CORONAVIRUS: A TALE OF TWO CITIES

Washington and Berlin, two cities, two governments, both dealing with the same nemesis:  the SAR-CoV-2 virus.  But their approaches to the pandemic couldn’t be more different.  It’s not just a matter of the numbers, although the German numbers are more favorable (if there could be such a thing when speaking of a pandemic) than those of the U.S.  As of this writing, according to Johns Hopkins, there are 761,964 confirmed coronavirus cases in the U.S., and 35,314 coronavirus deaths, for a mortality rate of 4.63%.  (That will increase over the course of the day.)  Because the U.S. did not start diagnostic testing early on and because it has not tested widely, the case and mortality numbers are likely higher than reported, how much higher we really don’t know. 

As of the same time, in Germany there are 145,743 confirmed cases and 4,642 deaths, for a mortality rate of 3.19%.  (In Berlin, there were 5,196 confirmed cases and 94 deaths, for a mortality rate of 1.81%.)  In contrast to the U.S., Germany developed a diagnostic test on January 16, 2020, started testing right away, and is still testing widely.  To be sure, German testing has not identified 100% of its coronavirus cases and resulting deaths, but the German numbers are likely to be much more reliable than the U.S. numbers precisely because of the mass scale of the testing.  In Germany, testing is the key to the puzzle.  In the U.S., testing is the puzzle.

There’s a revealing saying in German, “Glauben ist gut, aber kontrollieren ist besser.“  That translates, roughly, ”Belief is good, but proof is better.”  The Germans are crazy about knowledge, facts, measurements, accuracy; in a word, science.  (They have less desirable qualities, too, but that’s another story for another day.) I think this cultural bias towards fact-based problem-solving, plus trust in government, are responsible for the differing approaches to the pandemic.  The German preference for fact over rumor created the climate for solidarity, and it’s solidarity that is the essential ingredient for managing this pandemic.  How did the German state do it?

Politically, Germany is organized much like the U.S., in that it has an overarching federal government with 16 individual states, each of which has considerable autonomy.  This organizational system, based on the American model, was adopted after the Second World War to prevent the concentration of power in a central government.  So control in Germany is federalized, but decentralized, very much like it is the U.S.  But the constitutional similarities end there. 

While the American response to the coronavirus outbreak has been politicized and extremely heated, the German response has been scientific and comparatively calm.  To some degree that has to do with the personalities of the leaders themselves.  President Trump has made it known he does not respect scientists.  Chancellor Merkel is one.  The President thinks of himself as the disrupter-in-chief.  The Chancellor thinks of herself as the caregiver-in-chief.  As noted last Sunday in The New York Times, “the chancellor’s mixture of calm reassurance and clear-eyed realism—as well as her ability to understand the science and explain it to citizens—has been widely praised and encouraged Germans to follow social distancing rules.  Her approval ratings are now higher than 80%.”  By contrast, President Trump’s approval ratings stand around 43%, very low compared to other U.S. presidents who have faced national crises.

But these character and background differences and their sharply divergent approval ratings aside, the President and the Chancellor have more in common than you might think.  Both are leaders of conservative parties distinctly biased in favor of business, whose supporters tend to be Christian and predominantly white.  Both face strong liberal opposition parties, in addition to right-wing fringe elements. And make no mistake, the German economy, the largest in the European Union, is heavily based on exports, so business plays a strong role in political decision-making.  Yet business interests haven’t called the shots in the coronavirus pandemic here.  Science, trust, and solidarity have.  

It’s this insistence on “kontrollieren,” on proof of the facts, that begets trust in government, which in turn begets solidarity.  And it’s solidarity that begets a citizen buy-in, which is crucial to social distancing, flattening the curve, and getting the pandemic under control.  How did all of this “begetting” unfold in a decentralized political system, much like the U.S. system, and coalesce into a national approach where science and solidarity take central stage? How did Germany pull that off?

The first coronavirus case in Germany was confirmed near Munich in Bavaria (above) on January 27, 2020.  According to Wiki, 

The majority of the cases in January and early February originated from the headquarters of a car parts manufacturer there.  On 25 and 26 February, multiple cases related to the Italian outbreak were detected in Baden-Württemberg. A large cluster linked to a Carnival event was formed in Heinsberg, North Rhine-Westphalia, with the first death reported on 9 March 2020.

Using their constitutional autonomy, these three states acted on their own initiative to address their regional outbreaks by instituting statewide lockdowns.  However, as these localized outbreaks spread to other states, the federal government decided it was time to take coordinated, federal action to ensure a more effective and uniform response.  

