Differential associations between SARS-CoV-2 infection, perceived burden of the pandemic and mental health in the German population-based cohort for digital health research (preprint)

Introduction: Understanding the potential adverse effects of the Covid-19-pandemic remains a challenge for public mental health. In this regard, the differentiation between potential consequences of actual infection with SARS-CoV-2 and the subjective burden of the pandemic due to measures and restrictions to daily life remains elusive. Methods: Here we investigated the differential association between infection with SARS-Cov-2 and subjective burden of the pandemic in a study cohort of 7601 participants from the German population-based cohort for digital health research (DigiHero), who were recruited between March 4th and April 25th 2022. Data was collected using the online survey tool LimeSurvey between March and October 2022 in consecutive surveys, which included questionnaires on infection status and symptoms following COVID-19 as well as retrospective assessment of the subjective burden of the pandemic. Results: We observed an association of a past SARS-CoV-2 infection on deteriorated mental health related symptoms, whereas no association or interaction with burden of the pandemic occurred. The association was driven by participants with persistent symptoms 12 weeks after acute infection. On a symptom specific level, neuropsychiatric symptoms such as exhaustion and fatigue, concentration deficits as well as problems with memory function were the primary drivers of the association. Conclusion: Our findings underscore the impact of SARS-CoV-2 infections on mental health in patients suffering from ongoing symptoms 12 weeks after infection. As the association between SARS-CoV-2 infection and mental health appeared more pronounced in populations with higher vulnerability for mental disorders, increased attention should be dedicated towards these subgroups regarding the prevention of infection.

Health-care workers in gastrointestinal endoscopy are at higher risk for SARS-CoV-2 infection compared to other aerosol-generating disciplines (preprint)

ObjectiveHealthcare workers (HCW) are at high risk of SARS-CoV-2 infection due to exposure to potentially infectious material, especially during aerosol-generating procedures (AGP). We aimed to investigate the prevalence of infection among HCW in medical disciplines with AGP. DesignA nationwide questionnaire-based study in in- and outpatient settings was conducted between 12/16/2020 and 01/24/2021. Data on SARS-CoV-2 infections among HCW and potential risk factors were investigated. Results2,070 healthcare facilities with 25,113 employees were included in the study. Despite a higher rate of pre-interventional testing, clinics treated three times more confirmed SARS-CoV-2 cases than private practices (28.8% vs. 88.4%, p<0.001). Overall infection rate among HCW accounted for 4.7%. Multivariate analysis revealed that ZIP-regions having comparably higher incidences were significantly associated with increased risk of infection. Furthermore, clinical setting and the GIE specialty have more than double the risk of infection (OR 2.63; 95% CI 2.501-2.817, p<0.01 and OR 2.35; 95% CI 2.245-2.498, p<0.01). The number of procedures performed per day was also significantly associated with an increased risk of infection (OR 1.01; 95% CI 1.007-1.014), p<0.01). No treatment of confirmed SARS-CoV-2 cases was tending to lower the risk of infection (OR 0.72; 95% CI 0.507-1.025, p=0.068). ConclusionHCW in GIE seem to be at higher risk of infection than those in other AGP, especially in the clinical setting. Regions having comparably higher incidences as well as the number of procedures performed per day were also significantly associated with increased risk of infection. Significance of this studyO_ST_ABSWhat is already known on this subject?C_ST_ABSHealth care workers, especially those exposed to aerosol generating procedures, are assumed to have an increased risk of SARS-CoV-2 infection. However, data confirming this are lacking, especially for the outpatient care setting. What are the new findings?Health care workers in gastrointestinal endoscopy have a higher risk of SARS-CoV-2-infection than in other AGPs. This risk is particularly higher - in clinical settings compared to private practices - in regions having comparably higher incidences - the more procedures are performed per day How might it impact on clinical practice in the foreseeable future?Our study suggests making additional efforts to protect HCW in the gastrointestinal work field.

Are German endoscopy units prepared for the COVID-19 pandemic? A nationwide survey (preprint)

Objective: The COVID-19 pandemic challenges health care systems worldwide. In this situation, guidelines for health care professionals in endoscopy units with increased risk of infection from inhalation of airborne droplets, conjunctival contact and faeces are urgently needed. Recently, the European Society of Gastrointestinal Endoscopy (ESGE) and the German Society for Pneumology (DGP) issued recommendations. However, real-world data on the conditions and requirements of endoscopy units to adhere to this guidance are missing. Design: We conducted an internet-based survey among German endoscopy units from all levels of care from April 1st to 7th, 2020. The survey comprised 33 questions and was distributed electronically by the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the DGP. Results: In total, 656 endoscopy units completed the survey. Overall, 253 units (39%) cancelled fewer than 40% of their procedures. Of note, private practices cancelled less procedures than hospital-based units. Complete separation of high-risk and COVID-19 positive patients was achieved in only 20% of the units. Procedural measures were well adopted, with 91% of the units systematically identifying patients at risk and 85% using risk-adapted personal protective equipment (PPE). For the future, shortages in PPE (81%), staff (69%) and relevant financial losses (77%) were expected. Conclusion: Concise definitions of non-urgent, elective interventions and endoscopic surveillance strategies are needed to better guide endoscopic activity and intervention cancellations. In the short term, a lack of PPE can constitute considerable impairment of endoscopy units' operability and patient outcomes.