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How Covid-19 affects our mental health?

New longitudinal study analysed the mental health of the Luxembourgish population during first lockdown.

A new Research Luxembourg study found female and younger respondents reported higher rates of severe depression and anxiety symptoms, suggesting higher vulnerability to the pandemic control measures.

The first wave of the COVID-19 outbreak resulted in strict pandemic control measures in Luxembourg and other countries. While these measures expectedly had an impact on the mental health of Luxembourg residents, little data is available on the longitudinal evolution of population mental health measures during lockdown and during the gradual relaxation of the lockdown measures in spring 2020.

The new study conducted by the CON-VINCE consortium explored whether differential effects of COVID-19 restrictions on mental health could be observed by sex and age in a Luxembourgish nationally representative sample during the initial outbreak of COVID-19. The analysis assessed whether there are differences in risk and protective factors longitudinally at two assessment times.

A total of 1,756 respondents aged 18 years and older (50.74% women) reported sociodemographic and socio-economic characteristics, depression, anxiety, stress, and loneliness.

Women more vulnerable to depression

This study examined mental health during the initial COVID-19 containment measures in Luxembourg residents at baseline (one month after the start of the containment measures) and at follow-up (two weeks after baseline, at the start of the relaxation of the containment measures).

Overall, levels of stress, depression and anxiety were higher in women, indicating that the psychological effects of the COVID-19 pandemic may be greater for women. In fact, women were more likely to have part-time jobs, to be homemakers or family caregivers, to work in the health sector and to have lower incomes.

While Luxembourg has taken several steps to bring about equality between men and women, there were still visible gender-related socio-economic differences in the study. For instance, women reported on average a lower income than men. In addition, women reported a higher rate of caring tasks.

Since the first wave of the pandemic, policy measures have been implemented in Luxembourg to buffer the impact of childcare closures, family leave and other measures that could aim to reduce the impact of the pandemic. Other measures could contribute to ensure a more equal use of family leave to increase work-family balance for mothers. A follow-up analysis one year into the pandemic will help to understand whether the existing measures were effective.

Younger groups more likely to present severe depression

In Luxembourg, younger respondents reported more symptoms of stress, depression and anxiety than older respondents. This could be explained by the fact that younger study participants are more vulnerable because they are exposed to a greater uncertainty about their future in terms of careers in a changing world, employment and a possible economic crisis.

Given the impact of the pandemic on social contacts, daily routines, employment and mobility prospects, the higher degrees of depression, anxiety, stress and loneliness reported by young respondents may reflect the suddenly changed conditions and prospects of today’s younger generation.

This study contributes to the investigation of mental health consequences of the pandemic and the pandemic control measures. In particular, it stresses out shifts in care task responsibilities and gender and socio-economic inequalities. It also highlights younger groups’ uncertainty about the future.

Meet the authors

Fabiana Ribeiro Fabiana Ribeiro is a postdoctoral Research Assistant at University of Luxembourg. She completed a Ph.D. in Basic Psychology in 2019, in which she investigated the effects of emotions evoked by music in the mnesic capacity.

At the moment, she works as a postdoctoral research under supervision of Professor Anja Leist, in which she investigates gender inequalities in cognitive ageing and differences in prevalence of memory impairment in Latin America and the Caribbeans, with a focus on temporal changes and prevalence of associated risk factors.

Valerie E. Schröder is a clinical neuropsychologist/research and development specialist, who has worked in different health care institutions in Luxembourg, Germany and Belgium with the aim to diagnose and treat cognitive dysfunctions in patients suffering from neurological disorders (e.g. neurodegenerative diseases, strokes, traumatic brain injury, etc) and to provide psychological support for patients and their caregivers.

She is currently working as a research and development specialist in the Translational Neuroscience group at the Luxembourg Centre for Systems Biomedicine in the “programme dementia prevention (pdp), a nation-wide integrated care concept coordinated by  Prof. Dr. med. Rejko Krüger.