On March 18, 2020, Chancellor Merkel gave her first televised national address in her 14 years in office, (other than her annual New Year’s address), to educate the public on the seriousness of the outbreak and the need for citizen action based on science and solidarity.  According to my friend H, the Chancellor worked on the text of the speech herself with her chief speechwriter and her top aide, revising the text frequently to make sure it reflected her own voice, and rehearsing it many times before going on the air.  Here are the excerpts from her address which focus on science and solidarity (emphasis added).  You can read the address in full here Merkel March 18.

Fellow citizens,

I’m addressing you in this unconventional way today because I want to tell you what guides me as Federal Chancellor and all my colleagues in the Federal Government in this situation. This is part of what open democracy is about: that we make political decisions transparent and explain them. That we justify and communicate our actions as best we can, so that people are able to understand them.

As far as the epidemic is concerned – and everything I tell you about this comes from the Federal Government’s ongoing consultations with the experts from the Robert Koch Institute [Germany’s CDC] and other scientists and virologists: the most intensive research is being conducted around the world, but there is still neither a way to treat the coronavirus, nor is there a vaccine.

I firmly believe that we will pass this test if all citizens genuinely see this as THEIR task.

Allow me therefore to say that this is serious. Please also take this seriously.

I also want to tell you why all of you are needed here, and what each and every individual can do to help.

These are not just abstract numbers in statistics, but this is about a father or grandfather, a mother or grandmother, a partner – this is about people. And we are a community in which each life and each person counts.

I would like first of all to address all those who as doctors, nurses or in a different capacity work in our hospitals and in our healthcare system in general. You are doing tremendous work, and I would like to thank you from the bottom of my heart.

I know how dramatic the restrictions already are: no events, no trade fairs, no concerts any more, and, for the time being, also no school, no university, no kindergarten, no more playing at the playground. I know how invasive the closures that the Federation and the Länder [States] have agreed to are in our lives, and also in terms of how we see ourselves as a democracy. These are restrictions, the likes of which the Federal Republic has never seen before.

Allow me to assure you that, for someone like me, for whom the freedom of travel and the freedom of movement were a hard-fought right, such restrictions can only be justified if they are absolutely imperative. These should never be put in place lightly in a democracy and should only be temporary.  But they are vital at the moment in order to save lives.

Panic buying, as if there’s no tomorrow, is pointless and, at the end of the day, shows a complete lack of solidarity.

And allow me to express my thanks to those who are too seldom thanked. Those working as supermarket cashiers or restocking shelves, who are currently doing one of the most difficult jobs that there are at the moment. Thank you for being there for your fellow citizens and for keeping us all going.

Let me talk now about what I believe is most urgent today. All measures taken by the state would come to nothing if we were to fail to use the most effective means for preventing the virus from spreading too rapidly – and that is we ourselves.

Every individual counts. We are not condemned to accept the spread of this virus as an inevitable fact of life. We have the means to fight it. We must be considerate and keep a safe distance from one another. Virologists are giving us clear advice: no more handshakes, we must wash our hands thoroughly and often, and we must keep at least one and a half meter’s distance between ourselves and others. Ideally, we should avoid all contact with the elderly, because they are particularly at risk.

I know that this is asking a great deal of us. Especially when times are hard, we want to be close to one another. We show affection by staying close, and by reaching out to each other. But at this time, we must do the exact opposite. Every single one of us must understand that, right now, the only way to show we care is by keeping our distance.

We all must discover how we can show affection and express friendship. We are staying in touch via Skype, phone, email, and maybe also by writing old-fashioned letters. The post, after all, is being delivered. We’re hearing about beautiful examples of neighbors helping one another. People are assisting the elderly who cannot themselves go shopping. I am certain there’s plenty more we can do. We will prove, as a community, that we will not abandon one another.

I therefore urge you to abide by the rules that will remain in place for the time being.

This is a developing situation, and we will ensure that we continue to learn from it so that we can adjust our thinking and deploy new instruments at any time. If we do so, then we will explain our reasons once again.

Therefore, I call on you to not believe any rumors, but rather only the official messages that we will always translate into many languages.

We are a democracy. We thrive not because we are forced to do something, but because we share knowledge and encourage active participation. This is a historic task, and it can only be mastered if we face it together.

The situation is serious, and the outcome uncertain.

Our success will also largely depend on how disciplined each and every one of us is in following the rules.

Even though this is something we have never experienced before, we must show that we can act warm-heartedly and rationally – and thereby save lives. It is up to each and every one of us to do so, without any exception.

Take good care of yourself and your loved ones.

Thank you.

They don’t call her Mutti (Mom) for nothing!

