German Federalism

NPR: “We have a culture here in Germany that is actually not supporting a centralized diagnostic system,” said Drosten, “so Germany does not have a public health laboratory that would restrict other labs from doing the tests. So we had an open market from the beginning.”

In other words, Germany’s equivalent to the U.S. Centers for Disease Control and Prevention — the Robert Koch Institute — makes recommendations but does not call the shots on testing for the entire country. Germany’s 16 federal states make their own decisions on coronavirus testing because each of them is responsible for their own health care systems.

If only America had a federal system we might have had earlier and faster testing.

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And Drosten put the specs of his test on the WEB, for all to see, free of further charge. Immediately!

In the US, it's worse than anyone could have thought, and it's systemic. Desire for the utilization of central control now to increase output of respirators and other stuff is completely naive, misguided, and, yes, stupid.

I doubt this will be fixed after the emergency is over.

The federal system in Germany has advantages, but it also has extreme disadvantages:

We still do not know how many tests we actually carry out and how many negative results we actually have. As early as 8 weeks ago, Drosten wanted all negative results to be recorded so that he could then use them to extrapolate the number of undetected cases. This central register has not been established until this day.

The positive results are registered centrally, but there are over 300 local health authorities in Germany, where the positive results arrive first, then the results go to 16 different state offices, these 16 state offices then report the results to a central office. The whole process takes 2-3 days. If we want halfway current numbers we have to take the numbers of the American John Hopkins University.

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This is absolutely not how you run a quarantine, regardless of level or form of government. "One of the passengers was taken straight from the ship to a hospital, while the other was housed at Travis Air Force Base — one of the four installations that took in quarantined travelers — and taken to a hospital after he developed symptoms, officials said.

The exact number of people from the ship who contracted the virus will probably remain unknown because hundreds of passengers declined testing.

The passengers taken to bases — nearly 2,000 initially, though hundreds later returned to their home states early for quarantines there — were told that testing was optional and discouraged for those without symptoms, they said.

Cruise ships kept sailing as coronavirus spread. Travelers and health experts question why.

But what emerged from the hundreds who did agree to testing was that the virus spread more widely among those who had been on the ship than was initially confirmed by the testing onboard."

Spreading is inevitable from how this was handled. The entire point of a quarantining is to stop spreading, at least to a tightly defined group.

An opportunity for accurate testing of a single population was ignored, just another example of a testing failure to get a better picture of a novel disease's prevalence and rate of spread.

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Does South Korea have a federal system for health care? Taiwan? I honestly don't know, but I suspect that their excellent and rapid response to testing may well have been centrally guided. And did Italy have a central national agency mucking up their early response to testing, or was it much more nuanced than that?

To a man with a hammer, everything looks like a nail.

+1 Also, if a testing system approved by one state is flawed, it infects an adjoining state.

Viruses know no local state boundaries.

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I suspect culture and cultural homogeneity play a role as well, particularly in the case of Taiwan and South Korea - a pulling together and responding to the central government.

+1 pretty important from a behavioral- epidemiological perspective

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Because if there is one things Germans are famous for is reacting even less to government directives than the Italians or Spanish.

Honestly Germans don't react differently to other people. I am half German and half French, having grown up in the latter. I always expected Germans to be very obedient to their government, but when i moved here i was disappointed (actually rather positively surprised) they are not. They are pretty much the same in this regard then most other countries i know.

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The worst test is no test. So while I'm sure they had a South Korea wide agency deciding which tests were no good, my suspicion is they purchased off the wider market every test being made in order to test as many as they did as quickly as they did. It is plausible doing so resulted in lower than ideal testing quality, producing more false negatives than they wished. But, a false negative can always be tested again later when they develop symptoms or the people they're infecting begin turning up positive. As the system runs out of people to test, then the regulators can begin weeding out bad tests with no harm.

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The US has a federal system.

A bad one.

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Washington, New York, and California would have benefited tremendously from mustering their own local resources without all the distant red tape as we saw with Dr. Helen Chu's nearly stifled efforts.

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You can be competent with a centralized system. You can be competent with a decentralized system.

The problem with centralized is a single point of failure. You'd better have very competent people running things. Singapore, Taiwan, and SK are not resource rich and need to be clever. Thus they are incentivized to have very competent technocrats running things.

Do you think the US response could have been better had the CDC produced the tests and the FDA prohibited Biotech from producing their own, or do you think the structure of the US system is flawed?

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You can't run an efficient centralized medical system with 330 million people. Switzerland and Sweden are better because they're smaller.

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As others have pointed out, disparity among states in responding to the coronavirus discourages compliance: why comply with a lock-down in Florida if people in Alabama aren't subject to a lock-down, even a partial lock-down, and are free to travel to Florida for a vacation, or to flee a rising incidence of the virus in Alabama. I don't know about travel restrictions in Germany, but we don't have them here (there are no gates blocking the flow of traffic between states). An aside, I've been somewhat amused (somewhat because the risks are so great) by the libertarians among us. Many of them flailing about, while others are rationalizing this or that response to the crisis risking whiplash to themselves.

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Might have helped, but German's outbreak is worse than ours. And what i real Federalism meant interstate travel restrictions restrictions on shipment of medical supplies? I prefer to look for firs a little closer to the smoke.

Germany's outbreak was earlier, but it remains to be seen that it has been worse. First, the record-keeping has been more thorough and the level of testing has been higher, given those elements, the fact that the death rate appears to be so low suggests that the situation in Germany has been better, not worse than that in the US.

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So the guy who wants national licensing for doctors wants local licensing for medicines?

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One interesting possible example of this may be Seattle. I believe Seattle has been testing outside federal guidelines since at least the middle of Feb, Dr. Chu's work clearly suggests a research lab out there had developed primers by the end of Feb and had capacity to test. When you look at their case counts it appears that after an initial failure to identify the spread they have recently gotten it contained, so someone there was able to do contact tracing, and likely testing, in early March. Seattle was likely 3+ weeks ahead of New York in infections, yet was able to stop their outbreak, meanwhile New York has 20,000+ infections.

The current number in NY is 33,000+, 7,000 new cases being in the last day.

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Paging F.H. Buckley. Another endorsement of your recommendation for enhanced federalism in American Secession. And let’s not forget just last year Johns Hopkins rated the USA first out of 195 countries as the most prepared for a pandemic: putting all one’s eggs in a centralized basket is always foolish no matter how much the “experts “ seek to lull you.

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Federalism? Austerity at state level (especially after 2008 or so) messed up adoption in the US of the high through-put type of testing used abroad, as the existing labs couldn't handle those tests. It was probably thought better to shrink government to be able to drown it in a bathtub.

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If only America had a federal system we might have had earlier and faster testing.

If only America had a leader like Merkel, instead of an ignorant crook, we might be much better off in a number of ways.

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Seems a bit easy to think it s because of the federal vs. the centralized system.

My first thought was the difference in the infrastructure of the healthcare system. Then again the German Healthcare system is quite bad, better then the US, but i wouldn't say better then most other countries in Europe.

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