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1.
Euro Surveill ; 26(43)2021 10.
Article in English | MEDLINE | ID: covidwho-1528792

ABSTRACT

BackgroundDetailed information on symptom duration and temporal course of patients with mild COVID-19 was scarce at the beginning of the COVID-19 pandemic.AimWe aimed to determine the longitudinal course of clinical symptoms in non-hospitalised COVID-19 patients in Berlin, Germany.MethodsBetween March and May 2020, 102 confirmed COVID-19 cases in home isolation notified in Berlin, Germany, were sampled using total population sampling. Data on 25 symptoms were collected during telephone consultations (a maximum of four consultations) with each patient. We collected information on prevalence and duration of symptoms for each day of the first 2 weeks after symptom onset and for day 30 and 60 after symptom onset.ResultsMedian age was 35 years (range 18-74), 57% (58/102) were female, and 37% (38/102) reported having comorbidities. During the first 2 weeks, most common symptoms were malaise (94%, 92/98), headache (71%, 70/98), and rhinitis (69%, 68/98). Malaise was present for a median of 11 days (IQR 7-14 days) with 35% (34/98) of cases still reporting malaise on day 14. Headache and muscle pain mostly occurred during the first week, whereas dysosmia and dysgeusia mostly occurred during the second week. Symptoms persisted in 41% (39/95) and 20% (18/88) of patients on day 30 and 60, respectively.ConclusionOur study shows that a significant proportion of non-hospitalised COVID-19 cases endured symptoms for at least 2 months. Further research is needed to assess the frequency of long-term adverse health effects in non-hospitalised COVID-19 patients.


Subject(s)
COVID-19 , Adolescent , Adult , Aged , Berlin , Female , Germany/epidemiology , Humans , Longitudinal Studies , Middle Aged , Pandemics , SARS-CoV-2 , Young Adult
2.
Stud Health Technol Inform ; 287: 78-82, 2021 Nov 18.
Article in English | MEDLINE | ID: covidwho-1526756

ABSTRACT

The German Central Health Study Hub COVID-19 is an online service that offers bundled access to COVID-19 related studies conducted in Germany. It combines metadata and other information of epidemiologic, public health and clinical studies into a single data repository for FAIR data access. In addition to study characteristics the system also allows easy access to study documents, as well as instruments for data collection. Study metadata and survey instruments are decomposed into individual data items and semantically enriched to ease the findability. Data from existing clinical trial registries (DRKS, clinicaltrails.gov and WHO ICTRP) are merged with epidemiological and public health studies manually collected and entered. More than 850 studies are listed as of September 2021.


Subject(s)
COVID-19 , Germany , Humans , Metadata , SARS-CoV-2 , Surveys and Questionnaires
3.
GMS J Med Educ ; 38(4): Doc81, 2021.
Article in English | MEDLINE | ID: covidwho-1523662

ABSTRACT

Background: Due to the pandemic-related restrictions in classroom teaching at the medical faculties of the LMU Munich and the University of Basel, teaching methods with standardized patients (SPs), were shifted to a digital, web-based format at short notice as of April 2020. We report on our experiences with the WebEncounter program, which was used for the first time in German-speaking countries. The program enables one-to-one encounters between SPs and students. Students receive an invitational email with brief instructions and background information on the case. SPs use case-specific criteria that are compliant with the learning objectives for digital evaluation during the encounter. A feedback session takes place immediately following the encounter. The SPs address the didactically relevant sections and can illustrate them with the corresponding video sequences. Finally, the students receive the links to the video recordings of the encounter and the feedback unit by email. Project description: The aim of this pilot study was to analyze the practicability of the program and its acceptance by students and SPs. In addition, we examined whether the operationalization of the learning objectives in the form of assessment items has an impact on the content and thematic development of courses in the area of doctor-patient communication. Methods: To implement the program, patient cases previously tested in communication seminars in Munich and Basel were rewritten and case-specific evaluation criteria were developed. SPs were trained to use the program, to present their patient figure online and to give feedback. The experience of those involved (faculty, SPs and SP trainers, students) in implementing the program was documented at various levels. The frequency and causes of technical problems were described. Student results on the patient cases and on the feedback items were collected quantitatively and, where possible, supplemented by free-text statements. Results: Data from 218/220 students in Basel and 120/127 students in Munich were collected and evaluated. Students were very satisfied with the patient cases, the encounter with the SPs and their feedback: 3.81±0.42. SPs experienced the training as an increase in their competence and the structured feedback as particularly positive. The training effort per SP was between 2.5 and 4 hours. The results show predominantly normally-distributed, case-specific sum scores of the evaluation criteria. The analysis of the individual assessment items refers to learning objectives that students find difficult to achieve (e.g. explicitly structuring the conversation). Problems in the technical implementation (<10 percent of the encounters) were due mainly to the use of insufficient hardware or internet connection problems. The need to define case-specific evaluation criteria triggered a discussion in the group of study directors about learning objectives and their operationalization. Summary: Web-based encounters can be built into the ongoing communication curriculum with reasonable effort. Training the SPs and heeding the technical requirements are of central importance. Practicing the virtual consultation was evaluated very positively by the students - in particular, the immediate feedback in the protected dialogue was appreciated by all involved.


