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Problem At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reliable, globally applicable recommendations for safe and continuous school operations were lacking. Approach In October 2020, the German Association of Scientific Medical Societies' task force for COVID-19 guidelines and public health researchers at Ludwig-Maximilians-Universitat Munchen initiated the rapid development of a living evidence- and consensus-based guideline to reduce severe acute respiratory syndrome coronavirus 2 transmission in schools. To facilitate transparent, structured and comprehensive decision-making with a whole-of-society perspective, they applied the WHO- INTEGRATE evidence-to-decision framework. This framework supported a broad, multisectoral composition of the guideline panel. The panel used newly synthesized evidence on nine school measures. Participating medical societies or the guideline secretariat completed evidence- to-decision tables. They also drafted recommendations for the guideline panel, who discussed and revised them during moderated consensus conferences. Local setting In Germany, each state is responsible for organizing schooling. The German Association of Scientific Medical Societies coordinates development of evidence- and consensus-based guidelines. Relevant changes The first version of the guideline was published in February 2021, and the guideline dissemination created much media attention. Of the 16 state education ministries, almost all knew about the guideline, nine recognized it as a relevant source of information and five used it to check existing directives. Lessons learnt The WHO-INTEGRATE framework facilitated a comprehensive assessment of school measures from the start of guideline development, considering the broad societal impact of the measures. Using the framework in rapid mode was feasible, but it fell short of its potential. [phrase omitted] Probleme Au debut de la pandemie de maladie a coronavirus 2019 (COVID-19), il n'existait pas de recommandations fiables et applicables a l'echelle mondiale pour assurer le fonctionnement des ecoles sans interruption et en toute securite. Approche En octobre 2020, le groupe de travail de l'Association allemande des societes scientifiques et medicales charge d'emettre des lignes directrices sur la COVID-19, en collaboration avec des chercheurs en sante publique de l'Universite Louis-et-Maximilien de Munich, a lance le developpement rapide d'une orientation evolutive fondee sur le consensus et sur des preuves, afin de limiter la transmission du coronavirus 2 du syndrome respiratoire aigu severe dans les ecoles. Pour favoriser un processus decisionnel transparent, structure et exhaustif adoptant la perspective de la societe dans son ensemble, il a applique le cadre WHO-INTEGRATE, un outil privilegiant une prise de decision fondee sur des donnees probantes. Ce cadre a permis de composer un vaste panel multisectoriel qui, a la lumiere d'une synthese recente d'elements factuels, a examine neuf mesures scolaires. De leur cote, les societes medicales participantes ou le Secretariat des directives ont complete des tableaux de prises de decision fondees sur des donnees probantes. Ils ont egalement formule des recommandations a l'attention du panel, qui en a discute et les a revisees lors de conferences de concertation moderees. Environnement local En Allemagne, l'education releve de la responsabilite des Etats federes. C'est l'Association allemande des societes scientifiques et medicales qui coordonne l'elaboration de lignes directrices fondees sur le consensus et sur des preuves. Changements significatifs La premiere version de l'orientation a ete publiee en fevrier 2021 et sa diffusion a engendre une forte couverture mediatique. Parmi les 16 Ministeres de l'Education des Etats federes, presque tous en connaissaient l'existence, neuf d'entre eux la consideraient comme une source d'information pertinente et cinq l'utilisaient pour verifier les directives existantes. Lecons tirees Vu l'Impact majeur de ces mesures sur la societe, le cadre WHO-INTEGRATE a contribue a une evaluation globale des mesures scolaires des le debut de l'elaboration de l'orientation. Ce cadre a pu etre rapidement mis en oeuvre, mais n'a pas atteint son plein potentiel. [phrase omitted] Situacion Al principio de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19), no existian recomendaciones fiables y aplicables a escala mundial para el funcionamiento seguro y continuo de las escuelas. Enfoque En octubre de 2020, el grupo de trabajo encargado de las directrices sobre la COVID-19 de la Asociacion alemana de sociedades cientificas medicas e investigadores de salud publica de la Ludwig-Maximilians- Universitat Munchen iniciaron el desarrollo rapido de una directriz activa basada en la evidencia y el consenso para reducir la transmision del sindrome respiratorio agudo grave por coronavirus 2 en las escuelas. Para facilitar