Autopsies are an important tool in medicine, dissecting disease pathophysiology and causes of death. In COVID-19, autopsies revealed e.g., the effects on pulmonary (micro)vasculature or the nervous system, systemic viral spread, or the interplay with the immune system. To facilitate multicentre autopsy-based studies and provide a central hub supporting autopsy centres, researchers, and data analyses and reporting, in April 2020 the German COVID-19 Autopsy Registry (DeRegCOVID) was launched.The electronic registry uses a web-based electronic case report form. Participation is voluntary and biomaterial remains at the respective site (decentralized biobanking). As of October 2021, the registry included N=1129 autopsy cases, with 69271 single data points including information on 18674 available biospecimens gathered from 29 German sites.In the N=1095 eligible records, the male-to-female ratio was 1·8:1, with peaks at 65-69 and 80-84 years in males and >85 years in females. The analysis of the chain of events directly leading to death revealed COVID-19 as the underlying cause of death in 86% of the autopsy cases, whereas in 14% COVID-19 was a concomitant disease. The most common immediate cause of death was diffuse alveolar damage, followed by multi-organ failure. The registry supports several scientific projects, public outreach and provides reports to the federal health authorities, leading to legislative adaptation of the German Infection Protection Act, facilitating the performance of autopsies during pandemics.A national autopsy registry can provide multicentre quantitative information on COVID-19 deaths on a national level, supporting medical research, political decision-making and public discussion.German Federal Ministries of Education and Research and Health.Hintergrund: Obduktionen sind ein wichtiges Instrument in der Medizin, um die Pathophysiologie von Krankheiten und Todesursachen zu untersuchen. Im Rahmen von COVID-19 wurden durch Obduktionen z.B. die Auswirkungen auf die pulmonale Mikrovaskulatur, das Nervensystem, die systemische Virusausbreitung, und das Zusammenspiel mit dem Immunsystem untersucht. Um multizentrische, auf Obduktionen basierende Studien zu erleichtern und eine zentrale Anlaufstelle zu schaffen, die Obduktionszentren, Forscher sowie Datenanalysen und -berichte unterstützt, wurde im April 2020 das deutsche COVID-19-Autopsieregister (DeRegCOVID) ins Leben gerufen.Methoden: Das elektronische Register verwendet ein webbasiertes elektronisches Fallberichtsformular. Die Teilnahme ist freiwillig und das Biomaterial verbleibt am jeweiligen Standort (dezentrales Biobanking). Im Oktober 2021 umfasste das Register N=1129 Obduktionsfälle mit 69271 einzelnen Datenpunkten, die Informationen über 18674 verfügbare Bioproben enthielten, die von 29 deutschen Standorten gesammelt wurden.Ergebnisse: In den N=1095 ausgewerteten Datensätzen betrug das Verhältnis von Männern zu Frauen 1,8:1 mit Spitzenwerten bei 65-69 und 80-84 Jahren bei Männern und >85 Jahren bei Frauen. Die Analyse der Sequenz der unmittelbar zum Tod führenden Ereignisse ergab, dass in 86 % der Obduktionsfälle COVID-19 die zugrunde liegende Todesursache war, während in 14 % der Fälle COVID-19 eine Begleiterkrankung war. Die häufigste unmittelbare Todesursache war der diffuse Alveolarschaden, gefolgt von Multiorganversagen. Das Register unterstützt mehrere wissenschaftliche Projekte, die Öffentlichkeitsarbeit und liefert Berichte an die Bundesgesundheitsbehörden, was zu einer Anpassung des deutschen Infektionsschutzgesetzes führte und die Durchführung von Obduktionen in Pandemien erleichtert.Interpretation: Ein nationales Obduktionsregister kann multizentrische quantitative Informationen über COVID-19-Todesfälle auf nationaler Ebene liefern und damit die medizinische Forschung, die politische Entscheidungsfindung und die öffentliche Diskussion unterstützen.Finanzierung: Bundesministerien für Bildung und Forschung und für Gesundheit. 

