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In Japanese and Italian, the response to ["How are you?"] is "I'm fine, and you?" In German it's answered with a sigh and a slight pause, followed by "Not so good.

David Sedaris (2013). “Let's Explore Diabetes With Owls”, p.42, Hachette UK
In Japanese and Italian, the response to [How are you?] is I'm fine, and you? In German it's answered with a sigh and a slight pause, followed by Not so good.