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1.
Gesundheitswesen ; 83(4): 282-290, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1172579

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic diseases, such as inherited bleeding disorders (IBD) are often associated with high costs of medical care. COVID-19 containment measures, including isolation and triage, led to restrictions in the health care of chronically ill patients. The aim of the present study was to investigate the effects of the COVID-19 pandemic on the health care of IBD patients. METHODS: In this multicentre cross-sectional study to evaluate the effects of COVID-19 on the mental health and quality of care of patients with inherited bleeding disorder, an ad hoc questionnaire was sent to 586 patients/parents of children with haemophilia A, B or von Willebrand syndrome type 3. In addition to demographic and clinical data, patients/parents of patients with inherited bleeding disorders were asked about their thoughts, concerns and experiences regarding their medical care during the COVID-19 pandemic. Differences between clinical subgroups were calculated. RESULTS: Significant differences were found between subgroups (severity, type of therapy, product class, comorbidities) with regard to the transmission of COVID-19 through plasma products, the effects of COVID-19 positive test results, fear of getting COVID-19, delayed drug supply and physiotherapy treatment. DISCUSSION: The medical care of patients with inherited bleeding disorders, who need a continuous supply of essential drugs, is a particular challenge in times of pandemics. Therefore, worries and fears of IBD patients should be taken seriously and innovative communication channels established to maintain therapy standards and quality of care.


Subject(s)
Pandemics , Child , Cross-Sectional Studies , Germany/epidemiology , Humans
2.
Gesundheitswesen ; 83(4): 274-281, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1172578

ABSTRACT

BACKGROUND: The COVID-19 pandemic requires containment measures such as contact restrictions and hygiene requirements. It is accompanied by psychological problems and the fear of infection or of a severe course of the disease. This paper examines the relationship between fear of infection and adherence to rules of hygiene as well as the utilization of medical services. METHODS: 1005 patients (20-79 years, 626=62.4% female) were interviewed by online questionnaire before starting a psychosomatic rehabilitation program. Data are presented descriptively and analysed by variance analyses. RESULTS: 68.6% were rarely/sometimes afraid and 17.9% were always afraid of contracting coronavirus or of a severe course of the disease. Those who were afraid intended to wash their hands more frequently (97.2%) than those who were not afraid. Regardless of any change in their physical and mental health status, participants felt it to be risky to seek medical care. CONCLUSION: The intention to follow hygiene rules in people with pre-existing mental illness depends on a fear of infecting oneself or others with the coronavirus or of contracting a severe form of the disease. Especially mentally or psychosomatically affected individuals need to be informed adequately about the coronavirus and the necessary individual protective measures in order to reduce resistance and to increase willingness to seek medical help.


Subject(s)
Coronavirus , Mental Disorders , Cross-Sectional Studies , Fear , Female , Germany/epidemiology , Humans , Intention , Male , Mental Disorders/epidemiology , Pandemics , Perception
3.
BMJ Open ; 11(3): e044853, 2021 03 31.
Article in English | MEDLINE | ID: covidwho-1166495

ABSTRACT

OBJECTIVES: One major goal of the emergency department (ED) is to decide, whether patients need to be hospitalised or can be sent home safely. We aim at providing criteria for these decisions without knowing the SARS-CoV-2 test result in suspected cases. SETTING: Tertiary emergency medicine. PARTICIPANTS: All patients were treated at the ED of the Charité during the pandemic peak and underwent SARS-CoV-2 testing. Patients with positive test results were characterised in detail and underwent a 14-day-follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: Logistic regression and classification and regression tree (CART) analyses were performed to identify predictors (primary endpoint), which confirm safe discharge. The clinical endpoint was all-cause mortality or need for mechanical ventilation during index stay or after readmission. RESULTS: The primary test population of suspected COVID-19 consisted of n=1255 cases, 45.2% were women (n=567). Of these, n=110 tested positive for SARS-CoV-2 (8.8%). The median age of SARS-CoV-2-positive cases was 45 years (IQR: 33-66 years), whereas the median age of the group tested negative for SARS-CoV-2 was 42 years (IQR: 30-60 years) (p=0.096). 43.6% were directly admitted to hospital care.CART analysis identified the variables oxygen saturation (<95%), dyspnoea and history of cardiovascular (CV) disease to distinguish between high and low-risk groups. If all three variables were negative, most patients were discharged from ED, and the incidence of the clinical endpoint was 0%. The validation cohort confirmed the safety of discharge using these variables and revealed an incidence of the clinical endpoint from 14.3% in patients with CV disease, 9.4% in patients with dyspnoea and 18.2% in patients with O2 satuaration below 95%. CONCLUSIONS: Based on easily available variables like dyspnoea, oxygen saturation, history of CV disease, approximately 25% of patients subsequently confirmed with COVID-19 can be identified for safe discharge. TRIAL REGISTRATION NUMBER: DRKS00023117.