una toma de decisiones transparente, estructurada y exhaustiva con una perspectiva de toda la sociedad, aplicaron el marco WHO-INTEGRATE, una herramienta para la toma de decisiones basada en evidencias. Este marco propicio una composicion amplia y multisectorial del panel de directrices. El panel utilizo pruebas recientemente sintetizadas sobre nueve medidas escolares. Las sociedades medicas participantes o la secretaria de la directriz completaron las tablas de evidencia para la toma de decisiones. Tambien redactaron recomendaciones para el panel de directrices, que las debatio y reviso durante conferencias de consenso moderadas. Marco regional En Alemania, cada estado es responsable de organizar la escolarizacion. La Asociacion alemana de sociedades cientificas medicas coordina la elaboracion de directrices basadas en la evidencia y el consenso. Cambios importantes La primera version de la directriz se publico en febrero de 2021 y su difusion suscito una gran atencion mediatica. De los 16 ministerios de educacion estatales, casi todos conocian la directriz, nueve la reconocieron como fuente de informacion pertinente y cinco la utilizaron para verificar las directrices existentes. Lecciones aprendidas El marco WHO-INTEGRATE permitio una evaluacion exhaustiva de las medidas escolares desde el inicio de la elaboracion de las directrices, y tuvo en cuenta el amplio impacto social de las medidas. Utilizar el marco en modo rapido fue factible, pero no alcanzo su potencial., Introduction Public health and social measures played a pivotal role in containing the coronavirus disease 2019 (COVID-19) pandemic. Most governments closed schools during the early months of the pandemic. (1) [...]

Background: More than 767 million coronavirus 2019 (COVID-19) cases and 6.9 million deaths with COVID-19 have been recorded as of August 2023. Several public health and social measures were implemented in schools to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent onward transmission. We built upon methods from a previous Cochrane review to capture current empirical evidence relating to the effectiveness of school measures to limit SARS-CoV-2 transmission., Objectives: To provide an updated assessment of the evidence on the effectiveness of measures implemented in the school setting to keep schools open safely during the COVID-19 pandemic., Search Methods: We searched the Cochrane COVID-19 Study Register, Educational Resources Information Center, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease database, and the US Department of Veterans Affairs Evidence Synthesis Program COVID-19 Evidence Reviews on 18 February 2022., Selection Criteria: Eligible studies focused on measures implemented in the school setting to contain the COVID-19 pandemic, among students (aged 4 to 18 years) or individuals relating to the school, or both. We categorized studies that reported quantitative measures of intervention effectiveness, and studies that assessed the performance of surveillance measures as either 'main' or 'supporting' studies based on design and approach to handling key confounders. We were interested in transmission-related outcomes and intended or unintended consequences., Data Collection and Analysis: Two review authors screened titles, abstracts and full texts. We extracted minimal data for supporting studies. For main studies, one review author extracted comprehensive data and assessed risk of bias, which a second author checked. We narratively synthesized findings for each intervention-comparator-outcome category (body of evidence). Two review authors assessed certainty of evidence., Main Results: The 15 main studies consisted of measures to reduce contacts (4 studies), make contacts safer (7 studies), surveillance and response measures (6 studies; 1 assessed transmission outcomes, 5 assessed performance of surveillance measures), and multicomponent measures (1 study). These main studies assessed outcomes in the school population (12), general population (2), and adults living with a school-attending child (1). Settings included K-12 (kindergarten to grade 12; 9 studies), secondary (3 studies), and K-8 (kindergarten to grade 8; 1 study) schools. Two studies did not clearly report settings. Studies measured transmission-related outcomes (10), performance of surveillance measures (5), and intended and unintended consequences (4). The 15 main studies were based in the WHO Regions of the Americas (12), and the WHO European Region (3). Comparators were more versus less intense measures, single versus multicomponent measures, and measures versus no measures. We organized results into relevant bodies of evidence, or groups of studies relating to the same 'intervention-comparator-outcome' categories. Across all bodies of evidence, certainty of evidence ratings limit our confidence in findings. Where we describe an effect as 'beneficial', the direction of the point estimate of the effect favours the intervention; a 