As figures and data are released each day, many are citing Germany and South Korea as exemplary in their handling of the pandemic and are asking why, if these two countries can carry out so much testing and contract tracing, other countries cannot.
The death rate in both countries is much lower than elsewhere giving credence to the theory that high levels of testing and contact tracing are linked to a lower death rate.
But is it really as simple as that?
(All figures below are correct as of May 9th 2020)
Testing Kits.
At the beginning of the outbreak in the UK, testing was performed centrally at designated laboratories before being devolved to individual hospital laboratories.
The test, done by taking swabs from the back of the nose and throat looks for the presence of the virus itself, or specifically certain sequences of genetic code within the virus. To do this scientists need to know the structure of the virus, design the test and then validate it by proving it works with proven cases of COVID-19. This all takes time but is now up and running in hospitals throughout the UK.
However, whilst the NHS has what it needs in terms of machines to carry out the test it does not have the capacity to carry out the quantity of tests needed each day. Machines from elsewhere can be recruited but need to be tested and calibrated before using.
It is just not machine numbers though. Various parts of the process need people to carry out manual aspects of the testing, far more than currently work in any one laboratory. This, coupled with a high level of staff off sick or self-isolating, only compounds the problem further.
This is why, in the UK, testing has been reserved for those patients displaying symptoms who have also been admitted to hospital and not those in the community.
Testing people in the community uses up a lot of testing time and kits but the advice, irrespective of the result, remains the same, that they must observe the current lockdown rules. Testing seriously ill people in hospital however helps determine the type of clinical care needed and aids decision making by clinicians.
In Germany and South Korea there are public laboratories but also multiple independent laboratories who compete for work. This competitive process results in over-provision of tests at any given time because they are competing against each other to secure contracts. Companies want to be at the top of the lucrative supply and demand chain so testing kits have been plentiful.
The impressive results in South Korea are also a reflection of a government acting quickly. At the outset they united all their laboratories, public, private and research, so that all were producing test kits en mass. However to give some context, South Korea has only conducted around 400,000 tests which equates to about one third of NHS staff in the UK. Testing huge swathes of populations is, in my view, an not achievable aim.
//www.thetimes.co.uk/article/test-test-test-how-uk-is-failing-in-fight-against-coronavirus-92fdpg70w
Death Rates, why so much lower in Germany and South Korea?
Against a background of extensive testing compared to other countries one would expect the mortality rate to be lower in these two countries. The mortality rate is the percentage of deaths in the known cases. Test just one person who is positive and then dies and the mortality rate is 100%. If 100 people test positive and only one dies the mortality rate is 1%. Rates alone cannot be relied on to reflect how many people are dying.
However, the number of cases or deaths per 1 million people of the general population gives a more accurate interpretation of the statistics.
For every 1 million people in Italy there have been 500 COVID-19 deaths, but in Germany only 90 and South Korea just 5.
Before understanding why the death rate is Germany and South Korea is so much lower than elsewhere in the world we need to think a little more about the demographics of the cases in each country.
Not every country has released breakdowns of the age ranges of confirmed cases but Italy, Germany and South Korea have and they are as follows.
Age Range in Years Percentage of Cases
Italy
0-18 1.3
19-50 25.7
51-70 37.1
Over 70 35.9
Germany
0-14 8.8
15-59 69.7
Over 60 22.0
South Korea
0-18 6.42
19-50 51.32
51-70 31.19
Over 70 11.23
(Different countries have bracketed their age ranges differently which is why there is a mismatch in the age ranges. Also some cases are marked as “age unknown” so percentages do not necessarily add up to 100%).
The striking thing is that in Italy, nearly 75% cases were in people over the age of 50 with only 25% in the 19-50 age group. This contrasts with Germany where just 22% of cases were in the over 60 and the majority of cases were in the age range 15-59.
In South Korea 42% of cases were in the over 50 and more than half in the 19-50 age group.
The mortality rate of COVID-19 increases steeply with age and this is true worldwide. Over 14% of cases in the over 80 die compared to 0.4% in the 40-49 age group.
It is reasonable then to suggest that the lower death rates in Germany and South Korea are a reflection of the fact their disease demographic has been different to other places. A majority of their confirmed cases are in the younger age groups who statistically have a much lower chance of dying.
But why would the same virus vary in the way it infects different age groups in different countries?
The answer is, it probably doesn’t. Other events may explain discrepancies in the data.
In Germany it was mainly younger people who first became infected during skiing holidays and carnivals held in February. Hundreds of cases were traced back to a carnival in Langbroich and a ski centre in the Tyrol. Initially the virus spread through this younger age group. However the number of deaths in Germany is rising due in part to an increasing number of elderly people becoming infected.
In South Korea experts are concerned that there will be a second wave of infection as students come home from overseas as their universities close and move instead to online learning. These returning students may account for some of the cases in the younger age groups. It is also possible that some South Korean youngsters, frustrated by two months of isolation, are venturing out with less alarm because they know if they get COVID-19 they will more than likely have a mild illness. This may go some way to explaining why South Korea has such a high proportion of cases in the younger cohorts.
Only history will tell us how each country fared once this pandemic is over. However, it is too soon to hold up any one country’s approach as the gold standard of how to deal with COVID-19 when it is clear that there are many factors influencing the testing, treating and outcome of COVID-19 infection.
https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/
