The refrigerated trucks sat in the courtyard, waiting for bodies. Clemens Wendtner, the doctor in charge of treating infectious diseases at the Schwabing Clinic in Munich, had seen the news footage from the United States and Italy. It looked like hell on earth: sick people with no beds, bodies with no place to keep them. In COVID-19 hot spots around the world last spring, hospital morgues were overrun.
“We knew we were exactly nine days behind Italy,” Wendtner said in early October, sitting across from me in his light-filled office in Munich. As cases swept the northern Italian city of Bergamo in March, he said, “We prepared for the worst.”
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The worst didn’t come. They sent the trucks back.
When I left home in Somerville, the city was in a state of fevered compliance. But in Munich, life felt startlingly, achingly ordinary. No one on the streets wore a mask. I arrived to meet a new friend, and she stared when she found me masked and hovering anxiously in her doorway. I hadn’t been in a stranger’s house, let alone casually, since March. “No one wears them here,” she said, waving me in.
Oktoberfest had been canceled, but the air still smelled hopped. Men in lederhosen careened tipsily on electric scooters, restaurants were busy, and schools were open. The immediate feeling was one of time travel. But I couldn’t tell if I was seeing the future, post-COVID-19, or the past — a tableau of a beach before the tidal wave hit.
It turned out to be a little of both: within weeks cases were climbing again and Germany entered its second lockdown since the beginning of the pandemic, although as of mid-November schools have remained open and hospitals are not overrun. Masks appeared again in the city center, and bars and restaurants closed. But that window of time in the fall also provided a glimpse into the kind of normalcy that might have been possible, even here.
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In many ways, the United States and Germany are similar: They are large, rich countries where political power is diffused through strong regional governments and significant far-right fringes have hijacked the pandemic to serve their own ends. The virus hit Germany, the state of Bavaria in particular, early and hard, and now Germans are experiencing a second wave. But while the United States has four times as many people as Germany, it has had nearly 20 times as many COVID deaths: at the time of writing more than 250,000 people in the United States have died from the disease. We can also compare Bavaria and Massachusetts, both wealthy states that had big early outbreaks. Bavaria, with more than twice the population of Massachusetts, had about 3,300 deaths by mid-November. Massachusetts has had more than 10,400.
Why one country has responded so much more effectively to the pandemic than the other is an impossible question to answer fully. Inevitably, it comes down to some combination of preparedness, luck, leadership, infrastructure, and the vagaries of a virus that we still don’t fully understand. But we can tease out some threads. Germany’s health care system is world class and well funded. Germany is less politically polarized, which lets it respond to crises more quickly and effectively. It mandated a strict early lockdown, and it invested heavily in testing and tracing. The 16 German states also acted more or less in concert.
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But more fundamentally, looking at Germany shows us that the kind of COVID culture clash that continues in the United States — between individual rights and collective well-being — is actually a false choice. And basic protections for workers and citizens, in place long before the pandemic, shielded the country from the more serious outcomes experienced elsewhere. Germany offers an alternative model, a picture of what might have been possible if the United States had reacted quickly and coherently to the threat. Or, more accurately, if the US had the political, structural, and even moral capacity to handle a pandemic.
Like a lot of people, Clemens Wendtner first heard about the novel coronavirus on TV. He was in Jerusalem just after the Christmas holidays with his family, and saw something on CNN about what he remembers the anchor calling the “Wuhan virus.” Within a month, patients from Europe’s first outbreak were being treated in his Munich clinic.
The virus first traveled to Germany by plane. A Chinese businesswoman was visiting the headquarters of Webasto, an auto parts manufacturer in Stockdorf, a tiny Bavarian village of 4,000 outside of Munich. Webasto was Germany’s first stroke of luck. The woman had a tight schedule of meetings and lunches, which meant it was easy to trace the people she might have infected. More importantly, as soon as the first German employees tested positive, Webasto CEO Holger Engelmann moved to shut down the company headquarters.
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It was a step further than even the local health authorities had recommended at the time. But if Webasto hadn’t handled the crisis properly, Engelmann told me in October, they would have been “the ones who brought death to Germany.” Although outbreaks at other companies would later cause thousands of infections, Webasto bought Germany time — and gave Wendtner and his team the chance to study the first German patients.
This episode also provided crucial evidence for understanding asymptomatic transmission: The woman had not felt ill until she was on her flight home. In those early weeks, Wendnter and his team were working to treat patients, but also to learn everything they could about the virus, submitting the group to rigorous rounds of testing and sampling. When the patients were finally sent home, he breathed a sigh of relief. It had been stressful, but it was over. Soon, he knew better: In March, as skiers returned from vacations in the nearby Alps and cases climbed, Wendtner braced himself.