Subject(s)
/epidemiology , Decision Making , Emergency Service, Hospital/statistics & numerical data , Adult , Aged , /therapy , /statistics & numerical data , Cohort Studies , Cough/etiology , Dyspnea/etiology , Emergency Service, Hospital/organization & administration , Female , Fever/etiology , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Respiration, Artificial/statistics & numerical data
4.
Int J Equity Health ; 20(1): 86, 2021 03 25.
Article in English | MEDLINE | ID: covidwho-1154011

ABSTRACT

OBJECTIVE: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. METHODS: We analyzed data provided by National Health Commission of the People's Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. RESULTS: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. CONCLUSIONS: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China's goal is to eliminate the virus, and Germany's goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality.


Subject(s)
/epidemiology , Communicable Disease Control/legislation & jurisprudence , Health Policy/legislation & jurisprudence , Pandemics/legislation & jurisprudence , Pandemics/prevention & control , Public Health/legislation & jurisprudence , Adult , Aged , Aged, 80 and over , China/epidemiology , Female , Germany/epidemiology , Humans , Male , Middle Aged
5.
PLoS One ; 16(3): e0249251, 2021.
Article in English | MEDLINE | ID: covidwho-1150560

ABSTRACT

BACKGROUND: During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. METHODS AND FINDINGS: Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06-1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01-1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00-1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78-1.31], P<0.95). CONCLUSIONS: There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies.


Subject(s)
Ambulatory Care/trends , /pathology , /epidemiology , Cardiovascular Diseases/mortality , Cardiovascular Diseases/pathology , Databases, Factual , Germany/epidemiology , Hospital Mortality , Hospitalization/trends , Hospitals , Humans , Neoplasms/mortality , Neoplasms/pathology , Odds Ratio , Patient Admission/trends , /isolation & purification
6.
Int J Environ Res Public Health ; 18(6)2021 03 19.
Article in English | MEDLINE | ID: covidwho-1148295

ABSTRACT

An observational cross-sectional survey was planned to analyze the weekly workload reduction of German dentists during lockdown due to the global COVID-19 pandemic. Participants were predominantly members of the Free Association of German Dentists and filled in an online questionnaire. The questionnaire was sent to a total of 9416 dentists, with a response rate of 27.98% (n = 2635). Respondents were divided into seven macro areas by gross domestic product. Nearly two-thirds of dentists (65.16%) reported a reduction in their practice workload of more than 50% compared to the pre-pandemic period with statistically significant differences between German macro areas (p < 0.01). Weekly workload was reduced during the lockdown in 93.00% of study participants, while 55.33% dental care centers with multiple employed dentists under the direction of a non-dentist general manager had only a 40% reduction in weekly workload compared to a solo practice or a practice of a dentist with an employed dentist (30.24% and 28.39%, respectively). Dentists in Germany drastically reduced their practice activity during the first wave of the COVID-19 lockdown, both in rural and urban areas. Short, medium, and long-term effects of the pandemic on dental practices, dental staff as well as patient care need to be further investigated.


Subject(s)
Communicable Disease Control , Cross-Sectional Studies , Dentists , Germany/epidemiology , Humans , Pandemics , Surveys and Questionnaires , Workload
7.
PLoS One ; 16(3): e0248288, 2021.
Article in English | MEDLINE | ID: covidwho-1143294

ABSTRACT

Building on the epidemiological SIR model, we present an economic model with heterogeneous individuals deriving utility from social contacts creating infection risks. Focusing on social distancing of individuals susceptible to an infection we theoretically characterize the gap between private and social cost of contacts. Our main contribution is to quantify this gap by calibrating the model with unique survey data from Germany on social distancing and impure altruism from the beginning of the COVID-19 pandemic. The optimal policy is to drastically reduce contacts at the beginning to almost eradicate the epidemic and keep them at levels that contain the pandemic at a low prevalence level. We find that also in laissez faire, private protection efforts by forward-looking, risk averse individuals would have stabilized the epidemic, but at a much higher prevalence of infection than optimal. Altruistic motives increase individual protection efforts, but a substantial gap to the social optimum remains.


