How Germany Leveraged Digital Health to Combat COVID-19

If you take a look at the number of novel coronavirus cases, you will notice that Germany ranks among the top in terms of most cases. Now, if you take a closer look, you will see that the number of fatal cases in the country is merely a fraction of the total cases. Their mortality rate has been consistently lower than that of those nations sharing a similarly high number of confirmed cases like China, Italy and Spain.

How does Germany manage those numbers? The truth is that even experts aren’t sure. “We don’t know the reason for the lower death rate,” Marieke Degen, deputy spokeswoman of Germany’s Robert Koch Institute (RKI), told Vox.

However, there might be several factors contributing to the country’s successful management of the pandemic. Early tests, transparent communication, a well-prepared health IT infrastructure and digital health differentiated Germany’s approach from that of other countries.

Despite the early success, others still call for caution. They forecast a surge in cases in the coming weeks and that victory is far from over. Nevertheless, Germany makes for an interesting case study for the management of COVID-19.

Clear voice, transparent communication

At the beginning of the SARS outbreak, China covered up the existence of the virus from both its citizens and the world. However, the need to be transparent with such public health issues is unquestionable. Chinese officials apparently improved on that front, even if it does not convince some.

“There’s a big difference to SARS. We have a much more transparent China,” Jens Spahn, Germany’s health minister, told Bloomberg. “The action of China is much more effective in the first days already.”

For COVID-19, Germany was transparent from the beginning of the outbreak as well and did not delay to take strict measures. They became one of the first countries to develop a reliable COVID-19 test back in January. They rolled out production soon after to reach the population quicker. In comparison, the Food and Drug Administration (FDA) in the U.S. stalled, allowing tests from large companies to manufacture their tests only in March, leading to a shortage.

The country’s chancellor, Angela Merkel, sent out strong, yet clear messages to the population to respect restrictions imposed so as to curb the spread. “This is serious,” she said in her speech. “Since German unification — no, since the Second World War — no challenge to our nation has ever demanded such a degree of common and united action.”

The earlier the better

Another contributing factor is the earlier testing and tracing performed in the Central European country. “One advantage Germany has is that we started doing professional contact tracing when the first cases were reported,” said Marylyn Addo, head of the infectiology department at Hamburg’s University Medical Centre. “It bought us some time to prepare our clinics for the coming storm.”

To further help towards tracking those exposed, German authorities eye a method employed by some countries like South Korea, Israel and Singapore: phone tracking. The German health ministry drafted changes to the Infection Protection Act law . This will enable, among other measures, the tracking of those exposed to COVID-19. However, such methods are understandably raising privacy issues and need clearer protocols before placed into action.

Source: https://www.tracetogether.gov.sg/

Healthcare institutions even tested people who presented with milder symptoms. They could effectively be monitored and quarantined to prevent cross-infection. The country now plans to test 200 000 people a day. Such measures can alleviate the burden on the healthcare system.

“In general, we have a rather good intensive care situation in Germany,” virologist Martin Stürmer said. “We have highly specialized doctors and facilities, and maybe that’s part of the reason why our severely ill patients survive compared to those in other countries.”

Digital health to the rescue

The importance of digital health became paramount during the ongoing pandemic. It put telemedicine on the fast track as a means to monitor patients without having them risk going out. Robots became the de facto assistant in healthcare institutions being impervious to infections; allowing remote consultations and even to keep the elderly connected to loved ones. Those abiding to the #stayathome mantra are staying healthy indoors with digital health apps. Germany was swift to adopt similar solutions.

The Health Innovation Hub, established by Germany’s Ministry of Health, published a list of trusted telemedicine services. Most of these are available for free, towards which citizens can turn during the pandemic. GPs and specialists can offer remote consultations, helping in patient monitoring even during the lockdown. A local startup, DOCYET, launched an online chatbot to screen for those potentially infected with COVID-19. After analyzing the user’s input, the chatbot provides a risk assessment and even the option for a telemedicine consultation.

As a means to find innovative solutions to tackle the crisis, the German government organized a dedicated hackathon with over 42 000 participants. The latter came up with more than 800 projects, including an online symptom tracker. The latter functions as a diary to monitor one’s symptoms so health authorities can screen for suspicious cases more quickly.

It might be surprising then that until 2018, the country didn't allow remote consultations. But once restrictions lifted, authorities worked steadily towards setting up the necessary infrastructure to support such digital health solutions. The German parliament even passed the Digital Care Act some months ago. It's a direct attempt to not only digitize the country’s healthcare but to become a leader in digital health. It actively promotes digital technologies' use while providing care, which is crucial in fighting the pandemic.

Just the beginning…

Nevertheless, Germany’s apparent success might be due to other factors altogether, according to some experts.

Early testing and testing those with milder symptoms brought the total number of cases closer to the actual number. Other countries that have not adopted this approach or where tests are harder to provide have more undocumented cases, which could bring their mortality rate down. “I assume that many young Italians are or were infected without ever being detected,” said Christian Drosten, a virologist at Berlin’s Charité hospital. “This also explains the virus’s supposedly higher mortality rate there.”

Source: https://www.everlywell.com/

Others echo the same rationale that widespread testing contributed to the low fatality rate. “In some countries only very symptomatic cases are tested (e.g. in Italy) and in others a broader testing strategy is done (e.g. in Germany),” Dr. Dietrich Rothenbacher, director of the Institute for Epidemiology at Ulm University in Germany, told TIME.

Others yet are calling for caution. “We don’t do anything special compared to other countries,” virologist Martin Stürmer told Vox. This could mean that the country might face a similar trend to other countries in the coming weeks. Christian Drosten, who also advises the German health ministry, warned that the local number of fatal cases is likely to increase in the forthcoming weeks. He attributes it to strained testing capacities and to the fact that high-risk zones getting harder to identify.

Source: https://www.istockphoto.com/

However. Germany's management of the crisis with the help of digital health and clear communication can serve as an example for others to learn from. Once the pandemic subsides, other countries are likely to adopt similar policies as Germany did in order to improve their healthcare system.

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

Get access to exclusive content and analyses about the future of digital health on Patreon.com!

Subscribe here for The Medical Futurist newsletter to get exclusive details about digital health!