GIS2 at Ryerson

Summary of a Leaked Report from the Crisis Management Unit KM4 of the German Ministry of the Interior (BMI)

Mainstream and alternative media in Germany are brewing with news of a leaked report assessing the German government’s crisis management with respect to COVID-19. The liberal-conservative magazine Tichys Einblick first published extracts of the report that was circulated by its author, a civil servant who has since been suspended. Another alternative media platform, Die Achse des Guten, documents that a draft of the “corona paper” had been presented internally as early as March 23 and the minister’s office was approached by the report’s author on April 25, but as the report continued to be shut down, the author decided to circulate it more widely and it was eventually leaked. The Ministry responded with an unusual Sunday press release dismissing the report as a personal opinion. Interestingly, nine eminent medical experts who were consulted in preparing the report issued a press release of their own on Monday, stating their surprise that the Ministry seems determined to continue ignoring expert analyses of the collateral damage of the COVID-19 response and fail to substantiate its claims that the protective measures taken were effective and are continuously being reassessed.

So what’s in the leaked report? The 187-page PDF document that I downloaded from Achgut.com consists of an anonymized 1-page cover letter, an 8-page summary, an 82-page full report, and a 96-page appendix (pages 3-5 of the appendix are missing). The subject line of the cover letter – “Results of internal assessment of corona crisis management” – is supplemented with three brutally honest bullet points:

• Grave errors of judgement in crisis management
• Deficits in the regulatory framework for pandemics
• Corona crisis likely proves to be a false alarm

The report’s summary starts with the definition of the goal of crisis management: to detect and combat threats until the “normal” state is re-established (p. 2). The author further notes: “Therefore, a normal state cannot be a crisis.” This reads like a personal statement against the idea of a “new normal”, which has recently been promoted by many politicians and experts globally.

The remainder of the summary document outlines results of the author’s analysis (pp. 2-3, points 1-8) and conclusions (p. 2, points a) to c)). These sweeping points, which I will paraphrase below, are followed by an explanation of interdependencies during a crisis, including the declaration of an eminent threat (the pandemic) and the impact of protective measures and resulting collateral damage (pp. 3-4). The author then professes his perspective with respect to available courses of action (pp. 4-5) – also outlined below. What follows on pp. 5-8 is a section titled “Overview of health impacts (damages) of the government measures and limitations during the 2020 corona crisis”. This section is given a separate date of May 7 and is also attached to the press release of the nine medical experts mentioned above.

The report’s summary concludes with the author’s reasons to proceed with circulating the report without further consultation (p. 8). The stated reasons include the ongoing threat of collateral damage of the lockdown measures including avoidable deaths and the inability to have his analysis acknowledged through the ministerial hierarchy. The main report, which is double-dated to April 25 and May 7, 2020, is titled “Corona Crisis from the Perspective of Critical Infrastructure Protection”. In this blog post, I focus on summarizing, paraphrasing, and commenting on the 8-page summary.

Results of the Analysis

The author, who speaks alternatively in singular (“I”) or plural (“we”), summarizes his analysis in eight results:

1. Despite better knowledge, crisis management [in Germany] has not developed adequate tools for threat analysis and assessment. Status reports in the current crisis include only a fraction of information on the range of threats. Incomplete and unsuitable information does not allow for a proper threat assessment and thus does not support appropriate and effective emergency response. This methodological deficit translates upwards through levels of public administration; politics has had a much reduced ability to make evidence-based decisions.
2. The observed health impacts of COVID-19 on the general population suggest that we are dealing with a global false alarm. In relation to general mortality, there has likely never been an unusual threat to the population and the danger of COVID-19 was over-estimated. The author of the report adds a special note that these results were scientifically vetted and do not contradict the data and risk assessments presented by the German centre for disease control, the Robert Koch Institute (RKI).
3. The fact that the false alarm remained undetected to this point is owed to the lack of instruments that would trigger a warning in case of an unwarranted pandemic declaration or a situation in which the collateral damage of the response measures exceeds the disease’s impacts on public health, and specifically on fatalities.
4. At this point, it is plausible to assume that the direct loss of lives owed to the emergency response measures [i.e. lockdown, distancing, hospital procedures] is already greater than the COVID-19 death count [in Germany].
5. The collateral damage of the corona crisis is gigantic and pointless, will primarily manifest itself in the future, and can only be limited, not prevented any more.
6. As a consequence of the protective measures, the security and resilience of critical infrastructure has declined. Our society is subject to increased vulnerability and risk of failure of survival systems that could be fatal if a truly dangerous pandemic or another threat, such a bioterrorism attack, would occur.
7. Emergency orders and other protective measures that lost any meaning and are now causing collateral damage are still in place for the most part. It is urgently recommended to lift these measure immediately to avert harm to the population – in particular additional unnecessary deaths – and stabilize the possibly precarious state of critical infrastructure.
8. Deficits and errors in crisis management have led to the distribution of misinformation to the population. It could be said that the state has become one of the greatest producers of fake news in the corona crisis.

