[The first COVID-19 hotspot in a retirement home in Hamburg]. / Der erste COVID-19-Hotspot in einer Hamburger Senioreneinrichtung: Präventionskonzept, Letalität und Obduktionsbefunde.

Background: Coronavirus disease 2019 (COVID-19), a disease caused by the new coronavirus (SARS-CoV-2), is a particular threat to old people. At the end of March 2020, the first and so far largest outbreak of the disease occurred in a retirement home in Hamburg. Methods: Analysis of procedures in dealing with a residential unit affected by SARS-CoV­2, accommodating a risk group of 60 seniors with dementia is presented as well as a detailed presentation of post-mortem examination results of all 8 deceased tested positive for SARS-CoV­2. Results: Out of 60 residents, 39 were infected by SARS-CoV­2. Due to preventive procedures it was possible to stop further spreading of the infection to other residential areas. In all 8 fatal cases, the autopsy diagnosis was death due to COVID-19. Autopsies revealed all COVID-19 patients to have a fatal (broncho)pneumonia and signs of relevant pre-existing cardiac, renal and pulmonary conditions in all cases. In 75% (n = 6) of the cases a fresh venous thrombosis was found. In 66.7% (n = 4) of the cases thrombotic events were combined with peripheral pulmonary artery thromboembolisms. Conclusion: The cohort of SARS-CoV­2 infected residents of a nursing home is characteristic for clinical and epidemiological features of the new coronavirus disease. Due to a centralized evaluation of all fatalities at the Institute of Legal Medicine in Hamburg, a detailed examination of all deceased positive for SARS-CoV­2 was possible. Thereby, increased case fatality rates of approximately 20% could in all cases be assigned to a relevant number of pre-existing comorbidities of multiple organ systems, which was consistent with the clinical data available.

[Morbidity and cause of death in homeless persons]. / Erkrankungen und Todesursachen bei Wohnungslosen.

The Hamburg Institute of Forensic Medicine analysed 388 deaths of homeless people between 1990 and 1998 considering demographic data, post-mortem results and autopsy findings. The manner of death was either unnatural or unascertained; the autopsy rate amounted to 43.8%. The results confirm the observation discussed in the last few years that homeless people are usually in a poor state of health. In relation to the average age of death, which is 44.5 years, the number of previous diseases is high. Unnatural causes (excluding homicides) account for a high percentage, viz. 62.6%, primarily intoxications. The most frequent natural cause of death is infection (16.8%). Women account for 8.5% of the deaths with their organ findings and causes of deaths being different from those of homeless men in terms of distribution and incidence. The data presented in this report may be helpful for the improvement of the present system of medical help in Hamburg.