Subject(s)
COVID-19 , Communication , Physician-Patient Relations , Remote Consultation , Clinical Competence/statistics & numerical data , Feedback , Germany , Humans , Internet , Pilot Projects , Remote Consultation/standards , Switzerland
4.
Int J Environ Res Public Health ; 18(21)2021 11 03.
Article in English | MEDLINE | ID: covidwho-1512298

ABSTRACT

Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.


Subject(s)
Refugees , Attitude , Germany , Health Services Accessibility , Humans , Qualitative Research
6.
Euro Surveill ; 26(44)2021 Nov.
Article in English | MEDLINE | ID: covidwho-1504717

ABSTRACT

IntroductionNumerous CE-marked SARS-CoV-2 antigen rapid diagnostic tests (Ag RDT) are offered in Europe, several of them with unconfirmed quality claims.AimWe performed an independent head-to-head evaluation of the sensitivity of SARS-CoV-2 Ag RDT offered in Germany.MethodsWe addressed the sensitivity of 122 Ag RDT in direct comparison using a common evaluation panel comprised of 50 specimens. Minimum sensitivity of 75% for panel specimens with a PCR quantification cycle (Cq) ≤ 25 was used to identify Ag RDT eligible for reimbursement in the German healthcare system.ResultsThe sensitivity of different SARS-CoV-2 Ag RDT varied over a wide range. The sensitivity limit of 75% for panel members with Cq ≤ 25 was met by 96 of the 122 tests evaluated; 26 tests exhibited lower sensitivity, few of which failed completely. Some RDT exhibited high sensitivity, e.g. 97.5 % for Cq < 30.ConclusionsThis comparative evaluation succeeded in distinguishing less sensitive from better performing Ag RDT. Most of the evaluated Ag RDT appeared to be suitable for fast identification of acute infections associated with high viral loads. Market access of SARS-CoV-2 Ag RDT should be based on minimal requirements for sensitivity and specificity.


Subject(s)
COVID-19 , SARS-CoV-2 , Antigens, Viral , Diagnostic Tests, Routine , Germany , Humans , Sensitivity and Specificity
7.
Acta Biomed ; 92(5): e2021266, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1504149

ABSTRACT

The outbreak of coronavirus disease 19 (COVID-19) has dramatically imposed healthcare systems to reorganize their departments, including neurological wards. We aimed to describe the rearrangements made by stroke units (SU) and neurological intensive care units (ICU) in several German community and university hospitals facing the pandemic. This cross-sectional, survey-based, nationwide study collected data of 15 university and 4 community hospitals in Germany, being part of IGNITE Study Group, from April 1 to April 6, 2020. The rearrangements and implementation of safety measures in SUs, intermediate care units (IMC), and neurological ICUs were compared. 84.2% of hospitals implemented a separated area for patients awaiting their COVID-19 test results and 94.7% had a dedicated zone for their management. Outpatient treatment was reduced in 63.2% and even suspended in 36.8% of the hospitals. A global reduction of bed capacity was observed. Hospitals reported compromised stroke treatment (52.6%) and reduction of thrombolysis and thrombectomy rates (36.8%). All hospitals proposed special training for COVID-19 management, recurrent meetings and all undertook measures improving safety for healthcare workers. In an unprecedented global healthcare crisis, knowledge of the initial reorganization and response of German hospitals to COVID-19 may help finding effective strategies to face the ongoing pandemic.