https://doi.org/10.1016/j.lanepe.2022.100330

First report from the German COVID-19 autopsy registry

Abstract The ongoing SARS-CoV-2 pandemic is characterized by poor outcome and a high mortality especially in the older patient cohort. Up to this point there is a lack of data characterising COVID-19 patients in Germany admitted to intensive care (ICU) vs. non-ICU patients. German Reimbursement inpatient data covering the period in Germany from January 1st, 2020 to December 31th, 2021 were analyzed. 561,379 patients were hospitalized with COVID-19. 24.54% (n = 137,750) were admitted to ICU. Overall hospital mortality was 16.69% (n = 93,668) and 33.36% (n = 45,947) in the ICU group. 28.66% (n = 160,881) of all patients suffer from Cardiac arrhythmia and 17.98% (n = 100,926) developed renal failure. Obesity showed an odds-ratio ranging from 0.83 (0.79–0.87) for WHO grade I to 1.13 (1.08–1.19) for grade III. Mortality-rates peaked in April 2020 and January 2021 being 21.23% (n = 4539) and 22.99% (n = 15,724). A third peak was observed November and December 2021 (16.82%, n = 7173 and 16.54%, n = 9416). Hospitalized COVID-19 patient mortality in Germany is lower than previously shown in other studies. 24.54% of all patients had to be treated in the ICU with a mortality rate of 33.36%. Congestive heart failure was associated with a higher risk of death whereas low grade obesity might have a protective effect on patient survival. High admission numbers are accompanied by a higher mortality rate. 

/pdf/characteristics-and-mortality-of-561379-hospitalized-covid-2tcqxti1.pdf

Characteristics and mortality of 561,379 hospitalized COVID-19 patients in Germany until December 2021 based on real-life data

A third SARS-CoV-2 infection wave has affected Germany from March 2021 until April 24th, until the ´Bundesnotbremse´ introduced nationwide shutdown measures. The ´Bundesnotbremse´ is the technical term which was used by the German government to describe nationwide shutdown measures to control the rising infection numbers. These measures included mainly contact restrictions on several level. This study investigates which effects locally dispersed pre- and post-´Bundesnotbremse´ measures had on the infection dynamics. We analyzed the variability and strength of the rates of the changes of weekly case numbers considering different regions, age groups, and contact restrictions. Regionally diverse measures slowed the rate of weekly increase by about 50% and about 75% in regions with stronger contact restrictions. The 'Bundesnotbremse' induced a coherent reduction of infection numbers across all German federal states and age groups throughout May 2021. The coherence of the infection dynamics after the 'Bundesnotbremse' indicates that these stronger measures induced the decrease of infection numbers. The regionally diverse non-pharmaceutical interventions before could only decelerate further spreading, but not prevent it alone.

Effectiveness of extended shutdown measures during the ´Bundesnotbremse´ introduced in the third SARS-CoV-2 wave in Germany.

Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09-9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management.

COVID-19 among Healthcare Workers: A Prospective Serological-Epidemiological Cohort Study in a Standard Care Hospital in Rural Germany.