'harmful' effect does not favour the intervention and 'null' shows no effect either way. Measures to reduce contact (4 studies) We grouped studies into 21 bodies of evidence: moderate- (10 bodies), low- (3 bodies), or very low-certainty evidence (8 bodies). The evidence was very low to moderate certainty for beneficial effects of remote versus in-person or hybrid teaching on transmission in the general population. For students and staff, mostly harmful effects were observed when more students participated in remote teaching. Moderate-certainty evidence showed that in the general population there was probably no effect on deaths and a beneficial effect on hospitalizations for remote versus in-person teaching, but no effect for remote versus hybrid teaching. The effects of hybrid teaching, a combination of in-person and remote teaching, were mixed. Very low-certainty evidence showed that there may have been a harmful effect on risk of infection among adults living with a school student for closing playgrounds and cafeterias, a null effect for keeping the same teacher, and a beneficial effect for cancelling extracurricular activities, keeping the same students together and restricting entry for parents and caregivers. Measures to make contact safer (7 studies) We grouped studies into eight bodies of evidence: moderate- (5 bodies), and low-certainty evidence (3 bodies). Low-certainty evidence showed that there may have been a beneficial effect of mask mandates on transmission-related outcomes. Moderate-certainty evidence showed full mandates were probably more beneficial than partial or no mandates. Evidence of a beneficial effect of physical distancing on risk of infection among staff and students was mixed. Moderate-certainty evidence showed that ventilation measures probably reduce cases among staff and students. One study (very low-certainty evidence) found that there may be a beneficial effect of not sharing supplies and increasing desk space on risk of infection for adults living with a school student, but showed there may be a harmful effect of desk shields. Surveillance and response measures (6 studies) We grouped studies into seven bodies of evidence: moderate- (3 bodies), low- (1 body), and very low-certainty evidence (3 bodies). Daily testing strategies to replace or reduce quarantine probably helped to reduce missed school days and decrease the proportion of asymptomatic school contacts testing positive (moderate-certainty evidence). For studies that assessed the performance of surveillance measures, the proportion of cases detected by rapid antigen detection testing ranged from 28.6% to 95.8%, positive predictive value ranged from 24.0% to 100.0% (very low-certainty evidence). There was probably no onward transmission from contacts of a positive case (moderate-certainty evidence) and replacing or shortening quarantine with testing may have reduced missed school days (low-certainty evidence). Multicomponent measures (1 study) Combining multiple measures may have led to a reduction in risk of infection among adults living with a student (very low-certainty evidence)., Authors' Conclusions: A range of measures can have a beneficial effect on transmission-related outcomes, healthcare utilization and school attendance. We rated the current findings at a higher level of certainty than the original review. Further high-quality research into school measures to control SARS-CoV-2 in a wider variety of contexts is needed to develop a more evidence-based understanding of how to keep schools open safely during COVID-19 or a similar public health emergency., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Risk communication of public institutions should support the population in the decision-making process in the event of existing risks. It plays a particularly important role in health emergencies such as the SARS-CoV‑2 pandemic. After the SARS outbreak in 2003, the World Health Organization (WHO) revised its International Health Regulations (IHR 2005) and called for risk communication to be established as a core area of health policy in all member countries. While the emphasis on health policy was welcomed, the potential for risk communication in this area has not yet been fully exploited. Reasons include discrepancies in the understanding of risk communication and the large number of available methods.This discussion article is intended to help establish a new understanding of risk communication in public health emergencies (emergency risk communication - ERC). It is suggested that, in addition to the risks, the opportunities of the crisis should be included more and that risk communication should be understood more as a continuous process that can be optimized at various points. The "Earlier-Faster-Smoother-Smarter" approach and in particular the earlier detection of health risks ("Earlier") could support the management of public health emergencies in the future., (© 2022. The Author(s).)

