Critical Examination of the Exaggerated SARS-Cov-2 Test Strategy
Main Article Content
Abstract
With SARS-CoV-2 in 2019 a coronavirus started circulating, for which the population showed no specific defense mechanisms of the immune system due to its clear distinction from the previously circulating coronavirus strains. Nevertheless, in 2021 there was a significant decrease in respiratory infections with a simultaneous significant increase in pandemic-related SARS-CoV-2 infections found. There is also a reduction in reported cases of respiratory diseases, especially in the pandemic year 2021. The aim of this retrospective cohort study is to show optimizations in the test strategy during a pandemic and thus derive the improvement of civil protection.
For Evaluation the data of the German center of Disease Control (RKI) by the GrippeWeb, the RKI’s Survstat® tool and the RKI’s reporting data on the new coronavirus were used. In addition, an evaluation of billing data from the EBM (Uniform Value Scale) from 2017 to 2022 for the GOP (fee schedule item) 32816 as well as an evaluation of data on sick leave and illness statistics from 2019 to 2021 and the consideration of inpatient and outpatient health costs based on the data requested in writing from the Federal Ministry of Health was performed.
The data from the Influenza Working Group shows an average of 300,000 annual reports for ARI (Acute respiratory infection) per year. In 2019 it increased to 1,985,985 reports, in 2020 (5,453,017) and in 2021 to 29,681,158. There is also a correlation between the SARS-CoV-2 test frequency and the positive results, as well as an increase in the previously 6% positive rate for SARS-CoV-2 to over 50% in 2022. At the same time decreases the medical burden due to ARI contrary to the increase of the acute respiratory diseases reported to the RKI with 2684%.
What has been neglected so far is that corona viruses (HCoV) have been responsible for around 5-10% of acute respiratory infections for decades. The comprehensive Covid-19 control measures, including the obligation to wear masks, apparently had no significant impact on reducing the spread of Covid-19, since there was also no decrease in infections with the adenovirus or RS virus in 2020 and 2021. Furthermore, an infection positive rate should not be used as a criterion for infection avoidance strategies and the recording of test results should always be validated and controlled. Only the testing of symptomatic persons should be remunerated and only these validated test results should be considered in the registration. In addition, the DIVI register for the inpatient area with recording of the main admission diagnosis and the data from the electronic transmission of sick notes to the health insurance companies for the outpatient area could be used in real time to decide on containment measures in the context of the pandemic.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2 Hu B et al. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2021;19: 141–154.
3 https://www.aerzteblatt.de/nachrichten/111000/WHO-bezeichnet-Ausbruch-des-neuen-Coronavirus-nun-als-Pandemie , Accessed: January 15, 2023.
4 Alm E et al. Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European region, January to June 2020. Eurosurveillance. 2020;25:2001410.
5 Spiteri G et al. First cases of coronavirus disease 2019 (COVID-19) in the WHO European region, 24 January to 21 February 2020. Eurosurveillance. 2020;25:2000178.
6 Böhmer MM et al. Investigation of a COVID-19 outbreak in Germany resulting from a single travel-associated primary case: a case series. The Lancet Infectious Diseases, 2020:920–928.
7 https://countrymeters.info/de/World , Accessed: January 15, 2023.
8 https://coronavirus.jhu.edu/map.html , Accessed: January 15, 2023.
9 https://experience.arcgis.com/experience/478220a4c454480e823b17327b2bf1d4 , Accessed: January 15, 2023.
10 Karg MV, Alber B, Kuhn C, Bohlinger K, Englbrecht M, Dormann H. SARS-CoV-2, Influenza und Norovirus - Die Klinikperspektive im Vergleich. MedKlin IntensivmedNotfmed. 2022;117:209–217. https://doi.org/10.1007/s00063-021-00783-7.
11 Eigner. U, Verstraeten T, Weil J. Decrease in norovirus infections in Germany following COVID-19 containment measures. Letters to the Editor / Journal of Infection. 2021; 82:276–316
12 https://influenza.rki.de/Diagrams.aspx?agiRegion=0 , Accessed: January 26, 2023.
13 https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/Fallzahlen_Gesamtuebersicht.html , Accessed: January 26, 2023.
14 https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Daten/Testzahlen-gesamt.xlsx?__blob=publicationFile , Accessed: January 26, 2023.
15 Arbeitsunfähigkeit: Fälle und Tage nach Diagnosen 2020. Ergebnisse der Krankheitsartenstatistik der gesetzlichen Krankenversicherung. www.bundesgesundheitsministerium.de. S 1-48, Accessed: January 26, 2023.
16 Arbeitsunfähigkeit: Fälle und Tage nach Diagnosen 2019. Ergebnisse der Krankheitsartenstatistik der gesetzlichen Krankenversicherung. www.bundesgesundheitsministerium.de. S 1-52, Accessed: January 26, 2023.
17 Meyer M., Wing L., Schenkel A. Krankheitsbedingte Fehlzeiten in der deutschen Wirtschaft im Jahr 2021. Springer-Verlag GmbH, B. Badura et al. (Hrsg.), Fehlzeiten-Report 2022. Fehlzeiten-Report: 327ff. https://doi.org/10.1007/978-3-662-65598-6_19.
18 Grobe TG, Braun A, BARMER Gesundheitsreport 2022 Schriftenreihe zur Gesundheitsanalyse – Band 34. aQua – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH, 2023:44-59.
19 Grobe TG., Bessel S. Gesundheitsreport 2022 – Arbeitsunfähigkeiten, Herausgeber: Techniker Krankenkasse. aQua – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen GmbH. 2023: 21-34
20 https://www.rki.de/DE/Content/Infekt/Sentinel/Grippeweb/grippeweb_node.html , Accessed: January 26, 2023.
