COVID/coronavirus/vaccines

Liebe Patient:innen,

die Liefersituation der Impfstoffe hat sich deutlich entspannt. In der KW 27 & 28 impfen wir zusätzlich samstags um weiter aktiv zum Impfgeschehen in und um Köln beizutragen. Zudem konnten wir die Impfungen mit BioNTech/Pfizer - Impfstoff auf Patienten außerhalb unserer Praxis ausweiten.
Am kommenden Samstag (10.07.) stehen noch Impftermine mit BioNTech für alle Personen über dem 17. Lebensjahr für die online-Buchung zur Verfügung.

Am Samstag 17.07 bieten wir Impfungen mit dem Impfstoff von Johnson & Johnson an. Der Vorteil dieser Impfung: nur eine Dosis ist für einen kompletten Schutz ausreichend. Wir informieren Sie zeitnah auf unserer Homepage über die Buchungsoptionen.

Wir freuen uns über die entspanntere Situation. Ein Großteil unserer Patienten ist mittlerweile geimpft, dies beruhigt uns sehr.

Unsere telefonische und email Impf-Hotline steht für Ihre Fragen, Buchungswünsche und Kommentare weiter zur Verfügung! (impfung@praxis-ebertplatz.de Tel 0221-914 085 70)

Liebe Patienten!

Wir können Ihnen ein EU-konformes digitales Impfzertifikat (QR-Code) zur Verwendung in den Corona-Apps ausstellen

Folgendes Varianten werden angeboten:

= Mit der Zweitimpfung bei uns wird Ihnen seit Ende Juni automatisch das Zertifikat ausgestellt

= Patienten die in der Vergangenheit komplett bei uns geimpft wurden können unter der email Adresse impfung@praxis-ebertplatz.de den Impfcode anfordern. Dieser wird Ihnen dann zeitnah zugeschickt.

= Patienten die auswärts geimpft wurden müssen uns den ausgefüllten Impfpass oder die Ersatzbescheinigung der erfolgten Impfung an der Anmeldung persönlich vorlegen. Wir werden Ihnen das Zertifikat dann direkt zur Mitnahme ausstellen.

Liebe Patienten!
Hier einige Informationen zu den Impfungen in unserer Praxis:

• Seit Ostern sind die Hausärzte in die deutsche Impfkampagne eingebunden. Anfangs wird nur wenig Impfstoff geliefert werden - dies ändert sich voraussichtlich in der letzten Aprilwoche. Wir erfahren jeweils nur einige Tage im voraus, welche Mengen Impfstoff bei uns eintreffen werden.

• Wir werden deshalb jeweils nach Verfügbarkeit Impftermine freigeben. Wann das jeweils geschehen wird kann sich jede Woche ändern, es gibt bislang keinen zuverlässigen Rhythmus. Auf der Homepage werden wir aktuell verkünden, welche Impftermine für welche Patientengruppe buchbar sind.

• Um möglichst vielen Patienten eine Impfung zu ermöglichen bemühen wir uns darum, immer die maximal mögliche Anzahl an Impfdosen zu erhalten und zu verimpfen.

• Wir haben uns außerdem dazu entschlossen, die Termine in einem online Buchungssystem zur Verfügung zu stellen. Nur so sind die Mengen an Impfungen zu bewältigen und so hat jeder die Chance, einen Termin zu buchen. Für nicht-Internet-affine Menschen bieten wir natürlich auch weiterhin eine telefonische Terminbuchung.

• Um unser Telefonsystem nicht zu überlasten bitten wir Sie, immer nur zur Impftermin-Buchung anzurufen wenn wir auf der Homepage aktuell freien Impfstoff melden.

• Wir führen keine Liste impfwilliger Patienten, weil diese viel zu umfangreich wäre und weil wir aus Gründen der Gerechtigkeit jedem berechtigten Patienten eine Impfmöglichkeit einräumen möchten.

• Hochrisikopatienten kontaktieren wir weiter selbst um diesen vulnerablen Gruppen rasch eine Impfung zu ermöglichen.

