Changes in Lifestyle and Body Weight in Children and Adolescents during the COVID-19 Pandemic: A Representative Survey of Parents in Germany.

INTRODUCTION: The public restrictions taken during the COVID-19 pandemic have substantially affected lifestyle and health behavior of children and adolescents. In Germany, little is known how these changes influenced daily life in families with children and adolescents. METHODS: A cross-sectional survey was performed in April/May 2022 across Germany, similar to a survey performed in 2020. Parents (N = 1,004, 20-65 years) with at least one child aged 3-17 years filled in an online questionnaire released by the Forsa Institute for Social Research and Statistical Analysis. Fifteen questions related to eating habits, dietary patterns, physical activity, media consumption, fitness, mental health, and body weight were included, and standard socioeconomic parameters were assessed. RESULTS: Parents' answers indicated that there was a parental self-reported weight gain in every sixth child since the beginning of the COVID-19 pandemic. This was most obvious in children from families with lower household income and preexisting overweight. Parents also reported that lifestyle patterns had worsened: 70% reported an increase of media consumption during leisure time, 44% a decrease in daily physical activity, and 16% the worsening of dietary habits (e.g., 27% stated to eat more cake and sweets). Children aged 10-12 years were most severely affected. CONCLUSION: Negative health effects related to the COVID-19 pandemic are predominantly observed in children 10-12 years of age and in children from families with low household income, suggesting a worsening social disparity. Political action is urgently needed to tackle the adverse consequences of the COVID-19 pandemic on childhood lifestyle and health.

Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID-19 pandemic compared to previous years-Results from the German DPV registry.

BACKGROUND: The diverse stages of the COVID-19 pandemic led to several social circumstances that influenced daily life and health behavior. PURPOSE: To evaluate changes in cardiovascular risk factors and physical activity among children and young adults with type 1 diabetes (T1D) during the COVID-19 pandemic in Germany compared to previous years. METHODS: A total of 32 785 individuals aged 6-21 years at baseline with T1D from the German diabetes patient follow-up (DPV) registry contributed data on 101 484 person-years between 2016 and 2021. The first treatment year of each individual within this period was considered as baseline. Based on trends from 2016 to 2019, we estimated differences in body mass index-SD score (BMI-SDS), blood pressure (BP-SDS), and lipid levels (non-high-density lipoprotein [non-HDL]) between observed and predicted estimates for the years 2020 and 2021 using linear regression analysis standardized for age, diabetes duration, sex, and migratory background. The proportion doing organized sports and smoking cigarettes was analyzed using multivariable logistic regression models. RESULTS: BMI-SDS increased constantly from 2016 to 2021 without a significant increase above expected values for 2020/2021. Systolic BP-SDS (difference observed vs. expected with 95% confidence interval, 2020: 0.10 [0.07-0.14], 2021: 0.17 [0.14-0.20]) and non-HDL (2020: 2.7 [1.3-4.1] mg/dl, 2021: 4.1 [2.7-5.5] mg/dl) were significantly increased (all p < .001) in both pandemic years. The proportion of subjects participating in organized sports was reduced from over 70% in prepandemic years to 35%-65% in diverse stages/waves of the COVID-19 pandemic. The percentage smoking cigarettes did not change. CONCLUSIONS: We describe an increase in BP and atherogenic lipid levels coinciding with a reduction in physical activity but no acceleration of the prepandemic increases in BMI-SDS among young people with T1D during the COVID-19 pandemic.

Adherence to stay-at-home orders: awareness, implementation and difficulties of officially ordered quarantine measures in the context of the COVID-19 pandemic in Cologne - a retrospective cohort study.

OBJECTIVES: To estimate the awareness, implementation and difficulty of behavioural recommendations and their correlates in officially ordered domestic isolation and quarantine during the COVID-19 pandemic. DESIGN: Online retrospective cohort survey conducted from 12 December 2020 to 6 January 2021 as part of the Cologne-Corona Counselling and Support for Index and Contact Persons During the Quarantine Period study. SETTING: Administrative area of the city of Cologne, Germany. PARTICIPANTS: 3011 infected persons (IPs) and 5822 contacts over 16 years of age who were in officially ordered domestic isolation or quarantine between 28 February 2020 and 9 December 2020. Of these, 60.4% were women. OUTCOME MEASURES: Self-developed scores were calculated based on responses about awareness and implementation of 19 behavioural recommendations to determine community-based and household-based adherence. Linear regression analyses were conducted to determine factors influencing adherence. RESULTS: The average adherence to all recommendations, including staying in a single room, keeping distance and wearing a mask, was 13.8±2.4 out of 15 points for community-based recommendations (CBRs) and 17.2±6.8 out of 25 points for household-based recommendations (HBRs). IPs were significantly more adherent to CBRs (14.3±2.0 points vs 13.7±2.6 points, p<0.001) and HBRs (18.2±6.7 points vs 16.5±6.8 points, p<0.001) than were contact persons. Among other factors, both status as an IP and being informed about the measures positively influenced participants' adherence. The linear regression analysis explained 6.6% and 14.4% (corr. R²) of the adherence to CBRs and HBRs. CONCLUSIONS: Not all persons under official quarantine were aware of the relevant behavioural recommendations. This was especially true in cases where instructions were given for measures to be taken in one's own household. Due to the high transmission rates within households, HBRs should be communicated with particular emphasis.

