German professor of epidemiology: Germany has comprehensive medical services, and Germany seems very lucky. But it is too early to discuss, and I will be very happy if we can come to discuss why Germany is doing the right thing in two months.
As of 17:00 on March 31, Beijing time, Germany has a population of 82.79 million. New coronary pneumonia has been diagnosed with 61,913 and 583 deaths, with a case fatality rate of 0.94%.
Italy has a population of 60.48 million, with 102,106 diagnoses, 11,591 deaths, and a case fatality rate of 11.35 percent.
is also a big country in the European Union, and also the most aging country (Germany over 65 accounts for 21% of the population, Italy 23%), why in terms of the death rate of new coronary pneumonia, one is the highest in the world, and the other is among the big countries lowest?
△ From China Industry Information Network
Average age of infected people:
47 years old in Germany, 63 years old in Italy
As usual, the ski area of South Tyrol in the northern Italian Alps, this historic ski paradise is in February to March this year , Ushered in a tourist season.
This year is very different from usual. No one expected that it will become a hard-hit area. A head of a clinic living in Hamburg, Germany, told 8:00 Jianwen that the first 25 confirmed patients in Hamburg came back from the ski resort, and then 86 family members were infected. "The numbers have been flying upwards, and just like this, they slowly spread out." The neglected new crown pneumonia virus can reach any city on the earth by plane within 24 hours. The criss-crossing traffic lines connect various European countries to form a network. Once the virus entered the network, it spread quickly.
However, such a source is also an important reason for the low mortality rate in Germany. Lu Mengji, a professor at the Institute of Virology at the University of Duisburg-Essen School of Medicine in Germany, said: "The patients are all returning from skiing in Italy. They are in better health and are relatively young."
Shi Li, associate professor of the Department of Public Health Sciences at Clemson University, also ranked this reason first. "In a sense, Italy can be regarded as a place of European origin. It happened earlier and attacked the elderly. The Germans brought the virus back from Italy and brought back the disease. These people have many young and middle-aged people and have cardiopulmonary function. Fortunately, the death ending we are seeing now is this group of Germans. As for the next step, I don’t know for now.”
The opposite is true in Italy. According to a report released by the Robert Koch Institute in Germany on March 18, nearly 80% of the new crown cases in Germany are between 15 and 59 years old, with an average age of 47. According to Bloomberg, the average age of confirmed cases in Italy is 63 years old.
is a big aging country, but the age difference of infected persons is so large. In addition to the difference in the initial infected population, the difference in intergenerational lifestyles between the two countries is also a very important factor.
A Chinese professor who has lived in Germany for many years said that Germany will not have three generations together. Children will go out when they grow up. They don’t like living with the elderly. Basically everyone has an independent living space. .
On the contrary, Italy has a very strong family concept, and the family must be neat and tidy, as can be seen in the movie "The Godfather" series.
△ Screen shot of the movie "The Godfather"
Aceso Health Medical Business Operations Executive Director Wang Qian has lived in Germany all the year round and often goes to Italy on vacation. He is very familiar with the two countries. Highway rest stops, hotels, restaurants, beaches and valleys, and other public areas, there are always people who directly show that they like my children’s actions. Although they are strangers, they come up to say hello to him or pat his head. Squeeze his cheeks, make funny faces, and then have a brief chat with us. You can hardly see this in Germany."
lives in Italy for several generations. If you are not in an urban area, you usually live in a small bungalow, which is similar to the situation in rural China. In the city, it is usually in a large apartment. If the place is small, the ancestors lived in the city not far away, so they moved back and forth frequently. Every weekend, the whole family will go to the restaurant for lunch or dinner. And Italians are most proud of per casa di mama, whether it’s something or a product, it means it’s made by my mother’s house.Or do it in my mother's way.
These social and cultural differences have affected the development of the epidemic. "Pandemics are fundamentally different from the factors behind other tumors or non-communicable diseases. The three major factors of infectious diseases, the scope of the source of infection, the characteristics of the transmission route, and the susceptible population are all closely related to social and cultural factors. "Wang Qian said that because of this, the incidence of mental illnesses such as dementia and depression in Italy is lower than in Germany. But the new coronary pneumonia is more serious.