Introduction: During the SARS-CoV-2 pandemic, policymakers have to make far-reaching decisions that should be supported by scientific evidence. This presents a major challenge, given the limited availability of evidence, especially in the early phases of the pandemic. Decision-makers thus turned to scientific experts to help to convey and contextualize the evidence for public health policymaking. The way in which these experts were consulted varied widely. Some decision-makers called on expert committees in which they convened multiple experts from different disciplines. However, the composition and role of these committees have raised questions of transparency and representation. This study examines whether and how expert committees in Germany were convened at the federal and national level to advise governments and ministries during the SARS-CoV-2 pandemic. We investigated the disciplinary composition, gender representation and the transparency related to the convening of these bodies, work processes and the accessibility of results., Methods: We performed a multi-stage document analysis. Between May and July 2020, we submitted freedom-of-information requests to the governmental institutions at both a federal and a national level. In addition to analysing the responses to these requests, we conducted a thorough search and analysis of the i) pandemic preparedness plans, (ii) official press releases and (iii) minor interpellations ("Kleine Anfragen") at the federal and state level. We included documents on expert committees in the SARS-CoV-2 context for the period from January to the beginning of December 2020 and carried out a qualitative content analysis., Results: We identified a total of 21 expert committees that were established in ten federal states and four federal ministries. In eleven committees, the members were known by name, with women making up 26 % of the members. Biomedical disciplines such as virology, hygiene, medicine, and biology were the most commonly represented. Other disciplines including economics, law and sociology, and non-scientific experts were represented in seven federal states. The members of ten committees were not known by name. These committees covered different thematic areas (school and day-care, civil participation, medicine and care, economic topics), and their members were more commonly practitioners or came from affected populations., Discussion: The SARS-CoV-2 pandemic has led to an increased consultation of experts in public health policymaking. However, expert committees in Germany are not sufficiently representative and interdisciplinary to take different perspectives into account and ultimately advise politicians in complex pandemic situations. Furthermore, the work of these committees is not sufficiently transparent because access to information is limited., Conclusion: Due to this lack of transparency, it is unclear whether and how the expert committees exerted an influence on politics. Transparency of political decision-making processes and the consideration of pluralistic perspectives are considered essential for the legitimation and quality of political decisions in a pandemic and should therefore be strengthened in pandemic management in Germany., (Copyright © 2021. Published by Elsevier GmbH.)

Background: In response to the spread of SARS-CoV-2 and the impact of COVID-19, national and subnational governments implemented a variety of measures in order to control the spread of the virus and the associated disease. While these measures were imposed with the intention of controlling the pandemic, they were also associated with severe psychosocial, societal, and economic implications on a societal level. One setting affected heavily by these measures is the school setting. By mid-April 2020, 192 countries had closed schools, affecting more than 90% of the world's student population. In consideration of the adverse consequences of school closures, many countries around the world reopened their schools in the months after the initial closures. To safely reopen schools and keep them open, governments implemented a broad range of measures. The evidence with regards to these measures, however, is heterogeneous, with a multitude of study designs, populations, settings, interventions and outcomes being assessed. To make sense of this heterogeneity, we conducted a rapid scoping review (8 October to 5 November 2020). This rapid scoping review is intended to serve as a precursor to a systematic review of effectiveness, which will inform guidelines issued by the World Health Organization (WHO). This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and was registered with the Open Science Framework., Objectives: To identify and comprehensively map the evidence assessing the impacts of measures implemented in the school setting to reopen schools, or keep schools open, or both, during the SARS-CoV-2/COVID-19 pandemic, with particular focus on the types of measures implemented in different school settings, the outcomes used to measure their impacts and the study types used to assess these., Search Methods: We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, the CDC COVID-19 Research Articles Downloadable Database for preprints, and the WHO COVID-19 Global literature on coronavirus disease on 8 October 