Subject(s)
COVID-19 , Stroke , Critical Care , Cross-Sectional Studies , Germany/epidemiology , Hospitals, University , Humans , Intensive Care Units , Pandemics , SARS-CoV-2 , Stroke/epidemiology , Stroke/therapy
8.
GMS J Med Educ ; 38(1): Doc7, 2021.
Article in English | MEDLINE | ID: covidwho-1503862

ABSTRACT

Background: Within days, the corona crisis has forced the "Lernzentrum", as well as all other places of training and further education, to discontinue classroom teaching at German universities and vocational schools. In order to start teaching online, tutors had to face the challenge to develop new digital learning formats (virtual classrooms) for the peer teaching of practical skills within a short time. This paper aims at outlining the project of developing e-tutorials with regard to the teaching of practical skills. Methodology: After analyzing the classroom lessons (n=30), some of the tutorials were transformed into digital formats. These so-called "e-tutorials" were held via a digital platform. They have been evaluated continuously with a standardized online questionnaire. The results of this evaluation have been analyzed descriptively. Results: From 27/04/2020 to 17/07/2020 eleven different e-tutorial formats were offered on 246 dates. The evaluation revealed a high degree of acceptance with these course offers as well as with the implementation by the tutors. Interpretation: During the pandemic crisis the substitution of peer teaching into forms of e-tutorials was considered valuable; however, these learning formats present challenges, especially with regard to the interaction between teachers and students. They cannot therefore fully replace the peer teaching of practical skills.


Subject(s)
Education, Distance , Education, Medical , Teaching , Universities , COVID-19 , Education, Distance/methods , Education, Medical/methods , Education, Medical/standards , Germany , Humans , Peer Group , Surveys and Questionnaires , Teaching/standards
10.
Clin Infect Dis ; 73(9): e3055-e3065, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1501051

ABSTRACT

BACKGROUND: High infection rates among healthcare personnel in an uncontained pandemic can paralyze health systems due to staff shortages. Risk constellations and rates of seroconversion for healthcare workers (HCWs) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are still largely unclear. METHODS: Healthcare personnel (n = 300) on different organizational units in the LMU Munich University Hospital were included and followed in this prospective longitudinal study from 24 March until 7 July 2020. Participants were monitored in intervals of 2 to 6 weeks using different antibody assays for serological testing and questionnaires to evaluate risk contacts. In a subgroup of infected participants, we obtained nasopharyngeal swabs to perform whole-genome sequencing for outbreak characterization. RESULTS: HCWs involved in patient care on dedicated coronavirus disease 2019 (COVID-19) wards or on regular non-COVID-19 wards showed a higher rate of SARS-CoV-2 seroconversion than staff in the emergency department and non-frontline personnel. The landscape of risk contacts in these units was dynamic, with a decrease in unprotected risk contacts in the emergency department and an increase on non-COVID-19 wards. Both intensity and number of risk contacts were associated with higher rates of seroconversion. On regular wards, staff infections tended to occur in clusters, while infections on COVID-19 wards were less frequent and apparently independent of each other. CONCLUSIONS: Risk of SARS-CoV-2 infection for frontline HCWs was increased during the first pandemic wave in southern Germany. Stringent measures for infection control are essential to protect all patient-facing staff during the ongoing pandemic.


Subject(s)
COVID-19 , SARS-CoV-2 , Germany/epidemiology , Health Personnel , Hospitals, University , Humans , Longitudinal Studies , Pandemics , Prospective Studies
11.
Clin Infect Dis ; 73(9): e3036-e3041, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1501049