This article studies how different systems of policy advice are suited to provide relevant knowledge in times of acute crisis. The notion of evidence-based policymaking (EBP) originated in the successful 1997 New Labour program in the United Kingdom to formulate policy based not on ideology but on sound empirical evidence. We provide a brief overview of the history of the concept and the current debates around it. We then outline the main characteristics of the policy advisory systems in Germany, Switzerland, and Italy through which scientific knowledge-in the form of either person-bound expertise or evidence generated through standard scientific processes-was fed into policy formulation processes before the COVID-19 crisis. Whereas EBP takes place in the form of institutionalized advisory bodies and draws on expertise rather than on evidence in Germany, the system in Switzerland focuses more on the use of evidence provided through external mandates. Italy has a hybrid politicized expert system. The article then analyzes how this different prioritization of expertise vs. evidence in the three countries affects policymakers' capacity to include scientific knowledge in policy decisions in times of acute crisis. The comparison of the three countries implies that countries with policy advisory systems designed to use expertise are better placed to incorporate scientific knowledge into their decisions in times of acute crisis than are countries with policy advisory systems that relied primarily on evidence before the COVID-19 crisis.The online version of this article (10.1007/s11615-022-00382-x) contains supplementary material, which is available to authorized users.Dieser Artikel untersucht die Eignung unterschiedlicher Politikberatungssysteme im Hinblick auf die Bereitstellung von relevantem Wissen für politische Entscheidungen in Krisenzeiten. Das Konzept der evidenzbasierten Politikgestaltung (EBP) geht auf das erfolgreiche New-Labour-Programm aus dem Jahr 1997 im Vereinigten Königreich zurück, welches propagierte, dass Politik nicht auf der Grundlage von Ideologie, sondern basierend auf soliden empirischen Erkenntnissen formuliert werden soll. Der Artikel gibt zuerst einen kurzen Überblick über die Geschichte des Konzepts der EBP und die aktuellen Debatten darüber. Anschließend werden die Hauptmerkmale der Politikberatungssysteme in Deutschland, der Schweiz und Italien skizziert, durch die traditionell wissenschaftliche Erkenntnisse in die jeweiligen Politikprozesse einfließen. Dabei wird zwischen personengebundener Expertise und Evidenz aus wissenschaftlichen Analysen unterschieden. Während in Deutschland evidenzbasierte Politikgestaltung in Form von institutionalisierten Beratungsgremien stattfindet, die sich eher auf Expertise stützt, setzt die Schweiz eher auf die Nutzung von Evidenz, die durch externe Mandate bereitgestellt wird. Italien besitzt ein hybrides politisiertes Expertensystem. Der Artikel analysiert, wie sich diese unterschiedliche Priorisierung von Expertise gegenüber Evidenz in den drei Ländern auf die Fähigkeit der politischen Entscheidungsträger*innen auswirkt, in Krisenzeiten wissenschaftliche Erkenntnisse in politische Entscheidungen einzubeziehen. Der Vergleich der drei Länder zeigt, dass Länder mit Politikberatungssystemen, die auf die Nutzung von Expertise ausgerichtet sind, besser in der Lage sind, in Krisenzeiten wissenschaftliche Erkenntnisse in ihre Entscheidungen einfließen zu lassen, als Länder, die sich traditionell in erster Linie auf Evidenz stützen. 

https://link.springer.com/content/pdf/10.1007/s11615-022-00382-x.pdf

Evidence-Based Policymaking in Times of Acute Crisis: Comparing the Use of Scientific Knowledge in Germany, Switzerland, and Italy

Background The second wave of the COVID-19 pandemic led to substantial differences in incidence rates across Germany. Methods Assumption-free k-nearest neighbour clustering from the principal component analysis of weekly incidence rates of German counties groups similar spreading behaviour. Different spreading dynamics was analysed by the derivative plots of the temporal evolution of tuples [x(t),x’(t)] of weekly incidence rates and their derivatives. The effectiveness of the different shutdown measures in Germany during the second wave is assessed by the difference of weekly incidences before and after the respective time periods. Findings The implementation of non-pharmaceutical interventions of different extents resulted in four distinct time periods of complex, spatially diverse, and age-related spreading patterns during the second wave of the COVID-19 pandemic in Germany. Clustering gave three regions of coincident spreading characteristics. October 2020 showed a nationwide exponential growth of weekly incidence rates with a doubling time of 10 days. A partial shutdown during November 2020 decreased the overall infection rates by 20–40% with a plateau-like behaviour in northern and southwestern Germany. The eastern parts exhibited a further near-linear growth by 30–80%. Allover the incidence rates among people above 60 years still increased by 15–35% during partial shutdown measures. Only an extended shutdown led to a substantial decrease in incidence rates. These measures decreased the numbers among all age groups and in all regions by 15–45%. This decline until January 2021 was about -1•25 times the October 2020 growth rates with a strong correlation of -0•96. Interpretation Three regional groups with different dynamics and different degrees of effectiveness of the applied measures were identified. The partial shutdown was moderately effective and at most stopped the exponential growth, but the spread remained partly plateau-like and regionally continued to grow in a nearly linear fashion. Only the extended shutdown reversed the linear growth. Funding Institutional support and physical resources were provided by the University Witten/ Herdecke and Kliniken der Stadt Koln, German ministry of education and research ‘Netzwerk Universitatsmedizin’ (NUM), egePan Unimed (01KX2021).

