COVID/coronavirus

Für Rückkehrer aus den RKI-Risikogebieten gilt folgendes:
Der Rückreisende muss die Rückkehr nach Deutschland seinem örtlichen Gesundheitsamt melden. Grundsätzlich muss immer eine 14-tägige Quarantäne eingehalten werden. Diese Quarantänezeit kann aber verkürzt werden, indem nach Rückkehr ein Corona-Test erfolgt. Ist dieser negativ, kann die Quarantäne nach Rücksprache mit dem örtlichen Gesundheitsamt beendet werden.
Einen entsprechenden Test können Sie zum Beispiel in unserer Praxis oder in anderen Testzentren durchführen. Die Kosten dafür werden derzeit von den Behörden übernommen.

Der konkrete Ablauf: Rückkehr - Quarantäne - Abstrich/Test auf Corona - Ergebnismitteilung am Folgetag - Quarantäne kann beendet werden.

Für Rückkehrer aus Nicht-Risikogebieten: Tests sind nicht verpflichtend, aber selbstverständlich möglich. Die Kosten müssen allerdings durch den Reisenden selbst getragen werden. Die Gesamtkosten liegen derzeit bei €115.

Bitte vereinbaren Sie für die Testdurchführung unbedingt telefonisch einen Termin! Auch kurzfristige Termine sind möglich. Nur so können wir die Abläufe in der Praxis gut organisieren, Wartezeiten und Infektionsrisiken vermeiden!

Bitte sprechen Sie uns an wenn Fragen zum Thema bestehen!

Hier ein aktueller Einblick in den Stand der Impfstoffentwicklung gegen COVID. Die Geschwindigkeit der Entwicklung ist unglaublich! Als Orientierungwert: die übliche Entwicklungsdauer eines Impfstoffs beträgt 8 bis 10 Jahre - bei COVID scheint diese Zeit auf wenige Monate verkürzt werden zu können.

Vorab: "wenn alles gut läuft" - also falls es keine wesentlichen Rückschläge bei den Impfstoffkandidaten bezüglich Verträglichkeit/Sicherheit und Wirksamkeit gibt, rechnen wir Ende des Jahres mit der ersten europäischen Zulassung. Es ist also möglich, dass bereits Anfang 2021 die ersten Impfdosen verabreicht werden können. Wie konkret die diesbezügliche Logistik aussehen wird ist natürlich noch unklar: welche Länder und welche Personen werden den Impfstoff als erstes bekommen?
Aktuell sind 9 Impfstoffkandidaten in der sogenannten Phase-3 - Prüfung. Das bedeutet, grundlegende Untersuchungen zu Sicherheit, Verträglichkeit und Dosisfindung sind bereits mit positivem Ergebnis abgeschlossen worden (Phase 1 und 2). In der Phase 3 wird jetzt die eigentliche Wirkung gegen Coronaviren an Tausenden von Patienten überprüft, gleichzeitig werden weiter Daten zur Verträglichkeit gesammelt.
Der Mechanismus aller Impfungen: Bruchstücke des Virus, zum Beispiel Oberflächenproteine ("Antigen") werden dem Immunsystem präsentiert. Dieses stellt gezielt Antikörper und Immunzellen gegen diese Proteine her. Im Falle einer Infektion mit COVID kann dadurch das Virus rasch bekämpft und neutralisiert werden.

Grundsätzlich sind zwei Wirkmechanismen vertreten: Die erste Variante: Virus-Oberflächenprotein wird huckepack in der Hülle harmloser Erkältungsviren verpackt (sog. "viraler Vektor) und auf diese Weise in unseren Körper und zu den Abwehrzellen transportiert. Die zweite Variante: Der Bauplan von Virusproteinen wird in Form von Erbinformationen (RNA oder DNA) verabreicht. Der geimpfte Mensch produziert dann selbst Virusantigen - und entsprechende Abwehrmechanismen (Antikörper und Abwehrzellen) dagegen. Wichtig: diese Impfungen werden häufig als Eingriff in unser Genmaterial verunglimpft. Dies trifft aber nicht zu: das eingesetzte Erbmaterial wird nicht in unsere eigene DNA eingebaut sondern nur in bestimmten Zellorganellen in Proteine umgesetzt. RNA/DNA-Impfstoffe werden in der Tiermedizin schon seit vielen Jahren ohne Probleme eingesetzt. Ein Vorteil dieser Impfstoffe ist die Möglichkeit, sehr rasch große Mengen herstellen zu können. Dies ist bei der Anzucht von Viruspartikeln schwieriger.