Rejko Krüger is Professor for Clinical and Experimental Neuroscience at the University of Luxembourg and Director of Transversal Translational Medicine at the Luxembourg Institute of Health. He is coordinating the CON-VINCE study.

Since June 2019, he links between the Luxembourg Institute of Health (LIH) and the Luxembourg Centre for Systems Biomedicine (LCSB) to contribute to personalised medicine by implementing translational research programmes involving partners from different fields within a joint scientific strategy. Furthermore, he sees patients with Movement Disorders at the Centre Hospitalier de Luxembourg. Since 2017, the Ministry of Health is supporting Prof. Krüger to lead integrated healthcare concepts for neurodegenerative diseases in Luxembourg: the “Programme Démence Prévention” (an initiative to prevent dementia) and ParkinsonNet Luxembourg (a care network of health care professionals for Parkinson’s disease).

Anja Leist is Associate Professor in Public Health and Ageing and Vice-head of the Institute for Research on Socio-Economic Inequality in the Department of Social Sciences of University of Luxembourg. 

She is an expert on the topics of health inequalities, ageing, and cognitive ageing, with a social epidemiological and life course perspective. She had research stays at the universities of Luxembourg, Zurich/Switzerland, and Rotterdam/Netherlands, and was funded by several national and European funders, among them the European Research Council on the topic of cognitive ageing.

This work was supported by the Fonds National de la Recherche (FNR) and the André Losch Foundation.

Read complete study The evolution and social determinants of mental health during the first wave of the COVID-19 outbreak in Luxembourg

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About Luxembourg Covid-19 taskforce Latest news

Luxembourg comes second in dealing with COVID-19

Successful pandemic strategy.

German news site “Der Spiegel” compared and assessed the pandemic control strategies of 154 countries across the globe. Luxembourg is one of the front-runners and ranks 2nd, just behind Finland and ahead of Norway.

The analysis was based on a series of factors comprising the Stringency Index. Other aspects include excess mortality, restrictions on personal freedom, impact on the gross domestic product and vaccination progress.

Luxembourg brings Covid-19 pandemic under control

Based on these factors, Luxembourg holds the second position in the international ranking among the 154 countries analysed. Finland ranks first. Following Luxembourg are Norway, Denmark, Taiwan, and Singapore.

Finland, Luxembourg, Denmark, and Estonia are the only EU countries among the 16 countries that have weathered the crisis best.

When it comes to the stringency of the measures to contain the virus, Luxembourg ranks about in the middle, achieving a score of 45. The Stringency Index go from 0 (no measures) to 100 (high restrictions).

Luxembourg also managed to keep its economy afloat compared to the rest of the world. According to the data of the International Monetary Fund, Luxembourg deviated by -4 percent from the original GDP forecast and thus occupies 22nd place in the country ranking.

©Diese Länder haben es bisher am besten durch die Pandemie geschafft, Der Spiegel

Covid-19 Task Force – Research Luxembourg harnesses knowledge as well as human and material capacities

Since the outbreak of the pandemic, Luxembourg has implemented an extensive screening strategy including mass screening of its population and systematic screening of contacts.

With a population size of around 626,000 residents, on average every resident in Luxembourg has been tested at least 3.6 times. Luxembourg has had an overall positivity rate of 2.6% since the outbreak, while Belgium, France and Germany have had positivity rates of 8.1%, 7.4% and 5.6%, respectively.

In addition to mass screening and systematic contact tracing for SARS-CoV-2, Luxembourg has also conducted a representative serological sampling on a weekly basis among its residents since November 2020.

More about Research Luxembourg Covid-19 Task Force

Read Generalisation of COVID-19 incidences provides a biased view of the actual epidemiological situation by Paul Wilmes, Joël Mossong, Thomas G. Dentzer

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Covid-19 taskforce Latest news Sustainable & Responsible Development

How to make large-scale, voluntary COVID-19 testing work?

New research from a behavioural economics perspective.

Using behavioural economics insights complemented with data from a novel survey in the US and a survey experiment in Luxembourg, new research paper examines behavioural factors associated with the individual willingness to get tested.