But what happened next was crucial for keeping the virus at bay: Local leaders responded quickly and humbly to the threat. As the virus spread, Wendtner said he was in almost daily contact with the Bavarian health authorities. “They were asking, ‘How can we help? What do you need?’” By studying Italy’s outbreak, Wendtner said, “We knew exactly what would happen if we just wait and wait and wait.” Instead, they needed to prepare, even over-prepare. At peak times in the spring, Wendtner said, Bavaria had some 3,380 intensive care beds; the most they’d ever used simultaneously was 860.
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In Germany, as elsewhere, there were plenty of early mistakes, Wendtner told me. But when the first real wave hit, “We didn’t have to beg.”
In the course of reporting this story, I asked German epidemiologists and public health experts why things had gone so differently in the United States. Their response was often the same: a pause, followed by uncomfortable laughter. They didn’t have to say his name. A recent study from Cornell University researchers found that President Trump was “likely the largest driver” of misinformation about the coronavirus. German Chancellor Angela Merkel is a sharp contrast in leadership style: a scientist by training and disposition, with a calm and matter-of-fact demeanor. Her most famous phrase, uttered in 2015 about Germany’s policy of welcoming migrants, is, Wir schaffen das — ”We can handle this.”
But while Merkel, whose approval ratings are extraordinarily high across the globe, and Trump, whose are not, were responsible for setting the tone and agendas in their respective countries, the countries’ underlying structures may have contributed more directly to their different outcomes. America is so polarized that politicians from the two parties seem to instinctively oppose each other. In Germany, most political parties, with few exceptions, have stood behind Merkel.
Karl Lauterbach is a German epidemiologist and also a member of Parliament from the Social Democratic Party, which is part of a ruling coalition with Merkel’s conservative Christian Democratic Union. When the pandemic first hit, he told me, he simply went to members of the opposing Free Democratic Party and asked them to support Merkel’s measures, for the sake of the country. And they largely did. Moreover, he continued, any disputes were not about the fundamental science or about the seriousness of the virus. “There was some disagreement about some measures, but they would not come up with fake information,” he said. In contrast, members of the Trump administration have “isolated themselves from science.”
The results of polarization in America have been dramatic: The virus hit blue America — which tends to be more densely populated — first. While Trump left those areas to flounder, mask regulations and lockdowns in those cities and states helped get the virus under control. In Massachusetts, for instance, Governor Charlie Baker, unlike some other Republican leaders, issued a statewide mask mandate, effective May 6, that helped flatten the curve. Since June, leaders in red states, who have tended to follow Trump in resisting lockdowns and mask mandates, and in some cases have denied the seriousness of the virus, have seen markedly worse health outcomes.
When I spoke to ordinary Germans in the course of reporting this story, they often mentioned what they saw as cultural differences between Americans and Germans. I was told over and over again that Germans are rule followers, Germans keep to themselves, Germans speak quietly, and Germans are civic-minded. But Americans, they say (or imply), are short-sighted and selfish. We prize our individualism too much, and only care about freedom as it applies to ourselves. We can’t imagine that wearing a mask when we’d rather not does offer freedom — to others, perhaps the elderly or immunocompromised — and that it is also an investment in freedom for the weeks and months ahead. This idea that Americans are plagued by a fatal selfishness is reinforced by viral videos of mask meltdowns in supermarkets or in parking lots.
Putting it down to innate national character, however, simultaneously lets us off too easily and makes this catastrophe feel inevitable instead of eminently solvable. Similar numbers of Americans and Germans are willing to follow social distancing guidelines, according to surveys, but the citizens of only one of those countries have the infrastructure and support to make it feasible. As the epidemiologist Gregg Gonsalves said of AIDS in a speech at the Toronto AIDS conference in 2006, that pandemic was “essentially a crisis of governance, of what governments do and do not do, to and for their people.”
Two recent studies on health care workers at nursing homes tell us something profound about the COVID-19 pandemic in America. One, published September 10 in the journal Health Affairs, suggests that one of the most important factors in keeping patients alive was whether or not staff were unionized. At the time of the study’s publication, deaths of patients in nursing homes accounted for 43 percent of total COVID deaths nationwide. But the deaths weren’t equally distributed across all nursing homes. In the institutions where health care workers were unionized, the mortality rate was 30 percent lower than those without worker unions. Among other factors, the authors wrote, “Unions generally demand high staff-to-patient ratios, paid sick leave, and higher wage and benefit levels that reduce staff turnover.”