Conclusions

Three broad conclusions are drawn by the author:

a) The proportionality of restrictions of civil liberties is not evident, since governments have not properly assessed the consequences, as required by the German constitutional court on May 5.

b) Status reports from the ministries of the Interior and Health as well as federal communications to the provinces should immediately:

• undertake an adequate risk analysis and assessment,
• include a section with meaningful data on collateral damage,
• be cleared of superfluous data and information that are unhelpful for risk assessment, and
• develop and emphasize metrics [this point remains oddly vague].

c) An adequate risk analysis and assessment is to be completed immediately; otherwise, the state may become liable for damages.

Available Courses of Action

The report’s author sees the German government and administration in a precarious position, since in his assessment there is no reasonable doubt that the corona warning was a false alarm and that crisis management failed with respect to danger prevention and instead caused harm, including fatalities that continue to occur every day that the emergency response measures are kept in place.

The author further notes, which is not without humour, that technically a new crisis situation should be declared and the out-of-control pandemic crisis management itself be battled. In case the executive arm is not be able to regroup, the following options for a correction are proposed:

a) The legislative arm, i.e. the federal and provincial parliaments, could change the crisis management framework to force a change in the direction of the executive.

b) The judiciary has so far supported restrictions of constitutional rights with reference to the eminent threat but without in-depth test of plausibility of the government’s threat assessment. This could change as demonstrated in the author’s report.

c) The online and mainstream media could also serve as a corrective. However, at present the leading media not least the public broadcasters seem to view themselves as messengers of the dominant political orientation. This lack of plurality of opinions tends to stabilize the executive even when their actions threaten the existential interests of the nation, e.g. in case of a factual error of judgement.

Collateral Health Impacts

The following information was obtained from 10 eminent experts who were randomly selected (not representative) by the report’s author.

1. Fatalities:
   a) Due to limited availability of hospital beds and services, it is estimated that 2.5 million surgeries were delayed or cancelled that would have taken place in March or April. This could result in between 5,000 and 125,000 premature deaths.
   b) For the same reason, follow-up treatment for cancer, stroke, or heart attack patients, which number in the order of million(s) annually, were delayed or cancelled, resulting in the possibility of avoidable death of up to several thousand patients.
   c) The quality of long-term care homes and services with 3.5 million recipients has declined; a concrete estimate of fatalities is not feasible, yet even a tenth of a percent impact would result in 3,500 premature deaths.
   d) The current annual average of 9,000 suicides will increase due to long-term impact on living conditions that could become critical for psychologically unstable persons. Additional suicides also have to be expected due to personal bankruptcies and destroyed livelihoods, as well as emotional pressures for specific professional groups that are most affected by ongoing change.
   e) An unspecified number of acute heart attack and stroke sufferers will not receive timely treatment resulting in death or reduced life expectancy in the short- or long-term.
2. Other health and psychological damage from:
   a) isolation experienced by elderly long-term care patients;
   b) persons with psychoses and neuroses requiring treatment;
   c) domestic violence and child abuse;
   d) broad-based communication disorders, e.g. due to mandatory wearing of face masks.
3. A long-term reduction in life expectancy is likely to become the greatest harm from this crisis. The decline arises from reduced general prosperity and wellbeing.

