IMPACT OF HEALTH FACILITIES AND LOW DEATH RATE OF COVID-19-IN GERMANY COMPARE TO OTHER EUROPEAN COUNTRIES

This research investigates the Impact of Health Facilities and low death rate of COVID-19-in Germany compare to other European Countries. Data were collected from various secondary sources COVID-19 data base. According to results German health system with its up to 4 fold higher number regional public hospitals and topic of many political discussions might have been one factor to keep mortality rate -according to the given database-low. However German doctors, without out any medicine like colleges all over the world were as helpless as everywhere.One essential fact according the statements of reputed virologists might be an early discovery of Corona infection by sincere attention, focussed testing and early start of treatment. In Germany with its the easy access to health service in combination with the large number of hospitals might be the reason for the „lower“ death rate. Not to forget the tremendous engagement of highly qualified doctors and nurses who were willing and able to work beyond imagination of a routine work.


INTRODUCTION
The pandemic with its vigor impact and missing blueprint impose many questions and seduce to grab on any plausibel idea. As a matter of fact all serious virologist repeat and repeat agin that science has just started to understand slowly Covid-19. For example, despite of political blame games it is still not clear yet from which source/animal the virus skipped to the man and therefore basic helpful information to understand the virus remains in the dark.
In absence of understanding one tries to focus on observations one assume to proved facts as mortality rate, number of recovered persons …. As a matter of fact even these facts are no facts as during the crisis many who died could not get tested and are distorting mortality rate substantially. The same impact impose the reality that testing procedures, availability of equipment and quality of testing equipment differs extremely.
So, if from scientific point of view no judgement is serious the question arise why Germany is perceived to have managed so far the pandemic in a better way. For this purpose here a more wholistic approach was chosen to understand interaction of socio-cultural, political, economic and medical aspects which may have led to the impression that Germany did better than other countries. However one must consider that the pandemic is according most international virologists at the beginning and every statement is to consider as "so far" and up to now.

LITERATURE REVIEW
Historical preventative strategies and plays a central role in prevention of pandemic and epidemic. It simply refers to the isolation of vulnerable groups or suspected patients for specific period of time Recently, in 2019 at the end of December the corona outbreak has been observed and officials of public health from China notified the WHO -World health organization that they had an issue, a mysterious new virus was resulting in pneumonia-like sickness in the Wuhan city. They determined quickly that the infection was due to coronavirus and that it was transmitting rapidly throughout and outside of city.
However, scientists believe that this new infection primarily became capable to transmitting to human beings at the beginning of December. It first seemed like virus infected population at a seafood marketplace in Wuhan and transmitted from there. Although one investigation of early corona positive cases, published in January, 24th discovered that the first patient to get affected didn't have any contact with seafood market. Still the experts are trying to trace the occurrence back to its root. However, the virus was originated in China, Wuhan, but now this pandemic has transmitted across the globe, causing severe losses and rate of mortality and morbidity is inclining with the rapid pace. The governments of susceptible countries are taking aggressive initiatives in order to slow down the spread of virus, i.e. slowing down the transport, shutting down SME's and large corporations, and even suspending the public get-togethers. Nations across the world are racing to lower down the transmission through testing and also treating the patients, conducting contact tracing, quarantining the people, and banning large gathering places, for example, schools, sporting events, and concerts.
This disease is moving same as waveone that may yet crash on those least capable to combat.