Where is the greatest risk of COVID-19 infection? Findings from Germany's largest public health department, Cologne.

BACKGROUND: SARS-CoV-2 has been spreading worldwide since late 2019. Before vaccines became available, exclusively non-pharmaceutical measures were used to prevent transmission of infection. Despite the fact that vaccinations are now available, it is still important to identify relevant transmission routes in order to contain the COVID-19- or further pandemics. Therefore, this study aims to systematically analyse data from the largest public health department in Germany to determine the significance of the various known and unknown transmission situations in terms of the proportion of infections. METHODS: All infections in Cologne were systematically recorded by the local health department. In addition to clinical data, the transmission situations were recorded and categorised as pertaining to social contact, work contact, travellers, health care workers, users of educational institutions, visitors of community institutions, infection in the context of medical treatment, and unknown infection. FINDINGS: The analysis included 25,966 persons. A transmission situation could be identified in 82.7% of the cases (n = 21,477). Most persons (42.1%) were infected due to social contact, primarily within their own household. Another 22.3% were infected at their place of work; this was particularly common among staff members of medical facilities, nursing homes and educational institutions. In 17.3% of the cases, the transmission situation remained unknown; the cases with unknown transmission situation were slightly more often symptomatic (75.2%) than the cases with known transmission situation (69.4%). INTERPRETATION: Considering that during the study period the leading strains were the wild-type and alpha-variant transmission rather occurred during scenarios involving close contacts than in anonymous situations. Presumably, however, the findings can be transferred to the new variants. Therefore, in order to prevent transmission, besides vaccination regular antigen tests and/or appropriate protective measures remain relevant until this pandemic has subsided.

Vaccination and Transmission Risk during the Outbreak of B.1.1.529 (Omicron).

Since its first description in November 2021, the SARS-CoV-2 variant of concern Omicron (B.1.1.529) has emerged as the dominant strain in the COVID-19 pandemic. To date, it remains unclear if boosted vaccination protects against transmission. Using data from the largest German Public Health Department, Cologne, we analyzed breakthrough infections in booster-vaccinated infected persons (IP; booster-vaccinated group (BVG); n = 202) and fully vaccinated, not boosted SARS-COV2-positive patients (>3 month after receiving the second dose; unboosted, fully vaccinated group (FVG); n = 202) to close contacts compared to an age- and sex-matched unvaccinated control group (UCG; n = 202). On average, IPs had 0.42 ± 0.52 infected contacts in relation to the total number of contacts in the BVG vs. 0.57 ± 0.44 in the FVG vs. 0.56 ± 0.43 in the UVG (p = 0.054). In the median test, pairwise comparison revealed a significant difference between the BVG and both other groups; no difference was found between the fully vaccinated and the unvaccinated control group. Now, these findings must be verified in larger samples, considering the role of Omicron subvariants and the vaccination status of the contact person. However, the importance of the booster vaccination in breaking possible chains of infection in the immune escape variant Omicron is obvious.

Short report: Weight management of children and adolescents with obesity during the COVID-19 pandemic in Germany.

The aim of this analysis was to assess the effectiveness of a juvenile outpatient weight management program during the coronavirus pandemic in Germany, which was implemented digitally during the initial lockdown and thereafter under strict hygiene rules (e.g., adapted exercise sessions). Changes in body mass index standard deviation scores (BMI SDS), physical fitness, media consumption, health-related quality of life (HRQOL), and social self-concept of 28 children and adolescents were compared to data of 30 participants before the pandemic. Adjusted mean changes from baseline to follow-up in BMI SDS (M = -0.07 ± 0.30), relative physical fitness (M = 0.0 ± 0.3 W/kg), media use (M = 0.5 ± 2.6 hours/day), HRQOL (M = -1.6 ± 15.3), and social self-concept (M = -3.8 ± 13.2) during the pandemic were not significantly different from those of the pre-pandemic participants (all p > 0.05). Therefore, the results suggest that an adjusted approach to weight management, which combined digital and adapted in-person components to meet hygiene requirements during the pandemic, was as effective as the pre-pandemic program. It could thus be a potential solution to ensure continuity of care for vulnerable children with obesity during the pandemic and the associated restrictions.