My Take

As you can tell, the leaked BMI report convincingly argues for a comprehensive risk assessment and holistic crisis management rather than the current tunnel vision focused on virology and acute medical concerns around COVID-19. The report’s summary does not engage with the actual threat of the novel coronavirus, which I hasten to add is a serious illness that has caused deaths and individual hardship around the world. However, viewed at the population level, the report’s assessment is in line with a growing number of international experts who demonstrate that the threat of COVID-19 is no worse than a severe influenza cycle.

Our political decision-makers and public health officials would be well advised to conduct continuous (re)assessments of the lockdowns and other emergency response measures in comparison to their collateral damage, and inform the public of the outcome of these assessments. As a geographer, I am particularly interested in the fact that there is strong spatial clustering of confirmed COVID-19 cases and attributed fatalities, which suggests geographically specific responses. As a data scientist, I am puzzled by the high degree of uncertainty in all coronavirus-related datasets and the multitude of interpretations that each time series generates. In addition to the ongoing medical and epidemiological research there will be many more topics to study if and when we are able to leave this crisis behind us.

It is heartening to hear Ontario’s Premier Doug Ford explain that “we must listen to what the data tells us” about the threat of the novel coronavirus. Commitments from politicians to evidence-based decision-making are refreshing, even though it is well understood that the data (a plural word) do not actually speak to us, unless we ask the right questions of them. In the case of COVID-19, numerous analysts – myself included – have been playing with ways to visualize, interpret, and even predict the curves of confirmed infections, tests conducted, deaths, and cases resolved. Unfortunately, it is becoming increasingly clear that the underlying data are fundamentally flawed and should not be used for public information nor for executive decisions that drastically interfere with our freedoms to live a healthy life, move around, assemble, or conduct business.

number of fatalities
case-fatality rate = ———————————
number of cases

The release of Ontario’s COVID-19 prediction models on April 3rd based on data collected up to the previous day, reported a high case-fatality rate of 2.1%, as 67 deaths were counted against 3,255 confirmed cases of the disease. In Italy, the same metric is pegged at a staggering 10% as of late March, i.e. one in ten infected are dying. This would explain Premier Ford’s characterization of SARS-CoV2 as “this terrible, terrible virus” and the widespread fear, as seen e.g. in my Facebook feed, of getting infected by the “deadly virus”. Media attention has recently turned to the “German exception” (New York Times, April 4th), where the case-fatality rate had been a low 0.2% in mid-March, although it has now risen to 1.6%. The key factor influencing the rate was identified as the extensive testing regime in Germany, which resulted in the detection of more mild cases of COVID-19 than elsewhere, and thus a lower ratio of fatalities to confirmed cases. In other words, if other countries conducted more tests they would also find more infected people with moderate, mild, or no symptoms at all, thereby reducing the ratio of fatalities to cases.

Our governments’ and epidemiologists’ main concern is the exponential growth of infections and the resulting need for hospitalizations and intensive-care beds. Like everybody else, I have been looking out for daily updates of confirmed infections and death tolls. Both have been growing exponentially in most countries worldwide and the proportion of people who know what a logarithmic scale is must have multiplied too. But there is a catch: infections are confirmed only among those who are tested, and the scarce testing resources in most countries are focused on health-care workers, hospitalized patients, and those with symptoms. Despite this focus, it was noted that confirmed cases are stabilizing at around 10% of those tested. In other words, the growth of COVID-19 cases could be due entirely, or in part, to the increasing number of tests conducted. And more speculatively, it is currently possible that the disease does not actually grow but that it is only the confirmation of cases among an already infected population that grows.

In addition to the case-fatality rate’s denominator being under-estimated, there are now increasing questions about the accuracy of its numerator, the death count. The April 6 report by the Italian COVID-19 Surveillance Group notes that 96.7% among 1,290 hospitalized “COVID-19 positive deceased patients” had one, two, three or more diagnosed comorbidities, including cardio-vascular diseases, diabetes, kidney failure, chronic lung disease, and/or several other severe illnesses. This raises the question of the causal effect of SARS-CoV2 on the “corona deaths”, or how many people actually die from COVID-19 as opposed to dying with COVID-19. The German infectious disease agency Robert Koch-Institut acknowledged that anyone who dies with a confirmed SARS-CoV2 infection is considered a corona death, irrespective of the cause of death. This would obviously result in a vast over-estimation of the COVID-19 mortality count and thus the virus’ deadliness. On the other hand, the case-fatality rate may also be under-estimated since we tend to relate the death count to the current case count instead of the lower case count from the earlier time when the deceased got infected.

