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Background: Healthcare workers (HCW) of respiratory clinics are at major risk for SARS-CoV-2-infection. COVID-19 prevalence among HCWs in the pre-vaccination era is well documented but the effect of vaccination on COVID-19disease and development of symptoms is less well studied. One year after start of the vaccination campaign, we aimed to determine the work-related risk among HCWs of respiratory clinics in Germany. Method(s): A study-specific online questionnaire was created to investigate COVID-19 work-related risk and disease characteristics. HCWs of all occupational categories were surveyed from 1st to 23th Dec 2021. Result(s): 1136 HCWs of seven clinics, 75% females, age groups 18-25/26-35/36-45/46-55/>=56y 8.1/24.9/22.6/23.7/20.5%, took part. Overall SARS-CoV-2 prevalence was 9.5% (n=108), 55.9% occurring before introduction of vaccination. 82.3/6.5/11.2% were unvaccinated/single dose/double dose vaccinated at infection. Most infections were associated with hospital exposure in the unvaccinated, 45.5 vs. 18.2%, whereas infections after vaccination were predominantly attributed to private contacts, 21.1 vs. 42.1% (p=0.04). The majority of infected subjects (89%) were symptomatic at diagnosis. Regardless of vaccination status, 43.8 and 55.2% experienced dysgeusia/anosmia and fatigue, respectively, as severe. HCWs who were unvaccinated at the time of infection reported a higher symptom burden after recover. Conclusion(s): One year after start of the vaccination campaign, a decrease in workplace-related COVID-19 infections was observed, but a relevant number of the formerly infected still suffered from sequelae.
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Background: Staff absences due to illness or quarantine as result of the SARS-CoV-2 pandemic or vaccinationrelated adverse events are known. We examined their numbers in health care workers (HCW) from pulmonary hospitals in Germany. Method(s): A study-specific online questionnaire was created to assess individual experiences and the impact of the pandemic. From December 1 to 23, 2022 staff from all occupational groups at 7 pulmonary hospitals were surveyed. Result(s): A total of 1136 HCW participated, 75% being female, 92.6% having received at least one vaccine dose at the time of the survey, 65.2% three, and 108 reporting a previous SARS-CoV-2 infection. Of HCW with positive PCR test, 98% reported home quarantine, with a quarantine period of median (range) 14 (1-52) days, while of those without positive PCR test, 11.3% reported quarantine over 14 (1-25) days. In addition, 23.5% of HCW reported absences due to vaccination effects over 2 (1-21) days. Overall, 37% (n=420) of HCW reported pandemic-related absences (median 5 days), with 3523 cumulative days of absence from work, among them 2826 related to illness or quarantine, and 697 to vaccination effects. Independent risk factors for pandemic-related absences of more than 5 days included COVID-19 illness (p<0.001) and not having been vaccinated at the time of the interview (OR 2.6;95%CI: 1.2-5.6;p= 0.009). Sex, age, or working in direct patient care or risk areas were not relevant. Conclusion(s): In HCW from German pulmonary hospitals, the average total days of absenteeism from work related to SARS-CoV-2 were about 3 days per participant, and vaccination-associated absenteeism contributed about one fifth to this number.
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Introduction: The epidemiology of respiratory infections changed fundamentally during COVID-19 pandemic. While during lockdown periods numbers of respiratory infection were low, an increase of respiratory syncytial virus and rhinovirus infections was reported outside the natural season. Viral infections being the main trigger for asthma and wheeze episodes in children, we aimed to investigate the impact of this observation on children and adults. Method(s): Within the ALL Age Asthma Cohort (ALLIANCE), an observational, longitudinal multicenter asthma study, we assessed data regarding disease control, use of medication and etiology of exacerbations at three time points, during (pilot: Feb-Aug 2020: n= 280, phase 1: Oct-Apr 2020/21: n= 412) and after lockdown periods (phase 2: JunOct 2021: n= 327). Result(s): We observed high proportions of improvement in disease burden in preschool children (age 0-5.9 years) during lockdown periods in the pilot-phase (35%) and in phase 1 (32%). While after easing of hygiene measures none of the preschool children reported improvement (phase 1/phase 2;p = 0.02), 29% showed worsening of their condition (pilot/phase 2, p = 0.01) associated with viral infections and higher need for medication. Children aged 6-18 years showed a stable course over all phases. In contrast, adults reported worsening of their asthma (pilot, 19%, phase 1, 29%), but no significant change in phase 2 (23%). Conclusion(s): COVID-19 related measures caused a reduction and re-emerge of respiratory virus infections, which influenced the course of disease in preschool children with recurrent wheeze, but not in older children and adults with asthma.