1) Impfstoff von AstraZeneca

Hier werden wir alle Pesonen im Alter über 60 Jahren impfen, unabhängig von Vorerkrankungen. Dieser Impfstoff ist in dieser Altersgruppe sicher und besonders wirksam - nach den vorliegenden Daten nach der ersten Dosis gerade bei Älteren sogar wirksamer als z.B. der Impfstoff von BioNTech. Sinussthrombosen sind in dieser Altersgruppe nicht gehäuft aufgetreten.

Generell gilt: wir empfehlen Ihnen in Übereinstimmung mit allen wichtigen medizinischen Fachgesellschaften eine COVID-Impfung, egal mit welchem Impfstoff. Durch diese Impfung können Sie eine potentiell gefährliche COVID-Infektion schnell und extrem effektiv verhindern und sich vor Krankenhausaufenthalten und Folgezuständen nach COVID schützen.
Hier Informationen vom RKI zum AstraZeneca - Impfstoff.
Hier Informationen vom Paul-Ehrlich-Institut zum Impfstoff.
Hier Informationen von Quarks&Co zu den Impfstoffen.
Hier mehr Informationendes Gesundheitsministeriums zum AstraZeneca Impfstoff.

2) Impfstoff von BioNTech/Pfizer
Wir erhalten zudem den mRNA BioNTech-Impfstoff. Dieser darf derzeit ausschließlich an Menschen verabreicht werden, welche in Priorisierungsgruppe 1 und 2 sind. Hier finden Sie eine ausführliche Liste mit den Voraussetzungen für die verschiedenen Priorisierungsgruppen.

Die Impfmöglichkeiten werden sich in den nächsten Wochen verbessern, es wird voraussichtlich jedoch noch einige Zeit dauern, bis auch Mitglieder der Gruppe 3 ein Impfangebot mit BioNTech-Impfstoff erhalten. Wir raten über 60jährigen deshalb zu einer Impfung mit AstraZeneca.
Hier mehr Informationen zum Impfstoff vom RKI.

Liebe Patienten!
Wir empfehlen Ihnen, sich beim nicht-kommerziellen Portal www.sofort-impfen.de anzumelden falls Sie noch keinen Termin für eine Erstimpfung erhalten haben. Hier kann man sich kostenfrei zur Verwertung von Restdosen von Impfstoff registrieren lassen. Die Verteilung erfolgt dann entsprechend Verfügbarkeit und Wohnort. Wir wissen dass viele Praxen keine Warteliste führen - entsprechend werden sicher häufig Impfdosen zur Verwertung zur Verfügung stehen.

Hier eine Übersicht über die in unserer Praxis verfügbaren Impfstoffe:

1) Impfstoff von AstraZeneca: "Vaxzevria"

Diesen Impfstoff setzen wir bei allen Personen im Alter über 50 Jahren ein, unabhängig von Vorerkrankungen. Zudem bieten wir jüngeren Patienten nach individueller Aufklärung ebenfalls eine Impfung mit diesem Impfstoff an.
Dieser Impfstoff ist sicher und wirksam - nach den vorliegenden Daten nach der ersten Dosis gerade bei Älteren sogar wirksamer als z.B. der Impfstoff von BioNTech. Wir haben zum wichtigen Thema der Nebenwirkungen unter AstraZeneca Impfstoff einen Artikel auf dieser Seite hinterlegt.

2) Impfstoff von BioNTech/Pfizer: "Comirnaty"
Wir erhalten zudem den mRNA BioNTech-Impfstoff. Aufgrund der hohen Beliebtheit von Comirnaty sind diese Impftermine besonders schnell ausgebucht. Wir haben deshalb entschieden, diese Impfungen zunächst nur den Patienten zur Verfügung zu stellen, die bereits Patienten unserer Praxis sind.