All these issues suggest benchmarking the alarming COVID-related death counts against expected mortality. The web site “COVID-19 in Proportion?” does this for the UK, stating (as of April 7th) that “COVID-19 will be linked to around 3% of total deaths which number 172,384” for the year 2020. According to the latest cause-of-death data from Statistics Canada that I could find, about 8,500 people died of influenza and pneumonia in 2018, and another 13,000 died of chronic lower respiratory diseases. The total number of all-cause deaths in Canada was 283,706 in 2018, including 106,991 Ontarians. At the time of writing, Canada has 381 “corona deaths”, with 153 of those in Ontario. The fatalities therefore are in the order 0.1% of the expected annual mortality. A number of public health experts quoted by OffGuardian suggest that the impact of COVID-19 is no different from the annual flu. Reporting COVID-19 counts in context with a country’s overall mortality or the death counts of recent influenza cycles could go a long way in reducing the general sense of panic and distress caused by current news reports.

I admire lawyers for their ability to think through complex societal problems and succinctly outline a written argument. Numerous constitutional lawyers in Germany have now publicly argued that the extent of the COVID-19 response and the process by which it was instated, are out of proportion and therefore illegal. Quotes reported by the Swiss Propaganda Research project include the assessments that the German infectious disease law “cannot serve as a basis for such far-reaching restrictions of citizens‘ rights of freedom” and that “emergency measures do not justify the suspension of civil liberties in favour of an authoritarian and surveillance state”. The most pointed warning comes from a professor of public and ecclesiastical law in the context of the cancelled Easter masses and suggests that our “democratic constitutional state could turn into a fascist-hysterical hygiene state in no time”. At least one German lawyer, Beate Bahner of Heidelberg, is preparing a constitutional challenge of the federal and provincial corona bylaws passed on March 28. Her 18-page explanation (in German) of why the corona bylaws constitute the greatest legal scandal of post-war Germany is compelling.

Another lawyer, Viviane Fischer of Berlin, started an open petition with currently 69,000 signatures calling for a baseline study to generate a reliable database for public health decision-making in the coronavirus pandemic. The ongoing COVID-19 data issues noted in the petition include:

• The inclusion of all corona-positive deceased in the official COVID-19 statistics, irrespective of their cause of death. The vast majority of fatalities had comorbidities and are not tested for other pathogens such as influenza viruses.
• Tests are mostly limited to patients with COVID-19 symptoms, resulting in an inflated mortality rate. Conversely, untested asymptomatic infections have resulted in an unknown number of people who are now immune to the virus.
• Duration of infectiousness and mechanics of transmission are yet to be confirmed.

To summarize this post, the COVID-19 crisis presents a learning opportunity for science and social science students regarding the benefits and pitfalls of statistical data analysis and modelling. But unfortunately, hasty data collection and analysis in the context of this pandemic is having serious implications on our livelihood. The issues at hand concern data classification (what is a “corona death”?), data normalization (how to benchmark the death count or confirmed infections?), and data modelling (how to predict a disease when the underlying data are inaccurate, possibly by orders of magnitude?). In Canada, the National Post is the only major newspaper, in which I have so far found two critical articles: “The mystery behind the true COVID-19 death rate” (March 31, reprinted from the Financial Times) and “COVID-19 modelling numbers are scary. Have we mortgaged our future on an inexact science?” (April 8). In addition, an opinion piece in the Hill Times posits that “It’s time to talk about a COVID-19 exit strategy” (April 2). We need more critical journalism and a broader range of perspectives – from health sciences and statistics to social studies, economy, politics, and philosophy – to scrutinize and guide our governments’ COVID-19 response. In other words, calling STEAM* superheroes to the rescue!