The second report, a National Bureau of Economic Research working paper, shows that patients at nursing homes where staff had to work at multiple locations were more likely to die, because staff carried the infection from one facility to the next. The authors wrote: “Nursing homes often rely on temporary nurses and nursing aides to meet staffing needs. In addition, nursing assistants — whose median pay is under $30,000 — in some cases work two jobs to make ends meet.” When nurses work one job, in one place, with sick leave and benefits, more of their patients live. In other words, job precarity is literally fatal.
When I asked Engelmann, the Webasto CEO, about his employees’ sick pay, he was taken aback. “There was no discussion about what’s going to happen for them financially,” he finally said. In Germany, the law mandates six weeks of normal pay for sick employees; after six weeks, insurance provides 70 percent of their gross pay. In the United States, there is no federal requirement that companies must offer paid sick leave, and, according to the Bureau of Labor Statistics, only 31 percent of Americans who make $10.80 an hour or less have paid sick leave at all.
Strong labor protections are one form of inoculation from the virus, and widespread access to health care is another. Germany requires its residents to have health insurance; some people choose private health care, but most have public health insurance, which is funded by contributions from individuals and employers, with the wealthiest required to pay the most. Health care is “financed on the principle of solidarity,” reads a publication issued this year by the Federal Ministry of Health. “So the healthy pay for the sick, the rich for the poor and singles for families.”
If American individualism has hindered our ability to handle this pandemic, I don’t think it is because of anti-maskers having meltdowns in grocery stores. They are red herrings, or else countries with similar numbers of virus skeptics would be seeing similar outcomes. I wonder if we are in fact too ready to accept personal responsibility — or to blame the guy refusing to wear a mask in the grocery store — and not sufficiently prepared to ask why we are not taken better care of by the people we have voted into office. Or to ask that if we all do what we should — wear masks, stay home, take care of our neighbors — we won’t be punished, we won’t lose our jobs, lose our homes, or have to choose between rent and health care. As the Catholic theologian Peter Maurin said, “We must make the kind of society where it is easier for people to be good.”
There is another danger to attributing the catastrophe to personal choices rather than to social structures: It makes it too easy to blame the Americans who are suffering the most — poor people, Native Americans, Black people, and Hispanics who have disproportionately worse access to health care and to the resources that make it possible to isolate after infection. This scapegoating is precisely what Ohio Republican state Senator Stephen A. Huffman did when he speculated that Black people might not wash their hands as well as other groups.
In fact, the people who have been hardest hit in America are those who are least able to exercise personal choice: the elderly, confined to nursing homes; the incarcerated, packed together sometimes without even access to soap, let alone personal space; and the poor, who can’t afford to stay home when they are sick.
I expected to find Munich cautious and contained, for Germany’s relative success to be reflected in personal behavior. But I found a city that was both vibrant and relaxed, certainly compared with Greater Boston.
It’s easy to assume, as many Germans do, that Americans are simply less willing to follow the rules, and more susceptible to conspiracy theories. This is not true, at least according to polling (though polls of course have their limits, as the election demonstrated). Similar numbers of Germans and Americans believe in coronavirus conspiracies, according to polling from the YouGov-Cambridge Centre for Public Opinion Research. For example, 79 percent of Germans and 77 percent of Americans ranked this statement as either “definitely” or “probably” false: “Coronavirus is a myth created by some powerful forces, and the virus does not really exist.” If the problem were just misinformation, we would see similar infection rates in each country.
And despite appearances, support for restrictions is strong in both countries. “People want to do the right thing,” said Cornelia Betsch, a psychologist and expert on public health communication at Germany’s University of Erfurt. Those supermarket meltdowns and anti-mask demonstrations make good stories, but shouldn’t detract from the fact that the majority of people in both countries are willing to follow the rules if they know what they are.
Something curious happens when masks are universally mandated, as they have been at times in Germany. Rather than being complicated symbols — of party affiliation, of empathy, of self-righteousness — they are mostly uncontroversial. Once masks were mandated in Germany, she said, “Mask behavior went up steeply and is actually really well accepted.” But when wearing masks is only voluntary, as she demonstrated in a recent paper, it leads to polarization and negative emotions: Mask wearers feel unfairly burdened, and non-mask wearers feel unfairly judged. Moreover, if mask wearing is polarized, as it has been in the United States, Betsch said that a mask no longer communicates “I care about your health,” but rather, “I am a Democrat.”
