Explained: Why is the coronavirus mortality rate in Germany rising?

Germany has intrigued researchers for its relatively low coronavirus death toll - yet the fatality rate is rising. Why is this?

Explained: Why is the coronavirus mortality rate in Germany rising?
Coronavirus tests at Berlin's Charité. Photo: DPA

On Monday, the death toll in Germany rose to 541 out of more than 62,400 cases. While the country has a low death rate compared to other European nations hard hit by the pandemic such as Italy and Spain, this is starting to change.

According to virologist Christian Drosten of Berlin's Charité Hospital, an increase in confirmed coronavirus cases in German nursing homes marks a new phase in the outbreak, as infections among the elderly are associated with more reported deaths. 

“This is the beginning of a new development,” said Drosten on Monday in the public broadcaster NDR's podcast.

Earlier in the day, it was confirmed that 23 residents – as well as 17 staff members – of a nursing home in Wildeshausen, Lower Saxony had been infected with COVID-19, reported DPA.

So far, Germany has had a bit of luck: Initially, it was mainly younger, sporty people such as skiers who had brought the virus from their holidays and spread it in their networks of roughly the same age, or employees whose workplace contacts could quickly be traced. For the most part, these people experienced a more mild course of the disease.

READ ALSO: 'The mortality rate is puzzling': What explains Germany's low coronavirus death toll?

Yet now Germany's mortality statistics are beginning to rise, said Drosten: they are no longer between 0.2 and 0.4 percent, but in the range of 0.8 percent.

This is due to the fact that other age groups are now more affected by COVID-19. In addition, Drosten said that it is likely no longer possible to increase coronavirus testing – one of the factors which has been attributed to Germany's low death rate – to keep up with the growth of reported cases.

READ ALSO: Germany ramps up coronavirus tests to 500,000 a week

“I do not believe that we can realistically increase our current test capacity significantly,” said Drosten, pointing to the large demand for materials needed to produce the tests. At present, more than half a million of these tests could be done per week in Germany.

Looking at the statistics

Of the deaths in Germany, 66 percent have been men, and 34 percent women, with an average age of 82, according to an analysis by the Robert Koch Institute on March 28th. 

The oldest deceased patient was 99 years old and lived in a nursing home in Würzburg. However, the disease has also led to the death of younger patients in their 40s and 50s, such as a 42-year-old man in Berlin who already suffered from a lung disease and the partner of former Berlin mayor Klaus Wolwereit, who died from the disease at the age of 54

Germany has experienced a nearly exponential spike in its number of confirmed coronavirus cases. While the death rate continues to rise with it, its growth is not as fast – this can be attributed to the fact the age of the average coronavirus patient is 45 years – which Drosten expects to rise rapidly.

Every German state has reported at least one death from the disease, with the lowest number so being in northeastern Mecklenburg-Western Pomerania (one) and the highest in Baden-Württemberg (128), according to the latest figures from the Robert Koch Institute.

The following graph shows the rise in coronavirus cases since the first case was confirmed. An interactive version also lays out the number of new deaths reported per day.

Statistik: Erkrankungs- und Todesfälle
Graph: Statista

Death rate compared to other countries

Germany's death rate remains far lower than the 7.3 percent in Spain or 5.2 percent in France at the end of last week. But at this point it is still too early to say exactly what's going on.

Countries also follow differing procedures when it comes to testing, and even gathering data.

Besides the large-scale testing, experts in Germany also said that the virus has largely affected a younger, healthier section of the population compared to elsewhere.

At the same time, experts have repeatedly warned that in the country where almost a quarter of the population is over 60, the number of deaths could still skyrocket if people do not stick to measures to help halt contagion.

Lockdown measures are in place across Germany, preventing people from leaving their homes except for essential trips, while most shops, restaurants and bars are closed.

READ ALSO: Germany bans gatherings of more than two to control coronavirus spread

A slowing number of cases. 

Initially, the number of infected people in Germany doubled every two days, which has now slowed down to every four to five days, reported Welt on Monday. Yet authorities don’t yet see this as a reason to loosen national measures – which mandate non-essential store closures and no more than two people being together outside at once. 

“We have to achieve a lot more days through our measures, and we have to move towards the numbers doubling every ten days,” Merkel said at the end of last week.

“We need all measures unabated,” government spokesman Steffen Seibert stressed in Berlin on Monday.

In an internal meeting on Monday morning, the Christian Democratic (CDU) leadership also affirmed that the country would only be on the right track when the “doubling time” of infected people stood at 10 days.

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EXPLAINED: The new rules around getting a sick note over the phone in Germany

Due to high Covid infection numbers throughout the summer, it’s now possible to get a sick note from a doctor over the phone again for some illnesses. Here’s what you need to know.

EXPLAINED: The new rules around getting a sick note over the phone in Germany

What’s happened?

In spring 2020, German authorities changed the law so that people with a mild upper respiratory tract illness, such as the common cold, were able to get an incapacity to work certificate or AU-Bescheinigung by simply calling and speaking to their GP.

The rule was extended several times and finally reversed on June 1st this year due to falling infection figures. Since then people have had to go back to the practice – or do a video call if the doctor’s office has that system in place – to get a sick note.

Now, due to a decision by the Joint Federal Committee, the regulation has been reintroduced and patients can call their GP again for a sick note.

Can I get a sick note over the phone for any illness?

No. As before, the regulation only applies to patients suffering from a mild upper respiratory tract illness. Though Covid has not explicitly been named in the announcement, it seems that it is intended to be covered by the regulation.

If the doctor is convinced that the patient is unfit for work after a telephone consultation, then they can issue a sick note for up to seven days.

READ ALSO: EXPLAINED: The changes around doctor’s notes in Germany you should know

If the symptoms persist after seven days, the certificate can be extended once more for another week.

Why now?

According to the Chairman of the G-BA, Josef Hecken, the regulation has been introduced now as a response to rising Covid numbers and in anticipation of the cold and flu season in the coming months: “We want to avoid full waiting rooms in doctors’ offices and the emergence of new infection chains,” he said.

The telephone sick leave rule is a simple, proven and uniform nationwide solution for that, he said. The rule is also necessary because video consultation hours are not yet available everywhere.

What else should I know?

The health insurer DAK is calling for telephone sick leave in the case of light respiratory diseases to be made possible on a permanent basis in Germany. DAK’s CEO Andreas Storm said that this should “not always be up for debate, because it has proven itself.” 

READ ALSO: Everything you need to know about making a doctor’s appointment in Germany

The social association VdK also welcomed the reintroduction of the rule. The VdK’s President Verena Bentele said that the regulation would help to protect high-risk groups in particular from potential infections.

What are the rules to know about sick notes in Germany?

Germany has a strict system in place. If you are sick, you need to give your employer a Krankmeldung (notification of sickness) before the start of work on the first day (of your illness).

However, you also need to hand in a Krankschreibung (doctor’s note) on the fourth day of your illness. Some employments contracts, however, require you to submit a sick not earlier than the fourth day so check with your boss or HR on that point.