Tag Archives: Epidemiology

Beat the corona virus: Be faster than your test | Germany | News and in-depth reporting from Berlin and beyond | DW | Instant News

Arne Zels’ phone never stopped ringing. He is a “detention reconnaissance,” meaning that he comes into contact every day with people who have tested positive for the coronavirus or who have been in contact with someone who has it. Zels is based in the small town of Seelow in the state of Brandenburg, just outside Berlin. The windows were wide open and the morning sun shone on the office in the golden autumn light.

Even so, he could see that the market square outside was nearly empty. In recent weeks, as the number of COVID-19 infections has begun to rise again, Seelow’s health departments and many others like them around the country have stepped up operations to identify and control the source of the infection.

Arne Zels is actually a specialist in economic and business psychology. But he is on sabbatical and is using his knowledge to support the health department’s efforts. As a first step, he will be trained as a detention scout at the Robert Koch Institute, Germany’s leading public health authority. So lately the main task has been to find out who has been in contact with people who have tested positive and ensure that they also get tested and, if necessary, go to quarantine. “A key aspect of our work is we are trying to break the chain of infection.”

The phone rings again: A woman calls the office, worried that her boss has tested positive. How should he respond? Zels’ response was sensitive but firm: “You must stay in quarantine. Do you have someone to look after you? Don’t go shopping and stay away from your family.” This, however, is only the beginning. Zels and two colleagues will try to identify all the people the infected woman has contacted to find out where it first started spreading.

Read more: Germany has another five-point infection amid warnings of a lockdown

All the time: City Council member Falko Liecke completes his duties

‘Overpowered over the years’

This work, says Zels, takes time – although speed is critical: “But if we rush too much, we will leave behind people who don’t know how to deal with the situation. The best thing that can happen is that they will become depressed. But in the worst case, they will go out and harm others. “

The people at the health office say they are still on top of the problem – almost. However, they warned that if the numbers continued to increase, more people would have to join in, as they have been doing in recent months. “People hit the wall. They can’t do what their job demands,” Zels added. “However, we haven’t reached the limit where you would say we can’t get over it anymore.”

The Federal Ministry of Health acknowledged that at least nine local health departments across the country said they did not have enough staff to effectively track and trace people in the chain of infection. The bottom line is: “In most cases, it is no longer possible to fully implement infection protection measures.” In concrete terms this means that in most cases no one knows where the source of the infection is. “

The consequences can be fatal: As it becomes increasingly difficult to trace the source of infection, the more difficult it is to determine what patterns of behavior may have caused a particular outbreak. It appears that the strategies employed in recent months are no longer sufficient to contain the pandemic.

Falko Liecke, member of the city council for health and youth at Berlin district in Neukölln, have first-hand experience of the challenges. Its district was one of the hardest hit in all of Germany.

Corona virus contact tracer in Germany (Britta Pedersen / dpa / picture-alliance)

Containment scouts try to map the chain of infection

Liecke patiently gave one-on-one interviews – all outdoors despite the drizzle. The priority is clear to keep the media away from offices where staff need to focus on the task at hand. “Berlin’s health department has been understaffed for years. I’ve always said that if we face a really big crisis, we won’t have the resources to solve it. And that’s what we’re seeing now,” said Liecke.

About 200 people are working to contain the pandemic. Seventy of them specialize in contact tracing. Calls have been out for an additional 40 people to join a team that already includes 27 soldiers from the German military, and other colleagues who work every day. However, even if staff numbers are increasing and they all work 7 days a week, they will still lag behind their workload.

Read more: Germany prohibits entry of young au pairs

Neukölln: A new approach?

Those numbers have reached a level where the health department focuses only on people who test positive or those who are considered part of a high-risk group – such as people who have had the disease before. Others outside the group have to rely on information from those transmitting the infection or by institutions and locations where the infected person has spent time – such as children at school or fellow parents of younger children in kindergarten classes -children.

All of this explains why the authorities in Neukölln have carefully adopted a new approach based on the idea of ​​Chief Medical Officer Nicolai Savaskan. He smiled as he spoke and there was no sign that he was intimidated by the large scale of the work to come.

“Infections tend to spread in the same way as wildfires when they are out of control. There are areas where sources of fire can be found. And what firefighters should be doing is pretty clear.” The obstacle is that there are no more concrete sources. The situation is scattered and it is difficult to get an overview.

Nicolai Savaskan (Personal)

Neukölln’s Nicolai Savaskan wants to focus on the most vulnerable

One case and ten contacts: “It’s been a very time-consuming workload for my people,” says Savaskan. So what we want to do is shift the focus to citizens who take more personal responsibility. It is possible to notify people who have tested positive and then it is up to them to pick up the phone and then inform their own contact. That will allow medical specialists to focus their efforts on the most vulnerable. Savaskan isn’t convinced that a lockdown will help: “It’s like a nuclear weapon that easily flattens everything to the ground. There are other instruments we need to try first.”