Impact of physical activity on COVID-19-related symptoms and perception of physical performance, fatigue and exhaustion during stay-at-home orders.

Objectives: The measures used to contain the COVID-19 pandemic led to a significant reduction in physical activity. Due to the health benefits of exercise, recommendations were made for lockdown restrictions. Within the CoCo-Fakt study (Cologne-Corona counselling and support for index and contacts during the quarantine period), we aimed to determine how these recommendations were implemented, especially by individuals who were officially quarantined due to an infected persons (IPs) or as close contacts (CPs), and how this affected their physical and psychological condition. Methods: From 12 December 2020 to 6 January 2021, all IPs and CPs registered by Cologne's public health department up to the survey period were surveyed online. Of 10 547 people in the CoCo-Fakt sample, 8102 were integrated into the current analysis. In addition to demographic data, information regarding COVID-19-specific and persistent symptoms or conditions and their association with the amount and type of exercise and screen time before and during the quarantine were collected. Results: Before quarantine, 66.9% of IPs and 69% of CPs were physically active; during quarantine, this decreased by 49.4% in IPs depending on the course of the disease and by 30.6% in CPs. Physically active IPs and CPs felt less exhausted and more fit during their quarantine periods than those who were inactive, with active IPs significantly less likely to report prolonged physical and psychological symptoms than their more sedentary counterparts. Conclusion: Given the acute and long-term positive effects of exercise on quarantined individuals, corresponding recommendations should be communicated to those affected, especially CPs. Recommendations for IPs depend on their health status.

Changes in Motor Performance and BMI of Primary School Children over Time-Influence of the COVID-19 Confinement and Social Burden.

During the COVID-19 pandemic, physical inactivity and being overweight increased in children, especially those from lower socioeconomic backgrounds. Additionally, a decrease in motor performance has been increasingly reported; however, there is a lack of meaningful data on the relationship between these findings and socioeconomic status. Therefore, we examined the BMI, BMI z score, the prevalence of overweight/obesity, and motor performance (based on lateral jumping, the standing long jump, and the 6-min run) among three cohorts from timelines before (2016) and during the pandemic (2020, 2021), using a cohort sequential design. Our analysis revealed that all parameters examined showed a significant negative trend over time. For children with a low social burden, the trend was statistically detectable only for lateral jumping and the 6-min run. For children with a high social burden, the prevalence of overweight/obesity increased from 4.2% to 5.4% between 2016 and 2021. The prevalence of being underweight also increased from 3.4% to 4.3% during this time. Motor performance decreased from 11.3% to 12.3%, except in the standing long jump. Children with a high social burden showed significantly lower results (7.4% to 9.6%). Thus, our data confirm an increase in both measurements of overweight/obesity and underweight, as well as a decrease in motor performance under the pandemic conditions, especially in children from socioeconomically deprived backgrounds. These findings affirm the urgent need for action regarding health promotion measures, especially for children with high social burdens.

Stay at Home Order—Psychological Stress in Children, Adolescents, and Parents during COVID-19 Quarantine—Data of the CoCo-Fakt Cohort Study, Cologne

Measures taken to contain the COVID-19 pandemic are particularly stressful for families. Limited data is available regarding the effects of a mandatory quarantine on the psychological stress of children, adolescents and their parents. Quarantined individuals participating in the online-based CoCo-Fakt study had at least one child <3, 3 to <6, 6 to <10, 10 to <14 and 14 to <16 years old (n = 2153). Parents were asked about how often their children felt nervous, anxious, or tense, down or depressed, lonely or physical reactions occur. A relative sum score characterizing psychosocial stress was determined and related to parents’ socio-demographic factors, psychosocial distress, coping strategies and resilience. Parents reported significantly higher psychological stress if at least one child was quarantined. Parents’ relative psychological stress sum score had the strongest influence on the psychological state of the children across all age groups (β = 0.315–0.457) besides male sex of the reporting parent, no partnership, low to medium socioeconomic status, lower resilience and coping scores, and parents quarantined as close contacts. The variance in the linear regression models was between 17.8% and 31.4%. These findings highlight that the entire family system must be considered during official mandatory quarantines.

Changes in Alcohol Consumption, Eating Behaviors, and Body Weight during Quarantine Measures: Analysis of the CoCo-Fakt Study.

