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1.
BMC Public Health ; 22(1): 572, 2022 Mar 23.
Article in English | MEDLINE | ID: covidwho-1770514

ABSTRACT

BACKGROUND: Allocation of scarce medical resources can be based on different principles. It has not yet been investigated which allocation schemes are preferred by medical laypeople in a particular situation of medical scarcity like an emerging infectious disease and how the choices are affected by providing information about expected population-level effects of the allocation scheme based on modelling studies. We investigated the potential benefit of strategic communication of infectious disease modelling results. METHODS: In a two-way factorial experiment (n = 878 participants), we investigated if prognosis of the disease or information about expected effects on mortality at population-level (based on dynamic infectious disease modelling studies) influenced the choice of preferred allocation schemes for prevention and treatment of an unspecified sexually transmitted infection. A qualitative analysis of the reasons for choosing specific allocation schemes supplements our results. RESULTS: Presence of the factor "information about the population-level effects of the allocation scheme" substantially increased the probability of choosing a resource allocation system that minimized overall harm among the population, while prognosis did not affect allocation choices. The main reasons for choosing an allocation scheme differed among schemes, but did not differ among those who received additional model-based information on expected population-level effects and those who did not. CONCLUSIONS: Providing information on the expected population-level effects from dynamic infectious disease modelling studies resulted in a substantially different choice of allocation schemes. This finding supports the importance of incorporating model-based information in decision-making processes and communication strategies.

2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-329673

ABSTRACT

High antibody affinity against the ancestral SARS-CoV-2 strain seems to be necessary (but not always sufficient) for the control of emerging immune-escape variants. Therefore, aiming at strong B cell somatic hypermutation - not only at high antibody titers - is a priority when utilizing vaccines that are not targeted at individual variants. Here, we developed a next-generation sequencing based SARS-CoV-2 B cell tracking protocol to rapidly determine the level of immunoglobulin somatic hypermutation at distinct points during the immunization period. The percentage of somatically hypermutated B cells in the SARS-CoV-2 specific repertoire was low after the primary vaccination series, evolved further over months and increased steeply after boosting. The third vaccination mobilized not only naïve, but also antigen-experienced B cell clones into further rapid somatic hypermutation trajectories indicating increased affinity. Together, the strongly mutated post-booster repertoires and antibodies deriving from this may explain why the booster, but not the primary vaccination series, offers some protection against immune-escape variants such as Omicron B.1.1.529. Brief summary Priming SARS-CoV-2 vaccinations generate antibodies from low-level matured B cells while the third vaccination strongly boosts somatic hypermutation potentially explaining different protection from immune-escape variants.

4.
Dtsch Arztebl Int ; (Forthcoming)2022 03 18.
Article in English | MEDLINE | ID: covidwho-1707144

ABSTRACT

BACKGROUND: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. METHODS: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for various covariates). RESULTS: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. CONCLUSION: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-308689

ABSTRACT

Digital contact tracing is a public health intervention. It should be integrated with local health policy, provide rapid and accurate notifications to exposed individuals, and encourage high app uptake and adherence to quarantine. Real-time monitoring and evaluation of effectiveness of app-based contact tracing is key for improvement and public trust.

