Avoiding a crisis at Christmas: a systematic review of adverse health effects or 'Chrishaps' caused by traditional hazard sources and COVID-19.

OBJECTIVE: To complement the 2020 ANZJPH editorial "How COVID-safe Santa can save Christmas". In addition to a concise update regarding SARS-CoV-2/COVID-19, we aimed to explore some risks of Christmas in terms of adverse health effects, which we call 'Chrishaps'. Our overall study question was "which hazards have been scientifically associated with old Christmas essentials such as decoration, gifts, menus, and Santa himself, as well as new challenges associated with COVID-19?" METHOD: We searched the PubMed, Web of Science, and Open Grey databases systematically and Google unsystematically. RESULTS: Thirty-six pertinent articles - most of them case reports or retrospective analyses - documented Chrishaps. CONCLUSION: Overall results suggested that Chrishaps come in different shapes and guises. Implications for public health: Chrishaps pose a potential minor public health threat that should be borne in mind every festive season. Assessing and discussing specific public health implications of Chrishaps requires systematic risk research to be conducted.

Before, During, and After the First Wave of COVID-19: Mortality Analyses Reveal Relevant Trends in Germany and its States until June 2020.

OBJECTIVE: Well-established mortality ratio methodology can contribute to a fuller picture of the SARS-CoV-2/COVID-19 burden of disease by revealing trends and informing mitigation strategies. This work examines respective data from Germany by way of example. METHODS: Using monthly and weekly all-cause mortality data from January 2016 to June 2020 (published by the German Federal Statistical Institute) for all ages,<65 years and≥65 years, and specified for Germany's federal states, we explored mortality as sequela of COVID-19. We analysed standardized mortality ratios (SMRs) comparing 2020 with 2016-2019 as reference years with a focus on trend detection. RESULTS: In Germany as a whole, elevated mortality in April (most pronounced for Bavaria) declined in May. The states of Hamburg and Bremen had increased SMRs in all months under study. In Mecklenburg-Western Pomerania, decreased SMRs in January turned monotonically to increased SMRs by June. Irrespective of age group, this trend was pronounced and significant. CONCLUSIONS: Increased SMRs in Hamburg and Bremen must be interpreted with caution because of potential upward distortions due to a "catchment bias". A pronounced excess mortality in April across Germany was confirmed and a hitherto undetected trend of increasing SMRs for Mecklenburg-Western Pomerania was revealed. To meet the pandemic challenge and to benefit from research based on data collected in standardized ways, national authorities should regularly conduct SMR analyses. For independent analyses, national authorities should also expedite publishing raw mortality and population data, including detailed information on age, sex, and cause of death, in the public domain.

COVID-19: Heterogeneous Excess Mortality and "Burden of Disease" in Germany and Italy and Their States and Regions, January-June 2020.

Total mortality and "burden of disease" in Germany and Italy and their states and regions were explored during the first COVID-19 wave by using publicly available data for 16 German states and 20 Italian regions from January 2016 to June 2020. Based on expectations from 2016 to 2019, simplified Standardized Mortality Ratios (SMRs) for deaths occurring in the first half of 2020 and the effect of changed excess mortality in terms of "burden of disease" were assessed. Moreover, whether two German states and 19 Italian cities appropriately represent the countries within the European monitoring of excess mortality for public health action (EuroMOMO) network was explored. Significantly elevated SMRs were observed (Germany: week 14-18, Italy: week 11-18) with SMR peaks in week 15 in Germany (1.15, 95%-CI: 1.09-1.21) and in week 13 in Italy (1.79, 95%-CI: 1.75-1.83). Overall, SMRs were 1.00 (95%-CI: 0.97-1.04) in Germany and 1.06 (95%-CI: 1.03-1.10) in Italy. Significant SMR heterogeneity was found within both countries. Age and sex were strong modifiers. Loss of life expectancy was 0.34 days (1.66 days in men) for Germany and 5.3 days (6.3 days in men) for Italy [with upper limits of 3 and 6 weeks among elderly populations (≥65 years) after maximum potential bias adjustments]. Restricted data used within EuroMOMO neither represents mortality in the countries as a whole nor in their states and regions adequately. Mortality analyses with high spatial and temporal resolution are needed to monitor the COVID-19 pandemic's course.

Contribution of Occupational Health to multidisciplinary team work for COVID-19 prevention and management.

INTRODUCTION: The SARS-CoV-2/Covid-19 pandemic is a challenge for public health and occupational medicine and developing prevention and protection strategies needs expertise from many disciplines. To make prevention successful, individuals have to be motivated to participate and, in turn, motivation depends on understanding how and why prevention measures are implemented. We present a structured approach (the Cycle of prevention) which involves different stakeholders and perspectives to develop, and monitor, prevention strategies in transparent and effective ways.

COVID-19 and healthcare workers: a rapid systematic review into risks and preventive measures.

