[Structure of hospital care for COVID-19 patients up to July 2020 in Germany]

German GPs' Self-Perceived Role in the COVID-19 Pandemic: Leadership, Participation in Regional Services and Preferences for Future Pandemic Preparedness

General practitioners (GPs) played a vital role during the COVID-19 pandemic. Little is known about GPs' view of their role, leadership, participation in regional services and preferences for future pandemic preparedness. This representative study of German GPs comprised a web-based survey and computer-assisted telephone interviewing (CATI). It addressed GPs' satisfaction with their role, self-perceived leadership (validated C-LEAD scale), participation in newly established health services, and preferences for future pandemic preparedness (net promotor score; NPS; range -100 to +100%). Statistical analyses were conducted using Spearman's correlation and Kruskal-Wallis tests. In total, 630 GPs completed the questionnaire and 102 GPs the CATI. In addition to their practice duties, most GPs (72.5%) participated in at least one regional health service, mainly vaccination centres/teams (52.7%). Self-perceived leadership was high with a C-LEAD score of 47.4 (max. 63; SD ± 8.5). Overall, 58.8% were not satisfied with their role which correlated with the feeling of being left alone (r = -0.349, p < 0.001). 77.5 % of respondents believed that political leaders underestimated GPs' potential contribution to pandemic control. Regarding regional pandemic services, GPs preferred COVID-19 focus practices (NPS +43.7) over diagnostic centres (NPS -31). Many GPs, though highly engaged regionally, were dissatisfied with their role but had clear preferences for future regional services. Future pandemic planning should integrate GPs' perspectives.

Coping with COVID-19: the role of hospital care structures and capacity expansion in five countries

This contribution examines the responses of five health systems in the first wave of the COVID-19 pandemic: Denmark, Germany, Israel, Spain and Sweden. The aim is to understand to what extent this crisis response of these countries was resilient. The study focuses on hospital care structures, considering both existing capacity before the pandemic and the management and expansion of capacity during the crisis. Evaluation criteria include flexibility in the use of existing resources and response planning, as well as the ability to create surge capacity. Data were collected from country experts using a structured questionnaire. Main findings are that not only the total number but also the availability of hospital beds is critical to resilience, as is the ability to mobilise (highly) qualified personnel. Indispensable for rapid capacity adjustment is the availability of data. Countries with more centralised hospital care structures, more sophisticated concepts for providing specialised services and stronger integration of the inpatient and outpatient sectors have clear structural advantages. A solid digital infrastructure is also conducive. Finally, a centralised governance structure is crucial for flexibility and adaptability. In decentralised systems, robust mechanisms to coordinate across levels are important to strengthen health care system resilience in pandemic situations and beyond.

Experiences made by family physicians managing patients with SARS-CoV-2 infection during spring 2020 - a cross-sectional analysis

BACKGROUND

In Germany, family physicians care for about 85% of the patients infected with SARS-CoV-2. The geographic distribution of the first wave in 2020 was heterogeneous, and each federal state experienced different percentages of patients that died from COVID-19. Each of the 16 federal states implemented its own regulation about medical care for SARS-CoV-2 infected patients. Against this background, the objective of this analysis was to gather experiences made by primary care physicians managing SARS-CoV-2 infected patients during the first wave in March 2020 and to clinically characterize these patients.

METHODS

In total, 5,632 physicians were invited to participate in an online questionnaire surveying routine data regarding the general care situation at the physician practice level and the care for patients infected with SARS-CoV-2. Bivariate and multivariate analyses were applied to characterize treatment experiences and to identify patient characteristics predicting the course of disease.

RESULTS

132 family physicians from all German federal states (except from Berlin) participated in this analysis (response rate 2.3%) and provided routine care data for 1,085 patients. Information from 373 of these patients were provided in greater detail. On average, each physician treated 8.5 patients infected with SARS-CoV-2. About 15% of the physicians used video consultations to communicate with their infected patients. More than 82% made positive experiences with the exceptional regulation to provide a certificate of incapacity to work by telephone. Half of the physicians faced equipment insufficiencies due to a lack of protective gear, and in 10% of the practices, the staff themselves acquired SARS-CoV-2 infection. Greater numbers of SARS-CoV-2 cases treated in a practice translated into higher odds for members of the practice to get infected (odds ratio (OR) 1.03, 95% CI [1.01;1.06]). Older persons, males and patients in rural areas had higher odds of a severe course of disease.