Subject(s)
/economics , Cost of Illness , Models, Theoretical , Adult , Aged , /pathology , Female , Germany/epidemiology , Humans , Male , Middle Aged , Surveys and Questionnaires
8.
Gesundheitswesen ; 83(4): 250-257, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1142493

ABSTRACT

OBJECTIVES: The aim of this study was to give an early snapshot of primary care strategies that were implemented to cope with the early period of the COVID-19 pandemic in Baden-Wuerttemberg (Germany). METHODS: In June 2020, all 271 outpatient SARS-CoV-2 contact points, established by the National Association of Statutory Health Insurance Physicians (16 centers for testing, 204 specialized family practices, 51 Outpatients Corona Centers), and a randomly generated sample of 400 primary care practices of Baden-Wuerttemberg were invited to take part in a paper-based questionnaire. The data were gathered anonymously and analysed descriptively. RESULTS: Out of those invited, n=63 (15.8%) primary care practices and n=92 (33.9%) SARS-CoV-2 contact points participated; 78.7% of the primary care practices cooperated with SARS-CoV-2 contact points (n=48). In all, 92.1% had implemented a compulsory registration by phone for patients with (suspected) COVID-19 (n=58) and 81% offered consultation exclusively by phone or video in case of a mild courses (n=51). The new outpatient SARS-CoV-2 contact points were established in collaboration with several stakeholders, mainly led by primary care physicians (n=76, 82.6%) and almost 50% of these were established in March 2020 (n=42, 48.3%). The most commonly reported method of registration was regulated mainly by primary care practices (n=88, 95.7%) and public health departments (n=74, 80.4%). In 92.4% (n=85) of cases, it was possible to register by phone. The consultation response was most commonly given in the form of oral information to the patient (n=65, 77.4%). Less then 50% of the SARS-CoV-2 contact points used standardized sheets for registration, documentation and consultation. The assessment of future primary care structures for (suspected) COVID-19 patients were heterogeneous. CONCLUSIONS: Effort, improvisation and collaboration were required for a successful and rapid implementation of measures for primary care during the initial period of the COVID-19 pandemic. Impulses for ongoing development of primary care strategies during a pandemic can be derived out of these results.


Subject(s)
Pandemics , Germany/epidemiology , Humans , Primary Health Care
9.
Sci Rep ; 11(1): 6419, 2021 03 19.
Article in English | MEDLINE | ID: covidwho-1142468

ABSTRACT

Risk communication during pandemics is an element of utmost importance. Understanding the level of public attention-a prerequisite for effective communication-implicates expensive and time-consuming surveys. We hypothesise that the relative search volume from Google Trends could be used as an indicator of public attention of a disease and its prevention measures. The search terms 'RKI' (Robert Koch Institute, national public health authority in Germany), 'corona' and 'protective mask' in German language were shortlisted. Cross-correlations between these terms and the reported cases from 15 February to 27 April were conducted for each German federal state. The findings were contrasted against a timeline of official communications concerning COVID-19. The highest correlations of the term 'RKI' with reported COVID-19 cases were found between lags of - 2 and - 12 days, meaning web searches were already performed from 2 to 12 days before case numbers increased. A similar pattern was seen for the term 'corona'. Cross-correlations indicated that most searches on 'protective mask' were performed from 6 to 12 days after the peak of cases. The results for the term 'protective mask' indicate a degree of confusion in the population. This is supported by conflicting recommendations to wear face masks during the first wave. The relative search volumes could be a useful tool to provide timely and location-specific information on public attention for risk communication.


