Earlier this week, Germany became one of the first countries to start easing COVID-19 restrictions. That’s because its initial response to the pandemic helped keep the death rate low. Germany:
- Caught the coronavirus early
- Does lots of testing
- Has a robust health care system.
As the pressure mounts to reopen economies across the globe, other countries may have something to learn. On this episode of The Dose, Michael Laxy, a health economics researcher at the Helmholtz Center in Munich and former Commonwealth Fund Harkness Fellow, talks about the German approach.
Guest bio: Michael Laxy
Illustration by Rose Wong
MICHAEL LAXY: And I think in the long term it will still be a little bit of a back and forth, kind of going back step by step, monitoring it closely. And then hopefully this will be successful.
SHANOOR SEERVAI: Hi everyone. Welcome to The Dose. That was Michael Laxy, a health economics researcher at the Helmholtz Center in Munich. Like all countries, Germany is grappling with the COVID-19 pandemic. But experts have observed that some strategies are working really well to keep the death rate low. Germany started testing people early in large numbers. The country has plenty of hospitals and intensive care beds for the severe cases. And it also helps that for the most part, social distancing guidelines are being observed. As the pressure mounts to reopen economies across the globe, other countries may have something to learn from the German approach. So I asked Michael to join me on the show today. Michael is tracking the spread of the disease among households in Munich as well as the effects of the countermeasures on people’s health and economic situation.
Michael, welcome to the show.
MICHAEL LAXY: Hi Shanoor. Great to talk to you today.
SHANOOR SEERVAI: Great. So let’s get started with your research. Tell me what you’re working on.
MICHAEL LAXY: Yeah. First before I start to talk about in detail, I have to say in general, I’m doing research more on noncommunicable diseases. So my research was pretty much about diabetes, and obesity, and cardiovascular diseases, et cetera. But of course with the start of the pandemic everyone within health science tries to contribute little pieces and bits to solve actually the problem. And so did I. Currently I’m involved in two studies on COVID-19. The first study is the Munich prospective COVID-19 study. And so this is a study that tries to sample a representative number of households in the area around Munich. So it will be around 3,000 households. And it will interview these people, and also take blood samples, and we will do antibody tests with these samples, and trying to get a number of how many people already were infected and might have immunity today.
Our part in the study as health economic researchers is the assessment of the socioeconomic, and also of the psychological impact of the pandemic itself, but also of the countermeasures to tackle the disease. And I think the specific feature of this study is that these visits will be done repeatedly over a time period of almost 12 months. And so the overall goal is to understand and also monitor the dynamic and spread of the disease, but also trying to evaluate continuously the effectiveness on some of the countermeasures we actually take in place.
SHANOOR SEERVAI: So tell me what the value is of going to people’s houses repeatedly and collecting this data over and over again as we try to look forward and understand the dynamic.
MICHAEL LAXY: I think doing it repeatedly is particularly important to actually monitor and do kind of surveillance of what’s going on, to understand how the pandemic spreads over time, how its dynamic changes, if number’s climbing up again or if numbers stay constant over time. And by doing that repeatedly over time in a panel of households, we might also understand the effectiveness and also the side effects, of course, of some of the measures that are already in place or that will be taking possibly in the future. So I think this is the value of the study, and that’s what the study tries to figure out.
SHANOOR SEERVAI: I mean all countries are taking countermeasures. But let’s talk in some more detail about what Germany has done to control the spread of the pandemic.
MICHAEL LAXY: So I think in general, what we did in Germany also followed some of the approaches of other countries did, so first of all, we abandoned big mass meetings of more than 1,000 peoples. That was early March. And then the next step was closing down schools, and also kindergartens, et cetera. And that was followed by a measure by the end of March of kind of a social distancing measure, and restart also all nonessential shops and had to close at that point.
So these, I think were the first kind of more traditional measures that were taken. And of course, in Germany we try to build up very early high capacity for testing for the disease and for the virus. So already early March I think in Germany more than 80,000 tests per week were done. And I think currently we’re doing around 400,000 tests a week. And with that, probably much more than some or many other countries currently.