Germany has tested 500,000
in the past week. Italy has only tested 430,000
so far. Another reason for the huge difference in fatality rate is the difference in test scale, which is the denominator.
"Germany's case fatality rate seems to be relatively low. One reason is that its denominator is more exhaustive of those with mild and asymptomatic infections. If the detection rate is high, the case fatality rate will also appear to be very low." Shi Lu said.
According to the “Financial Times” report on March 20, Lothar Wieler, director of the Robert Koch Institute, said that German laboratories are now conducting about 160,000 coronavirus tests every week. This is a self-crisis. The total number of tests conducted by some European countries since the outbreak, and even South Korea, which conducts 15,000 tests a day and is cited by virologists as a model, has a lower level of testing than Germany. "And it can be further increased."
On March 26, according to the German media "The Local", German virologist Christian Drosten said, "The reason why the number of deaths in Germany is so small compared with the number of infections is that we have carried out quantitative An extremely large diagnostic test. According to estimates in the past few days, we have to perform 500,000 tests a week." Z1z
Shilu believes that Germany has an advantage. In terms of SARS-type coronavirus research, scientific research is very strong. As far back as mid-January, a virology expert who became famous in the SARS era, Christian Drosten, led the team to announce the detailed content and workflow of nucleic acid diagnostic tests, and developed diagnostic reagents.
And the general availability of medical care in Germany, everyone has medical insurance, the mechanism is very flexible, both private and public, it is easy to get tested. So they have done more careful testing, and the denominator is very large. "So, we see that among the 10,000 infections in Germany, it is likely that these asymptomatic infections and mild cases are included, and the so-called false positive results are not ruled out," Shi said.
Italy is also one of the countries with the strongest testing efforts. At the beginning of the epidemic, all suspected patients and those traveling from high-risk areas can be tested. However, in the face of the turbulent epidemic, it soon became unable to perform a comprehensive test, so the test subjects were turned to those with severe illness. According to statistics from the Italian Ministry of Health, as of 17:00 local time on March 28, nearly 430,000 new coronavirus tests have been carried out across the country. This number is not low and is growing rapidly, but it is very small compared to Germany.
In addition, "there is a reason that everyone overestimates the seriousness of Italy", Shi Li believes. Under normal conditions, in the peak season of winter flu and the season of high incidence of cardiovascular and cerebrovascular diseases, even without the new crown, there will be thousands of deaths in Italy. Among these cases, some people are indeed infected with the new crown, but not because of the new crown. However, Italy counts the death of the new crown as a result of the positive result of the autopsy after death. This is a very important detail. "So the mortality rate looks particularly terrible. If this factor is eliminated, of course it is still very bad, but it may not be as bad as the numbers show." Can medical resources cope with the run?
Lombardy is a hard-hit area of the Italian epidemic, which seems to be caught in a disaster movie scene. In an interview with Italy’s “Evening Post”, the head of the intensive care unit in Lombardy’s new crown virus crisis said: “We are currently forced to treat intensive care patients in corridors, operating rooms or rehabilitation rooms. We have cleaned up the entire hospital. It is understood that there are about 800 intensive care beds in Lombardy, where Milan is located, but the number of patients requiring intensive care has exceeded 1,135.
"When a large number of patients appear in a city at the same time, one of the biggest problems is that the beds are full, causing critically ill patients to stay outside.This is one reason for the particularly high mortality rate. "At the invitation of the Chinese Consulate General in Düsseldorf, Zhang Wenhong, director of the Department of Infectious Diseases, Huashan Hospital affiliated to Shanghai Fudan University, said in a video connection.
Germany is also facing the risk of a medical run, but the situation in Italy is not so severe for the time being. On March 22, the German media "Schwaebische Zeitung" can see such a message-in order to relieve the medical pressure in France, the hospital in Baden-Württemberg, Germany is open to patients with new coronary pneumonia in the adjacent areas of eastern France.