OBJECTIVE: The COVID-19 pandemic is demanding for occupational medicine and for public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front lines, we must create safe work environments through comprehensive risk assessments, evaluation and effective implementation of counter-measures. We ask: 'What does current literature report on health risks at workplaces regarding COVID-19?' and 'What do current studies report on the effectiveness of enacted preventative recommendations?' METHODS: As a snapshot of early HCW research, on 26 April 2020, we conducted a rapid systematic literature search in three databases (PubMed, Web of Science and PsycInfo) for COVID-19-related health outcomes and preventive measures in healthcare-associated workplaces. RESULTS: 27 studies were identified as relevant for exploring the risk of infection, 11 studies evaluated preventive measures. The studies described that SARS-CoV-2 impacts significantly on HCW's health and well-being, not only through infections (n=6), but also from a mental health perspective (n=16). 4 studies reported indirect risks such as skin injuries, one study described headaches to result from the use of personal protective equipment. Few studies provided information on the effectiveness of prevention strategies. Overall, most studies on health risks as well as on the effectiveness of preventive measures were of a moderate-to-low quality; this was mainly due to limitations in study design, imprecise exposure and outcome assessments. CONCLUSIONS: Due to widespread exposure of HCW to SARS-CoV-2, workplaces in healthcare must be as safe as possible. Information from HCW can provide valuable insights into how infections spread, into direct and indirect health effects and into how effectively counter-measures mitigate adverse health outcomes. However, available research disallows to judge which counter-measure(s) of a current 'mix' should be prioritised for HCW. To arrive at evidence-based cost-effective prevention strategies, more well-conceived studies on the effectiveness of counter-measures are needed.

COVID-19 and "natural" experiments arising from physical distancing: a hypothetical case study from chronobiology.

With countless "natural" experiments triggered by the COVID-19-associated physical distancing, one key question comes from chronobiology: "When confined to homes, how does the reduced exposure to natural daylight arising from the interruption of usual outdoor activities plus lost temporal organization ordinarily provided from workplaces and schools affect the circadian timing system (the internal 24 h clock) and, consequently, health of children and adults of all ages?" Herein, we discuss some ethical and scientific facets of exploring such natural experiments by offering a hypothetical case study of circadian biology.

SARS-CoV-2/COVID-19 and physical distancing: risk for circadian rhythm dysregulation, advice to alleviate it, and natural experiment research opportunities.

SARS-CoV-2/COVID-19 leads to numerous unplanned or natural experiments with health and disease. Physical (social) distancing - a counter-measure with no alternative, but with no precedence in scope and scale either - is a key intervention and trigger of natural experiments. From a practical perspective, concerned disciplines should increase awareness of, provide recommendations to meet, and develop research for, health challenges arising from physical distancing at home. From the field of chronobiology, prolonged home stays may place undue strain on the body's circadian timing system but straightforward and often underestimated advice for coping can be provided (herein we provide such advice). Of course, advice or recommendations from other concerned disciplines that identify challenges associated with current COVID-19 mitigation strategies are also needed. From a research perspective, different disciplines should rise to the occasion and explore unsuspected natural experiment angles toward novel insights to promote health and prevent disease.

[Deaths in nine regions of Italy in February/March 2020: "Mortality Excess Loupe" for SARS-CoV-2/COVID-19-Epidemiology in Germany]. / Todesfälle in neun Regionen Italiens im Februar/März 2020: "Mortalitäts-Exzess-Lupe" für SARS-CoV-2/COVID-19-Epidemiologie in Deutschland.

Italy is particularly affected by SARS-CoV-2/COVID-19. Recently, Colombo and Impicciatore compared the deaths in 1084 selected municipalities between 21 February 2020 and 21 March 2020 with deaths in the same time period in 2015 to 2019. We extend analyses of data from the Italian National Institute of Statistics (ISTAT) and calculate SMRs for all causes of death in the nine selected regions of Italy, separately for men and women and summarized. We analyze the effect of covariables by Poisson modelling and discuss the limitations of the current elaborations. We conclude: In agreement with Colombo and Impicciatore, in the particular corona situation, this "mortality excess loupe" - assuming otherwise constant determinants of death - can be a virus-test-independent tool to determine mortality effects of SARS-CoV-2. The current "loupe" is focused on municipalities with increases of more than 20% deaths in March 2020 compared to the average deaths on the same days in 2015-2019. The time window of investigation could be opened before 21 February 2020 to detect masked increases in mortality before the first "COVID-19 death" was ascertained. The current "loupe" conveys pronounced mortality increases also in regions that were not considered to be corona hotspots. In this respect, even in the absence of representative virus test results, mortality data can be important indicators of the distribution or spread of a newly acting factor. Overall, it is advisable to carry out SMR analyses for Germany on a regular basis, differentiated by region, gender, age group and cause of death. Such analyses can contribute to the early detection and evaluation of the severity of a deadly pandemic ("burden of disease") as well as to monitoring the dynamic spread of a factor such as SARS-CoV-2. SMR analyses can also be used to assess and evaluate both desired and undesired effects of measures taken against SARS-CoV-2/COVID-19 - and possibly other epidemics or pandemics.