ABSTRACT

BACKGROUND: With the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ongoing in Europe in June 2020, day care centers were reopened in the state of Hesse, Germany, after the lockdown. The role young children play in the dynamics of the transmission was unknown. METHODS: We conducted a longitudinal study over 12 weeks and 2 days (18 June 2020-10 September 2020) to screen attendees and staff from day care centers in the state of Hesse, Germany, for both respiratory and gastrointestinal shedding of SARS-CoV-2. A total of 859 children (age range, 3 months-8 years) and 376 staff members from 50 day care centers, which were chosen representatively from throughout the state, participated in the study. Parents were asked to collect both a buccal mucosa and an anal swab from their children once a week. Staff were asked to self-administer the swabs. Reverse transcriptas polymerase chain reaction for SARS-CoV-2 was performed in a multiple-swab pooling protocol. RESULTS: A total of 7366 buccal mucosa swabs and 5907 anal swabs were analyzed. No respiratory or gastrointestinal shedding of SARS-CoV-2 was detected in any of the children. Shedding of SARS-CoV-2 was detected in 2 staff members from distinct day care centers. One was asymptomatic at the time of testing, and one was symptomatic and did not attend the facility on that day. CONCLUSION: Detection of either respiratory or gastrointestinal shedding of SARS-CoV-2 RNA in children and staff members attending day care centers was rare in the context of limited community activity and with infection prevention measures in the facilities in place.


Subject(s)
COVID-19 , SARS-CoV-2 , Child , Child, Preschool , Communicable Disease Control , Day Care, Medical , Germany/epidemiology , Humans , Infant , Longitudinal Studies , RNA, Viral
12.
Gesundheitswesen ; 83(S 01): S45-S53, 2021 Nov.
Article in German | MEDLINE | ID: covidwho-1500783

ABSTRACT

OBJECTIVE: The Coronavirus Disease-2019 (COVID-19) pandemic has brought opportunities and challenges, especially for health services research based on routine data. In this article we will demonstrate this by presenting lessons learned from establishing the currently largest registry in Germany providing a detailed clinical dataset on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected patients: the Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS). METHODS: LEOSS is based on a collaborative and integrative research approach with anonymous recruitment and collection of routine data and the early provision of data in an open science context. The only requirement for inclusion was a SARS-CoV-2 infection confirmed by virological diagnosis. Crucial strategies to successfully realize the project included the dynamic reallocation of available staff and technical resources, an early and direct involvement of data protection experts and the ethics committee as well as the decision for an iterative and dynamic process of improvement and further development. RESULTS: Thanks to the commitment of numerous institutions, a transsectoral and transnational network of currently 133 actively recruiting sites with 7,227 documented cases could be established (status: 18.03.2021). Tools for data exploration on the project website, as well as the partially automated provision of datasets according to use cases with varying requirements, enabled us to utilize the data collected within a short period of time. Data use and access processes were carried out for 97 proposals assigned to 27 different research areas. So far, nine articles have been published in peer-reviewed international journals. CONCLUSION: As a collaborative effort of the whole network, LEOSS developed into a large collection of clinical data on COVID-19 in Germany. Even though in other international projects, much larger data sets could be analysed to investigate specific research questions through direct access to source systems, the uniformly maintained and technically verified documentation standard with many discipline-specific details resulted in a large valuable data set with unique characteristics. The lessons learned while establishing LEOSS during the current pandemic have already created important implications for the design of future registries and for pandemic preparedness and response.


Subject(s)
COVID-19 , Pandemics , Germany/epidemiology , Health Services Research , Humans , Pandemics/prevention & control , Registries , SARS-CoV-2
13.
Gesundheitswesen ; 83(S 01): S4-S11, 2021 Nov.
Article in German | MEDLINE | ID: covidwho-1500781

ABSTRACT

AIM OF THE STUDY: To demonstrate the feasibility and exemplarity of an app-based parent registry. METHODS: The app as an elaborated interactive electronic case report form and the underlying data structure of the registry are presented. The initial recruitment efforts are illustrated and the temperature distribution, as well as the distribution of fever events in 2020, are analyzed. RESULTS: The FeverApp successfully collects data into a central registry. Like every study, it also provides information on the current knowledge. The ecological momentary assessment can represent the illness situation at several levels (measurement, fever episode, individual, family, practice, country). Methods for data collection needed to be developed in a flexible manner due to pandemic conditions. The initial recruitment goal of 2400 fever phases in the first two years was met, with nationwide dissemination pending. It is shown that body temperature does not rise indefinitely; fevers reach an average of 39 degrees without antipyretics, although in rare cases temperatures beyond 41 degrees are reached without harm. Furthermore, a comparison with a reference practice shows that fever episodes can be recorded more comprehensively in the app, including infections that do not come to the presentation in a pediatrician's office. Thus, the FeverApp fulfills in a model-like fashion the use of registers in persons basically healthy and maps a multi-level diagnostics. CONCLUSION: The FeverApp could basically establish itself as a supporting tool, the registry can reliably collect data with the method used and maps the current infection situation. In researching the question of how infections develop in the post-Covid period, the app could perform an important task.