3) Impfstoff von Johnson&Johnson: "COVID-19 Vaccine Janssen"
Dieser Impfstoff steht seit Ende Mai zur Verfügung.
Als Besonderheit muss diese Impfung nur einmal verabreicht werden, die Schutzwirkung ist dennoch ausreichend hoch.
Es handelt sich wie bei Astra um einen Vektor-Impfstoff, die extrem seltene Nebenwirkung von Autoimmun-Thrombosen tritt hier also auch auf. Wir haben entschieden, den Impfstoff Patienten über 50 Jahren anzubieten, da hier das Thrombose-Risiko besonders niedrig ist. Beachten Sie auch unseren Artikel zur Vektor-Impfstoffen auf dieser Seite.

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Generell gilt: wir empfehlen Ihnen in Übereinstimmung mit allen wichtigen medizinischen Fachgesellschaften eine COVID-Impfung, egal mit welchem Impfstoff. Durch diese Impfung können Sie eine potentiell gefährliche COVID-Infektion schnell und extrem effektiv verhindern und sich vor Krankenhausaufenthalten und Folgezuständen nach COVID schützen.
Hier Informationen vom RKI zum AstraZeneca - Impfstoff.
Hier Informationen vom Paul-Ehrlich-Institut zum Impfstoff.
Hier Informationen von Quarks&Co zu den Impfstoffen.
Hier mehr Informationendes Gesundheitsministeriums zum AstraZeneca Impfstoff.

Liebe Patienten!
Sie kennen es alle aus der Presse: Leider ist es bei der Anwendung des AstraZeneca Impfstoffs "Vaxzevria" und des Johnson&Johnson Impfstoffs "COVID-19 Vaccine Janssen" zu gering erhöhten Raten an einer gefährlichen Nebenwirkung gekommen.

Was ist passiert?
Konkret geht es um sehr seltene Thrombosen (u.a. Hirnvenen/Sinusthrombose) im Zusammenhang mit einer erniedrigten Anzahl an Blutplättchen. Ähnliche Gerinnungsstörungen sind als seltene Autoimmun-Erkrankungen bekannt und tragen den Namen ITP (Morbus Werlhof), TTP oder HIT. Diese Phänomene haben nichts mit "normalen" Thrombosen zu tun sondern sind vielmehr Ausdruck einer Immunreaktion des Körpers gegen Blutbestandteile, die mit der Blutgerinnung zu tun haben (unter anderem Blutplättchen). Durch diese Entzündungsreaktion kann eine verstärkte Blutgerinnung mit Thrombosegefahr resultieren. Autoimmunphänomene können durch Medikamente ausgelöst werden, häufig kann die konkrete Ursache aber nicht identifiziert werden.

Wie ist der Krankheitsmechanismus?
Im Falle von Vaxzevria ist der genaue Mechanismus der Thrombose-Auslösung noch nicht erkannt, die Häufung dieser seltenen Thrombosen spricht aber deutlich für einen ursächlichen Zusammenhang mit der Impfung.

Wer war betroffen?
Die bisher identifizierten Risikofaktoren für das Auftreten der seltenen Nebenwirkung sind jüngeres Alter. Wahrscheinlicher Risikofaktor ist auch vorausgegangene Erkrankungen wie die oben genannte ITP, TTP oder HIT - auch wenn dieser Zusammenhang bisher nicht bewiesen wurde.

Wie häufig ist die Erkrankung?
In Deutschland kam es bis Mitte April zu 59 Fällen bei 4,2 Millionen Erstimpfungen und 4,1 Millionen Zweitimpfungen. In England wurde AstraZeneca bislang 20 Millionen mal verimpft, es sind dabei 80 Fälle von Sinusthrombosen aufgetreten. Konkreter ausgedrückt: das Risiko für eine Sinusthrombose unter AZ-Impfstoff liegt bei 0,0004%, also 1 Fall unter 250.000 Geimpften. Ein tödlicher Verlauf der Sinusthrombose trat bei 1 Fall von 1.000.000 (1 Million) Geimpften auf.
Im Vergleich dazu: das Risiko einer Sinusthrombose bei einer COVID-Erkrankung liegt 8 bis 10x höher als das Risiko für einen der COVID-Impfstoffe. Und die Gefahr durch COVID schwer zu erkranken oder zu sterben liegt um ein Zig-faches höher!

