{
    "abstract": "During the first wave of the COVID-19 pandemic a high case fatality rate (CFR) was noticed worldwide including also Germany where the first European cases have been observed. The\u00a0WHO recommended immediate intubation for patients with dyspnoea which has since been revised after reviewing the initial clinical outcome. The objective of this study is to analyze CFR and assess if there is an advantage of a more conservative management of COVID-19 induced hypoxemia.\nPCR confirmed COVID-19 infections and death counts were obtained for all German districts from 27 Jan 2020 until 15 Feb 2021 using official reports of Robert Koch Institute Berlin, Germany. A moving average CFRt was constructed by dividing disease related deaths two weeks after a given index day by the number of infections two weeks prior to that date. In addition to a local comparison also mortality outcomes in other German speaking countries were compared.\nThe mean CFR is estimated to be 2.92% based on 71.965 fatalities and 2.465.407 cases. There was a large regional scattering of CFRs across the German districts. Differences of the mortality pattern were observed also at state level and preserved across different sex and age groups while being largely independent of case numbers. Although Munich city had higher infection rates, more patients died during the first wave in Hamburg (OR 1.6, 95% CI 1.3-1.9) which was mirrored also by higher death risk at Hamburg intensive care units (OR 2.0, 95% CI 1.3-3.1). While the majority of Munich hospitals favoured a conservative management of hypoxemia including high flow nasal cannula (HFNC), Hamburg hospitals followed a more aggressive scheme of early mechanical ventilation (MV). Austria and Switzerland experienced higher CFRs than Germany during the first wave but after changing their treatment guidelines, both countries experienced lower CFRs during the second wave.\nUsing retrospective public health data, different case fatality rates have been observed across Germany. A more conservative management of COVID-19 induced Adult Respiratory Distress Syndrome (ARDS) is justified also by epidemiological data.",
    "authors": [
        {
            "affiliation": "Institut f\u00fcr Lungenbiologie (ILBD), Helmholtz Zentrum M\u00fcnchen, Deutsches Forschungszentrum f\u00fcr Gesundheit und Umwelt (GmbH), Ingolst\u00e4dter Landstr. 1, 85764, M\u00fcnchen-Neuherberg, Germany. wjst@helmholtz-muenchen.de.\nInstitut f\u00fcr KI und Informatik in der Medizin, Lehrstuhl f\u00fcr Medizinische Informatik, Klinikum rechts der Isar, Grillparzerstr. 18, 81675, M\u00fcnchen, Germany. wjst@helmholtz-muenchen.de.",
            "firstname": "Matthias",
            "initials": "M",
            "lastname": "Wjst"
        },
        {
            "affiliation": "M\u00fcnchen Klinik, Klinikum M\u00fcnchen Schwabing, K\u00f6lner Platz 1, 80804, M\u00fcnchen, Germany.",
            "firstname": "Clemens",
            "initials": "C",
            "lastname": "Wendtner"
        }
    ],
    "conclusions": "Using retrospective public health data, different case fatality rates have been observed across Germany. A more conservative management of COVID-19 induced Adult Respiratory Distress Syndrome (ARDS) is justified also by epidemiological data.",
    "copyrights": "\u00a9 2023. The Author(s).",
    "doi": "10.1186/s12889-023-15112-0\n10.1055/a-1286-0212\n10.1016/S1473-3099(20)30314-5\n10.1186/s13054-020-03022-1\n10.2807/1560-7917.ES.2020.25.12.2000256\n10.1016/S2213-2600(20)30316-7\n10.1186/s12931-020-01520-y\n10.1183/13993003.01692-2020\n10.1016/j.aucc.2020.10.009\n10.1126/science.abb4557\n10.1186/s12916-020-01790-9\n10.1016/j.medj.2021.03.019\n10.1002/jmv.26050\n10.1159/000516329\n10.1016/S2213-2600(20)30325-8\n10.1016/S2213-2600(20)30459-8\n10.1016/S2213-2600(21)00101-6\n10.1183/13993003.04247-2020\n10.1126/science.368.6490.455\n10.1056/NEJMoa2032510\n10.1016/S2213-2600(20)30121-1\n10.1056/NEJMp2002125\n10.1136/bmj.n450",
    "journal": "BMC public health",
    "keywords": [
        "COVID-19",
        "Case fatality rate",
        "Germany",
        "Hamburg",
        "High flow nasal cannula",
        "Mechanical Ventilation",
        "Munich"
    ],
    "methods": null,
    "publication_date": "2023-03-02",
    "pubmed_id": "36859258\n33246350\n32422201\n32235945\n32616077\n32234121\n32735842\n32972411\n32430410\n33250401\n32269067\n33087179\n32527379\n17811517\n33842906\n32441789\n34023830\n32735841\n33169671\n33684356\n33303538\n32355007\n33471452\n32735840\n32203711\n32074416\n33847695\n33658187",
    "results": "The mean CFR is estimated to be 2.92% based on 71.965 fatalities and 2.465.407 cases. There was a large regional scattering of CFRs across the German districts. Differences of the mortality pattern were observed also at state level and preserved across different sex and age groups while being largely independent of case numbers. Although Munich city had higher infection rates, more patients died during the first wave in Hamburg (OR 1.6, 95% CI 1.3-1.9) which was mirrored also by higher death risk at Hamburg intensive care units (OR 2.0, 95% CI 1.3-3.1). While the majority of Munich hospitals favoured a conservative management of hypoxemia including high flow nasal cannula (HFNC), Hamburg hospitals followed a more aggressive scheme of early mechanical ventilation (MV). Austria and Switzerland experienced higher CFRs than Germany during the first wave but after changing their treatment guidelines, both countries experienced lower CFRs during the second wave.",
    "title": "High variability of COVID-19 case fatality rate in Germany.",
    "xml": "<Element 'PubmedArticle' at 0x78850595b600>"
}