Working groups in the Competence Network Public Health Covid-19
The COVID-19 Public Health Research Network is an ad hoc consortium of more than 25 scientific societies and organisations that are active in the field of public health. They bring together their expertise in research methods, epidemiology, statistics, social sciences, demography, and medicine.
The task of the WGs is to work on COVID-19 relevant topics and to network with each other, with other scientists and with other institutions. The WGs work on topics and publish "products" (e.g. so-called policy briefs). We started with 13 WGs in March 2020.
Coordination: Prof. André Karch, Dr. Alexander Kuhlmann and Dr. Berit Lange
In order to understand the spread of infections at the population level, dynamic mathematical models are needed which simulate infection spread processes based on the available evidence. These models are continuously used in the context of the COVID-19 pandemic, and play an important role in the assessment of the effects of non-pharmacological interventions (NPI) at the population level. As knowledge increases over the course of the pandemic, more complex models can be used that can more accurately represent individual aspects of infection transmission and the effectiveness of initiated measures. In addition, the models can also investigate side effects of the NPIs and thus provide a platform for comparing different transition strategies.
The working group covers the following sub-topics.
- Development of a harmonized modelling platform at population level
- Investigation of the change in contact behavior as a basis for model parameterization
- Investigation of the effectiveness of non-pharmacological interventions (NPI) at population level
- Comparative simulation of transition strategies and long-term infection control concepts
- Derivation of further important measures based on model results (resources in the health care system, Years of Life Lost, excess mortality, DALYs)
Coordination: PD Dr. Verina Wild, PD Dr. Jan-Christoph Heilinger and Prof. Georg Marckmann
Indirect health effects of infection control measures
Coordination: Prof. Nico Dragano and Prof. Barbara Hoffmann
Social and economic crises have always had health consequences. When people's living conditions worsen, for example, because they become unemployed, their psychosocial and physical stress increase. In this context, the risk for numerous diseases (e.g. heart disease, depression) increases. When considering the health impact of far reaching measures, as in the protection against infection, this effect must be taken into account and evaluated on the basis of solid scientific evidence. Hence, those responsible can calculate possible health "follow-up costs" in their decisions and take them into account. The working group deals with this topic. Currently, the following subtopics are covered:
- Health consequences of increased unemployment or increased precarious employment
- Social inequalities in COVID-19 related health risks
- Findings from previous economic crises
- Consequences for environmental health
Health aspects of social isolation
Coordination: Prof. Steffi Riedel Heller, Prof. Andreas Seidler and Prof. Christian Apfelbacher
The current contact restrictions to avoid spreading the new coronavirus may lead to social isolation. Chronically-ill people, older people in assisted living facilities or nursing homes, and people in home isolation are particularly affected. Social isolation generates psychological stress with consequences for mental health.. In addition, cardiovascular diseases can develop or can be exacerbated, and last but not least, an increase in mortality due to social isolation has been described. The working group deals with the following subtopics:
- Psychological risks and consequences through social isolation
- Social isolation as a mortality risk
- Sedentary lifestyle and cardiovascular risks with social isolation (in cooperation with the working group “Indirect health effects of infection control measures”)
- Public mental health interventions to reduce the psychosocial consequences of the Covid-19 pandemic
- Age as an "isolation criterion" - effects on older employees (in cooperation with the working group “Work and Health”)
- Domestic violence
- Health and development of children and adolescents in crisis
Risk communication and risk perception
Coordination: Prof. Martin Härter (Hamburg)
Our working group primarily deals with the following questions:
- How can we communicate about the COVID-19 pandemic and its inherent risk in or-der to help citizens best understand the pandemic’s implications and adopt as well as maintain necessary behavioral and preventive measures as long as required?
- What rules should effective risk communication follow in the COVID 19 pandemic in order to promote responsible and community-oriented behavior of citizens?
- Can ineffective or confusing communication of risks cause harm, e.g "campaign fa-tigue" and non-compliance with behavioral and preventive measures?
Coordination: Prof. Kayvan Bozorgmehr and Prof. Sabine Oertelt-Prigione
From the perspective of equal health opportunities, the consideration of vulnerability during the course of the Sars-CoV2 pandemic is of great importance. On the one hand, vulnerability can be biologically determined and include groups of people who, due to their age or previous illnesses, are considered to be a classic “risk group” for serious consequences of an infection with Sars-CoV2. On the other hand, certain settings, contexts and socio-economic conditions can increase the risk of infection or the serious consequences of a COVID-19 disease manifestation in people who do not belong to the classic risk groups. Examples include working and living conditions that do not, or only to a limited extent, enable "social distancing" and self-isolation. Finally, the measures to curb the spread of Sars-CoV2 can in turn create "new" vulnerabilities or exacerbate existing ones. The working group summarizes and synthesizes scientific evidence, for example on the following sub-topics:
- Migration, Flight, and (precarious) labor migration
- Housing and homelessness
- Social disadvantage and deprivation
- (Domestic) violence
Health and work
Coordination: Prof. Volker Harth and Prof. Peter Angerer
People face a variety of physical and psychological stresses and strain factors at their workplace. These are closely interrelated between working and living environments, as well as between health and disease.