Welche Verwechslungsgefahr besteht?
Die Erstimpfung mit AstraZeneca führt häufig zu einer recht starken Immunreaktion. Diese äußert sich in Erkältungsgefühl, Kopf- und Gliederschmerzen, manchmal sogar Schüttelfrost und Fieber. Diese Reaktion ist ein Zeichen einer guten Reaktion des Immunsystems gegen das Coronavirus und absolut wünschenswert. Sie ist nicht gefährlich und besteht meist nur ein oder wenige Tage. Bei den mRNA-Impfstoffen BioNTech/Pfizer und Moderna tritt eine solche Immunreaktion häufig nach der zweiten Impfung auf. Diese harmlosen Reaktionen dürfen nicht mit gefährlichen Nebenwirkungen verwechselt werden - haben aber zu dem zu unrecht schlechten Ruf des AstraZeneca Impfstoffs beigetragen.

Was ist die Konsequenz?
Die deutsche Regulierungsbehörde für Impfstoffe, das Paul-Ehrlich-Institut, und die europäische Arzneimittelbehörde EMA haben nach intensiver Analyse der Daten entschieden: der Nutzen aller COVID-Impfstoffe, auch von AstraZeneca, überwiegt das Risiko bei der Anwendung bei weitem. Die deutsche Impfkommission STIKO ist auch dieser Meinung, schränkt aber aus Sicherheitsgründen die Anwendung von AstraZeneca auf Menschen über 60 Jahren ein.

Wie interpretieren wir die Daten?
In unserer Praxis haben wir entschieden, Personen über 50 Jahren eine AstraZeneca Impfung anzubieten: In dieser Altersgruppe ist der überragende Nutzen der Impfung durch den Schutz vor COVID-Erkrankungen und COVID-Komplikationen ohne jeden Zweifel.
Falls bei einem jüngeren Menschen aufgrund von Risikofaktoren wie Übergewicht, Lungen- oder Herzerkrankungen oder Diabetes ein deutlich erhöhtes Risiko für gefährliche COVID-Verläufe besteht kann im Einzelfall dennoch hier eine Impfung mit AstraZeneca sinnvoll sein. Diese Fälle müssen durch den Arzt individuell beurteilt werden.
Unser Fazit: AstraZeneca ist ein ausgezeichnet wirksamer, sehr sicherer Impfstoff zur Anwendung bei Personen über 50 Jahren, welcher uns entscheidend bei der Bekämpfung der COVID-Pandemie helfen wird. **

Wir empfehlen übrigens ein Einhalten des Impfabstands von 9-12 Wochen da bei dieser Verabreichung der Impfschutz am besten war. Kürzer würden wir den Impfabstand nicht wählen!

At present, lots of studies are done worldwide to evaluate the safety and efficacy of drugs used to fight COVID-infections. Not only vaccinations will help us to control the pandemic - we also need effective medications to treat infected patients.
A very promising treatment is the use of neutralizing antibodies. These work like a passive immunization - antibodies produced in a lab are given to patients in order to neutralize harmful Coronaviruses.
By using this therapy, researchers expect a rapid reduction of symptoms and therefore the need of hospitalizations, a reduction in infectiousness of patients and the reduction of cases of post-COVID-syndrome (dangerous and debilitating long-term health consequences of COVID).
Antibody-based therapies are generally extremely well tolerated and extremely efficacious, even against mutant virus types.
**In our practice, we currently take part in a study in which the use of neutralizing antibodies against COVID disease is evaluated. If you are currently sick from COVID or know someone who has symptomatic disease, we'd appreciate you getting in contact with us. We can offer you detailed information on how the study is performed and if you're eligible to take part. Please contact us at info@praxis-ebertplatz.de or call our study nurse Mrs. Kerstin Lammersmann at lammersmann@praxis-ebertplatz.de or call one of our doctors by phone.

Dear patients!
Our government offers each citizen living in Germany a weekly free Coronavirus rapid test. GP practices are involved, we've also decided to offer you such tests.