Subject(s)
COVID-19 , Documentation , Germany/epidemiology , Humans , Parents , Registries , SARS-CoV-2
14.
PLoS One ; 16(10): e0259108, 2021.
Article in English | MEDLINE | ID: covidwho-1496529

ABSTRACT

Governments around the globe use non-pharmaceutical interventions (NPIs) to curb the spread of coronavirus disease 2019 (COVID-19) cases. Making decisions under uncertainty, they all face the same temporal paradox: estimating the impact of NPIs before they have been implemented. Due to the limited variance of empirical cases, researchers could so far not disentangle effects of individual NPIs or their impact on different demographic groups. In this paper, we utilize large-scale agent-based simulations in combination with Susceptible-Exposed-Infectious-Recovered (SEIR) models to investigate the spread of COVID-19 for some of the most affected federal states in Germany. In contrast to other studies, we sample agents from a representative survey. Including more realistic demographic attributes that influence agents' behavior yields accurate predictions of COVID-19 transmissions and allows us to investigate counterfactual what-if scenarios. Results show that quarantining infected people and exploiting industry-specific home office capacities are the most effective NPIs. Disentangling education-related NPIs reveals that each considered institution (kindergarten, school, university) has rather small effects on its own, yet, that combined openings would result in large increases in COVID-19 cases. Representative survey-characteristics of agents also allow us to estimate NPIs' effects on different age groups. For instance, re-opening schools would cause comparatively few infections among the risk-group of people older than 60 years.


Subject(s)
COVID-19/transmission , Early Medical Intervention/methods , Quarantine/methods , Computer Simulation , Early Medical Intervention/trends , Germany , Hand Disinfection , Humans , Masks , Models, Theoretical , Pandemics/prevention & control , Physical Distancing , SARS-CoV-2/metabolism , SARS-CoV-2/pathogenicity , Schools
15.
PLoS One ; 16(10): e0259037, 2021.
Article in English | MEDLINE | ID: covidwho-1496524

ABSTRACT

Epidemiological simulations as a method are used to better understand and predict the spreading of infectious diseases, for example of COVID-19. This paper presents an approach that combines a well-established approach from transportation modelling that uses person-centric data-driven human mobility modelling with a mechanistic infection model and a person-centric disease progression model. The model includes the consequences of different room sizes, air exchange rates, disease import, changed activity participation rates over time (coming from mobility data), masks, indoors vs. outdoors leisure activities, and of contact tracing. It is validated against the infection dynamics in Berlin (Germany). The model can be used to understand the contributions of different activity types to the infection dynamics over time. It predicts the effects of contact reductions, school closures/vacations, masks, or the effect of moving leisure activities from outdoors to indoors in fall, and is thus able to quantitatively predict the consequences of interventions. It is shown that these effects are best given as additive changes of the reproduction number R. The model also explains why contact reductions have decreasing marginal returns, i.e. the first 50% of contact reductions have considerably more effect than the second 50%. Our work shows that is is possible to build detailed epidemiological simulations from microscopic mobility models relatively quickly. They can be used to investigate mechanical aspects of the dynamics, such as the transmission from political decisions via human behavior to infections, consequences of different lockdown measures, or consequences of wearing masks in certain situations. The results can be used to inform political decisions.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Contact Tracing/methods , Berlin , COVID-19/metabolism , Cell Phone/trends , Computer Simulation , Germany , Hand Disinfection/trends , Humans , Masks/trends , Models, Theoretical , Physical Distancing , Population Dynamics/trends , SARS-CoV-2/pathogenicity , Systems Analysis
16.
BMJ Open ; 11(7): e048198, 2021 07 20.
Article in English | MEDLINE | ID: covidwho-1495461