Selbstverständlich hat die Sicherheit der Impfung absolute Priorität. Unsere Zulassungsbehörden (Paul-Ehrlich-Institut) und die europäische Arzneimittelsicherheitsbehörde (ecdc) haben seit vielen Jahren extrem strenge Kontrollmechanismen etabliert, um Risiken auf ein absolutes Minimum zu reduzieren.

Was kann noch schief gehen? Es kann zu unerwünschten Wirkungen kommen, welche zu einer Gefährdung der Geimpften führen würden. Und es ist denkbar, dass die Wirkung nicht zu einer sogenannten "sterilisierenden Heilung" führt - also einer vollständigen Elimination des Coronavirus. Natürlich besteht gute Hoffnung, dass aufgrund der Vielzahl an Impfstoffkandidaten zumindest einzelne Präparatte alle Anforderungen an Wirkung und Sicherheit erfüllen werden. Wir sind gespannt!

Currently, quarantine time after having tested positive vor COVID-19 is under discussion.

Here are the currently known facts:
• Incubation time between infection and start of symptomatic disease is 5-7 days
• Infeciousness lasts for about 10 days in total: 5 days before plus 5 days after the onset of symptoms. Peak infectivity is seen when symptoms first occur, the risk thereof continuously decreases after time.
• Most infections will be symptomatic - however mildly.
• Most tests (swabs) for coronavirus-disease will be done because symptoms are present.

This is why a shortened self-quarantine time of 10 days in total is sufficient!
If patients have been symptomatic upon testing, an even shorter duration of quarantine (5 days) might be enough as half of the infecious period has already expired upon onset of symptoms. However, this has not been confirmed by authorities and is therefore not recommended.

Performing a control swab to confirm if infectiousness has expired is definitely not recommended! Even after cure, miniscule amounts of viral particles might be found in the airways leading to false-positive swab results and unncessary extension of quarantine.

Physicians and staff of local health authorities (Gesundheitsamt) might offer different advice regarding quarantine and self-isolation. Patients are required to adhere as medical information there is up to date and adjusted to local pandemic data.

What do we expect considering COVID-19 in the coming months?
There will most certainly be an increase in disease activity in the northern hemisphere in the following fall/winter months. Because of the colder temperatures there will be increased transmission as more people stay indoors.
We might get into a difficult phase if the numbers of COVID-patients increase and simultaneously multiple cases of the common cold emerge. Differentiation between the diseases is only possible by performing a swab, meaning that quarantine might be imposed on a lot of people with flu-like symptoms in order to prevent further spread. Capacity of doctor's offices /practices will be strained by far.
Our task will be to prevent the spread of infections within our premises, to cope with the large number of patients and to adequately care for everybody affected. During that time, mutual respect and tolerance will be required by each and every one.
We ask patients at risk for complications of influenza infections (everybody older than 60 and patients with chronic diseases) to get a flu shot! We'll have the vaccine ready by the end of September (there is a more detailled article in the same section of our webpage concerning flu vaccination).

Because of the worldwide spread of COVID-infections travel activity will continue to be restrained to a very large extent until an effective vaccination is available. Please consult information on the internet before planning to travel, i.e. from Auswärtiges Amt.

Generally speaking, as infectious diseases specialists we think that a majority of German politicians and the German medical community (public health institutions, hospitals and practices) have done a good job fighting Coronavirus. We trust the measures imposed by our government and are willing to support them whereever possible. As physicians we're glad to be able to play an active part in controlling the epidemic!

About the need to wear face coverings:
A multitude of international studies was able to show the extent of protection provided by mouth-nose-masks and the contribution to controlling the spread of Coronavirus. We therefore explicitly support the government agencies asking for use of face masks during close contact with other people. Most certainly, we ask you to wear a mask during your stay at our practice.

