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Article ; Online: A Comparison of Germany and the United Kingdom Indicates That More SARS-CoV-2 Circulation and Less Restrictions in the Warm Season Might Reduce Overall COVID-19 Burden

David Meintrup / Martina Nowak-Machen / Stefan Borgmann

Life, Vol 12, Iss 953, p

2022 Volume 953

Abstract: 1) Background: Between March 2020 and January 2022 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) caused five infection waves in Europe. The first and the second wave was caused by wildtype SARS-CoV-2, while the following waves were ... ...

Abstract	(1) Background: Between March 2020 and January 2022 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) caused five infection waves in Europe. The first and the second wave was caused by wildtype SARS-CoV-2, while the following waves were caused by the variants of concern Alpha, Delta, and Omicron respectively. (2) Methods: In the present analysis, the first four waves were compared in Germany and the UK, in order to examine the COVID-19 epidemiology and its modulation by non-pharmaceutical interventions (NPI). (3) Results: The number of COVID-19 patients on intensive care units and the case fatality rate were used to estimate disease burden, the excess mortality to assess the net effect of NPI and other measures on the population. The UK was more severely affected by the first and the third wave while Germany was more affected by the second wave. The UK had a higher excess mortality during the first wave, afterwards the excess mortality in both countries was nearly identical. While most NPI were lifted in the UK in July 2021, the measures were kept and even aggravated in Germany. Nevertheless, in autumn 2021 Germany was much more affected, nearly resulting in a balanced sum of infections and deaths compared to the UK. Within the whole observation period, in Germany the number of COVID-19 patients on ICUs was up to four times higher than in the UK. Our results show that NPI have a limited effect on COVID-19 burden, seasonality plays a crucial role, and a higher virus circulation in a pre-wave situation could be beneficial. (4) Conclusions: Although Germany put much more effort and resources to fight the pandemic, the net balance of both countries was nearly identical, questioning the benefit of excessive ICU treatments and of the implementation of NPI, especially during the warm season.
Keywords	COVID-19 ; SARS-CoV-2 ; non-pharmaceutical interventions ; seasonality ; Germany ; UK ; Science ; Q
Subject code	900
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Nine Months of COVID-19 Pandemic in Europe

David Meintrup / Martina Nowak-Machen / Stefan Borgmann

International Journal of Environmental Research and Public Health, Vol 18, Iss 6680, p

A Comparative Time Series Analysis of Cases and Fatalities in 35 Countries

2021 Volume 6680

Abstract: 1) Background: to describe the dynamic of the pandemic across 35 European countries over a period of 9 months. (2) Methods: a three-phase time series model was fitted for 35 European countries, predicting deaths based on SARS-CoV-2 incidences. ... ...

Abstract	(1) Background: to describe the dynamic of the pandemic across 35 European countries over a period of 9 months. (2) Methods: a three-phase time series model was fitted for 35 European countries, predicting deaths based on SARS-CoV-2 incidences. Hierarchical clustering resulted in three clusters of countries. A multiple regression model was developed predicting thresholds for COVID-19 incidences, coupled to death numbers. (3) Results: The model showed strongly connected deaths and incidences during the waves in spring and fall. The corrected case-fatality rates ranged from 2% to 20.7% in the first wave, and from 0.5% to 4.2% in the second wave. If the incidences stay below a threshold, predicted by the regression model ( <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><msup><mi>R</mi><mn>2</mn></msup><mo>=</mo><mn>85.0</mn><mo>%</mo></mrow></semantics></math> ), COVID-19 related deaths and incidences were not necessarily coupled. The clusters represented different regions in Europe, and the corrected case-fatality rates in each cluster flipped from high to low or vice versa. Severely and less severely affected countries flipped between the first and second wave. (4) Conclusions: COVID-19 incidences and related deaths were uncoupled during the summer but coupled during two waves. Once a country-specific threshold of infections is reached, death numbers will start to rise, allowing health care systems and countries to prepare.
Keywords	COVID-19 ; SARS-CoV-2 ; corrected case fatality rate ; time series analysis ; multiple regression ; flip effect ; Medicine ; R
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mumps in the Vaccination Age

Andrea-Ioana Beleni / Stefan Borgmann

International Journal of Environmental Research and Public Health, Vol 15, Iss 8, p

Global Epidemiology and the Situation in Germany

2018 Volume 1618

Abstract: Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several ... ...

