Julia Schilling

Bio: Julia Schilling is an academic researcher from Robert Koch Institute. The author has contributed to research in topics: Medicine & Cohort. The author has an hindex of 5, co-authored 8 publications receiving 414 citations.

First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020

Abstract: We are grateful for the essential work of a large number of public health experts, clinical microbiologists, practitioners and clinicians who have been involved in the investigations at national and regional level including all the professionals of the Canarian Health Service and the Balearic Islands Health Service. We acknowledge the work of ECDC data manager, particularly Zsolt Bartha, and country cooperation teams in rapidly establishing the online reporting system in TESSy by 26 January 2020. We thank also the efforts of Catalin Albu, Adrian Prodan, Skaidra Kurapkiene, Per Rolfhamre and Anca Dragnea. ECDC also thanks the Epidemic Intelligence team that provides vital and timely data on global cases of COVID-19. WHO thanks Ka Yeung (Calvin) Cheng, Silviu Ciobanu, Gudrun Freidl, Lauren MacDonald, and Miriam Sneiderman for assistance with data management.

[The different periods of COVID-19 in Germany: a descriptive analysis from January 2020 to February 2021].

Abstract: Am 27.01.2020 wurde in Deutschland der erste Fall mit einer SARS-CoV-2-Infektion diagnostiziert. Fur die Beschreibung des Pandemieverlaufs im Jahr 2020 wurden 4 epidemiologisch verschiedene Phasen betrachtet und Daten aus dem Meldesystem gemas Infektionsschutzgesetz (IfSG) sowie hospitalisierte COVID-19-Falle mit schwerer akuter respiratorischer Infektion aus der Krankenhaus-Surveillance eingeschlossen. Phase 0 umfasst den Zeitraum von Kalenderwoche (KW) 5/2020 bis 9/2020, in dem vor allem sporadische Falle <60 Jahre und regional begrenzte Ausbruche beobachtet wurden. Insgesamt wurden 167 Falle ubermittelt, die vorwiegend mild verliefen. Dem schloss sich in Phase 1 (KW 10/2020 bis 20/2020) die erste COVID-19-Welle mit 175.013 Fallen im gesamten Bundesgebiet an. Hier wurden vermehrt Ausbruche in Krankenhausern, Alten- und Pflegeheimen sowie ein zunehmender Anteil an alteren und schwer erkrankten Personen verzeichnet. In Phase 2, dem „Sommerplateau“ mit eher milden Verlaufen (KW 21/2020 bis 39/2020), wurden viele reiseassoziierte COVID-19-Falle im Alter von 15–59 Jahren und einzelne grosere, uberregionale Ausbruche in Betrieben beobachtet. Unter den 111.790 Fallen wurden schwere Verlaufe seltener beobachtet als in Phase 1. Phase 3 (KW 40/2020 bis 8/2021) war gekennzeichnet durch die zweite COVID-19-Welle in Deutschland, die sich zum Jahresende 2020 auf dem Hohepunkt befand. Mit 2.158.013 ubermittelten COVID-19-Fallen und insgesamt deutlich mehr schweren Fallen in allen Altersgruppen verlief die zweite Welle schwerer als die erste Welle. Unabhangig von den 4 Phasen waren v. a. Altere und auch Manner starker von einem schweren Krankheitsverlauf betroffen.

Krankheitsschwere der ersten COVID-19-Welle in Deutschland basierend auf den Meldungen gemäß Infektionsschutzgesetz