In order for us to keep up treatment of our regular patients, we had to limit the amount of daily tests offered. Please arrange appointments by phone. You'll get the written result after a few minutes.

If there's no appointments available any more please contact one of the test centers in Cologne which can be found online easily.

If you need a detailed transcript of the test result (i.e. when you're travelling, for authorities) we're obliged to charge you €5.

Dear patients!
At present, four coronavirus vaccines are licensed in Europe. All four have been deemed safe and effective by German and European regulatory agencies. Despite rapid research and development, patient safety has not been compromised!

= all four vaccines have an efficacy of way over 70% - which is an excellent result for a vaccine. This does incidentally not mean that 30% of patients are not protected, but that protection is somewhat less strong in some. What's really important is that protection against dangerous courses of COVID-disease is extremely high and according to most estimates is in the range of over 90%. This protection is necessary to avoid patients ending up in intensive care units and to dramatically reduce death rates of COVID.

= tolerability of all four vaccines seems to be good. There's a lot of local side effects like swelling and pain in the arm where the jab is applied. Some patients report circulatory problems or feeling as if they're developing a minor cold. These reactions are not dangerous but rather indicate immune response to the vaccine which is a good thing. Dangerous side effects of vaccinations have been rare, so far none have been causally related to the vaccinations - including the thrombotic complications seen in very few of those who received the AstraZeneca vaccine. We welcome the decision of German authorities to limit the use to persons older than 60 years as no thrombotic events were seen in those individuals.

= the younger the patients the stronger the immune reaction to vaccines. As more younger patients have received AstraZeneca COVID-19 vaccine due to regulatory procedures, more side effects have been reported by those. It generally looks like mRNA vaccines (BioNTech and Moderna) seem to produce more side effects upon the second jab, vector-based vaccines like Johnson&Johnson and AstraZeneca cause more reactions upon the first dose.

= there probably is not much choice concerning the type of vaccine as long as supply is limited. You risk to not be protected against COVID if you refuse a certain vaccine.

= getting any vaccine is much, much better than risking your health or even your life by not being vaccinated. We're not sure yet whether all of the vaccines will be equally effective against mutated virus - but even a partial protection will make dangerous COVID disease much less likely and keep out out of ICUs.

WE STRONGLY RECOMMEND YOU TO GET COVID-SHOTS. ALL LICENSED VACCINES ARE SAFE AND EFFECTIVE. YOU CAN PROTECT YOURSELF AND OTHERS FROM SERIOUS HEALTH EFFECTS OF COVID DISEASE

Since the situation considering test availability and cost coverage continue to change we try to keep this information updated constantly.
Here's typical scenarios where costs are covered by the government/insurances:
1) COVID-symptoms: If you show symptoms suggestive of COVID-infection like cough, fever, runny nose, sore throat or headaches a test for coronavirus will be covered by your insurance, be it private or public.
2) if your Corona app shows a red warning you can get tested for free within 10 days of being notified
3) risk contacts: if you had a clearly defined risk contact, COVID testing within 21 days will be possible for free. Risk contact means a minimum of 15 minutes indoors with another person who has been tested positive, especially if it involves activities like sports, partying, singing, dancing. Family members who live in the same apartment as a positive person can also be tested. Most of times, the Gesundheitsamt will tell you to get a test at your doctor's but you do not explicitly need their call.
4) teachers and pre-school employees: you're entitled to twice weekly test using a rapid point-of-care-test.
5) if you're admitted to a rehabilitative clinic or an out-patient procedure at a hospital you're allowed to do a free test

Every citizen living in Germany is entitled to a free weekly swab (rapid test). You can get these swabs at doctor's offices like ours or in a Testzentrum close to you.

Costs for tests required when traveling will not be covered by German authorities any more.

If you do not belong to any of the aforementioned categories, you will have to pay for the test. A PCR test at our site will be approximately 95€, a rapid antigen test will be 22€. Please call us or write an email to find out more.

Our practice offers two different types of coronavirus-tests. Both rely on swabs from your nose and throat. A soft cotton swab will be introduced deeply into your mouth and nose in order to gather secretions from your mucous membranes which might contain virus. The swab causes mild discomfort but is not painful and will be very quick.