Abstract	Vaccination against mumps virus (MuV) (mostly measles-mumps-rubella) is routinely performed in more than 120 countries and has resulted in a distinct decrease of mumps incidence. However, alteration of mumps epidemiology has been observed in several countries after implementation of the vaccine but is sparsely documented. Moreover, outbreaks have occurred after starting vaccination, even in highly vaccinated populations. In the former German Democratic Republic (DDR) mumps was a notifiable disease but vaccination against mumps was not implemented. In the five eastern German states forming the DDR until 1990, mumps was not notifiable until 2001. Except for the lack of reporting between 1990–2000, data from Eastern Germany allow analysis of mumps epidemiology after initiating the vaccination campaign. For the period from 2001 to 2016 the data show that the incidence of mumps dropped notably after initiating vaccines, and was accompanied by an increase of the median age of patients with mumps. In Eastern Germany, no outbreaks were noted, while several outbreaks occurred in Western Germany, possibly due to a lower vaccination rate. Further literature analysis revealed that outbreaks were facilitated by waning immunity and crowding. Nevertheless, although vaccination prevented infection, the course of illness, once infected, was sometimes more complicated. In comparison to non-vaccinated populations, high rates of complicated courses occurred and were marked by orchitis, due to higher age of mumps patients. Therefore, refusing vaccination against mumps increases the risk of severe courses when living in a vaccinated population.
Keywords	Jeryl Lynn ; Leningrad-Zagreb ; measles-mumps-rubella vaccination ; orchitis ; Urabe ; vaccination effectiveness ; waning immunity ; Medicine ; R
Language	English
Publishing date	2018-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Long-Lasting Decrease of the Acquisition of Enterococcus faecium and Gram-Negative Bacteria Producing Extended Spectrum Beta-Lactamase (ESBL) by Transient Application of Probiotics

Stefan Borgmann / Beate Rieß / David Meintrup / Ingo Klare / Guido Werner

International Journal of Environmental Research and Public Health, Vol 17, Iss 6100, p

2020 Volume 6100

Abstract: Previously it was shown that application of probiotics stopped the acquisition of vancomycin-resistant Enterococcus faecium (VRE) by patients in an early rehabilitation ward. Once the application of probiotics ended, we examined whether acquisition of ... ...

Abstract	Previously it was shown that application of probiotics stopped the acquisition of vancomycin-resistant Enterococcus faecium (VRE) by patients in an early rehabilitation ward. Once the application of probiotics ended, we examined whether acquisition of VRE reoccurred. Furthermore, we examined whether probiotics altered prevalence of vancomycin-susceptible E. faecium (VSE) and Gram-negative bacteria, which produce extended spectrum beta-lactamase (ESBL). Although probiotic application ceased in April 2018, VRE-colonized patients rarely presented on that ward until 2019. Probiotic treatment also resulted in a decreased number of patients with VSE and ESBL. While decreased incidence of VRE occurred immediately, decreased VSE and ESBL numbers occurred months later. A probiotic-mediated decrease of VSE and ESBL incidence cannot be explained when assuming bacterial transmission exclusively as a linear cause and effect event. The decrease is better understood by considering bacterial transmissions to be stochastic events, which depend on various driving forces similar to an electric current. We hypothesize that VRE, VSE and ESBL uptake by patients and by staff members mutually reinforced each other, leading staff members to form a bacterial reservoir, similar to a condenser that stores electrical energy. Probiotic treatment then inhibited regeneration of that store, resulting in a breakdown of the driving force.
Keywords	colonic bacteria ; Enterococcus faecium ; vancomycin-resistant Enterococcus faecium ; vancomycin-susceptible E. faecium ; Staphylococcus aureus ; beta-lactamase ; Medicine ; R
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Incidence and Death Rates from COVID-19 Are Not Always Coupled

Stefan Borgmann / David Meintrup / Kerstin Reimer / Helmut Schels / Martina Nowak-Machen

Healthcare, Vol 9, Iss 338, p

An Analysis of Temporal Data on Local, Federal, and National Levels

2021 Volume 338

Abstract: SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data ...

