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Increasingly, hospitals report finding the virus in patients with other diseases. What lies behind this and what it means for the data situation.

Hamburg/Berlin. There are pregnant women among them, children, people with a heart attack, after an accident or with a broken leg: In the Omikron wave, the cases of people who tested positive for Corona, but are being treated there for completely different reasons, are accumulating in normal wards of the University Medical Center Hamburg-Eppendorf (UKE). This is reported by the director of the UKE Clinic for Intensive Care Medicine, Stefan Kluge.

In Covid-19 hospitalization data, such incidental findings are likely to appear often anyway – in the bare numbers indistinguishable from patients with, for example, more typical Covid-19 severe pneumonia or respiratory failure. "It is not yet separately collected whether a patient is treated with or because of Sars-CoV-2" said Kluge.

Lack of differentiation could complicate interpretation of hospital situation in coming weeks, critics warn. Other voices don’t think the distinction is as important because it makes no difference to the burden on clinics.

That some accidentally found infected people end up in the statistics, although it was also possible in the past. According to Kluge, however, the scale is becoming notable these days: "We now have a growing group of patients with Omikron who are Sars-CoV-2 positive, but for whom the reason for admission is independent of this. Colleagues from Hanover and Bremen also report this – and it has recently already been seen in countries such as the USA and Great Britain. We have to be transparent about that", Said Kluge, who is a member of the executive committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi).

It is not possible to say with certainty how large the proportion of randomly tested positive patients is already nationwide and could still become. Kluge sees normal wards as being particularly affected. Surveys abroad had come to proportions of more than 50 percent of cases there that were treated with, rather than causally because of, Covid-19. There are probably significantly fewer in intensive care units.

To date, the hospital situation is recorded as follows: In the Divi Intensive Care Registry, the number of patients with corona infection in intensive care units can be retrieved on a daily basis. In addition, the Robert Koch Institute (RKI) reports values for hospital admissions of Corona-infected persons – calculated per 100.000 population per week and based on reports from hospitals. Because there is a high reporting delay in this process, the RKI reports an estimate in addition to this hospitalization incidence.

Case numbers lose significance

Regarding the reporting criteria for hospital admissions, the RKI writes that a direct causal link to Covid-19 does not yet need to be established at the time of reporting. "This should ensure low-threshold, rapid and low-effort reporting." If, however, it becomes clear that the program is not related to the Covid 19 diagnosis, for example in the case of a traffic accident, there is no obligation to report it.

Some experts complain that especially with the omicron wave and milder courses, better data on the situation in normal hospital wards would be needed. In her view, aspects such as disease burden and severity should be given more importance in the assessment of the situation. The pure case numbers, on the other hand, lost significance.

The burden cannot be estimated with the existing data, said, for example, the chairman of the German Foundation for Patient Protection, Eugen Brysch. It is incomprehensible that, even after two years of the pandemic, there are no daily updated situation reports that, for example, also show the bed capacities and the occupancy of the respective wards," said intensive care physician Kluge.

Increase in incidental findings

Brysch, like the German Hospital Federation (DKG), expects an increase in incidental findings in the omicron wave. DKG board chairman Gerald Gab explained that this is not only due to the widespread presence of the virus in the population, but in particular to the less pronounced symptoms of the disease due to the vaccinations. However, Gab also emphasized: "The distinction between Covid-19 as a primary or secondary diagnosis/incidental finding is irrelevant for hospitals. In both cases, the same elaborate isolation and protection measures would have to be taken in inpatient care."

In a statement, virologist Christian Drosten of Berlin’s Charite University Hospital argues that under Omikron, incidental findings in hospitals would become relevant for the first time and would have to be included in the assessment of the situation – but nothing more. "Crucially, the cases "because of Covid" are still in the majority even under Omikron and continue to dominate the situation picture."

It should also be taken into account that the so-called incidental findings also include those cases in which the infection could lead to a worsening of an underlying disease, writes Drosten. This can also be observed in the current omicron wave. There is a risk that people with relevant preexisting conditions may not initially experience the classic Covid symptoms, but rather a worsening of their general condition. "However, it would be misleading to assume a meaningless incidental finding of Sars-CoV-2 in these cases.", stresses the virologist. The reason for the deterioration is ultimately the infection. Treatments would often be particularly costly against this background.

The basic problem is digitization

RKI requirements, for example to maintain separate areas for infected patients and for suspected and quarantined cases with strict allocation of staff, now present "immense challenges" to normal wards, as described by intensive care physician Kluge. According to him, the rules would have to be adapted to the real situation. "We now have such a broad spectrum of infected patients that we need specialty-specific isolation areas in pediatric UKE, cardiology, surgery and so on. Originally, we had a covid ward for internal medicine."

Can now still be readjusted in the collection of patient data? Experts see Germany’s state of digitalization as a fundamental problem. "We would need automation, said Kluge. Until now, Covid 19 intensive care cases have been entered manually into the system every day. And faxes would be sent.

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