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Background: Post-COVID Syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence >3 months, subacute symptom onset, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lack of efficient means to assess the presence and severity of PCS. Method(s): COVIDOM is a population-based cohort study of PCR-confirmed cases of SARS-CoV-2 infection, recruited through local public health authorities in three German regions. Standardised interviews and in-depth onsite examinations were scheduled 6-12 months post infection. Based upon 12 long-term symptom complexes, we developed a comprehensive PCS severity score in a training cohort and validated the score in two independent subcohorts. Result(s): In the training sub-cohort (n=667, 56% female), 90% of participants were treated as outpatients for acute COVID-19. Neurological ailments (61.5%) and fatigue (57.1%) persisted most frequently. Across all sub-cohorts, higher PCS scores were associated with lower health-related quality of life (EQ-5D-5L-VAS/-index, all p<0.001). Similarly, participants with a higher PCS score consistently showed increased blood inflammatory markers and Ddimer as well as lower diffusing capacity in lung function (all p<0.01). Significant early predictors of the PCS score included the number and intensity of acute symptoms, resilience, and general anxiousness. Conclusion(s): PCS severity can be quantified by an easy-to-use score summarising individual disease burden and reflecting pathological processes. The PCS score promises to facilitate diagnosis of PCS, studies of its natural course, and of therapeutic interventions.
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The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.
Subject(s)
COVID-19 , Post-Acute COVID-19 Syndrome , HumansABSTRACT
Introduction During COVID-19 pandemic, the epidemiology of respiratory infections changed fundamentally. During lockdown periods rates of respiratory infection were low. An increase of respiratory syncytial virus and rhinovirus infections was reported after easing of hygiene measures compared to lockdown and pre-pandemic periods. We investigated the impact of this observation on children and adults with wheeze and asthma. Methods Within the ALL Age Asthma Cohort (ALLIANCE), we conducted questionnaires at three time points, during (Pilot: Feb-Aug 2020: n= 279, Phase 1: Oct-Apr 2020/21: n= 412) and after lockdown periods (Phase 2 Jun-Oct 2021: n= 327). Data on disease control (based on personal assessment and adapted GINA control status), use of medication and etiology of exacerbations were analyzed. Results Preschool children (age 0-5.9 years) showed a noticeable high improvement of 35% (Pilot) and 32% (Phase 1) in disease burden measured by specific symptoms and general personal assessment during lockdown periods. In contrast after easing of hygiene measures none of the preschoolers reported improvement compared to the beginning of the pandemic and lockdown phases (Pilot/ Phase 2;p= 0,0003;Phase 1/Phase 2;p = 0.004), but 29% showed worsening of their condition (Pilot/Phase 2, p = 0.02), associated with viral infections and higher need for medication. Children aged 6- 18 years had a stable asthma course over all phases. Adults reported higher proportion of worsening of their asthma in Phase 1 (30%) in comparison to the Pilot (19%), (p = 0.02), but not in Phase 2 (22%) compared to the Pilot (p= 0.39) or Phase 1 (p= 0.14). Conclusion COVID-19 related measures caused a reduction and re-emergence of respiratory virus infections, which influenced the course of disease in preschool children with recurrent wheeze, but not in older children and adults with asthma.
Subject(s)
COVID-19 , Lung Diseases/epidemiology , Pandemics , Respiratory Tract Diseases/epidemiology , Germany , Humans , Risk Assessment , Societies, MedicalABSTRACT
Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6â% require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (>â30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.