Abstract	SARS-CoV-2 has caused a deadly pandemic worldwide, placing a burden on local health care systems and economies. Infection rates with SARS-CoV-2 and the related mortality of COVID-19 are not equal among countries or even neighboring regions. Based on data from official German health authorities since the beginning of the pandemic, we developed a case-fatality prediction model that correctly predicts COVID-19-related death rates based on local geographical developments of infection rates in Germany, Bavaria, and a local community district city within Upper Bavaria. Our data point towards the proposal that local individual infection thresholds, when reached, could lead to increasing mortality. Restrictive measures to minimize the spread of the virus could be applied locally based on the risk of reaching the individual threshold. Being able to predict the necessity for increasing hospitalization of COVID-19 patients could help local health care authorities to prepare for increasing patient numbers.
Keywords	time series analysis ; COVID-19 incidence ; case-fatality rate ; herd immunity ; Upper Bavaria ; Medicine ; R
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Age and Comorbidity Burden of Patients Critically Ill with COVID-19 Affect Both Access to and Outcome of Ventilation Therapy in Intensive Care Units

Marie Louise de Hesselle / Stefan Borgmann / Siegbert Rieg / Jörg Janne Vehreschild / Sebastian Rasch / Carolin E. M. Koll / Martin Hower / Melanie Stecher / Daniel Ebert / Frank Hanses / Julia Schumann / on behalf of the LEOSS Study Group

Journal of Clinical Medicine, Vol 12, Iss 2469, p

2023 Volume 2469

Abstract: During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome ... ...

Abstract	During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient’s age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient’s wishes.
Keywords	COVID-19 ; SARS-CoV-2 ; age ; comorbidities ; intensive care medicine ; ventilation ; Medicine ; R
Subject code	616
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients

Marie Louise de Hesselle / Stefan Borgmann / Siegbert Rieg / Jörg Janne Vehreshild / Christoph D. Spinner / Carolin E. M. Koll / Martin Hower / Melanie Stecher / Daniel Ebert / Frank Hanses / Julia Schumann / on behalf of the SAREL Investigators

Journal of Clinical Medicine, Vol 11, Iss 5239, p

2022 Volume 5239

Abstract: Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on ... ...

Abstract	Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.
Keywords	COVID-19 ; SARS-CoV-2 ; multidrug-resistant pathogens ; bacterial infections ; fungal infections ; secondary infections ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-09-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Specific Risk Factors for Fatal Outcome in Critically Ill COVID-19 Patients

David Meintrup / Stefan Borgmann / Karlheinz Seidl / Melanie Stecher / Carolin E. M. Jakob / Lisa Pilgram / Christoph D. Spinner / Siegbert Rieg / Nora Isberner / Martin Hower / Maria Vehreschild / Siri Göpel / Frank Hanses / Martina Nowak-Machen

Journal of Clinical Medicine, Vol 10, Iss 3855, p

Results from a European Multicenter Study

2021 Volume 3855

Abstract: 1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable ... ...