Subject(s)
/epidemiology , Search Engine , /prevention & control , Communication , Germany/epidemiology , Humans , Masks , Public Health , /isolation & purification
10.
Epidemiol Infect ; 149: e68, 2021 03 11.
Article in English | MEDLINE | ID: covidwho-1142397

ABSTRACT

We analysed the coronavirus disease 2019 epidemic curve from March to the end of April 2020 in Germany. We use statistical models to estimate the number of cases with disease onset on a given day and use back-projection techniques to obtain the number of new infections per day. The respective time series are analysed by a trend regression model with change points. The change points are estimated directly from the data. We carry out the analysis for the whole of Germany and the federal state of Bavaria, where we have more detailed data. Both analyses show a major change between 9 and 13 March for the time series of infections: from a strong increase to a decrease. Another change was found between 25 March and 29 March, where the decline intensified. Furthermore, we perform an analysis stratified by age. A main result is a delayed course of the pandemic for the age group 80 + resulting in a turning point at the end of March. Our results differ from those by other authors as we take into account the reporting delay, which turned out to be time dependent and therefore changes the structure of the epidemic curve compared to the curve of newly reported cases.


Subject(s)
/epidemiology , Age Distribution , Aged , Aged, 80 and over , Bayes Theorem , Female , Germany/epidemiology , Humans , Male , Regression Analysis
11.
Gesundheitswesen ; 83(4): 265-273, 2021 Apr.
Article in German | MEDLINE | ID: covidwho-1139769

ABSTRACT

EINLEITUNG: Als Reaktion auf die Corona-Pandemie fand im Frühjahr 2020 ein gesellschaftlicher Stillstand statt. Untersucht werden soll, wie diese Pandemie-Maßnahme auf die Bevölkerung eines ländlich geprägten, strukturschwachen Bundeslandes am Beispiel der Notaufnahmefallzahlen eines Schwerpunktversorgers gewirkt hat. METHODEN: Abruf von anonymisierten aggregierten Routinedaten und Auswertung der Phasen "Vergleich" (03.07.2019-15.03.2020), Corona-Phase 1" (16.03.2020-06.05.2020) und "Corona-Phase 2" (07.05.2020-31.07.2020). ERGEBNISSE: Auswertung von 24977 Patientendaten (2493 Patienten Corona-Phase 1/5106 Patienten Phase 2). 53% der Patienten sind älter als 50 Jahre, ca. 30% älter als 70 Jahre. Regulär suchen 67,6 Patienten die Notaufnahme je Tag auf. In der Corona-Phase 1 reduziert sich die Zahl um 19,7 Patienten/Tag; in der Phase 2 sind 8,2 Patienten/Tag weniger als in der Vergleichsgruppe - bei insgesamt unveränderter Altersstruktur. 56% der Patienten suchen eigenständig (Selbstvorstellung) die Notaufnahme auf, 24% auf Veranlassung eines Vertragsarztes, 17% werden durch den Rettungsdienst (Notarzt, RTW) vorgestellt. Besonders auffällig ist der Fallzahlrückgang bei den Patienten, die sich selbst in der Notaufnahme vorstellen und vom Kassenarzt eingewiesen werden. Die Fallzahlen über den Rettungsdienst (NEF, RTW) sind relativ stabil - bzw. in der 2. Corona-Phase anteigend (Notarzt+7%, RTW+36%). Das Hauptdiagnosespektrum der aus der Notaufnahme stationär aufgenommenen Patienten umfasst bei den Vertragsarzteinweisungen und Selbstvorsteller 375 bzw. 360 ICD-10-GM Dreistellergruppen. Hierbei reduzieren sich typische Notfallerkrankungen deutlich (Hirninfarkt (I63) -52%, Herzinfarkt (I21) -61%, Cholelithiasis (K80) -75% bei Selbstvorstellungen/Vorhofflimmern (I48) -55%, akute Bronchitis (J20) - 35%, Gastroenteritis (A09) -48% bei Vertragsarzteinweisungen - jeweils Corona-Phase 1 zu Vergleichsgruppe). Diese Fallzahlverluste sind überwiegend in der Corona-Phase 2 persistent (Hirninfarkt (I63) - 29% bei Selbstvorstellern) und nur z. T. reversibel (Herzinfarkt (I21)+10%). SCHLUSSFOLGERUNG: Eine Reduktion von Notfallkontakten, die nicht final durch den Pandemieverlauf erklärbar ist, v. a. der Selbstvorstellungen, Kassenarztvorstellungen fanden statt. Die Reduktion der Fallzahlen v. a. der überwiegend älteren Patienten, die selbstständig oder über den Kassenarzt vorgestellt wurden, überwog den Anteil des professionellen Rettungsdienstes deutlich. Es kann vermutet werden, dass Pandemie-Maßnahmen selbst zu diesem Effekt - trotz ausreichender medizinischer Ressourcen- geführt haben. "Infektionsangst" als alleiniges Erklärungsmodell überzeugt nicht, da in Mecklenburg die Pandemie einen sehr milden, fallzahlschwachen Verlauf ohne Hotspot-Ereignisse in Krankenhäusern hatte. Untersuchungen zur Entscheidungsfindung der Bevölkerung bei Notfällen im weiteren Pandemieverlauf sind notwendig. BACKGROUND: Extensive lockdown restrictions were implemented by the government to cope with the COVID-19 pandemic situation. OBJECTIVES: We investigated whether and how access to the emergency department (ED) changed during the COVID-19 outbreak compared to baseline parameter in a hospital in the county Mecklenburg in Germany. MATERIALS AND METHODS: Data on patients who accessed the ED in "Corona - Phase 1" (16.03.2020-06.05.2020) and "Corona - Phase 2" (07.05.2020-31.07.2020) were collected and compared with the"pre-Covid-era" (03.07.2019-15.03.2020). RESULTS: Data on 24,977 patients were evaluated; of these, 2493 patients in the Corona-Phase 1 and 5106 patients in the Corona-Phase 2 periods. Among these patients, 53% patients were older than 50, 30% older than 70 years. Normally 67.6 patients/day (p/d) visit the ED. This value decreased to 19.7 p/d in Phase 1 and 8.2 p/d in phase 2. 24% of the patients were referred by the GP, 56% presented themselves and 17% by the rescue service. Wo observed a decline of stroke cases by 52%, heart attacks by 61% and atrial fibrillation by 55% in Phase 1. The decline of cases mainly persisted in phase 2 (e. g. stroke 29%). CONCLUSIONS: Access to the ED decreased during the COVID-19 outbreak especially by patients who presented to the ED by themselves or referred by the GP - these were more than those brought into the ED by the rescue service. Based on literature and our own data, we suspect the lockdown restrictions could be responsible for the observed decrease of cases, too. In the context of the mild course of COVID-19 cases in Mecklenburg, these results are surprising. Further studies regarding whether and how the population used the ED should be performed.