COVID-cases in our practice:
Corresponding to nationwide epidemiologic data we have seen a small surge in positive COVID-tests done at our practice during the last couple of weeks. Most of those patients have traveled to risk areas abroad. By screening all of our patients and separate waiting areas for people at risk we were able to reduce contact between patients and have minimized infection risk within our practice.

German Corona tracing app:
We ask all of our patients to install the German tracing-app. The more people follow this advice, the easier the identification of people at risk. Data protection requirements have largely been met. Support our agencies in their important work with this app.
We are able to screen for infection by performing a throat/nose swab if you have been informed of possible risk encounters by our app.

In infected patients, COVID-19 and influenza cause similiar symptoms. Both disease can lead to damage in the same organ systems (i.e. lungs, heart). Patients mostly affected show the same risk factors. Simultaneous infection with SARS-CoV-2 (the cause of COVID) and influenza viruses probably leads to a more aggressive course of disease with a higher risk of complications and death.
That's why we recommend vaccination against the flu even more strongly than ever. If you're older than 60, or if you suffer from chronic diseases like heart disease, kidney disease, lung disease or metabolic changes like diabetes you're eligible for free vaccinations.
We have ordered a large stock of vaccine doses to accommodate all of our patients. It will probably be available by the end of September. Please arrange for a specific appointment to get the vaccination - this way we'll avoid overcrowding within our facility.

Starting August, Teachers and pre-school employees in NRW are eligible for free Corona-Tests every 14 days until October 9th. Costs will be covered by German Landesbehörde. We can offer to do those tests at our Praxis.
Your employer will hand you a certificate which you're required to bring to our Praxis.
You will get the results via text messaging the same day, at the latest the next day, respectively.
Please arrange by phone for a specific appointment to get the swab. This way we'll make sure you don't have to wait too long and we'll avoid crowds.

There's two types of diagnostic tests available concerning COVID-19:
1. Swab/PCR-test. This test is able to detect the virus itself. The result will tell if you have acquired Coronavirus recently and if you're infectious at the moment of testing.
If you have symptoms suggestive of COVID-infection (e.g. dry cough, fever, malaise, headaches, night sweats) a nose/throat swab will be the method of choice. As quite a lot of COVID-infections do not show any symptoms, the same test is done to find out if you have been infected - even if you are completely asymptomatic. The costs for the test will be covered if there are typical symptoms or if you are a returning traveler.
You'll get the results the very same day or the next day at the latest, depending on the work load within our cooperating lab.
If you need to know about possible current infeciousness for other reasons, e.g. if you plan to travel abroad, if you are visiting relatives and/or friends or if your employer asks you to do a test, the insurance/authorities will not cover the costs. Charges will be about 115 Euros per patient. We're happy to inform you in detail about the procedure.
2. Antibody-test: This test detects antibodies that your body produces when you're infected by Coronavirus. Those antibodies are probably protective for some time after cure to prevent a secondary infection. This test will be positive about 10 days after you're shown symptoms of infection as it takes some time for your immune cells to produce antibodies.
Costs for this test are generally not covered by insurances or authorities and will be about 30 Euros.

Please do not hesitate to contact us if there are further questions!

Dear patients!

Our goal is to reduce infection risk within our practice as much as possible.
These are the measures taken to achieve that goal:

• We're reducing the number of patients/visitors who simultaneously visit our practice. This is possible by offering specific appointments for everybody and spreading patients within our practice's multiple rooms in an intelligent way to avoid overcrowding.

• We ask all patients to disinfect their hands upon entering our Practice. There's disinfectant at all the entrances to our premises.

• Patients with acute problems are asked to arrange for a specific appointment. If patients show symptoms of respiratory infection, they are separated from the regular customers. We offer special consultation times for those patients, they are seated in separate waiting areas and are seen by a physician immediately. Contact to symptom-free patients can therefore be minimized.

• Within the premises used for potentially contagious patients, more advanced hygiene rules apply. We disinfect surfaces and furniture after each patient, personal protective gear requirements are even more strict, there's no mingling whatsoever with patients without symptoms.