Abstract: As of December 31, 2019, initial reports circulated internationally of an unusual cluster of pneumonia of unknown cause in China. By the end of January 2020, the virus affected Germany with the first case confirmed on January 27, 2020. Most cases (80 %) were mild and two thirds of the cases were younger than 60 years (median age: 50 years). Severe cases were primarily reported among men aged 60 or over who had at least one risk factor (particularly cardiovascular disease, diabetes, neurological disorders and/or lung diseases). Cases between the ages of 40 and 59 years had the longest interval between symptom onset and hospitalisation (median: six days) and if admitted to an intensive care unit (ICU) – also the longest ICU stay (median: eleven days). Mit dem ersten laborbestätigten Fall einer SARS-CoV-2-Infektion am 27. Januar 2020 erreichte das Virus Deutschland (LGL, RKI 2020). Es war ein 33-jähriger Mann, der bei einem Unternehmen in Bayern tätig war (Böhmer et al. 2020; Rothe et al. 2020). Kurze Zeit später wurden unter Personen, die aus China repatriiert (zurückgeholt) wurden, zwei Personen nach ihrer Ankunft in Deutschland positiv auf SARS-CoV-2 getestet (LGL, RKI 2020). Auf Basis dieser ersten Fälle in Deutschland wurden wertvolle InJULIA SCHILLING1, ANN-SOPHIE LEHFELD1, DIrK SCHUMACHEr1,2, ALEXANDEr ULLrICH1, MICHAELA DIErCKE1, SILKE BUDA1, WALTEr HAAS1, rKI COVID-19 STUDY GrOUP1 * Der Artikel wurde 2020 im Journal of Health Monitoring (Ausgabe 5 (S11), DOI: 10.25646/7169) veröffentlicht und liegt hier in leicht gekürzter Form vor. 1 robert Koch-Institut, Berlin, Abteilung für Infektionsepidemiologie. 2 Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIG), Berlin, Fachbereich Medizinische Biometrie und Statistik. KRANKHEITSSCHWERE DER ERSTEN COVID-19-WELLE IN DEUTSCHLAND DISEASE SEVERITY OF THE FIRST COVID-19 WAVE IN GERMANY Nr. 1/2021 SEITE 40 formationen zur Übertragbarkeit des neuartigen Virus gewonnen. Die Dynamik des Geschehens zeigte sich dann ab Mitte Februar in Deutschland, als weitere Fälle in Zusammenhang mit Karnevalsfeiern und Rückreisen aus Skigebieten (RKI 2020a) bekannt wurden und sich die Lage Anfang März verschärfte. Nach umfangreichen Maßnahmen konnte die Übertragung des Virus bis Mitte Juni eingedämmt werden. Die Situation in Deutschland wurde seitdem kontinuierlich anhand des Pandemic Influenza Severity Assessment Tools (PISA) der WHO bewertet, in dem Informationen zur Übertragung des Virus, zur Krankheitsschwere sowie zur Belastung des Gesundheitssystems berücksichtigt wurden (WHO 2017). Quelle: Michael Bührke / pixelio.de. Basierend auf den gemäß Infektionsschutzgesetz übermittelten Fällen wurde die erste COVID-19-Welle in Deutschland im Rahmen der Vorbereitung auf einen möglichen erneuten Anstieg der Fallzahlen im Herbst/Winter 2020 analysiert. Im Fokus der Auswertung steht die Bewertung der Krankheitsschwere in der ersten Welle als eine Komponente der Risikobewertung.

Disease severity of the first COVID-19 wave in Germany using reporting data from the national notification system

Abstract: As of December 31, 2019, initial reports circulated internationally of an unusual cluster of pneumonia of unknown cause in China. By the end of January 2020, the virus affected Germany with the first case confirmed on January 27, 2020. Intensive contact tracing and infection control measures contained the first two clusters in the country. However, the dynamic of the first wave gained momentum as of March, and by mid-June 2020 over 190,000 laboratory-confirmed cases had been reported to the Robert Koch Institute. This article examines these cases as part of a retrospective descriptive analysis focused on disease severity. Most cases (80%) were mild and two thirds of the cases were younger than 60 years (median age: 50 years). Severe cases were primarily reported among men aged 60 or over who had at least one risk factor (particularly cardiovascular disease, diabetes, neurological disorders and/or lung diseases). Cases between the ages of 40 and 59 years had the longest interval between symptom onset and hospitalisation (median: six days) and – if admitted to an intensive care unit (ICU) – also the longest ICU stay (median: eleven days). This analysis provides valuable information about disease severity of COVID-19 and particularly affected groups.

Inhibition of SARS-CoV-2 (previously 2019-nCoV) infection by a highly potent pan-coronavirus fusion inhibitor targeting its spike protein that harbors a high capacity to mediate membrane fusion.

Abstract: The recent outbreak of coronavirus disease (COVID-19) caused by SARS-CoV-2 infection in Wuhan, China has posed a serious threat to global public health. To develop specific anti-coronavirus therapeutics and prophylactics, the molecular mechanism that underlies viral infection must first be defined. Therefore, we herein established a SARS-CoV-2 spike (S) protein-mediated cell–cell fusion assay and found that SARS-CoV-2 showed a superior plasma membrane fusion capacity compared to that of SARS-CoV. We solved the X-ray crystal structure of six-helical bundle (6-HB) core of the HR1 and HR2 domains in the SARS-CoV-2 S protein S2 subunit, revealing that several mutated amino acid residues in the HR1 domain may be associated with enhanced interactions with the HR2 domain. We previously developed a pan-coronavirus fusion inhibitor, EK1, which targeted the HR1 domain and could inhibit infection by divergent human coronaviruses tested, including SARS-CoV and MERS-CoV. Here we generated a series of lipopeptides derived from EK1 and found that EK1C4 was the most potent fusion inhibitor against SARS-CoV-2 S protein-mediated membrane fusion and pseudovirus infection with IC50s of 1.3 and 15.8 nM, about 241- and 149-fold more potent than the original EK1 peptide, respectively. EK1C4 was also highly effective against membrane fusion and infection of other human coronavirus pseudoviruses tested, including SARS-CoV and MERS-CoV, as well as SARSr-CoVs, and potently inhibited the replication of 5 live human coronaviruses examined, including SARS-CoV-2. Intranasal application of EK1C4 before or after challenge with HCoV-OC43 protected mice from infection, suggesting that EK1C4 could be used for prevention and treatment of infection by the currently circulating SARS-CoV-2 and other emerging SARSr-CoVs.

Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil

Abstract: The COVID-19 pandemic has challenged researchers and policy makers to identify public safety measures forpreventing the collapse of healthcare systems and reducingdeaths. This narrative review summarizes the available evidence on the impact of social distancing measures on the epidemic and discusses the implementation of these measures in Brazil. Articles on the effect of social distancing on COVID-19 were selected from the PubMed, medRXiv and bioRvix databases. Federal and state legislation was analyzed to summarize the strategies implemented in Brazil. Social distancing measures adopted by the population appear effective, particularly when implemented in conjunction with the isolation of cases and quarantining of contacts. Therefore, social distancing measures, and social protection policies to guarantee the sustainability of these measures, should be implemented. To control COVID-19 in Brazil, it is also crucial that epidemiological monitoring is strengthened at all three levels of the Brazilian National Health System (SUS). This includes evaluating and usingsupplementary indicators to monitor the progression of the pandemic and the effect of the control measures, increasing testing capacity, and making disaggregated notificationsand testing resultstransparentand broadly available.

COVID-19 length of hospital stay: a systematic review and data synthesis

Abstract: The COVID-19 pandemic has placed an unprecedented strain on health systems, with rapidly increasing demand for healthcare in hospitals and intensive care units (ICUs) worldwide. As the pandemic escalates, determining the resulting needs for healthcare resources (beds, staff, equipment) has become a key priority for many countries. Projecting future demand requires estimates of how long patients with COVID-19 need different levels of hospital care. We performed a systematic review of early evidence on length of stay (LoS) of patients with COVID-19 in hospital and in ICU. We subsequently developed a method to generate LoS distributions which combines summary statistics reported in multiple studies, accounting for differences in sample sizes. Applying this approach, we provide distributions for total hospital and ICU LoS from studies in China and elsewhere, for use by the community. We identified 52 studies, the majority from China (46/52). Median hospital LoS ranged from 4 to 53 days within China, and 4 to 21 days outside of China, across 45 studies. ICU LoS was reported by eight studies—four each within and outside China—with median values ranging from 6 to 12 and 4 to 19 days, respectively. Our summary distributions have a median hospital LoS of 14 (IQR 10–19) days for China, compared with 5 (IQR 3–9) days outside of China. For ICU, the summary distributions are more similar (median (IQR) of 8 (5–13) days for China and 7 (4–11) days outside of China). There was a visible difference by discharge status, with patients who were discharged alive having longer LoS than those who died during their admission, but no trend associated with study date. Patients with COVID-19 in China appeared to remain in hospital for longer than elsewhere. This may be explained by differences in criteria for admission and discharge between countries, and different timing within the pandemic. In the absence of local data, the combined summary LoS distributions provided here can be used to model bed demands for contingency planning and then updated, with the novel method presented here, as more studies with aggregated statistics emerge outside China.

COVID-19 and Iranian Medical Students; A Survey on Their Related-Knowledge, Preventive Behaviors and Risk Perception.

Abstract: BACKGROUND: Since December 2019, a novel coronavirus disease (COVID-19) began its journey around the world. Medical students, as frontline healthcare workers, are more susceptible to be infected by the virus. The aim of this study was to assess COVID-19 related knowledge, self-reported preventive behaviors and risk perception among Iranian medical students within the first week after the onset of the outbreak in Iran. METHODS: This cross-sectional study was conducted from 26th to 28th of February, 2020. Participants were Iranian medical students (5th-7th year) whose knowledge, preventive behaviors and risk perceptions of COVID-19 were assessed using an online questionnaire. The questionnaire consisted of 26 questions including 15 items about COVID-19 related knowledge, 9 items regarding preventive measures and 2 items about COVID-19 risk perception. The validity and reliability of the questionnaire were shown to be satisfactory. RESULTS: A total of 240 medical students completed the questionnaire. The mean age of participants was 23.67 years. The average of correct answers of knowledge was 86.96%; and 79.60% had high level of related knowledge. The average rate of practicing preventive behaviors was 94.47%; and 94.2% had high level of performance in preventive behaviors. The cumulative score of risk perception was 4.08 out of 8 which was in moderate range. Risk perception was significantly different between stagers and interns and between those being trained in emergency room (ER) and non-ER wards. There was a significant negative correlation between preventive behaviors and risk perception. CONCLUSION: We found a high level of COVID-19 related knowledge and self-reported preventive behaviors and moderate risk perception among Iranian medical students.