There are still dissenters in Germany, of course. On a sunny day in September I watched the Theresienwiese, the traditional location of Oktoberfest, fill with anti-mask demonstrators. Most people went maskless, but some wore masks made of mesh or fishnet, intended as taunts. One man wore a Calvin Klein thong over his face, another wore pantyhose — implying, I assume, that masks are effeminizing. I saw symbols for fringe groups (QAnon featured heavily), traditional Bavarian dress (women in dirndls, men in lederhosen), New Age adherents, a popular German TV preacher. America’s influence was palpable: I stopped a man in a Make America Great Again hat. He wore the hat because Trump had done a great job handling the crisis, he said, unlike Merkel, whom he called “a Communist spy,” a popular trope among conspiracy theorists here. He held up the hat for a photo and grinned: “Best wishes to our friends in America.”
The Munich police later estimated there were about 10,000 people at this demonstration. It was peaceful, though others have not been. Experts who study the far right tell me that the danger of these protests is less that these people will spread the virus — none of the demonstrations have yet caused outbreaks — the danger is violence. In late October, incendiary devices were thrown at Germany’s public health institute. Anti-Semitic attacks, which are generally linked to and inflamed by other conspiracy theories, are a regular feature of life here. But attempts by the far-right party, the AfD or Alternative for Germany, to capitalize on the crisis have largely failed, in part because of the unity shown by the other parties.
Germany isn’t perfect. It is possible to catalogue major scientific and bureaucratic errors from the very beginning, from muddled research to red tape to Germany’s much-hyped but not very effective Corona-Warn-App. A vaccine is still some months away, and Germany has more vaccine skeptics than many other countries, partly due to a legacy of mistrust from gruesome Nazi medical experiments. As Clemens Wendtner said, although Germany has done well, it is still a case of “mission not accomplished.”
But that is an important point: A country does not have to be perfect to contain the spread of the virus. Its leaders can make mistakes, and it can have busy restaurants and anti-maskers in the streets, if it is set up to allow sick people to stay home, to pay their bills, and to have health insurance. Perhaps this is something most Americans realize in moments when our illusions of independence flicker — pain, illness, injury, childbirth, death — when we are reminded of the extent to which we are at each other’s mercy. But for once we are experiencing this together, seeing how setting up a society that works for you only when you are healthy and independent is a bad bet, one that everyone loses eventually, but some more spectacularly than others.
On October 21, the headline of Munich’s main newspaper, the Süddeutsche Zeitung, was Die Angst ist zurück: “The fear is back.” Cases were rising; masks proliferated once more on the streets. It was cold; people were moving indoors. In the last week of October, German tabloids started warning of a looming “lockdown light,” and within days Merkel announced strict measures for November. Bars and restaurants would close, and people could only meet with the members of one other household. The lockdown was designed to slow the spread of the disease so that people could see their families over Christmas, although there are rumors it may be extended through December. “Freedom isn’t being able to do whatever you want. Freedom is taking responsibility,” Merkel said on the day she announced the new measures. The United States is also experiencing a second wave, but it is far more severe than Germany’s, and there has so far been no coherent national response.
The lesson of Germany might be one similar to the parenting concept of the “good enough mother,” which was popularized by the psychoanalyst and pediatrician Donald Winnicott. Reasonably competent leadership combined with a reasonably compliant public will go a long way to getting the virus under control. This might be good news for Joe Biden when he takes up the presidency: a strategy, any strategy, will go far. But we still have to reconsider the underlying structures that allowed the flames to spread.
In her book about vaccines, On Immunity, Eula Biss wrote: “We have more microorganisms in our guts than we have cells in our bodies — we are crawling with bacteria and we are full of chemicals. We are, in other words, continuous with everything here on earth. Including, and especially, each other.” The virus has proved our continuity and our permeability with spectacular speed and fury. I don’t have to like you for you to give me the virus. We don’t have to be of the same political party. My feelings about you don’t matter. All that matters is that we share, for some space of time, a patch of earth or a breath of air.
We are learning to accept that biological reality, that idea that we are all always caught up and implicated in each other. The pandemic shows, like sunlight on invisible ink, how fatal it is to pretend otherwise in our politics, our economics, and our health care. Now we have to decide whether we will structure our society to accept our continuity, our dependence, and our frailty, or whether we will pretend, right to the end, that we can have safety, health, work, or rights, when others don’t. Or that any of us stay healthy forever.
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Annalisa Quinn is a freelance writer. Her reporting in Germany was supported in part by the National Geographic Society’s COVID-19 Emergency Fund for Journalists. Send comments to magazine@globe.com.