Subject(s)
Communicable Disease Control , Emergency Service, Hospital , Germany/epidemiology , Hospitals , Humans , Pandemics
12.
Medicine (Baltimore) ; 100(10): e24893, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1138015

ABSTRACT

ABSTRACT: Chronic renal replacement therapy by either a kidney transplant (KTX) or hemodialysis (HD) predisposes patients to an increased risk for adverse outcomes of COVID-19. However, details on this interaction remain incomplete. To provide further characterization, we undertook a retrospective observational cohort analysis of the majority of the hemodialysis and renal transplant population affected by the first regional outbreak of severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) in Germany. In a region of 250,000 inhabitants we identified a total of 21 cases with SARS-CoV-2 among 100 KTX and 260 HD patients, that is, 7 KTX with COVID-19, 14 HD with COVID-19, and 3 HD with asymptomatic carrier status. As a first observation, KTX recipients exhibited trends for a higher mortality (43 vs 18%) and a higher proportion of acute respiratory distress syndrome (ARDS) (57 vs 27%) when compared to their HD counterparts. As a novel finding, development of ARDS was significantly associated with the time spent on previous renal replacement therapy (RRT), defined as the composite of dialysis time and time on the transplant (non-ARDS 4.3 vs ARDS 10.6 years, P = .016). Multivariate logistic regression analysis showed an OR of 1.7 per year of RRT. The association remained robust when analysis was confined to KTX patients (5.1 vs 13.2 years, P = .002) or when correlating the time spent on a renal transplant alone (P = .038). Similarly, longer RRT correlated with death vs survival (P = .0002). In conclusion our data suggest renal replacement vintage as a novel risk factor for COVID-19-associated ARDS and death. The findings should be validated by larger cohorts.