2020., Selection Criteria: We included studies that assessed the impact of measures implemented in the school setting. Eligible populations were populations at risk of becoming infected with SARS-CoV-2, or developing COVID-19 disease, or both, and included people both directly and indirectly impacted by interventions, including students, teachers, other school staff, and contacts of these groups, as well as the broader community. We considered all types of empirical studies, which quantitatively assessed impact including epidemiological studies, modelling studies, mixed-methods studies, and diagnostic studies that assessed the impact of relevant interventions beyond diagnostic test accuracy. Broad outcome categories of interest included infectious disease transmission-related outcomes, other harmful or beneficial health-related outcomes, and societal, economic, and ecological implications., Data Collection and Analysis: We extracted data from included studies in a standardized manner, and mapped them to categories within our a priori logic model where possible. Where not possible, we inductively developed new categories. In line with standard expectations for scoping reviews, the review provides an overview of the existing evidence regardless of methodological quality or risk of bias, and was not designed to synthesize effectiveness data, assess risk of bias, or characterize strength of evidence (GRADE)., Main Results: We included 42 studies that assessed measures implemented in the school setting. The majority of studies used mathematical modelling designs (n = 31), while nine studies used observational designs, and two studies used experimental or quasi-experimental designs. Studies conducted in real-world contexts or using real data focused on the WHO European region (EUR; n = 20), the WHO region of the Americas (AMR; n = 13), the West Pacific region (WPR; n = 6), and the WHO Eastern Mediterranean Region (EMR; n = 1). One study conducted a global assessment and one did not report on data from, or that were applicable to, a specific country. Three broad intervention categories emerged from the included studies: organizational measures to reduce transmission of SARS-CoV-2 (n = 36), structural/environmental measures to reduce transmission of SARS-CoV-2 (n = 11), and surveillance and response measures to detect SARS-CoV-2 infections (n = 19). Most studies assessed SARS-CoV-2 transmission-related outcomes (n = 29), while others assessed healthcare utilization (n = 8), other health outcomes (n = 3), and societal, economic, and ecological outcomes (n = 5). Studies assessed both harmful and beneficial outcomes across all outcome categories., Authors' Conclusions: We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Aims: Quality control, benchmarking, and pay for performance (P4P) require valid indicators and statistical models allowing adjustment for differences in risk profiles of the patient populations of the respective institutions. Using hospital remuneration data for measuring quality and modelling patient risks has been criticized by clinicians. Here we explore the potential of prediction models for 30- and 90-day mortality after colorectal cancer surgery based on routine data., Study Design: Full census of a major statutory health insurer., Setting: Surgical departments throughout the Federal Republic of Germany., Patients: 4283 and 4124 insurants with major surgery for treatment of colorectal cancer during 2013 and 2014, respectively., Predictors: Age, sex, primary and secondary diagnoses as well as tumor locations as recorded in the hospital remuneration data according to §301 SGB V., Outcomes: 30- and 90-day mortality., Statistical Analysis: Elixhauser comorbidities, Charlson conditions, and Charlson scores were generated from the ICD-10 diagnoses. Multivariable prediction models were developed using a penalized logistic regression approach (logistic ridge regression) in a derivation set (patients treated in 2013). Calibration and discrimination of the models were assessed in an internal validation sample (patients treated in 2014) using calibration curves, Brier scores, receiver operating characteristic curves (ROC curves) and the areas under the ROC curves (AUC)., Results: 30- and 90-day mortality rates in the learning-sample were 5.7 and 8.4%, respectively. The corresponding values in the validation sample were 5.9% and once more 8.4%. Models based on Elixhauser comorbidities exhibited the highest discriminatory power with AUC values of 0.804 (95% CI: 0.776 -0.832) and 0.805 (95% CI: 0.782-0.828) for 30- and 90-day mortality. The Brier scores for these models were 0.050 (95% CI: 0.044-0.056) and 0.067 (95% CI: 0.060-0.074) and similar to the models based on Charlson conditions. Regardless of the model, low predicted probabilities were well calibrated, while higher predicted values tended to be overestimates., Conclusion: The reasonable results regarding discrimination and calibration notwithstanding, models based on hospital remuneration data may not be helpful for P4P. Routine data do not offer information regarding a wide range of quality indicators more useful than mortality. As an alternative, models based on clinical registries may allow a wider, more valid perspective., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)