 

Four days later, on March 22, 2020, with Germany’s infections having risen to 23,974 with 92 deaths, the Chancellor issued federal guidelines for containing the virus.  But before doing so, she consulted by videoconference with the premier of each state, leaving it up to each to maintain or impose more stringent restrictions, depending on their unique circumstances.  Here are the guidelines, which are similar to, but much more specific than, those suggested by President Trump a few days earlier:

• Public gatherings of more than two people will be banned. There will be exceptions for families and those living together.
• General contact with others should be reduced to a minimum.
• A 1.5-meter (4.9 feet) distance should be kept at all times when in public.
• Gastronomy businesses must close. Businesses offering food delivery and collection will be allowed to remain open.
• Service providers such as hair-dressers, cosmetic, massage and tattoo studios where a 2-meter distance between people is not possible must also close. Businesses and centers offering medical treatments may remain open.
• Police and other law enforcement agencies will enforce any infractions of the new rules.
• Hygiene regulations must be implemented for staff in the workplace, or for visitors.
• Commuting to work, helping others and exercising alone outside will still be permissible, as long as the activities are carried out in abidance with the guidelines.
• The measures will remain in place, initially for the next two weeks [April 5].

At the expiration of the two-week period, the guidelines were extended for an additional two-week period through April 19, and then they were relaxed somewhat and extended through May 3, 2020.  You can read the modified guidelines applicable to Germany and specifically to Berlin here.

But more interesting than the relaxed social restrictions themselves is the tripartite process that led to them, involving scientists, business people, and politicians.  The Chancellor’s reliance on scientists in the decision-making is described in Der Spiegel.  You can read the entire article here:  Der Spiegel Leopoldina.  

From the article:

In her final public appearance before the Easter holidays, Chancellor Angela Merkel stated very clearly which scientific advice she intends to consider in steering further action in response to the novel coronavirus pandemic. "For me, a very important study will be that of the National Academy of Sciences, the Leopoldina,” Merkel said at a press conference on Thursday. The chancellor said it was important to be "on firm ground” in making the upcoming decisions. Merkel said this is the only way that the many drastic restrictions on public life can be lifted again.

According to Deutsche Welle at DW, the Leopoldina (above), originating in 1652, is the oldest continuously-operating scientific academy in the world.  The academy has 1,600 members from 30 countries and advises the Chancellor and her government directly, as well as the premiers of the 16 German states. Its mission statement is to represent the German scientific community internationally and provide policy makers and the public with science-based advice.   Its recommendation to focus on testing capacity has seen Germany test over 1.5 million people by April 12.

Twenty-six members of the academy were involved in the study that informed the decision to relax the lockdown.  According to Der Spiegel Leopoldina:

The 26 scholars spent hours over the Easter holidays discussing the current status in Germany before coming to an agreement on the recommendations they submitted to the German government. Highly regarded scientists including Lars Feld, the chair of the German Council of Economic Experts, which advises the government on economic issues, ethicist Claudia Wiesemann, legal philosopher Reinhard Merkel and sociologist Armin Nassehi, among others, agreed on the language via conference calls and came up with clear standards for lifting the restrictions currently imposed in Germany.

"We wanted to adopt a calm and balanced approach in the heated political debate, and we wanted to give people an optimistic outlook,” Leopoldina President Gerald Haug [below] told DER SPIEGEL. The overriding priority is "the protection of every single person” from getting infected with the coronavirus.

I was particularly struck by the inclusion of an economist, an ethicist, a legal philosopher, and a sociologist in the academic advisory group, which also included a pedagogue, a paleoclimatologist, and a tax policy expert, among others.  The inclusion of non-business, non-medical perspectives seems to me to be essential for a holistic solution to what is more than an economic and public health problem.  The coronavirus has affected every aspect of human life and all of its various impacts must be taken into account when considering the imposition and lifting of social distancing guidelines.  

President Trump has also reportedly convoked a Thought Leader Task Force of 200 persons, in addition to his Presidential Coronavirus Task Force and his Economic Coronavirus Task Force, to advise on re-opening America for business.  While 200 seems to me an unwieldy number, and while I can find no information on who serves as a thought leader on this task force, or who the President considers to be a thought leader, I find the potential inclusion of voices from communities outside the medical and economic worlds encouraging.  (Provided we’re not talking about Kim Kardashian, Tom Brady, or Rush Limbaugh as thought leaders.)

I was also struck by the reference in the Leopoldina’s report to the “heated political debate” and the need to adopt “a calm and balanced approach.”  Germany, a democracy with a parliamentary style government, is not immune to political controversy.  Robust debate is encouraged here.  But unlike the polarized discussion of how to manage the coronavirus in the U.S., where science seems to have been grudgingly accepted but only for this special case, and where solidarity is not a word often if ever heard, here in Germany, solidarity and science steered the discussions down the road to compromise and conclusion. 