Subject(s)
/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Transplantation/mortality , Renal Dialysis/statistics & numerical data , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Kidney Failure, Chronic/therapy , Logistic Models , Male , Middle Aged , Retrospective Studies , Risk Factors
13.
Euro Surveill ; 26(10)2021 03.
Article in English | MEDLINE | ID: covidwho-1136423

ABSTRACT

IntroductionThe Robert Koch Institute (RKI) managed the exchange of cross-border contact tracing data between public health authorities (PHA) in Germany and abroad during the early COVID-19 pandemic.AimWe describe the extent of cross-border contact tracing and its challenges.MethodsWe analysed cross-border COVID-19 contact tracing events from 3 February to 5 April 2020 using information exchanged through the European Early Warning Response System and communication with International Health Regulation national focal points. We described events by PHA, number of contacts and exposure context.ResultsThe RKI processed 467 events, initiating contact to PHA 1,099 times (median = 1; interquartile range (IQR): 1-2) and sharing data on 5,099 contact persons. Of 327 (70%) events with known exposure context, the most commonly reported exposures were aircraft (n = 64; 20%), cruise ships (n = 24; 7%) and non-transport contexts (n = 210; 64%). Cruise ship and aircraft exposures generated more contacts with authorities (median = 10; IQR: 2-16, median = 4; IQR: 2-11) and more contact persons (median = 60; IQR: 9-269, median = 2; IQR: 1-3) than non-transport exposures (median = 1; IQR: 1-6 and median = 1; IQR: 1-2). The median time spent on contact tracing was highest for cruise ships: 5 days (IQR: 3-9).ConclusionIn the COVID-19 pandemic, cross-border contact tracing is considered a critical component of the outbreak response. While only a minority of international contact tracing activities were related to exposure events in transport, they contributed substantially to the workload. The numerous communications highlight the need for fast and efficient global outbreak communication channels between PHA.


Subject(s)
/diagnosis , Contact Tracing , Germany/epidemiology , Humans , Pandemics
14.
Int J Environ Res Public Health ; 18(5)2021 03 08.
Article in English | MEDLINE | ID: covidwho-1134153

ABSTRACT

Briefly before the first peak of the COVID-19 pandemic in Berlin, Germany, schools closed in mid-March 2020. Following re-opening, schools resumed operation at a reduced level for nine weeks. During this phase, we aimed at assessing, among students and teachers, infection status, symptoms, individual behaviour, and institutional infection prevention measures. Twenty-four primary and secondary school classes, randomly selected across Berlin, were examined. Oro-nasopharyngeal swabs and capillary blood samples were collected to determine SARS-CoV-2 infection (PCR) and specific IgG (ELISA), respectively. Medical history, household characteristics, leisure activities, fear of infection, risk perception, hand hygiene, facemask wearing, and institutional preventive measures were assessed. Descriptive analysis was performed. Among 535 participants (385 students, 150 staff), one teenager was found to be infected with SARS-CoV-2 (0.2%), and seven individuals exhibited specific IgG (1.3%). Compared to pre-pandemic times, screen time (e.g., TV, gaming, social media) increased, and the majority of primary school students reported reduced physical activity (42.2%). Fear of infection and risk perception were relatively low, acceptance of adapted health behaviors was high. In this post-lockdown period of low SARS-CoV-2 incidence in Berlin, individual and school-level infection prevention measures were largely adhered to. Nevertheless, vigilance and continued preventive measures are essential to cope with future pandemic activity.


Subject(s)
Adolescent , Berlin , Communicable Disease Control , Cross-Sectional Studies , Germany/epidemiology , Humans , Pandemics , Perception , Schools
15.
J Prim Care Community Health ; 12: 2150132721996898, 2021.
Article in English | MEDLINE | ID: covidwho-1133542

ABSTRACT

Since December 2019, the coronavirus disease-2019 (COVID-19) has been keeping the world in suspense. Proven risk factors for a severe course of COVID-19 are common diseases like diabetes, hypertension, cardiovascular or respiratory disorders. Until today, little is known about the psychological burden of individuals suffering from these high-risk diseases regard to COVID-19. The aim of the study was to define the impact of the coronavirus pandemic on behavior and mental health in individuals at high risk for developing a severe COVID-19 course. Items assessed generalized anxiety (GAD-7), COVID-19-related fear, adherent/dysfunctional safety behavior, and the subjective risk perception of regarding symptoms, having a severe course and dying because of COVID-19. Data were compared between participants with the high risk diseases and individuals without any of those diseases. 16,983 respondents completed the study. Generalized anxiety, COVID-19-related fear, adherent/dysfunctional safety behavior and subjective risk perception were elevated in participants with high-risk diseases. The increased COVID-19-related fear as a functional concern is a conclusion on the increased risk of a severe course. The functionality of the fear is reflected in people's increased need for security and includes an increase in both adherent and dysfunctional safety behavior that underlines the need for psychological support strategies.