In the pandemic situation, there are a number of specific questions about how to deal with the risk of infection in the workplace, as well as with the risk on the way to work, which cannot simply be answered with the general rules. In a public health-oriented approach, it is particularly important to maintain the physical and mental health as well as the performance of working people during a pandemic. To this end, measures must be derived on a scientific basis, taking somatic, psychological and social factors into equal account.
In cooperation with various scientific disciplines, the "Health and Work" working group will therefore critically evaluate the available scientific evidence and design concrete recommendations for action, with which not only those responsible in politics and society, but also the general population receive relevant information on individual prevention and health promotion at the workplace.
With the involvement of various scientific disciplines, the "Health and Workplace" working group established sub-working groups in the following subject areas:
- Risk groups in the company, operational risk assessment
- Technical, organizational, and personal protective measures
- Home office / virtual work
- Social isolation and age as an isolation criterion
- Mental workloads during the COVID-19 pandemic (for workers in the regular workplace)
Effectiveness and side effects of non-pharmacological intervention (NPIs)
Coordination: Prof. Dr. Gerald Gartlehner and Prof. Dr. Uwe Siebert
In response to the COVID-19 pandemic, various non-pharmacological interventions (NPIs), such as school closures, imposing curfew, contact restriction or the wearing of mouth and nose protection, have been put in place. Measures for contact tracing have also been discussed. These measures have intended and unintended effects on individual and public health. The expected effectiveness in terms of reducing the speed of propagation, morbidity and mortality is directly opposed by health, social and economic side effects with ethical and legal implications. In this context, there is a need for (1) an evidence-based evaluation of the effectiveness and side effects of NPIs and (2) a professional, explicit, transparent, interdisciplinary and democratic balancing of the effectiveness and unintended effects of the NPIs. Due to the inevitable indication that the COVID-19 pandemic will be among us for months or even years to come, a forward-looking long-term perspective is urgently needed in addition to short-term policy advice. The following sub-themes are currently planned:
- Evaluation of the effectiveness of NPIs
- Evaluation of the side effects of NPIs
- Evidence-based approaches to balance effectiveness (benefits) and side effects (harms)
- Quality assurance of rapid reviews and original empirical studies on NPIs
The working group sees itself as a platform for interdisciplinary exchange between other working groups and for international exchange with other networks. The instruments of evidence-based medicine and health technology assessment, among others, are used in the evaluation of studies, the synthesis of study results and the systematic weighing of the consequences of NPIs. Among other aspects, the activities are intended to serve the evidence-based prioritization of necessary research projects.
Coordination: Prof. Eva Bitzer and Prof. Christian Apfelbacher
Health literacy essentially describes the individual ability to access, to understand, to appaise and apply health information for good health-related decisions. Distinct personal health literacy is a resource which is expressed in adequate health decisions, and thus supports the maintenance and promotion of health. Individual health literacy can be taught. The question is, which of the strategies identified as effective in other fields are promising in the context of COVID-19. The following subtopics currently covered are:
- How can you spread reliable information as widely as possible?
- How can you communicate uncertainty in an understandable way?
To deal with false information and disinformation:
- Misinformation – how to quantify and observe
- The correction of misinformation (how, who, effectiveness)
- The role of fact checking
Requirements for the German Healthcare System
Coordination: Prof. Dagmar Starke, Prof. Andrea Icks und Dr. Melanie Messer
The working group wants to retrospectively and prospectively analyze the provision of COVID related health care in Germany. This includes the direct care provision, the care provision structures, the flow of information, management of regional and cross-regional cross-sectoral care provision, health economics and patient participation. In particular, we will deal with the question of ways to promote evidence-based government action and data-based management of the distribution of resources in the health care system in times of crisis, i.e. in times of uncertainty. Further key areas of focus will be to analyze the impact of the corona crisis on the care of other disease patterns (e.g. elective surgery, strokes, myocardial infarctions, diabetes) and to design concepts that minimize underprovision, misprovision and overprovision.
The working group is dedicated to prospective and retrospective analyses of the provision of COVID related health care with respect to health economics, demand planning and (regional) care structures and their organization. An important topic are the necessary and reasonable precautions for crisis situations. The first current studies on these topics have been started and the working group will follow the activities and will include (interim) results of these studies in the analysis.
- Which consequences does the switch to COVID-19 patients have for clinics and patients with other (chronic diseases) in the short and medium term (collateral damage)? Which need for change can be derived from recent experiences in the corona crisis, to ensure good treatment quality for all patients in Germany?
- How effective and valid was the information provided? What information flows are necessary for effective management? Based on what information can the fine tuning of opening measures and the monitoring of their effects, if necessary regionally differentiated, be successful? How can the German health care system prepare itself organizationally and administratively for coping with future crisis situations? This also includes legal and financial issues.
- Which institutions, which structures, capacities, equipment, materials and personnel must be provided regionally and additionally financed to be able to react appropriately and quickly in crisis situations?
