How Did Germany Contain COVID-19?

With a low death rate, Germany has fared better during the COVID-19 pandemic than some of its Western counterparts. The key lies in crisis preparedness and an orientation toward following rules, according to David A. Brenner, professor in the Department of International Studies at Texas A&M University.

Brenner, an expert in German and European studies, said Germany has been a leader in containing the virus among its European neighbors.

“The Federal Republic of Germany has been so effective at containing the COVID-19 virus in spite of its large population — 83 million — and its federalized state structure, or ‘states’ rights’ German style,” he said. “This is in large part due to three factors: political culture, collectivism, and a sensitivity to questions of medical ethics.”

Political Culture

The political leaders and culture of Germany play a large role in the country’s overall preparedness for epidemics. “They wanted to be prepared for a crisis because of their history,” Brenner said. “It goes back to the last century, when the current Federal Republic of Germany was established after World War II.”

That war, which ended only 75 years ago, continues to influence German society in a number of ways. In particular, the aftermath of social disaster has made the Federal Republic and its citizens risk averse.

“Caution is very important in post-WW2 German culture and they want to be able to adequately handle a crisis,” Brenner said. “That pragmatic and realistic worldview makes them more prepared for disaster.”

Germany’s political culture also results in a greater trust in the government to act responsively to disasters, a trust not seen in the United States, Brenner said.

The chancellor of Germany, Angela Merkel, has an 80% approval rating, compared to  roughly 49% approval for President Donald Trump, according to recent polls. Merkelis seen as a leader with a calm demeanor who is highly credible, at least partially due to her Ph.D. in quantum chemistry. This effectively allows citizens of the Federal Republic to trust that the government — and virologists such as Christian Drosten (the German equivalent of the United States’ Dr. Anthony Fauci) — will make transparent decisions and communicate them honestly in times of crisis.

Collectivism

There is also a sense of solidarity in Germany that contributed to getting a better handle on a global pandemic, Brenner said. In fact, Merkel, in her major televised speech of March 18, urged citizens to have a “spirit of solidarity” and “social togetherness.”

“More so than in the U.S., there is a feeling of ‘We as a society are responsible for each other,’” Brenner said. “There is a greater sense of obligation to fellow citizens, whom they see as entitled to certain benefits from the government.”

The odds were stacked against an effective response by Germany. With a population of about 83 million people and a federal government that grants states a large amount of power and authority to make decisions, there were fears that Germany’s response might be disorganized. But collectivism helps.

“The Germans were able to test people for COVID-19 early and broadly,” Brenner said. “There was a willingness of the citizens to contribute, even by permitting contact tracing of people who came in contact with the disease, despite considerable concern about privacy.”

Medical ethics

Similarly, Brenner said a sensitivity to medical ethics, has played a large part in the culture’s desire to be prepared, specifically concerning public health capacity and issues of end-of-life care.

This mindset is seen in the country’s healthcare structures. Germany has the largest capacity for intensive care in Europe — intensive care that has not yet reached its full capacity with the number of patients per number of hospital beds and ventilators available.

“There is a desire among Germans to not leave end-of-life-care decisions in the hands of medical professionals,” he said. “They don’t want healthcare personnel having to make those ethical decisions, as Nazi medical personnel chose to do in the late 1930s and early 1940s.”

This is part of a larger, ongoing conversation in Europe right now about triage, or how to provide intensive care to COVID-19 patients based on the severity of their conditions. Instead of having to decide which patients are more in need of such treatment, the Germans have sought to avoid those decisions by having adequate medical supplies and capacity.

As a consequence of ethical violations under the Nazi dictatorship, the present-day German constitution declares that human dignity is non-negotiable, Brenner said.

“The legacy of Nazism still plays a role, even now,” Brenner said. “The highest value of German law is the dignity of every person. They are trying not to repeat that negative past, and the legacy of the Third Reich and the Holocaust still affects the practice of medicine today.”

Learning from others

Germany is similar in many ways to the U.S. in its Western values, but tends to be less individualistic than America. Solidarity with other citizens has allowed Germany to fare better in the pandemic, Brenner said.

“Conditioned by bad circumstances in the past century, there is a greater sense of social obligation to others,” he said. “Citizens are more willing to ration for the sake of the collective good.”

America, too, can learn from history and its Western allies. Germany was seen as the leading country in medicine and public health before WWII. The question remaining even today is how fascist tyranny could arise in a modern society — showing that even the best societies are not immune to making fatal mistakes.

“Because of its history, Germany is now prepared for disaster,” Brenner said. “We must not think we are too sophisticated when faced with bad circumstances. We, too, must be prepared.”