Subject(s)
/psychology , Fear/psychology , Health Behavior , Health Knowledge, Attitudes, Practice , Adolescent , Adult , Aged , Anxiety/epidemiology , Comorbidity , Cross-Sectional Studies , Female , Germany/epidemiology , Humans , Male , Middle Aged , Multimorbidity , Risk Assessment , Risk Factors , Safety , Severity of Illness Index , Surveys and Questionnaires , Young Adult
16.
Sci Rep ; 11(1): 5803, 2021 03 11.
Article in English | MEDLINE | ID: covidwho-1132102

ABSTRACT

While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017-18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45-71] vs 66 [52-77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.


Subject(s)
/epidemiology , Influenza, Human/epidemiology , Aged , Comorbidity , Female , Germany/epidemiology , Hospitalization/statistics & numerical data , Humans , Immunosuppression , Male , Middle Aged , Retrospective Studies
17.
Epidemiol Psychiatr Sci ; 30: e16, 2021 Jan 19.
Article in English | MEDLINE | ID: covidwho-1127120

ABSTRACT

AIMS: It remains unclear whether the coronavirus disease 2019 (COVID-19) pandemic is having an impact on suicide rates (SR). Economic insecurity and mental disorders are risk factors for suicide, which may increase during the pandemic. METHODS: Data on suicide events in a major city in Germany, and the corresponding life years (LY) were provided by the local authorities. For the year 2020, periods without restrictions on freedom of movement and social contact were compared with periods of moderate and severe COVID-19 restrictions. To avoid distortions due to seasonal fluctuations and linear time trends, suicide risk during the COVID-19 pandemic was compared with data from 2010 to 2019 using an interrupted time series analysis. RESULTS: A total of 643 suicides were registered and 6 032 690 LY were spent between 2010 and 2020. Of these, 53 suicides and 450 429 LY accounted for the year 2020.In 2020, SR (suicides per 100 000 LY) were lower in periods with severe COVID-19 restrictions (SR = 7.2, χ2 = 4.033, p = 0.045) compared with periods without restrictions (SR = 16.8). A comparison with previous years showed that this difference was caused by unusually high SR before the imposition of restrictions, while SR during the pandemic were within the trend corridor of previous years (expected suicides = 32.3, observed suicides = 35; IRR = 1.084, p = 0.682). CONCLUSIONS: SR during COVID-19 pandemic are in line with the trend in previous years. Careful monitoring of SR in the further course of the COVID-19 crisis is urgently needed. The findings have regional reference and should not be over-generalised.


Subject(s)
/psychology , Pandemics , Quarantine/psychology , Social Isolation/psychology , Suicide/psychology , Suicide/trends , /epidemiology , Female , Germany/epidemiology , Humans , Loneliness/psychology , Suicide/statistics & numerical data , Suicide, Attempted/psychology
18.
Eur Psychiatry ; 64(1): e20, 2021 03 09.
Article in English | MEDLINE | ID: covidwho-1123674

ABSTRACT

BACKGROUND: Public health measures to curb SARS-CoV-2 transmission rates may have negative psychosocial consequences in youth. Digital interventions may help to mitigate these effects. We investigated the associations between social isolation, COVID-19-related cognitive preoccupation, worries, and anxiety, objective social risk indicators, and psychological distress, as well as use of, and attitude toward, mobile health (mHealth) interventions in youth. METHODS: Data were collected as part of the "Mental Health And Innovation During COVID-19 Survey"-a cross-sectional panel study including a representative sample of individuals aged 16-25 years (N = 666; Mage = 21.3; assessment period: May 5, 2020 to May 16, 2020). RESULTS: Overall, 38% of youth met criteria for moderate or severe psychological distress. Social isolation worries and anxiety, and objective risk indicators were associated with psychological distress, with evidence of dose-response relationships for some of these associations. For instance, psychological distress was progressively more likely to occur as levels of social isolation increased (reporting "never" as reference group: "occasionally": adjusted odds ratio [aOR] 9.1, 95% confidence interval [CI] 4.3-19.1, p < 0.001; "often": aOR 22.2, CI 9.8-50.2, p < 0.001; "very often": aOR 42.3, CI 14.1-126.8, p < 0.001). There was evidence that psychological distress, worries, and anxiety were associated with a positive attitude toward using mHealth interventions, whereas psychological distress, worries, and anxiety were associated with actual use. CONCLUSIONS: Public health measures during pandemics may be associated with poor mental health outcomes in youth. Evidence-based digital interventions may help mitigate the negative psychosocial impact without risk of viral infection given there is an objective need and subjective demand.