CONCLUSIONS

Our results show that a large percentage of primary care physicians additionally managed their COVID-19 patients remotely by telephone or video during the outbreak, while also being at a higher risk for SARS-CoV-2 infection. Further, the increased severity in rural areas underlines the importance of strong primary health care in order to enable hospitals to concentrate on critically ill patients.

[Intensive care bed requirements for COVID-19 in the fall/winter of 2021 : Simulation of different scenarios under consideration of incidences and vaccination rates]

Hintergrund

Auch im Herbst 2021 droht trotz der steigenden Impfquoten gegen SARS-CoV-2 aufgrund saisonaler Veränderungen und der damit verbundenen erhöhten Infektionsraten eine erneute Infektionswelle mit einhergehender erneuter möglicher starker Belastung der Intensivmedizin. Im Folgenden sind verschiedene Szenarien mithilfe mathematischer Modelle simuliert, die unter der Annahme bestimmter Voraussetzungen eine Einschätzung hinsichtlich der Auslastung der Intensivbettenkapazitäten im Herbst in bestimmten Grenzen ermöglichen.

Methodik

Die Simulation der Szenarien verwendet ein stationäres Modell, ergänzt um den Effekt der Impfungen. Das altersgruppenspezifische Risikoprofil für einen intensivpflichtigen Krankheitsverlauf wird anhand von Einweisungsdaten der 3. Welle auf Intensivstationen in Sentinel-Kliniken, den lokalen DIVI-Register-Belegungsdaten sowie den entsprechenden lokalen Inzidenzen durch lineare Regression mit Zeitversatz berechnet. Wir simulieren hierbei Impfquoten von 15 % für die U18-Kohorte, 70 % für die 15- bis 34-jährige Kohorte, 75/80/85 % für die Kohorte von 35 bis 59 Jahren sowie 85/90/95 % für die Ü60-Kohorte. Die Simulationen berücksichtigen, dass eine Impfung zu 100 % vor einem intensivpflichtigen Krankheitsverlauf schützt. Für den Schutz vor Infektion der Geimpften wurden die Simulationen zum einen für das Szenario Impfschutz für 70 % der Geimpften und zum anderen für das Szenario Impfschutz für 85 % der Geimpften dargestellt.

Ergebnisse

Die Intensivbettenauslastung verläuft proportional zur Inzidenz. Der Faktor für dieses Verhältnis (Proportionalitätsfaktor) ist höher als in der 2. und 3. Welle, sodass vergleichbare Intensivbettenbelegungen erst bei höherer Inzidenz erreicht werden. Eine 10 %ige Steigerung der Impfquoten der Ü35 auf 85 % und der Ü60 auf 95 % führt zu einer erheblich verringerten Intensivbettenbelegung.

Diskussion

Es besteht auch in den kommenden Monaten eine enge und lineare Beziehung zwischen der SARS-CoV-2-Inzidenz und der Intensivbettenbelegung. Bereits ab Inzidenzen von 200/100.000 ist wieder eine erhebliche Belastung der Intensivstationen mit mehr als 3000 COVID-19-Patienten zu erwarten, sofern die Impfquote nicht noch deutlich gesteigert wird. Wenige Prozentpunkte in der Impfquote haben eine erhebliche Auswirkung auf die potenzielle Intensivbelegung im Herbst, sodass Bemühungen um die Steigerung der Impfakzeptanz in den kommenden Wochen im Vordergrund stehen sollten. Für die Intensivmedizin ist die Impfquote der über 35-Jährigen von entscheidender Bedeutung.

Zusatzmaterial online

Die Online-Version dieses Beitrags (10.1007/s00063-021-00862-9) enthält 3 weitere Abbildungen mit ergänzenden Daten zur Prognose der Intensivbettenbelegung, falls der Impfschutz gegenüber der COVID-19-Infektion auf 70 % reduziert ist.