Different spreading dynamics throughout Germany during the second wave of the COVID-19 pandemic: a time series study based on national surveillance data.

Background: The second wave of the COVID-19 pandemic led to substantial differences in incidence rates across Germany  

Methods: Assumption-free k-nearest neighbour clustering from the principal component analysis of weekly incidence rates of German counties groups similar spreading behaviour Different spreading dynamics was analysed by the derivative plots of the temporal evolution of tuples [x(t),x’(t)] of weekly incidence rates and their derivatives The effectiveness of the different shutdown measures in Germany during the second wave is assessed by the difference of weekly incidences before and after the respective time periods  

Findings: The implementation of non-pharmaceutical interventions of different extents resulted in four distinct time periods of complex, spatially diverse, and age-related spreading patterns during the second wave of the COVID-19 pandemic in Germany Clustering gave three regions of coincident spreading characteristics October 2020 showed a nationwide exponential growth of weekly incidence rates with a doubling time of 10 days A partial shutdown during November 2020 decreased the overall infection rates by 20–40% with a plateau-like behaviour in northern and southwestern Germany The eastern parts exhibited a further near-linear growth by 30–80% Allover the incidence rates among people above 60 years still increased by 15–35% during partial shutdown measures Only an extended shutdown led to a substantial decrease in incidence rates These measures decreased the numbers among all age groups and in all regions by 15–45% This decline until January 2021 was about -1∙25 times the October 2020 growth rates with a strong correlation of -0∙96  

Interpretation: Three regional groups with different dynamics and different degrees of effectiveness of the applied measures were identified The partial shutdown was moderately effective and at most stopped the exponential growth, but the spread remained partly plateau-like and regionally continued to grow in a nearly linear fashion Only the extended shutdown reversed the linear growth

Funding Statement: Institutional support and physical resources were provided by the University Witten/ Herdecke and Kliniken der Stadt Koln, German ministry of education and research ‘Netzwerk Universitatsmedizin’ (NUM), egePan Unimed (01KX2021)

Declaration of Interests: Dr Karagiannidis reports personal fees from Maquet, personal fees from Xenios, personal fees from Bayer, non-financial support from Speaker of the German register of ICUs, grants from German Ministry of Research and Education, during the conduct of the study Dr Schuppert reports grants from Bayer AG, outside the submitted work Dr Jens Karschau has nothing to disclose Dr Polotzek has nothing to disclose Dr Schmitt reports personal fees from Sanofi, Lilly, ALK, Novartis, grants from Sanofi, Pfizer, ALK, Novartis, outside the submitted work Dr Busse reports grants from Berlin University Alliance, non-financial support from German Federal Ministry of Health, during the conduct of the study

Katja Polotzek

Papers

Different spreading dynamics throughout Germany during the second wave of the COVID-19 pandemic: a time series study based on national surveillance data.

Effectiveness of extended shutdown measures during the ´Bundesnotbremse´ introduced in the third SARS-CoV-2 wave in Germany.

Different Spreading Dynamics Throughout Germany During the Second Wave of the COVID-19 Pandemic: Link to Public Health Interventions