And I mean, that's where research like yours comes in. So thank you for doing it. And thank you for joining me on the show today. All right. Thank you very much. It was a pleasure. The Dose is hosted by me, Shanur Sirvai. Our sound engineer is Joshua Tallman.

We produced this show for the Commonwealth Fund with editorial support from Barry Scholl and design support from Jen Wilson. Special thanks to our team at the Commonwealth Fund. Our theme music is Arizona Moon by Blue Dot Sessions. Additional music by Poddington Bear. Our website is thedose.show. There you'll find show notes and other resources. That's it for The Dose. Thanks for listening.