6.
Front Psychiatry ; 12: 743158, 2021.
Article in English | MEDLINE | ID: covidwho-1596387

ABSTRACT

Background: Previous findings suggest that university students are at an elevated risk to experience financial hardship and to suffer from depressive symptoms. This vulnerability may have substantially increased during the coronavirus disease 19 (COVID-19) pandemic which might have affected students' socio-economic situation but possibly also their mental well-being. We examined whether the financial situation changed during the COVID-19 pandemic among German university students, and whether changes were associated with mental well-being. Methods: We conducted a cross-sectional online survey in May and July 2020 at five German universities. Participants were asked, if they had sufficient financial resources to cover monthly expenses before and during the pandemic. The answer options were dichotomized into worsened and no change/better financial situation compared to before the COVID-19 pandemic. Depressive symptoms were assessed using the CES-D 8 scale. For examining associations between sociodemographic, study-related, and financial factors and "worsened financial situation," we ran a generalized linear mixed model. To assess associations between depressive symptoms and worsened financial situation, we performed a linear mixed model. Results: We included 7,199 participants in the analyses (69% female, 30% male, 1% diverse, mean age: 24 years, standard deviation: 4.7). Overall, 25% of the participants reported to have a worsened financial situation at the time of the survey than in the time before COVID-19. Factors associated with a worsened financial situation were migration background, parents not being academics, not being able to borrow money, and payment of tuition fee by student and loan [odds ratios (OR) ranging from 1.20 to 2.35]. Factors associated with lower odds were: being single, living with others, studying a health-related field, being enrolled in a doctoral/Ph.D. or state exam program, and publicly funded tuition/tuition paid with a scholarship (OR ranging from 0.42 to 0.80). A worsened financial situation was associated with 1.02 points more on the CES-D 8 scale (95% CI: 0.80-1.24). Conclusion: Our results suggest that the pandemic put a number of students under financial strain with detrimental consequences for their mental well-being. Renewed attention must be paid to this vulnerable group to prevent the potentially damaging effects on their mental health.

7.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-296168

ABSTRACT

Background The effect of contact reduction measures on infectious disease transmission can only be assessed indirectly and with considerable delay. However, individual social contact data and population mobility data can offer near real-time proxy information. Aim To compare social contact data and population mobility data with respect to their ability to predict transmission dynamics during the first wave of the SARS-CoV-2 pandemic in Germany. Methods We quantified the change in social contact patterns derived from self-reported contact survey data collected by the German COVIMOD study from 04/2020-06/2020 (compared to the pre-pandemic period), and estimated the percentage mean reduction in the effective reproduction number R(t) over time. We compared these results to the ones based on R(t) estimates from open-source mobility data and to R(t) values provided by the German Public Health Institute. Results We observed the largest reduction in social contacts (90%, compared to pre-pandemic data) in late April corresponding to the strictest contacts reduction measures. Thereafter, the reduction in contacts dropped continuously to a minimum of 73% in late June. R(t) estimates based on social contacts underestimated measured R(t) values slightly in the time of strictest contact reduction measures but predicted R(t) well thereafter. R(t) estimates based on mobility data overestimated R(t) considerably throughout the study. Conclusions R(t) prediction accuracy based on contact survey data was superior to the one based on population mobility data, indicating that measuring changes in mobility alone is not sufficient for understanding changes in transmission dynamics triggered by public health measures.

8.
SSRN; 2021.
Preprint in English | SSRN | ID: ppcovidwho-292692

ABSTRACT

Background: The COVID-19 pandemic called for a fast conduct of studies to establish vaccines and therapies, but also to identify the natural history and drivers of post-acute sequelae of COVID-19 (PASC). Digital epidemiology may serve this aim by rapidly generating large sample sizes allowing dedicated analyses of biomaterial in a subsample of interest. Methods: Of 129,733 households in Halle (Saale) invited to the cohort study for digital health research in Germany (DigiHero), 8,077 individuals participated, among these 919 that reported prior positive SARS-CoV-2 testing in their households. These were invited to respond to a PASC-focused questionnaire and to undergo blood sampling for cytokine and autoantibody profiling. Cytokine profiles were validated in a second cohort with early infections and single-cell transcriptomics datasets. Results: The analysis is based on the first 318 DigiHero participants, 258 thereof on average eight months after mostly mild infection. PASC were reported in 67.8% of cases and consisted predominantly in fatigue, dyspnea and concentration deficit. The recovery from PASC was not associated with post-infection vaccination suggesting that it may not be driven by a cryptic SARS-CoV-2 reservoir. We confirmed the high percentage of individuals with autoantibodies after COVID-19, but found no association with PASC. While our data show that a broad range of cytokines remain deregulated long after infection, IL-1ß, IL-6 and TNF-α represented a triad that was associated with PASC. Blood profiling and single-cell data from early infection indicated that these cytokines are induced in COVID-19 lung pro-inflammatory macrophages creating a feedback loop that may trigger their long-term activation. Conclusion: We provide evidence for a long-lasting cytokine signature potentially underlying many of the clinical symptoms of PASC that may be driven by macrophage primed during acute infection. This study demonstrates how the combination of digital epidemiology with selective biobanking can rapidly generate hints towards disease mechanisms.