INTRODUCTION: Public health measures enacted to reduce COVID-19 transmission have affected individuals' lifestyles, mental health, and psychological well-being. To date, little is known how stay-at-home orders have influenced the eating behaviors, weight development, and alcohol consumption of quarantined persons. The CoCo-Fakt cohort study analyzed these parameters and their association with psychological distress and coping strategies. METHODS: An online survey was conducted of all persons who tested positive for SARS-CoV-2 (infected persons [IP]) between December 12, 2020, and January 6, 2021, as well as their close contacts (contact persons [CP]) registered by the public health department of Cologne. 8,075 of 33,699 individuals were included in the analysis. In addition to demographic data, psychological distress, and coping strategies, information on changes in body weight, eating, and drinking behaviors was collected. RESULTS: IP lost 1.2 ± 4.4 kg during the quarantine period, and CP gained 1.6 ± 4.1 kg. The reasons given by IP for weight change were mainly loss of taste and feeling sick, whereas CP were more likely than IP to eat out of boredom. Higher psychological burden and lower coping strategies were associated with both weight gain and loss. Of the 30.8% of participants who changed their alcohol consumption during the quarantine period, CP in particular drank more alcohol (IP 15.2%; CP 47.7%). Significantly less alcohol was consumed by individuals with higher coping scores. CONCLUSION: In this short but psychologically stressful period of stay-at-home orders, changes in eating and drinking behavior as well as weight development are evident, mainly in high-risk contacts. To avoid possible long-term sequelae, health authorities should take these findings into account during the quarantine period; in particular, general practitioners should consider these findings during follow-up.

COVID-19 Breakthrough Infections and Transmission Risk: Real-World Data Analyses from Germany's Largest Public Health Department (Cologne).

BACKGROUND AND METHODS: Vaccination is currently considered the most successful strategy for combating the SARS-CoV-2 virus. According to short-term clinical trials, protection against infection is estimated to reach up to 95% after complete vaccination (≥14 days after receipt of all recommended COVID-19 vaccine doses). Nevertheless, infections despite vaccination, so-called breakthrough infections, are documented. Even though they are more likely to have a milder or even asymptomatic course, the assessment of further transmission is highly relevant for successful containment. Therefore, we calculated the real-world transmission risk from fully vaccinated patients (vaccination group, VG) to their close contacts (CP) compared with the risk from unvaccinated reference persons matched according to age, sex, and virus type (control group = CG) utilizing data from Cologne's health department. RESULTS: A total of 357 breakthrough infections occurred among Cologne residents between 27 December 2020 (the date of the first vaccination in Cologne) and 6 August 2021. Of the 979 CPs in VG, 99 (10.1%) became infected. In CG, 303 of 802 CPs (37.8%) became infected. Factors promoting transmission included non-vaccinated status (ß = 0.237; p < 0.001), male sex (ß = 0.079; p = 0.049), the presence of symptoms (ß = -0.125; p = 0.005), and lower cycle threshold value (ß = -0.125; p = 0.032). This model explained 14.0% of the variance (corr. R2). CONCLUSION: The number of transmissions from unvaccinated controls was three times higher than from fully vaccinated patients. These real-world data underscore the importance of vaccination in enabling the relaxation of stringent and restrictive general pandemic control measures.

How to manage quarantine-adherence, psychosocial consequences, coping strategies and lifestyle of patients with COVID-19 and their confirmed contacts: study protocol of the CoCo-Fakt surveillance study, Cologne, Germany.

INTRODUCTION: The current coronavirus (SARS-CoV-2) pandemic has placed unprecedented restrictions on people's lives and routines. To counteract the exponential spread of this virus, a lockdown was implemented in Germany in March 2020. Infected persons and their contacts were also quarantined. Compliance with quarantine measures is essential for containing the spread of the virus and avoiding incalculable consequences in terms of morbidity and mortality. On the other hand, prolonged homestays, particularly quarantining, may lead to fear, panic, anxiety and depression. Hence, determining the psychological response in people during quarantine and their coping strategies is relevant for the counselling and support of affected persons by healthcare workers. METHODS AND ANALYSIS: The CoCo-Fakt-Survey (Cologne-Corona-Beratung und Unterstützung Für Index- und KontAKt-Personen während der Quarantäne-ZeiT; Cologne-Corona counselling and support for index and contacts during the quarantine period-author's translation) will examine a cohort of persons in Cologne quarantined since the beginning of the SARS-CoV-2 outbreak during March 2020. The questionnaire will include demographic data, transmission route, health status, knowledge of and adherence to quarantine measurements, psychological impact on individuals and their family members including children, mental health status, and lifestyle (physical activity/sedentary behaviour, relaxation techniques, nutrition, smoking). All Cologne residents who needed to be quarantined due to a coronavirus infection and the individuals with whom they had contact will be surveyed. ETHICS AND DISSEMINATION: No risks have been identified and no complications are expected. Ethics approval was obtained from the Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen Human Ethics Research Committee (351/20), and the research will be conducted in accordance with the approved protocol. The results will be disseminated through peer-reviewed journals and social medicine conferences.