Abstract	(1) Background: The aim of our study was to identify specific risk factors for fatal outcome in critically ill COVID-19 patients. (2) Methods: Our data set consisted of 840 patients enclosed in the LEOSS registry. Using lasso regression for variable selection, a multifactorial logistic regression model was fitted to the response variable survival. Specific risk factors and their odds ratios were derived. A nomogram was developed as a graphical representation of the model. (3) Results: 14 variables were identified as independent factors contributing to the risk of death for critically ill COVID-19 patients: age (OR 1.08, CI 1.06–1.10), cardiovascular disease (OR 1.64, CI 1.06–2.55), pulmonary disease (OR 1.87, CI 1.16–3.03), baseline Statin treatment (0.54, CI 0.33–0.87), oxygen saturation (unit = 1%, OR 0.94, CI 0.92–0.96), leukocytes (unit 1000/ <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mi mathvariant="sans-serif">μ</mi></semantics></math> L, OR 1.04, CI 1.01–1.07), lymphocytes (unit 100/ <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mi mathvariant="sans-serif">μ</mi></semantics></math> L, OR 0.96, CI 0.94–0.99), platelets (unit 100,000/ <math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mi mathvariant="sans-serif">μ</mi></semantics></math> L, OR 0.70, CI 0.62–0.80), procalcitonin (unit ng/mL, OR 1.11, CI 1.05–1.18), kidney failure (OR 1.68, CI 1.05–2.70), congestive heart failure (OR 2.62, CI 1.11–6.21), severe liver failure (OR 4.93, CI 1.94–12.52), and a quick SOFA score of 3 (OR 1.78, CI 1.14–2.78). The nomogram graphically displays the importance of these 14 factors for mortality. (4) Conclusions: There are risk factors that are specific to the subpopulation of critically ill COVID-19 patients.
Keywords	COVID-19 ; SARS-CoV-2 ; risk factors ; critically ill patients ; comorbidities ; lasso regression ; Medicine ; R
Subject code	610
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hospitalized patients dying with SARS-CoV-2 infection-An analysis of patient characteristics and management in ICU and general ward of the LEOSS registry.

PLoS ONE, Vol 17, Iss 7, p e

2022 Volume 0271822

Abstract: Background COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients ... ...

Abstract	Background COVID-19 is a severe disease with a high need for intensive care treatment and a high mortality rate in hospitalized patients. The objective of this study was to describe and compare the clinical characteristics and the management of patients dying with SARS-CoV-2 infection in the acute medical and intensive care setting. Methods Descriptive analysis of dying patients enrolled in the Lean European Open Survey on SARS-CoV-2 Infected Patients (LEOSS), a non-interventional cohort study, between March 18 and November 18, 2020. Symptoms, comorbidities and management of patients, including palliative care involvement, were compared between general ward and intensive care unit (ICU) by univariate analysis. Results 580/4310 (13%) SARS-CoV-2 infected patients died. Among 580 patients 67% were treated on ICU and 33% on a general ward. The spectrum of comorbidities and symptoms was broad with more comorbidities (≥ four comorbidities: 52% versus 25%) and a higher age distribution (>65 years: 98% versus 70%) in patients on the general ward. 69% of patients were in an at least complicated phase at diagnosis of the SARS-CoV-2 infection with a higher proportion of patients in a critical phase or dying the day of diagnosis treated on ICU (36% versus 11%). While most patients admitted to ICU came from home (71%), patients treated on the general ward came likewise from home and nursing home (44% respectively) and were more frequently on palliative care before admission (29% versus 7%). A palliative care team was involved in dying patients in 15%. Personal contacts were limited but more often documented in patients treated on ICU (68% versus 47%). Conclusion Patients dying with SARS-CoV-2 infection suffer from high symptom burden and often deteriorate early with a demand for ICU treatment. Therefor a demand for palliative care expertise with early involvement seems to exist.
Keywords	Medicine ; R ; Science ; Q
Subject code	616 ; 610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation of Outbreak Start

Ulrich Sagel / Berit Schulte / Peter Heeg / Stefan Borgmann

Emerging Infectious Diseases, Vol 14, Iss 2, Pp 317-

2008 Volume 319

Abstract: On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs (≈1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we ... ...

Abstract	On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs (≈1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method.
Keywords	vancomycin resistance ; cost analysis ; disease outbreaks ; Germany ; dispatch ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2008-02-01T00:00:00Z
Publisher	Centers for Disease Control and Prevention
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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