9.
BMC Med ; 19(1): 271, 2021 10 14.
Article in English | MEDLINE | ID: covidwho-1468065

ABSTRACT

BACKGROUND: The effect of contact reduction measures on infectious disease transmission can only be assessed indirectly and with considerable delay. However, individual social contact data and population mobility data can offer near real-time proxy information. The aim of this study is to compare social contact data and population mobility data with respect to their ability to reflect transmission dynamics during the first wave of the SARS-CoV-2 pandemic in Germany. METHODS: We quantified the change in social contact patterns derived from self-reported contact survey data collected by the German COVIMOD study from 04/2020 to 06/2020 (compared to the pre-pandemic period from previous studies) and estimated the percentage mean reduction over time. We compared these results as well as the percentage mean reduction in population mobility data (corrected for pre-pandemic mobility) with and without the introduction of scaling factors and specific weights for different types of contacts and mobility to the relative reduction in transmission dynamics measured by changes in R values provided by the German Public Health Institute. RESULTS: We observed the largest reduction in social contacts (90%, compared to pre-pandemic data) in late April corresponding to the strictest contact reduction measures. Thereafter, the reduction in contacts dropped continuously to a minimum of 73% in late June. Relative reduction of infection dynamics derived from contact survey data underestimated the one based on reported R values in the time of strictest contact reduction measures but reflected it well thereafter. Relative reduction of infection dynamics derived from mobility data overestimated the one based on reported R values considerably throughout the study. After the introduction of a scaling factor, specific weights for different types of contacts and mobility reduced the mean absolute percentage error considerably; in all analyses, estimates based on contact data reflected measured R values better than those based on mobility. CONCLUSIONS: Contact survey data reflected infection dynamics better than population mobility data, indicating that both data sources cover different dimensions of infection dynamics. The use of contact type-specific weights reduced the mean absolute percentage errors to less than 1%. Measuring the changes in mobility alone is not sufficient for understanding the changes in transmission dynamics triggered by public health measures.


Subject(s)
COVID-19 , SARS-CoV-2 , Germany/epidemiology , Humans , Pandemics , Surveys and Questionnaires
10.
Nat Commun ; 12(1): 5096, 2021 08 19.
Article in English | MEDLINE | ID: covidwho-1366815

ABSTRACT

Nearly all mass gathering events worldwide were banned at the beginning of the COVID-19 pandemic, as they were suspected of presenting a considerable risk for the transmission of SARS-CoV-2. We investigated the risk of transmitting SARS-CoV-2 by droplets and aerosols during an experimental indoor mass gathering event under three different hygiene practices, and used the data in a simulation study to estimate the resulting burden of disease under conditions of controlled epidemics. Our results show that the mean number of measured direct contacts per visitor was nine persons and this can be reduced substantially by appropriate hygiene practices. A comparison of two versions of ventilation with different air exchange rates and different airflows found that the system which performed worst allowed a ten-fold increase in the number of individuals exposed to infectious aerosols. The overall burden of infections resulting from indoor mass gatherings depends largely on the quality of the ventilation system and the hygiene practices. Presuming an effective ventilation system, indoor mass gathering events with suitable hygiene practices have a very small, if any, effect on epidemic spread.