Possible factors to the success story to manage the first impact
Time and vigor of appearance of Covid-19 in Germany: Germany was warned by dramatic and shocking pictures fro Italy showing how army was necessary to transport coffins to foreign cities as capacity of graveyards were too limited and … In consequence the few first contacts with Chinese persons identified to have Corona were followed up seriously and people were isolated.
In addition at that time no infected people visited mega-spreading events with thousands of persons like the football match or the international exposition in Milan in Northern Italy or big prayer event in France where people came and returned all over the country. Only in a later phase 2 hotspots arose when already some hospitals had some experience of handling Corona.
As a result Germany had reasonable time to push capacity of the health system. The lead time surely helped a lot and was not due to any superior performance expect the political sincerity at a time when in Germany nearly no impact was perceivable.
Capacity, structure and quality of German health system to bear the pandemic impact. The indeed powerful but very expensive German health system with its up to 4 fold higher number regional public hospitals and topic of many political discussions might have been one factor to keep mortality rate -according to the given database-low. However German doctors, without out any medicine like colleges all over the world were as helpless as everywhere.
One essential fact according the statements of reputed virologists might be an early discovery of Corona infection by sincere attention, focussed testing and early start of treatment. In Germany with its the easy access to health service in combination with the large number of hospitals might be the reason for the "lower" death rate. Not to forget the tremendous engagement of highly qualified doctors and nurses who were willing and able to work beyond imagination of a routine work.
However hospitals are only able to treat people and may be reduce mortality but the heath system as such can not influence the pandemic itself.
In combination with rigorous postponing of planned surgeries, people who did not risk to visit hospitals due to fear to get infected and innovativ and substantial temporary changes of procedures, walkways which allowed to treat much more people the capacity in Germany in general was except in areas with hoptspots never at its limits. This gave somehow a feeling to be able to manage the pandemic and might be according my opinion the major reason for psychological perception to to do better than so sadly hidden neighbors like Italy, France or Spain.
Political ability of finding and implementing feasible rules and procedures e-ISSN : 2620 3502 p-ISSN : 2615 3785 Volume 3, Issue VI, June 2020 | Somehow unexpected the presidents of all districts acted highly coordinated and with one voice. Based on recommendations of politically accepted virologist the district parliaments issued continuously the necessary decrees within only few days despite the strongest limitations of constitutionals rights ever seen since foundation of the country after world war II. The unity of rules, the clarity of rules and the noiseless implementation led to an astonishing acceptance by the population.
Social distancing and its complexity All over the world efficient social distancing and prohibiting smear infection bei washing hands are judged meanwhile from nearly every virologist as the crucial factors to reduce the spread of Covid-19.
It is all about to bring down the R(o) below 1. Saying that one person infect less than one other person. Although this figure was the key for all activities related to lockdown it is not a scientific "hard" figure as it depends on too many factors. Therefore it is even today not possible to use the development of R(o) as a criteria to judge the ability to manage the pandemic.
Analysing quality of political management we must consider that at beginning that the dominant suitability was not scientifically clear and is even today partially denied from some political leaders. Especially due to its even letal economic impacts, lockdowns were partially ordered only very late or not executed a sincere as it is required.
Lockdown, known as an often practiced political behaviour of autocracies and other dictatorial political systems, represents as such unacceptable political action in democratic societies and are specially in Germany (based on experiences of the Third Empire until 1945, by constitution only allowed unter extreme conditions. The growing number of serious legal and partially even successful action against the decrees showed that in European countries and specially in Germany a Lockdown depends strongly on the acceptance of the population. Therefore the the following considerations focus on how Germany has managed acceptance and execution of taken measurements (Lockdown) to control the basic reproduction number RO Factors of acceptance harming lockdown The first important factor to accept harming activities is the perspective of being somehow financially supported. Fortunately the public finances were in sound conditions and the politicians were able to distribute within absolutely incredible short time of 2-4 weeks to distribute money by pure application (more than 100.000) and direct bank transfer as well by the worldwide singular but often proved tool of"short-work-money". By this procedure the companies do not fire employees but reduce working time substantially and ministry of work compensates part of income by own public money.
The second factor was already partially explained above. The unity, professionalism and speed of legal actions.
A third, mostly underestimated factor according to my opinion was the role of the public media. Different to many countries, even within Europe, media in Germany are quite independent and could have quarreled about political actions, which were due to the situation and speed of accomplishment always somehow vulnerable. By far being not attentive or neglecting its responsibility, the media provided very serious broadcasts discussing and explaining pro and cons without noise, prejudges and fights for the best story. This serious background information was surely a basic factor for a very broad acceptance of lockdown rules.