SHANOOR SEERVAI: Let’s talk about the testing infrastructure in more detail. Like how is Germany able to test so many people?
MICHAEL LAXY: I think that, that just also has to do with the general health care and public infrastructure here in Germany. I think we have a lot of laboratories across the country that were able to do a lot of tests from the beginning. And due to the political decision quite early that testing is important and we need to expand the testing capacity. I think these were the two main ingredients also to assure that testing can be done and will be done.
SHANOOR SEERVAI: So lots of testing. You said a couple of times that Germany started doing things early. So tell me more about that. I mean, was there a crystal ball? Like how did you know to do these things?
MICHAEL LAXY: There were two things. First of all, I think we had a little bit more time than some of the other countries that were hit really hard by the pandemic, particularly Italy. So the spread of the pandemic in Italy is probably a couple of weeks happened earlier than in Germany. And I think seeing the massive consequences the pandemic had in Northern Italy was really a big warning sign for actually enacting countermeasures. And I think that happened both on a political level, but I think it also happened more of individual population level, where people really realize, “Okay, we have a problem here. And we better should follow maybe the measures that will be enacted now.”
SHANOOR SEERVAI: You know, we’re recording this podcast in the week when Germany is reopening. So what’s going on?
MICHAEL LAXY: So first of all there were a lot of discussions how to do it. And I think there were also some scientific associations who were asked to provide their guidance and their opinion on how to do that, et cetera. So first of all, I think there was a good exchange between politicians and also between scientists what next steps to do. And I think politicians now made a decision to reopen, but in very small doses, and do it with a very low speed. So for example, we started this week again to reopen schools.
But just for example, the classes in most states who will graduate this year and have to prepare for their final examinations, et cetera. And small stores and shops were also allowed to reopen. But also there’s now an upper limit in terms of the space shops need to provide that are allowed to reopen. And so think it’s going now step by step. And what is also clear, and it has been emphasized by politicians as well, the spread of the pandemic will be monitored quite closely during this process. And probably if we see now the numbers skyrocket again as they did a couple of weeks ago, and this might be also a bad message. And some of the things might be done backwards. I don’t hope so. But at the current stage, no one really knows. And that’s the current situation here in Germany.
SHANOOR SEERVAI: So what about people in Germany who have chronic conditions? What about somebody with heart disease or hypertension, diabetes?
MICHAEL LAXY: So probably for them they might have the biggest problems with that. Young healthy people don’t need a routine care that often. But of course if I have hypertension or diabetes, I need routine care checkups every few weeks, I need to get prescriptions regularly, to take my medications, et cetera. So probably, yeah. The older people, of course, are more likely to have chronic conditions, et cetera. They’re probably more burdened if there is actually a big effect. And we still don’t have hard data on that yet. So we might speculate that this is a problem. We know that isolation might have an impact on mental health and physical health. So this might be a problem.
And particularly if that’s the case, we might also expect bigger impacts on the elderly who are more often living alone, or more often are depending on visits by friends and family members, et cetera. I think we see the same thing right now. So kindergartens and KiTas are still closed. I think also kids are actually desperately looking forward to meeting again, friends and peers, et cetera. So we need to also consider the potential side effects of the things that are in place.
SHANOOR SEERVAI: So it makes sense that the people who are most likely to have side effects on their health are the people who are already struggling with health conditions. But then there’s a whole other aspect of the countermeasures, and those are economic. Because with social distancing, so many people are confined to their homes, can’t go to work. So who are the people who are worst impacted economically by the crisis in Germany?
MICHAEL LAXY: It’s kind of a complex question. I’m trying to answer it the best I can. I think we also need to differentiate between two levels. So there’s like direct consequences of the pandemic and of course, this is a little bit more simple. It affects elderly people. Those with chronic conditions are at highest risk. And of course, those who still work in system relevant jobs like for example health care workers, but maybe also people working in grocery stores, bus drivers, the police workforce, et cetera. They still are like in the front and most exposed to actually get infected by the virus itself. So this is more like a direct effect. And this is a little bit more easier to quantify.
