COVID-19 Is Here to Stay: Seasonal Endemic SARS-CoV-2 Infection Patterns Indicate Recurring Waves Adding to Respiratory and Cardiovascular Disease Burden in Germany

OBJECTIVES: SARS-CoV-2 has progressed from a pandemic into an endemic setting, becoming a mainstay in the picture of seasonal respiratory infections. The German real-world linked data study ROUTINE-COV19 was initiated to characterize the progression, including predictive factors and the clinical and economic impact of the Omicron SARS-CoV-2 variants and resulting COVID-19 disease burden.

METHODS: This interim analysis of the ROUTINE-COV19 study utilized German statutory health insurance (SHI) data from more than 3 million people in Thuringia and Saxony, which gives a representative picture of the total German population. The cross-sectional analysis investigated COVID-19 disease patterns from July 1, 2022, until June 30, 2023, using a 12-month pre-index period to describe specific risk populations/case characteristics and ensure a wash-out period to identify new cases.

RESULTS: In the analyzed one-year period, clinicians diagnosed 414,648 new COVID-19 cases (in 371,382 patients), leading to an age-/gender-standardized rate of 13.2% for the overall SHI population (9.7 million cases). In the reviewed post-pandemic/endemic setting, COVID-19 disease activity in Germany has shifted to a strong peak in the fall with a minor peak in the spring. This had a notable impact on the total number of sick days due to COVID-19 that was sustained post-pandemic. Of all identified COVID-19 cases, 2.1% were classified as severe cases within hospitalizations, translating to 241 cases per 100,000 people in the German SHI population. This rate was considerably higher in the cardiovascular risk population with 9.8%; mostly with a length of hospital stay of more than 5 days (6.8% of all cases).

CONCLUSIONS: COVID-19 has become a core contributor to non-severe and severe seasonal respiratory disease burden in the German healthcare system.