21 https://survstat.rki.de/Content/Query/Create.aspx , Accessed: January 26, 2023.
22 Steffen R, Lautenschlager S, Fehr J. Travel restrictions and lockdown during the COVID-19 pandemic-impact on notified infectious diseases in Switzerland. J Travel Med. 2020;27(8):taaa180.
23 Wu D, Liu Q, Wu T, Wang D, Lu J. The impact of COVID-19 control measures on the morbidity of varicella, herpes zoster, rubella and measles in Guangzhou, China. Immun Inflamm Dis. 2020;8(4):844–846.
24 de Miguel Buckley R, Trigo E, de la Calle-Prieto F, Arsuaga M, Diaz-Menendez M. Social distancing to combat COVID-19 led to a marked decrease in food-borne infections and sexually transmitted diseases in Spain. J Travel Med. 2020;27(8):taaa134
25 Zhu N, Zhang D, Wang W. et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. Engl J Med. 2020;382(8):727-733. doi: 10.1056/NEJMoa2001017.
26 Lamb RA, Choppin PW. The gene structure and replication of influenza virus. In: Annual Review of Biochemistry. 1983.52;467–506,
27 Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 2020;368 (6493):860–8.
28 Bjørnskov, Christian. 2021a. “Did Lockdown Work? An Economist’s Cross-Country Comparison.” CESifo Economic Studies (00):14. https://doi.org/10.1093/cesifo/ifab003.
29 Chaudhry, Rabail, George Dranitsaris, Talha Mubashir, Justyna Bartoszko, and Sheila Riazi. 2020. “A Country Level Analysis Measuring the Impact of Government Actions, Country Preparedness and Socioeconomic Factors on COVID-19 Mortality and Related Health Outcomes.” EClinicalMedicine. 2020;25:100464. https://doi.org/10.1016/j.eclinm.2020.100464.
30 Herby, Jonas, Lars Jonung, and Steve H. Hanke. “Protocol for ‘What Does the First XX Studies Tell Us about the Effects of Lockdowns on Mortality? A Systematic Review and Meta-Analysis of COVID-19 Lockdowns.’” SSRN Electronic Journal. 2021. https://doi.org/10.2139/ssrn.3872977.
31 Mccafferty, Sean, and Sean Ashley. “Covid-19 Social Distancing Interventions by Statutory Mandate and Their Observational Correlation to Mortality in the United States and Europe.” Pragmatic and Observational Research. 2021. 4:15–24. https://doi.org/10.2147/POR.S298309.
32 Jefferson T, Del Mar CB, Dooley L, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews. 2020: 11. Art. No.: CD006207. DOI: 10.1002/14651858.CD006207.pub5.
33 Park S, Lee Y, Michelow IC, Choe YJ. Global Seasonality of Human Coronaviruses: A Systematic Review. Open forum infectious diseases 2020;7(11):ofaa443.
34 Biere B, Djin-Ye O, Wolff T, Dürrwald R. Surveillance of endemic human Coronaviruses in Germany, 2019/2020. The Lancet Regional Health – Europe. 2021; 11:100262.
35 Lübbert C. et al. PCR-Tests auf SARS-CoV-2. Deutsches Ärzteblatt. 2020,117, 31–32: A 1513.
36 Gillissen A. Übersicht zu Sensitivität und Spezifität des SARS-CoV-2-Nachweises mittels PCR. Pneumo News. 2020;12(5):21-23. doi: 10.1007/s15033-020-1912-4.
37 Corman VM, Landt O, Kaiser M. et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3):pii=2000045. https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045.
38 https://de.statista.com/statistik/daten/studie/1183325/umfrage/anteil-positiver-testergebnisse-auf-das-coronavirus-in-deutschland/ , Accessed: January 26, 2023.
39 Arbeitsgemeinschaft Influenza. Bericht zur Epidemiologie der Influenza in Deutschland Saison 2017.18:7-9
40 https://tropeninstitut.de/aktuelle-krankheitsmeldungen/31.12.2021-welt-omikron#studien , Accessed: January 26, 2023.
41 Pezzullo AM, Axfors C, Contopoulos-Ioannidis DG, Apostolatos A, Ioannidis JPA. Age-stratified infection fatality rate of COVID-19 in the non-elderly population. Environ Res. 2023;1:216(Pt 3):114655. doi: 10.1016/j.envres.2022.114655.
42 Dorn F, Fuest C, Gstrein D, Peichl A, Stöckli M. Corona-Infektionen und die Dunkelziffer: Vergleichen wir Äpfel mit Birnen? ifo Schnelldienst digital. 2020;12:1-5.
43 Farkas K, Williams R, Alex-Sanders N, Grimsley JMS, Pântea I, et al. Wastewater-based monitoring of SARS-CoV-2 at UK airports and its potential role in international public health surveillance. PLOS Global Public Health. 2023;3(1): e0001346. https://doi.org/10.1371/journal.pgph.0001346
44 https://www.aerztezeitung.de/Wirtschaft/PCR-Test-auf-SARS-CoV-2-nach-GOP-32816-wird-zum-1-Juli-deutlich-abgewertet-429285.html , Accessed: January 26, 2023.
45 https://www.kvwl.de/fileadmin/user_upload/pdf/Mitglieder/Abrechnung_und_Honorar/EBM_und_regionale_Gebuehrenziffern/EURO-Gebuehrenordnung/Euro-Gebuehrenordnung_Juli_2021.pdf , Accessed: January 26, 2023.
46 https://www.kbv.de/media/sp/Ambulante_Versorgung_Corona_Pandemie_Zahlen_Fakten.pdf , Accessed: January 15, 2023.