To understand Quebec's COVID-19 approach, look toward Germany

In the middle of his daily update on COVID-19 Sunday, Premier François Legault offered a glimpse of the strategy guiding Quebec's response to the pandemic: it's based on the approach taken by Germany.

Germany's model is "the one we all try to follow," Legault said, citing that country's significantly lower death rate, its relatively high rate of testing and the level of discipline demonstrated by Germans in following public-health directives.

The relative success — so far — of Germany's measures has been highlighted in recent days by various major media outlets, all of them remarking on the country's efficient testing systems, its well-funded health-care infrastructure and the stark contrast between Germany's low COVID-19 mortality rate and Italy's high one.

So how well has Quebec been following Germany's example?

In terms of testing and their mortality rates, Quebec and Germany are very closely aligned. But in terms of hospital readiness, there appears to be some big differences.

Sunday's data puts Quebec's mortality rate from the coronavirus at 1.18 per cent; on Saturday, Germany's was at 1.5 per cent, according to the Johns Hopkins University Coronavirus Resources Center.

By comparison, the mortality rates in several countries in western Europe are over 5 per cent, with Italy's at 12.3 per cent.

Germany, with a population of around 83 million, had carried out 918,460 COVID-19 tests as of March 29. That translates to 11,127 per million people.

As of Sunday, Quebec, with a population of around 8.4 million people, had done 98,783 tests — or 11,642 per million.

Testing capacity in Germany is said to be as high as 500,000 per week, according to Dr. Christian Drosten, the director of the Institute for Virology at Berlin's Charité, Germany's largest teaching hospital.

Last week, Quebec did just over 40,000.

Taking into account the difference in population size, that's about 20 per cent lower than Germany's capability. Germany's testing systems are decentralized, with private labs sharing the load and permitting more tests to be processed.

Germany also began testing widely early on in the crisis, and it quickly established itself as a European leader. Quebec, on the other hand, initially trailed other provinces when it came to daily tests, although now only Alberta tests more citizens, per capita.  

'Quebecers are disciplined people'

On Sunday, Legault began his remarks by noting that Google data has shown Quebecers have taken physical distancing more seriously than Canadians in any other province or Americans in any of the 50 U.S. states.

He observed that German Chancellor Angela Merkel had been very firm about physical distancing.

"We know Germans are disciplined people," said Legault. "And what we can see is that Quebecers are disciplined people."

Merkel gave a rare national address on television on March 18, in which she implored the German public to take the crisis very seriously.

Legault updates citizens on Quebec's situation each day at 1 p.m., making a similarly sober plea each time.

After introducing a series of smaller measures over the first 10 days of the crisis, Quebec enacted major restrictions on public life on March 21, banning all gatherings, closing non-essential businesses and emphasizing the need for physical distancing. Germany took similar steps one day later.

Both Legault and Merkel are enjoying strong support as the crisis progresses, which may account to some extent for the high levels of public co-operation in both places with the restrictions in place.

A recent poll put Legault's approval rating among Quebecers at 69 per cent. A survey last week by a German public broadcaster shows Merkel at a similar 64 per cent approval rating.

Where things may vary is in terms of medical facilities. Dr. Uwe Janssens, the head of the German Intensive Care and Emergency Medicine Association, told CBC that the country had up to 10,000 ICU beds available.

Quebec has said it has around 578 ICU beds available (164 are now in use), and it is taking steps to bring that total to 1,000. That would bring it to the same level as Germany, factoring in the difference in population size.

That 10,000 figure might be low, however: on March 19, Germany's defence minister, Annegret Kramp-Karrenbauer, said the number of intensive-care beds equipped with respirators would be increased to about 50,000 from 28,000.

Germany also has some 500,000 hospital beds and plans to double that, Kramp-Karrenbauer said. Quebec, with around 7,000 beds at the ready, would need to increase the number of beds sevenfold to reach a population-adjusted equivalent of Germany's current half million beds.

Still, there are quite a few parallels between the measures in place in Germany and Quebec, which may be reason for hope in a difficult time.

Even if the comparison is apt in many respects, the pandemic is far from over, and some experts in Germany and elsewhere wonder if that country's success so far will continue.

"There is nothing special about what we are doing. We had good luck," Dr. Karl Lauterbach, an epidemiologist and a member of the German Parliament, told CBC's Jonathon Gatehouse recently.

"We are very well aware that in a couple of weeks, we may be in big trouble."