*STEAM = the integration of Arts with Science Technology Engineering and Math (STEM)

Why Germans are more concerned than most about a COVID-19 lockdown

I have never been a supporter of Germany’s conservative parties but their leader, Chancellor Dr. Angela Merkel, is making German politics great again, at least seen from across the Atlantic. In a rare, televised address to the nation on 18 March 2020, Dr. Merkel urges her “dear fellow citizens” to voluntarily practice the hygiene and distancing measures recommended by public health authorities. At the time, there were some 12,000 confirmed COVID-19 cases and 28 deaths in Germany.

Dr. Merkel’s speech can be seen as a last attempt to avoid enforcing stricter isolation rules. There is a unison of voices from politicians, epidemiologists, and the public calling for the “total shutdown” of society to stop the coronavirus spread, both in Germany and over here in Canada. Merkel however conveys a deeper understanding of the risks of social isolation. She characterizes COVID-19 as the greatest challenge faced by Germany since WWII – not in general terms, as was wrongly reported, but in terms of a challenge that requires every single person’s solidarity and commitment to flattening the curve. Merkel acknowledges the degree to which limitations on non-essential activities are already invading not just our personal lives but our understanding of a democratic society. She refers to her upbringing in totalitarian East Germany and the struggle to fight for the freedom of movement that is now effectively being withdrawn. She established that “such restrictions can only be justified if they are absolutely imperative” and “these should never be put in place lightly in a democracy and should only be temporary.”

Fast forward five days to March 22nd and approaching 25,000 COVID-19 infections and 100 deaths, Germany’s federal and provincial governments agreed on a contact ban, but still did not impose a general curfew. Citizens are free to leave their homes for any purpose as long as they keep among their co-habitants or stick around with no more than one other person. In a commentary entitled “The Other Danger“, Die Zeit journalist Christian Bangel acknowledges that Merkel did not take the easy route. He views her speech as a reminder of what is at stake, reminder to those who call for more drastic measures. Bangel, also born in East Germany, notes how many people who usually lament Germany’s culture-of-prohibitions (“Verbotskultur”), e.g. when it comes to taking climate change action, now call for lockdowns and celebrate the Bavarian premier for jumping the gun with a province-wide curfew. Bangel cautions against the collective-conformist effect of the coronavirus panic, when we forget the difficult balance of freedom and safety in our democracies. He asks what restrictions on civil liberties will be acceptable in the next crisis situation? Accepting such restrictions out of ease and convenience reminds me of how we willingly trade privacy for the convenience of digital services. Bangel concludes that in addition to fighting the virus we also need to fight against complacency and an attitude that views civil rights as a burden for public health and wellbeing.

Germany has learned from two totalitarian regimes in its not too distant past, and Dr. Angela Merkel, the Leader of the Free World according to some, set the tone for a thoughtful, measured pandemic response. Maybe that’s what you get with a conservative, female leader who boasts a doctoral degree in physical chemistry. Merkel shows great empathy when she thanks supermarket cashiers and warehouse employees for keeping things going (“den Laden am Laufen halten”, akin to the expression “the show must go on”) and is cited with the frustration over keeping families from enjoying the sunny spring weather if confined to their homes. In addition to the political dimension of the crisis, I expect that we will also see broader public health issues from a wide-spread sedentary life style under coronavirus lockdowns. Our mental health will be challenged to say the least. And the expected increase in domestic violence is a real danger, too. I therefore hope that other leaders will take a page from Dr. Merkel’s book and avoid full lockdowns or clearly limit them in duration, plus justify them in the context of democratic standards and civil liberties.

To be clear, I am not suggesting to take the coronavirus pandemic lightly or disregard public health guidelines, rules, and laws. I do argue to take a step back and not call for hasty political decisions in a panic. Some experts even recommend “social-media distancing” to “Flatten the Curve of Armchair Epidemiology“! Let’s consider the possible longterm impacts of our response and ensure that we as individual citizens can continue to monitor our authorities’ actions rather than be locked out of decision-making. But ultimately, a slowing of economic and social life under COVID-19 may not be such a bad thing, for nature and humans alike.