[Innovative SARS-CoV-2 crisis management in the public health sector: Corona dashboard and wastewater surveillance using the example of Berchtesgadener Land, Germany]. / Innovatives SARS-CoV-2-Krisenmanagement im öffentlichen Gesundheitswesen: Corona-Dashboard und Abwasserfrühwarnsystem am Beispiel Berchtesgadener Land.

BACKGROUND: The rise of an infectious disease crisis such as the SARS-CoV­2 pandemic posed significant challenges for the administrative structures of the public health service, which resulted in varying levels of efficiency in outbreak management as a function of staffing and digital resources. This substantially impeded the integration of innovative pandemic outbreak management tools. Innovative crisis management, such as cluster tracking, risk group testing, georeferencing, or the integration of wastewater surveillance recommended by the EU Commission, was made significantly more difficult. AIM: In this case study in Berchtesgadener Land, we present the integration of an area-wide georeferenced wastewater surveillance system that captured 95% of the entire population since November 2020. METHODOLOGY: Sampling occurred twice a week at nine municipal wastewater treatment plants and directly from the main sewer at three locations. Samples were pre-treated by centrifugation and subsequently analyzed by digital droplet polymerase chain reaction (PCR) targeting four specific genes of SARS-CoV­2. RESULTS: The integration of an area-wide georeferenced wastewater surveillance system was successful. Wastewater occurrences are plotted for each municipality against cumulative infections over seven days per 100,000 inhabitants. Changes in the infection pattern in individual communities are noticeable ten days ahead of the official case numbers with a sensitivity of approximately 20 in 100,000 inhabitants. DISCUSSION: The integration of this innovative approach to provide a comprehensive overview of the situation by employing a digital dashboard and the use of an early warning system via quantitative wastewater surveillance resulted in very efficient, proactive management, which might serve as a blueprint for other municipalities in Germany.

COVID-19 Pandemic & Bureaucracy: The Crisis Inside the Crisis.

The Medical Intelligence and Information (MI2) Unit of the German Armed Forces (Bundeswehr) is experienced in crisis support in military missions since several years. It gained additional experiences during the current coronavirus 2019 (COVID-19) pandemic on different levels of the response to crisis and was requested to share the findings and expertise with the overloaded civil public health agencies inside Germany. Since the beginning of the pandemic, the unit is constantly developing new products for crisis communication, knowledge sharing techniques in new databases, dashboards for leadership, and training for laypersons in contact tracing. Hence, trying to innovate in crisis since the first severe acute respiratory syndrome coronavirus (SARS-CoV)-2-disease wave. During the second wave, the unit was requested to evaluate the outbreak management of different national civil public health agencies in southern Germany, and to support the development of dashboards in a comprehensive public health approach as a necessary start toward digitalization.

Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis.

BACKGROUND: The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases. OBJECTIVE: The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp. METHODS: DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation. RESULTS: For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed. CONCLUSIONS: We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps.