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. 2025 Mar 14;17(3):424.
doi: 10.3390/v17030424.

COVID-19 Disease Burden in the Omicron Variant-Dominated Endemic Phase: Insights from the ROUTINE-COV19 Study Using Real-World German Statutory Health Insurance Data

Sabrina Müller  1 , Andrea Schmetz  2 , Julia K Knaul  2 , Thomas Wilke  3 , Jingyan Yang  4 , Sabine Dornig  5 , Clara Lehmann  6 , Christoph D Spinner  7
Affiliations

COVID-19 Disease Burden in the Omicron Variant-Dominated Endemic Phase: Insights from the ROUTINE-COV19 Study Using Real-World German Statutory Health Insurance Data

Sabrina Müller et al. Viruses. .

Abstract

The ROUTINE-COV19 study explores the burden of COVID-19 in Germany during the early endemic phase, assessing disease patterns and their impact on the healthcare system from 1 July 2022 to 30 June 2023. Using anonymized statutory health insurance data from over 3 million individuals in Thuringia and Saxony, COVID-19 cases were identified through diagnostic codes, with severe and critical cases defined by hospitalization and intensive care criteria. The study focused on high-risk populations as identified by the German Immunization Technical Advisory Group. During the study period, 414,648 new COVID-19 cases were documented, with peaks in October 2022 and March 2023. Severe cases occurred at a rate of 241.6 per 100,000 persons, with in-hospital mortality exceeding 12%. Critical cases requiring intensive care had an in-hospital mortality rate of 32.2%. COVID-19-related hospitalizations averaged 9.94 days, generating direct costs of EUR 64.9 million, while indirect costs from work absenteeism amounted to EUR 454.3 million, representing 7.5% of all-cause absenteeism costs. Despite entering an endemic phase, COVID-19 continues to pose a substantial burden, particularly among older adults and those with pre-existing cardiovascular conditions.

Keywords: COVID-19 case severity; COVID-19 endemic phase; economic impact; healthcare burden; in-hospital COVID-19 case mortality; statutory health insurance data Germany.

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Conflict of interest statement

C.D.S. reports grants and personal fees from AstraZeneca; personal fees and non-financial support from B. Braun Melsungen; personal fees from BioNTech; grants, personal fees, and non-financial support from Gilead Sciences; grants and personal fees from Janssen-Cilag; personal fees from Eli Lilly; personal fees from Formycon; personal fees from Pfizer; personal fees from Roche and others from Apeiron; grants and personal fees from MSD; grants from Cepheid; personal fees from GSK; personal fees from Molecular partners; personal fees from Pfizer and others from Eli Lilly; personal fees from SOBI during the conduct of the study; personal fees from AbbVie; personal fees from MSD; personal fees from Synairgen; personal fees from Shionogi; and grants and personal fees from ViiV Healthcare, outside the submitted work. C.L. reports receiving grants from Gilead, receiving advisory fees from ViiV, Pfizer, Novartis, BioNTech, Merck Sharp & Dohme, and Gilead, and receiving non-financial support from Gilead outside the submitted work. No other disclosures than those related to the affiliations listed were reported by the other authors.

Figures

Figure 1
Figure 1
Crude rates of all COVID-19, severe COVID-19, and critical COVID-19 cases per month (July 2022–June 2023).
Figure 2
Figure 2
Age- and gender-standardized rate of severe COVID-19 cases during the one-year cross-sectional analysis period, categorized by main diagnosis. SHI: Statutory Health Insurance.
Figure 3
Figure 3
Rate of severe cases per 1000 persons (one-year cross-sectional period) in different subpopulations. CI: confidence interval; CV: cardiovascular.
Figure 4
Figure 4
Age- and gender-standardized rate of severe COVID-19 cases during the one-year cross-sectional analysis period, categorized by hospital length of stay. SHI: Statutory Health Insurance; LOS: length of stay.
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