Here is a glimpse at how specific scientific advice regarding reopening played out in the political discussion among Chancellor Merkel and the 16 state premiers, including Markus Söder of the Christian Social Union Party in Bavaria (above) and Hamburg Mayor Peter Tschentscher of the Social Democratic Party (below).  You can imagine the horse trading that went on, yet a compromise was achieved nonetheless.  As reported in Der Spiegel Frustration:

German Chancellor Angela Merkel isn't generally one to get overexcited, so when she does reach for hyperbole, it tends to reflect genuine elation. "We have achieved a high degree of unity in our approach, which is almost a miracle for a federal republic," she said on Wednesday, after a videoconference with the governors of Germany's 16 states.

The governors spent around four hours speaking with the chancellor and key cabinet ministers about the path forward in the fight against the coronavirus. They managed to produce a declaration with concrete resolutions.

The strict social distancing measures will remain in place until May 3, though car dealerships, bicycle shops and bookstores can open, presuming certain regulations are observed. Shops with a floor space of up to 800 square meters (8,600 feet) are also allowed to reopen. Schoolchildren in grades approaching graduation or on the cusp of transferring to the next level of schooling will return to the classroom. Large events will remain prohibited until Aug. 31 and the wearing of masks in buses and stores is recommended, but not mandated. [That’s because masks are in short supply here, too.]

However, the devil is always in the details, and reopening is exceedingly fraught.  Consider the case of education, a prime example of just how devilishly complicated the lifting of restrictions can be.

From Der Spiegel Leopoldina:

The researchers at Leopoldina are pressing strongly for schools to be reopened "as soon as possible,” because forcing children to learn at home further exacerbates pre-existing social inequality in education. Since this applies foremost to the primary school level, where curricula are generally taught in a classroom environment, the experts argue that those schools should reopen first, starting with the upper classes in which pupils are preparing to make the transition to secondary school. But they recommend that students be required to wear masks, and that they should initially be given instruction in the basic subjects of German and mathematics in a "group size of a maximum of 15 pupils.”

Implementing the lifting of these educational restrictions will be impossible without cooperation and creativity.  As reported in Der Spiegel Frustration:

In the recommendations it issued last week, Germany’s Leopoldina academy of science, made it clear what schools now need to do for teaching in the classroom to resume: staggered school hours, a focus on core subjects, lessons with a maximum of 15 pupils. Students and teachers will also need to social distance from one another, wear facial coverings and comply with hygiene regulations, like regularly washing their hands.

But if a primary school usually has three fourth-grade classes with 25 students each, how many classrooms will it need if no more than eight or nine children are allowed to sit in a room at a time? It sounds like a math lesson, but Martina Reiske (below), the director of [a] primary school in the western German city of Bielefeld, has had to make these calculations.

The answer? Nine classrooms. "When I take into account that I need two additional rooms for children in emergency child care because their parents are key workers, I arrive at 11,” Reiske explains by phone. The school has 15 classrooms in total, including a music room and a playroom. The director says that the numbers would work if only one grade of students is being taught, but the school has three additional grades.

The staffing situation is also critical. Reiske has 33 teaching staff at her school, including many in part-time positions, as well as a social-education worker and two social workers. But one teacher is pregnant, and two other members of the teaching staff have disabilities and can’t teach on-site at the school during the corona crisis. The same applies to three other staff members above the age of 60, who qualify as members of a risk group and should therefore not be exposed to any danger of infection. That makes 33 minus six.

Politicians now need to be thinking about the big picture in ways that can creatively and quickly solve problems like the ones encountered by the schools, improving people’s everyday lives despite the coronavirus.

“Creatively and quickly,” and I would add “cooperatively.”

Within the context of the intense polarization of the American electorate, the heated and at times intransigent political debate, the disdain for science at the top, and the burial alive of truth, nothing can be accomplished creatively, quickly, or cooperatively, certainly not the mitigation of a pandemic.  In Germany, where the path has been rocky and strewn with difficulty, the respect for science, the willingness to trust political leaders, and the feeling of “all for one and one for all” has shown that both the extraordinary and the mundane problems presented by the pandemic can be managed. 

The signposts are there.  The direction is clear.  The Road to Rancor ends in Perdition.  The Streets of Science and Solidarity intersect the Way to Recovery.  You’re in the driver’s seat.  Take the wheel!

Keep it real!  Wear your mask!

Marilyn