ABSTRACT

INTRODUCTION: Myasthenia gravis (MG) is a rare, chronic, autoimmune disease, mediated by immunoglobulin G antibodies, which causes debilitating muscle weakness. As with most rare diseases, there is little patient-reported data with which to understand and address patient needs. This study explores the impact of MG in the real world from the patient perspective. METHODS AND ANALYSIS: This is a 2-year prospective, observational, digital, longitudinal study of adults with MG, resident in the following countries: the USA, Japan, Germany, France, the UK, Italy, Spain, Canada and Belgium. The planned sample size is 2000. Recruitment will be community based, via patient advocacy groups, social media and word of mouth. Participants will use a smartphone application (app) to check eligibility, provide consent and contribute data. Planned data entry is as follows: (1) personal profile on enrollment-covering demographics, MG characteristics and previous care; (2) monthly event tracker-current treatments, healthcare visits, treatment-related adverse events, productivity losses; (3) monthly selection of validated generic and disease-specific patient-reported outcomes instruments: EQ-5D-5L, Myasthenia Gravis Activities of Daily Living, Myasthenia Gravis Quality of Life 15-item revised scale, Hospital Anxiety and Depression Scale and Health Utilities Index III. Analyses are planned for when the study has been running in most countries for approximately 6, 12, 18 and 24 months. ETHICS AND DISSEMINATION: The study protocol has been reviewed and granted ethics approval by Salus IRB for participants resident in the following countries: Germany, the UK and the US. Local ethics approval is being sought for the following study countries: Belgium, Canada, France, Italy, Japan and Spain. Study results will be communicated to the public and participants via conference presentations and journal publications, as well as regular email, social media and in-application communication. TRIAL REGISTRATION NUMBER: NCT04176211.


Subject(s)
Activities of Daily Living , Myasthenia Gravis , Adult , Belgium , Canada , France , Germany , Humans , Italy , Japan , Longitudinal Studies , Observational Studies as Topic , Prospective Studies , Quality of Life , Spain , Treatment Outcome
17.
J Emerg Manag ; 19(7): 157-163, 2021.
Article in English | MEDLINE | ID: covidwho-1497655

ABSTRACT

When people think about hazards, the types that easily come to their mind include natural hazards, such as earthquakes, tornados, and tsunamis, and manmade ones, such as plane crashes, bomb explosions, and exposure to toxic industrial chemicals. Disease outbreaks are a source of hazards that are often overlooked, and the largely forgotten smallpox was an example of such disease. This article provides a review of the emergency management practices that curtailed the potentially devastating spread of smallpox at Meschede, Germany in 1970. Lessons that can be transferred to the COVID-19 pandemic are also discussed.


Subject(s)
COVID-19 , Smallpox , Disease Outbreaks , Germany , Humans , Pandemics , SARS-CoV-2 , Smallpox/epidemiology
18.
Euro Surveill ; 26(43)2021 10.
Article in English | MEDLINE | ID: covidwho-1496928

ABSTRACT

BackgroundIn the SARS-CoV-2 pandemic, viral genomes are available at unprecedented speed, but spatio-temporal bias in genome sequence sampling precludes phylogeographical inference without additional contextual data.AimWe applied genomic epidemiology to trace SARS-CoV-2 spread on an international, national and local level, to illustrate how transmission chains can be resolved to the level of a single event and single person using integrated sequence data and spatio-temporal metadata.MethodsWe investigated 289 COVID-19 cases at a university hospital in Munich, Germany, between 29 February and 27 May 2020. Using the ARTIC protocol, we obtained near full-length viral genomes from 174 SARS-CoV-2-positive respiratory samples. Phylogenetic analyses using the Auspice software were employed in combination with anamnestic reporting of travel history, interpersonal interactions and perceived high-risk exposures among patients and healthcare workers to characterise cluster outbreaks and establish likely scenarios and timelines of transmission.ResultsWe identified multiple independent introductions in the Munich Metropolitan Region during the first weeks of the first pandemic wave, mainly by travellers returning from popular skiing areas in the Alps. In these early weeks, the rate of presumable hospital-acquired infections among patients and in particular healthcare workers was high (9.6% and 54%, respectively) and we illustrated how transmission chains can be dissected at high resolution combining virus sequences and spatio-temporal networks of human interactions.ConclusionsEarly spread of SARS-CoV-2 in Europe was catalysed by superspreading events and regional hotspots during the winter holiday season. Genomic epidemiology can be employed to trace viral spread and inform effective containment strategies.