• Our staff wears professional mouth-nose covering all the time, hands are disinfected after each patient contact, we have split our team into two separate entities to avoid any risk of contagion within our staff.

• Each and every day, we make sure the rules and regulations we apply are up to the newest medical knowledge and are enforced by everybody. We arrange meetings with our staff every time around noon to discuss current data concerning coronavirus and protection thereof. Our physicians are in steady close contact with the German authorities like Robert-Koch-Institut, the Infecious Diseases department of the University Clinic of Cologne and other infecious diseases Practices within the region.

• At present times, we refrain from shaking hands with each other and with patients. This is not meant as an unfriendly act but is a necessary precaution.

Please do not hesitate to contact us if there are further questions!

In the meantime, risk factors have been identified which are associated with an aggressive course of COVID-19.

Age is the most prominent of those risk factors. This is probably caused by decreased healing capacity and impaired organ function because of concomitant diseases in older patients.

Typical concomitant diseases leading to increased risk are:
Lung disease like COPD, emphysema, fibrosis. Those are all leading to reduced lung capacity which then additionally can be decreased by COVID-infection leading to critical illness. Medically treated asthma is probably just a minor risk factor, while smokers are running a high risk - another very good reason to quit!
Obesity is a strong risk factor. The exact reasons for this remain unknown.
Heart disease leading to reduced heart capacity is a risk factor. In medical terms, this is called congestive heart failure. It's most often caused by coronary heart disease, untreated high blood pressure and diabetes. COVID-19 can affect the heart, and a pre-diseased organ is more likely to fail. Additionally, people with impaired heart function are more prone to succumb to lung disease by COVID.
Diabetes mellitus has been identified as risk factor, most likely because of a generally impaired immune function in affected patients. If diabetes is treated adequately, the risk can be quite low.
Renal disease leading to reduced renal clearance.
Immune suppression can be a risk factor, but largely depending on the extent of reduced immune function. Slight decreases in immune reactivity could turn out be protective as aggressive inflammatory responses are less likely.
In any case, as this topic is quite complicated, do not hesitate to ask us if there are further questions. We will try to find the right balance between necessary protections and caution avoiding exaggerated fears.

A very promising therapy option against COVID-19 is a passive immunization. Antibodies against Covonavirus are produced during infection and can be recovered from formerly infected patients. Plasma with concentrated antibodies can then be given to currently ill patients. Protection can thus be transferred to other people.
How can someone be sure to have recovered from COVID? By a positive swab result done during symptomatic phase of disease or by a positive antibody-test.
This therapeutic option has been used in other diseases for a long time. The associated risk for donor or recipient is minimal.

A pro-bono initiative from Cologne tries to build a network of possible donors from Germany in order to secure large amounts of reconvalescent plasma. If you've recovered from COVID and are interested to help other patients, you can contact them in order to find a place where to donate plasma.

We welcome this initiative and would like to ask as many patients as possible for their support.

If your're tested positive for COVID (by throat-nose swab):

• please quarantine yourself for 10 days. This might further be shortened by presenting a negative swab result - this will be decided by your local public health institution (Gesundheitsamt).
• there is no proven effective medical treatment for COVID in an outpatient setting. You're free to take antiinflammatory medicines (i.e. Ibuprofen) or Acetaminophen pagainst head- or bodyaches. Ingest lots of liquids, get enough rest. It takes a few days for the symptoms to disappear.
• During quarantine, you should avoid any contacts to other people. In case of non-avoidable contacts, wear mouth-nose-coverings and keep as much distance as possible.
• In case you need medical treatment or advice do not hesitate to contact us. We'll help you decide whether a phone call, a video conference or a house call will be necessary.
• Members of the same household should take care not to get infected themselves. Infections within households can lead to exposure to large numbers of infectious viruses and aggressive courses of disease. Keep distance from coughing or sneezing patients!
• Complications typically arise starting day 5 after infections. They usually present with increasing shortness of breath, especially upon physical exercise. If you do encounter this symptom contact us!
  Here's more information on quarantine!

