COVID/coronavirus

The following set of rules will apply if you're a returning traveler from one of the countries mentioned in the RKI-Risikoland listing.

You'll have to register online (regardless of your means of transport when traveling) at www.einreiseanmeldung.de. You'll have to carry a written transcript of your registration details when traveling.

If you're returning from high-risk countries in which mutated virus occurs frequently (at present: GB, Ireland, South Africa) these rules will apply:
a) immediately before departure from abroad or straight after immigration into Germany, you'll have to get tested for SARS-CoV-2.
b) you have to inform your local Gesundheitsamt (health authority) about your travel itinerary
c) you have to start quarantining yourself immediately after arrival
d) you'll have to have another SARS-CoV-2 test done on day 5 or your quarantine. If that result is negative you can stop isolating yourself

For "standard" risk areas the following rules apply:
a) you'll be tested for SARS-CoV-2 within 48 hours before or straight after immigration into Germany
b) if the result is negative, quarantine will not be necessary

Costs for tests associated with travel activity will not be reimbursed by the German authorities. We can offer to do all the required tests in our Praxis.

For more information take a look at the official NRW Coronavirus website

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 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 a maximum of six tests using a rapid point-of-care-test starting January 11th until March 29th.

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. We'll inform you about the costs involved. Please call us or write an email to find out more.

Dear patients!

Vaccinations against Coronavirus in Germany have started! Although things are going a bit slow at the moment, we expect large amounts of vaccine to be delivered within the next couple of months.
Although clinical development of coronavirus-vaccines have been speeded up to unforeseen levels, necessary studies concerning safety and tolerability have been performed. The demand for 100% safety in regard to medical procedures can never be fulfilled. The potential risk of coronavirus-infections by far exceeds the risk associated with getting vaccinated with a EU-licenced serum! We recommend you to get the shot as soon as possible once you're invited.
All of our staff has decided to get the coronavirus vaccine as quickly as possible!

In the licensing studies involving tens of thousands of participants, only light side effects were seen. Allergic reactions have occurred sporadically - all of them were self-limiting and without long-term consequences. So far, no death and no serious long-term health consequence has been associated with the effect of the available vaccines.

Changes of our genetic material (DNA) are not plausible as the mRNA used in the modern vaccines does not enter the nucleus of our cells where DNA is stored.

For now, vaccinations are only offered to residents of retirement homes and - starting February - in the large vaccination centers. As a Praxis, we expect to take part in the vaccinations sometime in the spring. There's been no release of detailed information about this yet.

Patients with serious chronic diseases - including HIV-infection - will be offered vaccination within risk stratification group 3. As your GP, we'll either certify that you're part of a risk group or we'll vaccinate you ourselves within our premises, depending on the availability of vaccines.
Please get back to us for further information about this topic.

So far, the question whether someone vaccinated could still get infectious COVID-infection has not been answered. We expect results of studies about this shortly. We do know that vaccination protects you from serious COVID-disease and complications!

Here's more information by the NRW-government.
Hier Informationen des Bundesgesundheitsministeriums zur Impfung.

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 €105.

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!

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.

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.

This also explains while presently during the second wave of disease death rates are very low. Most infected patients are young and show no concomitant disease which could complicate COVID.

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. That'll be the way to get over the following months with as little health damage to our population as possible.

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. 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.

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!