High variability of COVID-19 case fatality rate in Germany

Area of Science:

• Epidemiology
• Public Health
• Critical Care Medicine

Background:

• The initial COVID-19 pandemic wave saw high case fatality rates (CFR) globally, including Germany.
• Early WHO recommendations for immediate intubation in patients with dyspnea were revised based on initial clinical outcomes.
• This study investigates the impact of management strategies on COVID-19 mortality.

Purpose of the Study:

• To analyze the case fatality rate (CFR) of COVID-19 in Germany.
• To assess the potential advantage of conservative management for COVID-19-induced hypoxemia.
• To compare mortality outcomes across different regions and management approaches.

Main Methods:

• Utilized PCR-confirmed COVID-19 infection and death data from German districts (Jan 2020 - Feb 2021).
• Calculated a moving average CFR by correlating deaths and infections with a two-week lag.
• Compared mortality outcomes within Germany and with Austria and Switzerland.

Main Results:

• The overall mean CFR in Germany was estimated at 2.92% (71,965 deaths / 2,465,407 cases).
• Significant regional variations in CFR were observed across German districts and states.
• Hamburg showed higher mortality than Munich, correlating with earlier adoption of mechanical ventilation (MV) versus conservative high flow nasal cannula (HFNC) management.

Conclusions:

• Epidemiological data from Germany suggests varying case fatality rates.
• A more conservative management of COVID-19-induced Adult Respiratory Distress Syndrome (ARDS) appears justified.
• Findings support the use of conservative strategies like HFNC over early MV for hypoxemia.