Subject(s)
COVID-19 , Cross Infection , Cross Infection/epidemiology , Genome, Viral , Genomics , Germany/epidemiology , Hospitals , Humans , Phylogeny , SARS-CoV-2
19.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(11): 1440-1451, 2021 Nov.
Article in German | MEDLINE | ID: covidwho-1491066

ABSTRACT

BACKGROUND: Application-based data regarding sexual health and sexual behavior in various sexually active populations are scarce but at the same time relevant with regards to prevention and healthcare supply strategies. Given the structure of its attendees, the Walk In Ruhr (WIR) Center for Sexual Health and Medicine is able to obtain data from diverse living environments. OBJECTIVES: Based on the online HIV/STI risk test, questionnaires, and attendee data from the WIR, this study aims to deduce population-related findings with regards to age, gender, sexual orientation, and sexual and risk behavior as well as the respective needs for prevention. The influence of the SARS-CoV-19 pandemic on sexual behavior is examined by comparing various phases. METHODS: The analyzed data sources are the online HIV/STI risk test, the COWIR, and the PrEP study as well as the immunological outpatient clinic and the public health department at the WIR. RESULTS: Notwithstanding contact restrictions, sexually transmitted infections (STIs) have increased from 2019 to 2020. Apart from men having sex with men and females having sex with females, young people also have an increased risk of STIs based on sexual practices and the number of sexual contacts. A large number of bisexual and transsexual contacts was found. SARS-CoV­2 led to a decrease in sexual contacts; sexual practices continued. There was a growing proportion of STI tests and the treatment rate including partner treatment rose. DISCUSSION: Data from the WIR center show that young attendees with an active sexual life are being reached. The results from questionnaires and the online HIV/STI risk test are mirrored in increased positive STI test results. These results vary depending on sexual behavior and sexual preferences such that specific strategies for sexual education, prevention, testing, and therapy are required.


Subject(s)
COVID-19 , HIV Infections , Sexually Transmitted Diseases , Adolescent , Delivery of Health Care , Female , Germany , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Pandemics/prevention & control , SARS-CoV-2 , Sexual Behavior , Sexually Transmitted Diseases/epidemiology , Sexually Transmitted Diseases/prevention & control
20.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(11): 1452-1462, 2021 Nov.
Article in German | MEDLINE | ID: covidwho-1491065

ABSTRACT

BACKGROUND AND OBJECTIVE: Since spring of 2020, the COVID­19 pandemic has disrupted our day-to-day lives and led to negative consequences in various areas of life, including mental and physical wellbeing. In this article, we take a closer look at the situation of trans people, who - due to experiences with discrimination and marginalization as well as their specific health-related interests - could be characterized by a particular vulnerability. METHODS: Using an online cross-sectional survey, which we designed collaboratively with experts from the trans community, we investigated the mental and physical health of trans people from German-speaking countries and their access to trans-related healthcare during the COVID­19 pandemic in the period from 1 May 2020 to 31 January 2021. RESULTS: Since the beginning of the COVID­19 pandemic, trans people have experienced barriers in access to gender-affirming treatments, mental health services, and COVID­19-related medical care. At the same time, trans people reported being affected by chronic diseases disproportionately more often than the general population, including those leading to a higher risk for poorer outcomes of a COVID­19 infection. Moreover, the participants reported being exposed to many risk factors associated with higher mental distress (e.g., having a chronic illness, belonging to a minority based on a non-heterosexual orientation, or having a low income). DISCUSSION: The results of this survey indicate that prior vulnerabilities with regards to health problems and the restricted access to an informed and qualified transgender healthcare were exacerbated by the COVID­19 pandemic.


Subject(s)
COVID-19 , Transgender Persons , Cross-Sectional Studies , Delivery of Health Care , Germany/epidemiology , Humans , Pandemics , SARS-CoV-2
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