We receive a lot of questions about serologic COVID-tests, i.e. antibody tests.
There's a multitude of tests available, some of them can be self-purchased in the internet. The quality of those tests vary greatly, with some of them being extremely unreliable.
The test our cooperating lab offers yields precise results. If it turns out positive, you can be sure that you did have COVID-infection in the past. A negative test means that with an extremely high likelihood you have not yet have contact with SARS-CoV-2 or that this infection has been quite a while ago and that antibodies have since vanished from your bloodstream.
Unfortunately, no answer has yet been given to this question: do the antibodies really protect from re-infection? And if yes - for how long? There's another unanswered question: how quickly do these antibodies disappear from the blood of infected persons and what does that mean about protection from re-infection.
As is the case with other viral diseases - not only antibodies confer protection but also cytotoxic immune cells. Such immune cells providing immunity against COVID have been identified, but there's still no commercial test available to detect them in individuals outside of sparse clinical studies. Possibly, those cells confer immunity when antibodies have long vanished from patients.
It is because of those unanswered questions that we rarely recommend our patients to do an antibody test. We are expecting more scientific knowledge about antibodies, their protective effect, the durability of such a protection and more information about cytotoxic immune cells in the near future. This will help us to interpret test results and to reassure our patients considering their individual risk.
Please do not hesitate to contact us if there are further questions considering this complicated topic.

Current medical data show that there seems to be no increased risk for medically treated HIV-positive patients regarding COVID-infections. If your helper cells (CD4+ lymphocytes) are above 200/µl and stable and your viral load is suppressed you do not heed to worry.
We're waiting for further confirmation of these findings, medical knowledge concerning COVID is constantly evolving.

Reports show that fatal outcomes are rare but do nonetheless occur with young people. Risk for dangerous complications of COVID-infections is mostly seen in patients older than 55 years of age and progresses further with increased age.
The reason for aggressive courses of disease in young people is probably an exaggerated immune response to the viral infection leading to a strong inflammation reaction. This inflammation can cause malfunction in lungs, heart and other organ systems.
Why this overly reaction occurs in certain patients is hitherto unknown. Most likely, genetic factors are responsible.
Another factor identified for aggressive courses of disease is being simultaneously infected by a large number of viruses. Medical staff and/or relatives of infected patients are mostly at risk as affected patients can spread large numbers of infectious particles by sneezing or coughing. It's therefore imperative to keep your distance to symptomatic COVID-patients!

The period between infection and the emergency of symptoms is called incubation period. With COVID-19 infections, period is usually around 4 to 5 days. There are cases where this time span is only 2 days or can last up to 14 days, however.
Most people infected by Coronavirus develop symptoms, however mild in the majority of cases. Typical symptoms are fever, dry cough, malaise, sore throat and aches and chills.
There seem to be asymptomatic cases in about 25% of patients. The younger the patient, the more likely there are none or only weak symptoms.
Infectiousness is present about 5 days before symptoms occur, will peak upon start of the symptomatic period, and subsides after about another 5 days after symyptoms have disappeared.
Quarantining for 10 days after onset of symptoms therefore seems to be enough to protect others from infection.

The spread of Coronavirus can happen by several mechanisms:

• When your're coughing or sneezing, small droplets are formed which are extremely infectious due to their containing a large number of viral particles. A COVID-patient showing symptoms of respiratory infection can therefore be considered very infectious. The droplets mentioned can travel several meters through the air.
• Coronavirus can also spread by aerosols. These tiny droplets are formed in the airways when speaking or breathing. Due to their smaller size, the can linger in the air for longer periods of time, but they typically do not travel as far as droplets shed when sneezing or coughing. Virus-containing aerosols are the reason why people are infectious even before they develop flu-like symptoms.
• The third means of contagion can be through surfaces. Virus-containing droplets or aerosol can settle on surfaces and be transferred to other people by touching mouth and/or nose. Coronaviruses are quite resiliant concerning environmental factors and can remain infectious for hours or even days.
  This is why you're supposed to wash your hands regularly especially after having been in contact with things touched by many people like door handles, shopping carts and/or handles in public transport. It does not make sense however to disinfect hands too often - washing your hands thoroughly will be sufficient!