Subject(s)
Air Pollution, Indoor/prevention & control , COVID-19/transmission , Hygiene/standards , SARS-CoV-2/pathogenicity , Ventilation/methods , Aerosols , COVID-19/diagnosis , COVID-19/virology , Computer Simulation , Disease Transmission, Infectious/prevention & control , Humans , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
11.
BMC Med Res Methodol ; 21(1): 165, 2021 08 10.
Article in English | MEDLINE | ID: covidwho-1352645

ABSTRACT

BACKGROUND: A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and pre-symptomatic cases. Therefore, different polymerase chain reaction (PCR)- or rapid antigen test (RAT)-based approaches are being discussed and applied to identify infectious individuals that would have otherwise gone undetected. In this article, we provide a framework to estimate the time-dependent risk of being infectious after a negative SARS-CoV-2 test, and we simulate the number of expected infectious individuals over time in populations who initially tested negative. METHODS: A Monte Carlo approach is used to simulate asymptomatic infections over a 10-days period in populations of 1000 individuals following a negative SARS-CoV-2 test. Parameters representing the application of PCR tests or RATs are utilized, and SARS-CoV-2 cumulative 7-day incidences between 25 and 200 per 100,000 people are considered. Simulation results are compared to case numbers predicted via a mathematical equation. RESULTS: The simulations showed a continuous increase in infectious individuals over time in populations of individuals who initially tested SARS-CoV-2 negative. The interplay between false negative rates of PCR tests or RATs, and the time that has passed since testing determines the number of infectious individuals. The simulated and the mathematically predicted number of infectious individuals were comparable. However, Monte Carlo simulations highlight that, due to random variation, theoretically observed infectious individuals can considerably exceed predicted case numbers even shortly after a test was conducted. CONCLUSIONS: This study demonstrates that the number of infectious individuals in a screened group of asymptomatic people can be effectively reduced, and this effect can be described mathematically. However, the false negative rate of a test, the time since the negative test and the underlying SARS-CoV-2 incidence are critical parameters in determining the observed subsequent number of cases in tested population groups.


Subject(s)
COVID-19 , Communicable Diseases , Computer Simulation , Humans , Polymerase Chain Reaction , SARS-CoV-2
13.
Z Evid Fortbild Qual Gesundhwes ; 153-154: 32-38, 2020 Aug.
Article in German | MEDLINE | ID: covidwho-598452

ABSTRACT

INTRODUCTION: In order to stem the spread of an epidemic, widespread adherence to safety measures and their acceptance within the German population are of key importance. This survey examines the levels of knowledge and the perception of risk within the population and analyses implementation and adherence to the recommended and legally mandated safety measures in the early phase of the COVID-19 pandemic. METHODS: In March 2020, participants registered on the HeReCa-Online-Panel from Saxony-Anhalt, Berlin and Schleswig Holstein were invited to complete a 65-question survey. RESULTS: 1048 respondents answered the questionnaire, which amounts to a response of 3.5%. 83% of respondents stated that they felt themselves to be well-informed or very well-informed concerning COVID-19 and the coronavirus. The majority of respondents reported fears for the well-being of family members (60%) or the health of the German population as a whole (45%); 79% reported concerns regarding adverse economic impacts. 79% of respondents have implemented individual protective measures, such as reducing social contacts and maintaining the recommended physical distance in public spaces. Most respondents regarded the government-mandated safety measures as predominantly reasonable and appropriate. CONCLUSIONS: In the early phase of the pandemic, most people kept themselves informed about of COVID-19 and started to take individual measures for risk reduction. Acceptance of governmental measures to stem the spread of the pandemic was high.


Subject(s)
Coronavirus Infections/epidemiology , Health Knowledge, Attitudes, Practice , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Germany/epidemiology , Humans , Pandemics , Risk Reduction Behavior , SARS-CoV-2 , Surveys and Questionnaires
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