If you’re standing in Germany, the coronavirus pandemic might look a little bit less overwhelming than if you’re standing in, say, Italy or the United States. Germany’s coronavirus mortality rate is among the lowest in the world ― 1.4% as of Saturday ― while Italy’s is a shocking 9.4% and the U.S. is standing at 2.7%.
Why does the virus appear to be so much deadlier in certain places?
The answer, like the coronavirus crisis itself, is complicated. But it has to do with a few distinct factors: how much testing has been done, the overall health of the population, how the public reacted to the threat and what their health care system looks like.
Testing affects our understanding of the true mortality rate of the virus.
In March, a single Italian nursing home lost one-third of its residents, but none were tested for COVID-19, the disease caused by the coronavirus, according to a Wall Street Journal report. There are many such incidents across Italy: People who have died while the pandemic rages around them, but since they are not tested, their deaths get recorded as something else, like pneumonia.
It’s easy to see how the scope of testing affects our data about the virus. It’s very possible that there are COVID-19 deaths that aren’t being recorded as COVID-19 deaths in many places around the world. It is also likely that there are a good number of people who get infected and recover, but their infections are going unrecorded because they don’t have symptoms, or they believe they just had a cold, or they are turned away from getting tested.
There are also different ways to define “mortality rate,” Dr. Daniel Diekema, director of the University of Iowa’s Division of Infectious Diseases, told HuffPost. Some researchers define it as the number of deaths over the number of people who were sick enough to require hospitalization. Another way to look at it is the number of deaths compared to the total number of people who actually got infected ― a number that is impossible to know.
But researchers will do their best to work backwards. Using “serosurveys,” or antibody tests, they can figure out how many people in a certain area have developed antibodies to the virus, which indicates they were infected and recovered. That will help us understand how far and wide the virus actually spread compared to how many people died from it. Right now, those tests are in the early stages of being rolled out.
Overall, the World Health Organization estimates that the coronavirus mortality rate will be between 2% and 4%.
Diekema thinks that’s a bit high.
“If you could know the absolute truth, and you knew the total number of people who are infected around the world and the total number of deaths, I think it will end up being lower than that,” he said. “But there will be a lot of variation from region to region and state to state.”
How people in a country or city responded to the virus — and how quickly they mobilized — affects the mortality rate, too.
In South Korea, officials were quick to confer with medical researchers and pharmaceutical companies to start whipping up tests back in January. By February, the country was testing aggressively to identify cases even in people who weren’t showing symptoms, allowing them to quarantine efficiently and squash the virus.
Italy, by comparison, was slow to mobilize and its residents were initially reluctant to stay at home to prevent the spread of the virus. The result was an explosion of cases that has overwhelmed the nation’s health care system, leading to more deaths than might have otherwise occurred.
The age and health of a population is also a big factor.
In Germany, officials believe that many of those who first contracted the virus were exposed to it at ski lodges, and they tended to be younger and more physically healthy, according to The New York Times. Officials then managed to step in with robust testing and strong preventative measures to try to keep it from spreading to more vulnerable, older groups.
In New Orleans, residents are disproportionately affected by a number of health problems ― hypertension, kidney disease and obesity among them. That is one of the reasons the Southern city has one of the highest COVID-19 mortality rates in the country.
For public health officials, there is also the problem of categorization. Some deaths are complicated by underlying factors.
“If someone dies with COVID for whom the immediate cause of death might have been cardiac arrhythmia, that is still related,” Diekema said. “That likely never would have happened had the patient not been infected and had that additional stressor and the need for hospitalization.”
As is health care infrastructure — and access to it.
“I think we’re going to see mortality rates significantly higher among those communities in the United States that are frequently disenfranchised,” Diekema said. “There’s a lot of racial disparities, income disparities that impact health care.”
Already, there are more COVID-19 cases in poor neighborhoods in New York City than wealthier ones. Rural residents across the U.S. are bracing for the coronavirus while worrying about their lack of access to hospitals, which have been shutting down in rural America over the last decade.
American governors have had to compete with each other for access to essential medical equipment, which remains in short supply. New York state has been able to ramp up its supply of ventilators, in part by asking China for help, but it remains unprepared for the worst that is yet to come.
“If you have a dysfunctional, fragmented system like we do in the United States, a generally unjust one, the impact of something like this is unevenly distributed in society,” Diekema said. “Whereas most other industrialized countries have universal access to care.”
In Germany, “corona taxis” drive around with medical staff to check on people with coronavirus. They look for those who might need hospitalization, because getting patients to the hospital right when they need help is crucial to whether or not they survive. The country tests widely so positive patients can be isolated, and it has managed to deploy its health care resources for maximal efficiency.
“If you’re running out of ventilators, if you’re having to have physicians or other health care personnel take care of intensive care unit patients or critically ill patients [who] haven’t been trained to do so,” Diekema said, “the outcomes are not going to be as good. More people are going to die.”
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