[COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon]. / COVID-19 als Versicherungsfall der gesetzlichen Unfallversicherung: Berufskrankheit oder Arbeitsunfall : Relevantes Wissen für den (Allgemein­/Viszeral­)Chirurgen.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was a dramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No. 3101 and the AU are presented.Results (key points)- According to § 7 SGB VII, AU and BK are insured events of the statutory accident insurance.- In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV­2 infection with post-COVID in personnel for occupational medical prevention and as a case to be recognized by the statutory accident insurance (BK or AU) becomes clear.- Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV­2 occupational health and safety rule of 20 August 2020 essentially recognizes a contact duration of at least 15 min at a spatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).- No case numbers can be elicited for the detailed presentation of the surgery setting.- There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV­2 pandemic is a special challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.

[The problem of long/post-COVID in expert assessments]. / Problematik von Long­/Post-COVID in der Begutachtung.

Assessing long/post-COVID syndrome (PCS) following an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multidisciplinary challenge due to the diverse and complex symptoms. Besides discipline-specific evaluation of infection-related organ damage, the main issue is expert objectivity and causality assessment regarding subjective symptoms. The consequences of long/PCS raise questions of insurance rights in all fields of law. In cases of persistent impairment of performance, determining reduction in earning capacity is crucial for those affected. Recognition as an occupational disease (BK no. 3101) is vital for employees in healthcare and welfare sectors, along with occupational accident recognition and assessing the illness's consequences, including the reduction in earning capacity (MdE) in other sectors or work areas. Therefore, expert assessments of illness consequences and differentiation from previous illnesses or damage disposition are necessary in all areas of law, individually based on corresponding organ manifestations in medical fields and interdisciplinarily for complex late sequelae, for instance, by internists with appropriate qualifications for pulmonary or cardiac manifestations and neurologists, psychiatrists, and neuropsychologists for neurological and psychiatric manifestations, etc.

[Severe injury type procedures-Influence of the cipher 11 "complications" and the COVID-19 pandemic on a center for maximum care of severe injuries]. / Schwerstverletzungsartenverfahren ­ Einfluss der Ziffer 11 "Komplikationen" sowie der COVID-19-Pandemie auf ein Haus der traumatologischen Maximalversorgung.

INTRODUCTION: Ensuring the best treatment options for injured patients (healing process, Heilverfahren, HV) is the main goal and responsibility of the German statutory accident insurance (DGUV). The injury type catalogue is the tool to guide the HV. The development of the number of cases treated in a center for severe injury type procedures, the effects of the cipher 11 "complications" of the catalogue and the effects of the COVID-19 pandemic are presented. METHODS: A retrospective study of all patients treated in the context of the DGUV from January 2019 to December 2021 was carried out. The number of cases before and during the legal lockdown actions were compared. The case mix index, the mean number of operations, the mean time in the operating room and the hospital stay were analyzed. Additionally, the cases under the cipher 11 were classified according to the specific anatomical regions. RESULTS: Out of 2007 cases 67% were classified as severe injury type procedures (SAV). Of these cases 51% were categorized to the cipher 11 of the injury type catalogue. Complications were observed particularly in the anatomical regions of the shoulder girdle, elbow, hand, knee, ankle joint and foot. These complex cases are economically not sufficiently represented. During the governmental COVID-19 lockdown actions, the number of patients treated in the context of the DGUV significantly decreased. CONCLUSION: The injury type catalogue is used effectively in the catchment area of the present trauma center. Most of the cases treated in the present trauma center are severe injury type procedures; however, more than half of these cases are classified as complications. This development might show the need for a structural change or an adjustment of the HV. The current comments on the injury type catalogue offer important definitions and specifications; however, the conciseness of the entire catalogue should be maintained.

COVID-19 as an occupational disease and accident at work – diagnostics, management, and assessment from the BGW’s point of view

Especially at the beginning of a pandemic, the risks of infection for health professionals but also for other professions are increased. As a result, more than 220,000 insurance claims due to COVID19 have been reported to the statutory accident insurance institutions (DGUV) since the end of December 2021. COVID19 can be recognized as either an accident at work or an occupational disease. To do this, certain conditions relating to diagnosis and occupational exposure must be met. The recognition rate for occupational diseases is approximately twice as high as for accidents at work (60.0 vs. 30.2%). The most commonly affected by occupational SARSCoV2 infections are nurses in the hospital and in inpatient geriatric care. In 2021, educators were also frequently affected. The assessment of the causal relationship usually does not cause any major problems, as the occupations with an increased risk of infection are already well described in epidemiological studies. So far, there is little experience with the assessment of longterm consequences of COVID19. There are two reasons for this. „Rehabilitation before retirement“also applies to the DGUV. Several specific rehabilitation services have been developed for patients with postCOVID symptoms, the effectiveness of which needs to be evaluated. As a further reason for the lack of experience in the assessment, it must be taken into account that naturally the spontaneous course of the longterm consequences of COVID19 cannot yet be known. An assessment is probably best carried out by the discipline in whose area the most pronounced symptoms fall, i.e. in the case of shortness of breath by pulmonologists, in the case of cardiac arrhythmias by cardiologists or in fatigue and concentration disorders by neurologists. If necessary, the assessment should be carried out with the support of the other disciplines. The good news, the likelihood of severe, longterm courses of COVID19 has been significantly reduced by vaccination.

Occupational Infections among Dental Health Care Workers in Germany – 14-Year Time Trends

Introduction: Dental health workers (DHW) are at increased risk of acquiring occupational infections. Due to various protective measures and a positive epidemiologic development in the general population, it might be assumed that infection risk for DHW have decreased. In order to proof the hypothesis, the time trend was analyzed. Material and Methods: Secondary data from an accident insurance company were analyzed in terms of reported and recognized occupational diseases (OD) in DHW from 2006 to 2019. Claims concerning COVID-19 in DHW submitted until February 2021 were analyzed and full time equivalences (FTE) per 1,000 DHW compared with those for other HW. Results: From 2006 to 2019, 271 claims were reported and 112 recognized as OD, representing an average of eight per year. The number of claims and confirmed ODs has decreased by 65.6% and 85.7%, respectively. The decrease was most evident for hepatitis B (HBV) and C (HCV) infections while the number of tuberculosis (TB) infections was stable. A total of 44 HCV, 33 HBV, 6 TB, and 24 latent TB infections were recognized as OD. Between March 2020 and February 2021, 155 COVID-19 claims were registered, and 47 cases were recognized as OD in DHW. The rate of ODs per 1,000 FTE was 0.4 in DHW, 28.9 in hospital HW and 10.5 in all HW. Conclusions: The positive time trend assumed for the infection risk in DHW was confirmed until 2019. The pandemic than changed the picture completely. Instead of eight ODs per year, the number of ODs because of COVID-19 alone increased more than fivefold. Therefore, continued attention should be paid to infectious disease prevention for DHW.