2 Oct 2020

Number of cases: Germany: 301,974 UK: 505,619 Global: 35,179,573

Number of deaths: Germany: 9,542 UK: 42,440 Global: 1,037,340

How does the health system work?  

In Germany, citizens pay into a mandatory health insurance scheme which provides inpatient, outpatient, mental health and prescription drug coverageApproximately 88% of the population is covered by the scheme with the rest of the country opting for a private insurance scheme to provide their healthcare. 

Compared to other healthcare systems, Germany’s response to the pandemic has been viewed as largely successful with both cases and deaths from COVID-19 much lower than the UK, for example. The country benefits from a strong health system with higher than average hospital capacity and a relatively healthy population. Its containment strategy and testing system has also helped to reduce the impact of COVID-19 on the economy and general public. 

How has the national government responded to COVID-19? 

Just 5 days after the first case of COVID-19 was confirmed in Germany on 28 January, the Government mandated that all healthcare providers report suspected cases within 24 hours to local public health authorities.  

The Government was supported by in depth data from the Robert Koch Institutea German federal government agency and research institute responsible for disease control and prevention who, from the early days of the virus, were providing daily situation reports. This allowed Germany to contain an early outbreak in Bavaria. 

By the end of February, the Government had set up an inter-ministerial national crisis management group and required all travellers arriving from high-risk countries to provide information about possible exposure. Using a combination of epidemiological methods such as interviews and whole genome sequencing, the team was able to reconstruct and describe transmission events precisely.  

O22 March, Chancellor Angela Merkel announced a “contact ban”, limiting public gatherings to two people (outside families), requiring physical distance of at least 1.5 meters and closing many businesses. However, the contact ban was less stringent than the national lockdowns that were imposed in other countries. Germans were still able to leave the house and could get daily exercise. This approach was only possible because of the contact tracing system in place which ensured any outbreaks could be managed quickly and effectively. In addition, o10 April, all travellers arriving in Germany, regardless of their origin, were required to quarantine for 14 days. 

By mid-April the number of new cases had fallen dramatically, and Merkel announced a gradual easing of physical distancing measures. Even when restrictions were relaxed, there was no increase in new infections, indicating that the country’s contact tracing, and robust testing and treatment strategies, may have carried it through the worst of the outbreak.

What is the impact on the health system of these measures? 

In March a register of intensive care units (ICUs) was established and since April ICU capacity and COVID-19 patients treated in these units has been reported daily. These data have helped the Government to understand the severity of the disease and the potential impacts on its health systemIn fact, Germany’s health system coped so well under the additional pressure that it was able to offer some of its ICU beds to patients in France. 

Except the U.S. and Switzerland, Germany spends more money than any other on health and it runs a much more decentralised system than many other countries. This means that town hospitals are often controlled by locally elected mayors and so were able to respond quickly to developments in the local areas as opposed to waiting for directives from national government. During the pandemic, local GP practices have also set up drive-in diagnostic testing centres which has helped to relieve pressure on hospitals. Due to the high rate of testing in Germany, people with COVID-19 were able to be identified at a much earlier stage and so could be treated in hospital before their condition worsened and they had to be put on a ventilator.  

The management of the supplies of personal protective equipment (PPE), particularly masks, in Germany has been less successful and in March it was forced to ban the export of all PPE to ensure there was sufficient supplies to cover the country. In April, doctors began an online protest over PPE shortages with more than 100 million single-use masks, 50 million filter masks, and 60 million aprons and disposable gloves still required for the service. In response, the Government put contracts out to tender and around 50 German companies now supply PPE to frontline health workers.