Germany is the country with the most complete medical equipment in the EU, with 29.2 intensive care beds per 100,000 inhabitants, 12.5 in Italy, less than half of Germany. At present, Germany has 28,000 intensive care units, while Italy has about 28,000 intensive care units. 5293 beds. The intensive care unit is an extremely important "internal strength" in the medical system. It cannot be quickly developed overnight. It is of great significance for the rescue of severe illness and reducing the mortality rate. Lu Mengji said, "In order to deal with the epidemic, Germany is currently The goal is to double the number of intensive care beds to the level of 60,000". In addition, ventilators and extracorporeal membrane oxygenation (ECMO) are the most effective devices for providing patients with extracorporeal life support, and they determine the mortality rate of the new crown. This situation is very serious in Italy. In order to alleviate the shortage, the Italian car brand Ferrari even recently prepared to produce ventilator parts. According to the German "News Today" report, Germany urgently placed an order with the medical equipment company Dräger 10,000 ventilators. Purchased 10,000 ventilators. What is the concept? Zhang Wenhong explained in the connection that if 10% of people need to use ventilators, then it can satisfy at least 100,000 patients with extremely severe illness Yes. Germany’s current procurement of ventilators is equivalent to at least 100,000 or more patients. According to data from the European Center for Disease Control and Prevention, Germany already has about 28,000 ventilators, plus the latest order, the total The volume reached 38,000.
Germany is a relatively sound welfare state system, and medical and health care has always been a field where the federal government has invested more.
△ OECD website screenshot
The comparison between the two is undeniable, the German "hardware" foundation is slightly better One thing. Wang Qian pointed out that in the 1990s, Germany had planned the number of intensive care units.
"At that time, the cost control awareness was not pushed into the hospital management system, just thinking about how to better provide for patients. medical service. "Wang Qian said that the utilization rate of the entire hospital bed is between 75% and 80%, because Germany will not allow its own beds to be in a state of high load operation. It has been envisaged that if the hospital is fully loaded all the year round, how to go if it encounters an emergency. Responding.
But in the absence of a pandemic, Germany has so many ICU beds, which is criticized by the entire society. "Because its operation requires personnel and equipment, it is a big deal for the operator. Burden. Especially since 2003, Germany implemented the DRGS reform, and ICU became a cost department. "Z1z
Lu Mengji's hospital has 200 intensive care beds and 150 isolation beds, but now there are only 10 patients. "What's more beneficial to us is that the flu patients have been discharged from the hospital before and many resources have been released. On the other hand, Germans prefer to have surgery and surgery, these people will occupy a part of the intensive care bed, and now all unnecessary operations are stopped. Including, there are some physicians in our hospital who are now being trained, and they may be transferred to the emergency team. We have already done this work. "Z1z
is also a slightly fortunate place in Germany. Unlike Italy, it has a high flu season while encountering the new crown epidemic.
The German epidemic is in its early stage, and the fatality rate will change.
Although the fatality rate in Germany seems so special, However, many experts believe that the German epidemic is still in its early stages, and it is not possible to conclude that the case fatality rate is very low for the time being. Lu Mengji believes that the case fatality rate has a lag effect. German patients are still being treated and will increase in the future, estimated to be about 1%.
In addition, with the increase in the number of infections, can Germany’s medical resources continue to cope with medical runs? And once the virus spreads among the elderly on a large scale, the situation may worsen.
"The ultimate indicator for assessing epidemic control is still the number of deaths. Even non-new crown deathsThe number of people, has it caused such damage? "The law of history pays more attention to Japan. The aging rate is higher than that of Germany and Italy. The epidemic broke out earlier than other European countries. It has entered the middle of the epidemic, but the number of deaths is very low (52 cases). "I think many people ignore it. Japan’s achievements in this regard. "Z1z
Leibniz Institute of Prevention Research and Epidemiology Professor Hajo Zeeb (Hajo Zeeb) said, "I think what we are seeing is the result of a combination of multiple factors. Germany has comprehensive medical services, and Germany looks very lucky. But it is too early to discuss these. If we can discuss why Germany is doing the right thing in two months, I will be very happy. "Z1z
Tan Zhuozhao|Written by
Wang Jilu|Editor in charge