One contested possibility is for every citizen to undergo what is called a rapid home test to see if they pose a risk to others. The other is a time corridor that allows vulnerable groups to shop in relative comfort with those who are not high-risk groups away.

Savaskan to call it: “Faster than your test!” Any symptom, the slightest suspicion that someone is positive, and it should be: Responsible directly to quarantine! “However you look at it,” Savaskan painstakingly emphasizes, “this is a job for society as a whole.” And, he added: “If people don’t want to take personal responsibility, then we already have it.”


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Confirmed coronavirus cases in Germany increased by 5,186 to 380,762: RKI | Instant News

People wearing face masks take pictures on the shopping street Schloss Strasse, as the coronavirus disease (COVID-19) outbreak continues, in Berlin, Germany, 20 October 2020. REUTERS / Fabrizio Bensch

BERLIN (Reuters) – The number of confirmed coronavirus cases in Germany increased by 5,186 to 380,762, data from the Robert Koch Institute (RKI) for infectious diseases showed on Wednesday.

The reported death toll rose by 26 to 9,875, the tally showed.

(This story corrects the number of deaths and infections in a day)

Reporting by Berlin Newsroom; Edited by Jacqueline Wong


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Confirmed coronavirus cases in Germany increase by 4,325 to 366,299: RKI | Instant News

FILE PHOTOS: People walking down a shopping street in Konstanz, Germany October 16, 2020. REUTERS / Arnd Wiegmann

BERLIN (Reuters) – The number of confirmed coronavirus cases in Germany increased by 4,325 to 366,299, data from the Robert Koch Institute (RKI) for infectious diseases showed on Monday.

The reported death toll rose by 12 to 9,789, the tally showed.

Reporting by Berlin Newsroom; Edited by Himani Sarkar


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About 80% of People With No Symptoms With COVID-19 Develop Symptoms | Instant News

Editor’s note: Find the latest COVID-19 news and guides on Medscape’s Coronavirus Resource Center.

About 20% of asymptomatic people who test positive for COVID-19 will remain symptom-free over time, according to two studies published Sept. 22 in a separate journal. Therefore, the investigators propose that most asymptomatic patients should be considered asymptomatic.

“Only a small proportion of people with SARS-CoV-2 have completely asymptomatic infection. Most patients with SARS-CoV-2 who are asymptomatic at the time of testing will continue to develop symptoms,” study author Nicola Low, MD, chiefs. from the Research Group at the Institute of Social and Preventive Medicine at the University of Bern in Switzerland, said Medscape Medical News.

The results also suggest expanded testing for SARS-CoV-2 infection is needed, especially among those at high risk, and supports the use of control measures including masks, physical distancing and isolation.

“People with asymptomatic infections are contagious. All should be isolated and contact tracing must be initiated,” added Low.

Low and colleagues did a systemic review and live meta-analysis evaluating the occurrence and transmission of asymptomatic and presymptomatic patients. They publish their findings on PLOS Medicine.

Sung-Han Kim, MD, PhD, and fellow researchers did a studies comparing SARS-CoV-2 levels in the nose and throat of asymptomatic vs symptomatic individuals published in the journal Thorax.

Research teams from Switzerland and South Korea point to the need for more clarity about asymptomatic vs asymptomatic patients with COVID-19. Most researchers had previously tested people for SARS-CoV-2 infection at one time, preventing identification of the percentage who later developed symptoms.

Previous work is also heterogeneous. “Researchers have investigated the proportion with asymptomatic infections in various settings, including hospitals, as part of the outbreak, through contact tracing, and through screening,” Low said. The variability between estimates was “very high,” from 3% to 83% in individual studies, he added.

Main Meta-Analysis Findings

Low and colleagues searched PubMed, Embase, bioRxiv and MedRxiv for relevant studies. The “live” meta-analysis reflects the updates that were taking place in March, April, and June this year. They used reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2.

The data included a statistical modeling study of all 634 passengers from Diamond Princess cruise ship with a positive RT-PCR test result.

Overall, in 79 studies conducted in a variety of different settings, 20% of people with SARS-CoV-2 infection remained asymptomatic during follow-up.

When restricted to seven studies that screened the population as defined by follow-up, a higher proportion (31%) remained asymptomatic over time.

The investigators caution that their asymptomatic estimate is limited by bias in the study design. In addition, they found it difficult to identify the proportion of asymptomatic patients who contributed to SARS-CoV-2 transmission as a whole.

Part of the five studies includes detailed contact tracing. From this data, the researchers calculated the risk of asymptomatic people transmitting SARS-CoV-2 (summary risk ratio, 0.35, compared to people with symptoms of 0.63). More trials are needed to confirm these findings, they wrote.