1) PCR-test
This test will detect genetic material from Coronaviruses. It is extremely precise and will find even the slightest amount of virus present. PCR-tests are "gold standard" - meaning they're the most established form of test, results will be recognized everywhere. Disadvantages of this test are the higher costs associated and the fact that the results will take up to 24 hours to be available.
PCR-tests will be done if your insurance pays for the procedure, i.e. if you're a returning traveler from risk areas, if you had risk contacts with COVID-patients, for teachers or if you've received a red warning from your Corona-app.
The cost for the PCR-test is €95.

2) Antigen-test
This test detects surface proteins from coronaviruses. This test is also extremely precise with very little chance of getting a false negative or positive result. We're using one of the most advanced and secure tests available. It's the perfect test if you want to exclude active infectious COVID-disease, for example if you plan to visit relatives or colleagues, if your job requires a COVID-test or if you're traveling. We cannot guarantee that the results will be accepted worldwide, some countries will require PCR-testing upon entry. Within Europe, there will usually be no problem considering official recognition of test results (exception: if you're traveling to the Canary islands you will have to present a negative PCR-test upon embarking).
The cost for the rapid-antigen-test is €45.

Please make an appointment if you plan to get tested at your Praxis. You don't have to decide on the two test variants beforehand, you can decide after having talked to our team and after all your questions have been answered.
Please do not hesitate to contact us if you've got questions!

Current scientific evidence shows that age is the one decisive factor determining whether COVID-patients are at risk to develop complications and die from the disease. The older the patient, the higher the risk.

The rate of complications starts to rise approximately at age 55, the highest risk is seen in patients over 85 years of age.
It has been observed that 8 out of 10 deaths from COVID are in patients over 70. This certainly does not mean that most patients affected at this age will die from COVID. Scientific data from China could for example show that 85% of patients over 80 years of age survived COVID and could be released from hospital care.

Interestingly, age is obviously the factor responsible for low mortality rates seen in Germany over the first months of the pandemic compared to other european countries. In neighboring countries, the percentage of older patients was much higher, leading to increased rates of complications and death. In Germany, by a large majority, the first patients affected caught the virus while on ski vacation in the alps - and those patients and their social contacts were rather young and were thus more protected against aggressive courses of disease.

What does this mean for us? Protecting older patients is of utmost importance. The fewer infections we see in young people, the less infections will be carried to the elderly. We should make sure to keep rates low by wearing mouth coverings and by social distancing. Go and get tested for Coronavirus if you show symptoms or if you did have a risk contact. Get the Corona App.

As physicians specialized in the treatment of infectious diseases, we have since the start of the pandemic dedicated a lot of attention adjusting our Praxis organization to the counseling and treatment of COVID-patients. We're happy to contribute to our medical community's adequate response to COVID-disease.

Large parts of our daily consultation time is reserved for patients with typical COVID-symptoms, people in need of medical information on coronavirus disease and teachers and returning travelers willing to get tested. We're constantly adjusting those times to the current need. As you know: the course of the pandemic is extremely volatile.

However, we're taking care that the needs of our non-COVID patients are still met!
We're taking great care optimizing our organization so that there's no crowding in our Praxis and that patients with COVID-symptoms or at risk of COVID-infection do not mix with our other patients.

Fortunately, our large physician team consists of 8 fully qualified doctors and our Praxis offers lots of space. We are optimistic to continue to be able to meet the needs of our various patients and clients.

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.
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 95 Euros per patient. We're happy to inform you in detail about the procedure.
2. Rapid antigen test: This test will also detect infecious virus in your airways. Higher concentrations of virus are required for this test to return positive by comparison to the PCR-Test. The safe answer to the question "Am I currently infecious?" can be given by a negative result with antigen-testing, though.
3 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. We can offer rapid tasting at our site (duration of test 15 min) or a lab test (duration one working day).

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.

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

• please quarantine yourself for 14 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 by the German authorities.

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!