Subject(s)
Internet-Based Intervention/statistics & numerical data , Mental Health , Quarantine , Social Isolation/psychology , Stress, Psychological , Anxiety/prevention & control , Anxiety/psychology , /prevention & control , Cross-Sectional Studies , Female , Germany/epidemiology , Humans , Male , Quarantine/methods , Quarantine/psychology , Stress, Psychological/etiology , Stress, Psychological/prevention & control , Telemedicine/methods , Young Adult
19.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(3): 285-293, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1118208

ABSTRACT

With the declaration of a pandemic situation of national significance by the German Bundestag, the Federal Centre for Health Education (BZgA) is fulfilling its task of providing information for understanding the pandemic situation and implementing the necessary protective measures in a clear manner throughout Germany within the framework of the adapted National Pandemic Plan COVID-19. The BZgA targets its information according to the needs of specific groups and actively involves multipliers.In order to incorporate the perspectives of the population as well as those of prevention and health promotion professionals into the services developed by the BZgA, given the particularly initial low level of knowledge in the population, various methods and data sources were used: the COVID-19 Snapshot Monitoring (COSMO) population survey, the monitoring of citizens' enquiries via telephone and e­mail to the BZgA, surveys of counselling professionals from nationwide telephone and online counselling centres, surveys of health professionals in early help (NZFH) and interdisciplinary practice expert hearings. Beyond providing pure information, practical and everyday offers should be developed and provided according to WHO guidelines and evidence-based criteria of effective communication in order to support the competences for a gradual adaptation to a "new normality".The paper describes the data-based and evidence-informed development process of communication content and offers, their dissemination via existing websites and channels for other topics as well as their integration into the new online platform www.zusammengegencorona.de . This demonstrates how demand-driven and target group-specific communication offers can be implemented beyond the classic and proven campaign appearance.


Subject(s)
Pandemics , Communication , Germany/epidemiology , Health Education , Humans , Pandemics/prevention & control
20.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; 64(3): 353-359, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1118207

ABSTRACT

BACKGROUND: At the beginning of the COVID-19 pandemic, the German Robert Koch Institute (RKI) published several guidelines addressing the medical health services helping to detect SARS CoV­2. Needing an available and specific test strategy regarding SARS-CoV­2, our own test strategy strictly followed these testing criteria. MATERIALS AND METHODS: Using a retrospective analysis, we verified if such a test strategy was an effective tool in the context of infection prevention control and as reliable SARS-CoV­2 detection. Therefore, we analysed our own test results of suspected SARS-CoV­2 cases between 26 February and 6 April 2020. Additionally, we used a geovisualisation tool to visualise test frequencies and positive test results within different districts of Mannheim based on people's addresses. RESULTS: There were on average 7% positive test results of SARS-CoV­2 within a population with typical symptoms of COVID-19 (n = 2808). There was no positive test result within an asymptomatic population (n = 448). However, one positive test result turned out to be a nosocomial infection. Finally, geovisualisation highlighted a shift of test frequencies and local positive rates for SARS-CoV­2 from one district of Mannheim to another. DISCUSSION: In conclusion, our test strategy strictly based on testing criteria suggested by the Robert Koch Institute resulted in a steady rate of positive tests and allowed us to increase test capacity without causing numbers of nosocomial infections of COVID-19. Geovisualisation tools can offer support in analysing an ongoing spread of transmissible diseases. In the future, they could be used as helpful tools for infection prevention control, for example in the context of vaccination programs.


Subject(s)
Pandemics , Germany/epidemiology , Humans , Pandemics/prevention & control , Retrospective Studies
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