And then the indirect consequences of the countermeasures, they’re a little bit more complex, I guess. So I think that the largest immediate economic impact we will see in people who do not have system-relevant jobs but who cannot work from home. And here I particularly think about people, like first of all small-business owners, but also employees working in hotels and restaurants, et cetera. These things that are closed right now. We might expect the hardest economic hit in these people. Like when we talk about the professions and in the sectors where probably the economic crisis hits the hardest, will probably be in a population segment of people who already make less money than the average. So we probably will see or hear disproportionate negative economic effect on people who have a low socioeconomic status.
SHANOOR SEERVAI: What is the German government doing to help these people who are hardest hit economically?
MICHAEL LAXY: There are different measures that they’re trying to enact. I think the most important one that is a measure that is called Kurzarbeit. So this tries to prevent losses of jobs and sort of mechanism works when companies actually cut down the working hours of their employees, the employee leaves will be compensated from the Federal Institute of Employment in Germany to kind of level off the income losses they see. And so this is a scheme or a model that actually worked also quite well in the economic crisis here in Germany 10 years ago.
And I think there are also some scientific evidence from economics that says or that is hypothesizing that this measure was also successful in preventing that unemployment rates go up a lot. So of course, these are measures that are more in the short term. Government will not be able to subsidize salaries over years. And I think the things are in place right now. And as soon as the economy recovers, of course, these things will also be taken back step by step.
SHANOOR SEERVAI: The thing that strikes me about this is that it means that people haven’t lost their jobs. So when the economy is ready to reopen as it sounds like Germany is right now, people can just go straight back to work. They don’t have to look for a new job because they lost their job.
MICHAEL LAXY: Right. So I think this is the underlying intention of this measure, trying to prevent losses of job that first of all, of course, cause a lot of distress for the people that get fired and are unemployed then. And of course, then also trying to keep the economy as stable as possible. And when we were maybe also in a couple of weeks go back to kind of normal business or kind of a normal business that these employees actually are still like in place, and can be productive again.
SHANOOR SEERVAI: Well, this is a good note to end on, actually. Let’s talk about going back to normal. Because I know that here in the U.S. people are getting restless. People want to go back to normal. Germany has started that a little bit, as we talked about earlier. But before you can go back to normal, so many things need to be done to make sure that the country is prepared for that. So what are some of these things that people are really paying attention to in Germany?
MICHAEL LAXY: So of course one really big issue people are talking about a lot was also how are we going back to kind of normality in schools and in kindergartens. Because as long as schools are closed, and KiTas and kindergartens are closed, for many employees there’s not even the question about going back to work. Because as long as they have to do homeschooling their kids. So this is one thing where there’s really a discussion currently ongoing. Because I think we need smart concepts, making sure kids can go back to school, but that is also in a safe environment. And I think a lot of people are working on concepts to assure that right now.
And then I think the overall premise is to further adhere to hygiene and to the measures that are in place, to keep the distance in daily life. This is still a very important thing to do. And this is independently if it’s at schools, or at workplace, or in a supermarket, et cetera. So I think these are essential things we haven’t paid a lot of attention in the past. And I think we do that now, and we will need to continue to do that in the future. And I think on top of that, there’s also a little bit of hope that is the digital contact tracing that is aimed to be implemented soon, that we might also have another measure for actually having an early kind of detection where we can maybe also isolate people who might be infected but don’t have symptoms, et cetera. So this is very difficult right now when we do that the old way, and in an analog way, and phoning the contacts of people that got infected.
And of course, last we as a scientific community also hope to do or to provide our support or impact on that. Providing data that actually inform politicians to make informed choices. And I think in the long term it will still be a little bit of a back and forth, kind of going back step by step, monitoring it closely. And then hopefully this will be successful. But I think we need to wait a couple of more weeks to evaluate if the way we are doing that currently in Germany is actually successful, and sustainable, or not.
SHANOOR SEERVAI: And I mean that’s where research like yours comes in. So thank you for doing it. And thank you for joining me on the show today.
MICHAEL LAXY: Alright. Thank you very much. It was a pleasure.