Coordination: Dr. Verena Hoffmann, Prof. Carsten Oliver Schmidt, Dr. Irene Schmidtmann
In addition to questions of modelling the pandemic and the resulting recommendations, the pandemic and the measures taken to contain it, pose many methodological challenges. On the one hand, ongoing studies are adversely affected, and on the other hand, there is a need for guidance on the harmonized establishment of new COVID-19 related studies.
The working group on methods will focus on these challenges with the following main points:
- Clinical trials, especially randomized controlled trials (RCTs), often cannot be continued according to protocol, e.g. if patients cannot attend study visits as planned. Furthermore, study endpoints may be affected by the pandemic. The disruptions in the course of the study and effects on study endpoints can lead to bias in the study results. Nevertheless, it is desirable to use the information already obtained and to continue studies as far as possible.
- Epidemiological observational and intervention studies face similar problems, especially if parameters such as quality of life, exercise or nutrition are to be compared before intervention with the corresponding parameters after intervention. The interruption of studies in cohort studies currently underway (Nako, EPIC, SHIP, GHS, KORA, ...) also poses methodological problems that need to be addressed. This also includes a reference to secondary data.
- With the start of numerous population-based and clinical-epidemiological studies on the COVID-19 pandemic, new methodological requirements with regard to design and analysis arise, for example due to still existing uncertainty regarding the sensitivity and specificity of the tests, incomplete testing or also selection effects in the recruitment of study participants. At the same time, care must be taken to ensure that studies are implemented with the greatest possible comparability and are F.A.I.R. as far as possible.
Methodological and statistical guidance documents will result from the work in cooperation with the professional associations and national and international initiatives.
Nursing, Health, Ageing
Coordination: Dr. Annett Horn and Prof. Thomas Fischer
Nursing care makes substantial contributions in all health care settings and includes health promotion, prevention, education and counselling as well as acute and chronic care. Nurses provide care for persons across the life span but in particular bear responsibility for those with ongoing needs, who are often older persons. Therefore, registered nurses are often at the forefront in dealing with the effects of the COVID-19 pandemic. Furthermore, family members and other informal carers are also crucial for the provision of social care at home.
The COVID-19 disease leads to pronounced, complex care needs, that often cannot be adequately met by standard concepts of care. Concurrently, resources provided for nursing care are often lacking and consequences of a decade-long shortage of qualified nurses have become palpable. Increased pressure and strain on nurses lead to increased morbidity in the profession and the COVID-19-pandemic is even associated with increased mortality. Varying degrees of health literacy in the population influence, among other factors, the requirements for nursing and social care. Digital health offerings can provide opportunities for the development of nursing and social care.
The spectrum of the working group mainly covers the following topics:
- Promotion of health, social participation and health and social care of older persons during the COVID-19 pandemic.
- Opening of residential care facilities / care homes.
- Effects of the pandemic and containment measures on:
residents and users of residential and community care, palliative care and end-of-life care; for example, in terms of morbidity, mortality, care needs, social participation and quality of life,
nurses, for example in terms of strains and workload, morbidity and mortality,
availability of resources and supply processes in health care organisations.
- Contributing factors of COVID-19 clusters in residential and community care / protective factors.
- Situation of and support measures for family members and other informal carers, especially in community care.
- Demand-oriented concepts for nursing care and necessary qualifications for the acute care of COVID-19 patients in acute and rehabilitation hospitals.
- Institutional changes to the health sector, in particular regarding the collaboration between physicians and nurses, co-operative models of health care provision.
- The role of nurses in public health services and in the field of community-based infection control.
Cross-sectional working group Rapid Reviews
Coordination: Prof. Andreas Seidler, Prof. Christian Apfelbacher, Dr. Barbara Nußbaumer-Streit
Many policy briefs of the Competence Network Public Health on COVID-19 are based on systematic evidence syntheses. Often rapid review methods are used to produce these evidence syntheses faster. The aim of the cross-sectional working group Rapid Reviews is to promote the exchange of scientists on systematic evidence syntheses methods (with a focus on rapid review methods) within the competence network. For this purpose, close coordination with the Cochrane Rapid Reviews Methods Group (RRMG) is sought. While Cochrane Reviews are often related to clinical questions, the reviews of the competence network also refer to etiological questions. Very different approaches are often used when adapting Risk of Bias procedures or GRADE assessment to etiological questions. The working group is striving for a standardization, which can be used also for questions beyond COVID-19.
In many countries around the world extensive and partly drastic measures have been taken to curb the spread of the pandemic, to break the chains of infection and, above all, not to overload the healthcare capacity - with varying degrees of success. During this time, social life has largely come to a standstill, including in Germany. In the meantime, lockdowns restrictions have eased, but in many cases new restrictions were imposed later-on as well. What comes next, which scenarios and strategies are being discussed, and what are the effects of different approaches? The working group deals with various transition scenarios and – in close cooperation with other groups - studies the associated measures and their potential consequences.
Coordination: Prof. Hajo Zeeb and Prof. Ansgar Gerhardus
- Overview of the most important scenarios discussed
- Structured analysis of individual scenarios with regard to epidemiological, social and economic consequences and effects on the healthcare system
- Health impact assessments of individual scenarios based on experience in other countries
- COVID-19 apps