“The findings from the systematic review, including ours, do not support the claim that most SARS-CoV-2 infections are asymptomatic,” they added. Furthermore, because SARS-CoV-2 can be transmitted several days before an infected person develops symptoms, “asymptomatic transmission is likely to have contributed substantially to the SARS-CoV-2 epidemic as a whole.”

Similar Viral Load Found in South Korea

Kim and colleagues found that in nearly the same proportion, 19% of the 213 patients, without severe COVID-19 symptoms, remained asymptomatic through potential exposure, laboratory confirmation, and hospital admission.

Upper respiratory tract viral load did not differ significantly between asymptomatic and asymptomatic individuals in South Korean upper respiratory tract samples.

“Our data adds to the recent growing evidence that asymptomatic individuals with SARS-CoV-2 infection do indeed contribute to the ongoing community spread of COVID-19, senior study author Kim told Medscape Medical News.

The SARS-CoV-2 gene’s cycle mean threshold (Ct) value, which reflects viral load, “was very similar between asymptomatic individuals and symptomatic patients,” added Kim, professor of infectious diseases and head of the Office for Infection Control at Asan Medical Center at Asan Medical Center. Seoul South Korea.

These findings suggest that asymptomatic individuals have “comparable potential to transmit the virus to as many symptomatic patients,” he said. “To prevent transmission from asymptomatic individuals with SARS-CoV-2 infection, the use of face masks by the general public – regardless of symptoms – is strongly recommended.”

The study was feasible because of the unique situation – the COVID-19 outbreak in Daegu City was traced to one religious group. 3000 close contacts identified reported symptoms as being absent to severe, and asymptomatic people were isolated and monitored in specialized facilities.

“We were able to assess many asymptomatic individuals who were unlikely to be identified as cases of COVID-19,” wrote the investigators.

Most of the 183 patients, including 39 asymptomatic and 144 asymptomatic, underwent a follow-up RT-PCR test. Swab samples from the nasopharynx and oropharynx were combined in one test.

As most asymptomatic people with COVID-19 continue to live in a community setting, the researchers note, “such people can act as important drivers for the spread of the COVID-19 community and the state of the ongoing pandemic.”

The limitation of this study is that the population consists mainly of individuals in their 20s and 30s, so generalization to other age groups is unknown.

Uncertainty Remains

“This study represents a valuable contribution, but also underscores how much uncertainty remains. There isn’t much to say about asymptomatic transmission,” Jonathan Dushoff, PhD, professor, Department of Biology, McMaster University, Hamilton, Canada, told Medscape Medical News when asked to comment on research.

“In my opinion, they don’t change the consensus that people without symptoms, whether asymptomatic or asymptomatic, should be seen as potential transmitters, despite weak evidence that they are less contagious than people with symptoms,” added Dushoff, who one of the study authors about the timing of transmission of SARS-CoV-2 asymptomatically published in June in the journal Epidemic.

Not an Easy Task

“It would actually be difficult and challenging to provide a true estimate of the asymptomatic transmission rate,” says Lei Huang, MD, Medscape Medical News when asked for comment. People without symptoms may not realize they were exposed to other people during the virus incubation period, Huang added.

Studying randomly selected populations, which are representative and generalizable to settings where disease transmission is known to occur, would be a more ideal approach, Huang said.

Current research “shows that in places where transmission has occurred, it is always beneficial to pay special attention to self-protection, even when dealing with someone who appears to be very healthy,” said Huang, the lead author of the study. prospective, contact tracing study which revealed the rapid transmission of COVID-19 in asymptomatic people aged 16 to 23 years.

“While the likelihood of transmission from asymptomatic cases may be lower than from symptomatic cases, the importance of asymptomatic transmission should not be overlooked given the uncertainty of the true proportion of asymptomatic cases,” said Huang, who is affiliated with the Department of General Surgery. , The First Affiliated Hospital of Anhui Medical University, Anhui Province, China.

Low is a member of the editorial board of PLOS Medicine. Kim, Dushoff, and Huang did not disclose the relevant financial relationships.

The Swiss National Science Foundation, the European Union Horizon 2020 research and innovation program, the Swiss government excellence scholarship, and a grant from the Swiss School of Public Health Global P3H fund the study of PLoS Medicine.

A grant from the Korea Health Technology Research and Development Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea, supports research on Thorax.

PLOS Med. Published online 22 September 2020. Full text

Thorax. Published online 22 September 2020. Full text

Damian McNamara is a staff member journalist based in Miami. It covers a wide range of medical specialties, including infectious diseases, gastroenterology, and primary care. Follow Damian on Twitter: @Detikcom.


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Germany: Coronavirus vaccine might not be widely available before mid-2021 | Instant News

BERLIN, July 29 (Reuters) – German Research Minister Anja Karliczek said on Wednesday that a coronavirus vaccine might not be widely available before the middle of next year.

“We must continue to assume that vaccines for the wider population will only be available from the middle of next year,” he told a news conference. (Reporting by Reuters Television Writing by Michelle Martin, edited by Thomas Escritt)


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