Testing is widely seen as one core element of a successful strategy to curtail the COVID-19 pandemic and many countries have increased their efforts to provide testing at large scale. As most democratic governments refrain from enacting mandatory testing, a key emerging challenge is to increase voluntary participation. 

Researchers from the Luxembourg Institute of Socio-Economic Research (LISER) have recently published an article entitled “How to make universal, voluntary testing for COVID-19 work? A behavioural economics perspective” in the journal Health Policy. In the paper, co-authored by Francesco Fallucchi, Joël Machado, Marc Suhrcke of LISER, Luise Görges of Leuphana University of Lüneburg, and Arne Pieters, an independent researcher, the authors lay out the challenges and potential solutions to encourage voluntary testing.

Testing heavily

In the early summer of 2020 (and again in this summer), European countries have been gradually reducing lockdown measures, upon having achieved significant reductions in the number of registered infections with SARS-CoV-2, while also having ramped up their health care and testing capacity and improved vaccine rollout. This allowed them to enter a new phase, trying to control the spread of the virus by a combination of looser measures and active monitoring. Such a strategy will need to involve some version of large-scale testing.

Most democratic governments hitherto prefer to rely on the voluntary participation of the population. Yet, both for accurately monitoring the virus spread and for successfully identifying infected individuals, it is crucial that a large share of people – and in particular those most likely to carry (and hence spread) the virus – are willing to participate. This does pose some challenges.

Will people go for testing if they don’t have to?

Will people come forward for testing if they do not have to? If not, why not? And do compliers, those taking the test, differ systematically from non-compliers, in ways that could seriously limit the usefulness of the entire strategy?

To assess this, policymakers need to understand people’s incentives for taking or avoiding a test. A good starting point is to assume that people act “rationally”, which means that people act as if they weigh (consciously or unconsciously) their personal (monetary and non-monetary) costs and benefits of testing and ultimately go for the option with the highest expected net benefits.

The personal expected benefits will derive from knowing one’s current COVID-19 status, which allows individuals to:

  1. quickly eliminate uncertainty about their COVID-19-related health status and obtain a certificate in case of a negative result;
  2. improve their health status and odds of recovery by seeking healthcare if needed;
  3. prevent harming others in their immediate inter-personal environment, such as family and friends, as well as contacts in other relevant settings (work, school).

Critically now, the most important benefit from testing accrues at the societal level – getting tested has a positive externality for society, by helping the government to control the pandemic. While individuals also obtain benefits from getting tested, those benefits may not outweigh the personal costs of getting tested, leading to a misalignment of incentives. Paradoxically, this problem intensifies as strategies to manage and contain the spread of the virus become more and more successful: If the chances of contracting an infection are relatively small, so are the expected personal benefits from knowing one’s health status, seeking healthcare, protecting others. (It is important to note that, in the very current context (June/July 2021) – several months after the time of writing the article – the perks of showing certified, positive test results have significantly increased.)

Early evidence from Luxembourg, which embarked on a large-scale testing strategy (Luxembourg), pointed to what may appear as limited take-up of the test (in May 2020). For instance, take-up among final grade secondary students and teachers was around 40% according to some media sources; another report announced a take-up of less than 40% among students before the Government made a weekly self-test as a mandatory condition for school attendance.

These numbers illustrate the importance of aligning the societal with the individual benefits to raise the number of tests taken closer to the socially optimal level. To achieve this, policy makers may consider to

  1. reduce personal costs and
  2. increase personal (expected) benefits of test-taking, using both monetary and/or non-monetary incentives.  

Potential solutions

Reducing individual costs

Convenience and safety

Making testing very convenient and safe possible for test-takers will undoubtedly reduce individual costs associated with testing.

Psychological costs

Psychological costs from a positive diagnosis can be addressed in two ways: Medical treatment including counselling upon a positive diagnosis, as well as de-stigmatisation of positive individuals at the society level.

Self-isolation upon testing positive

Need to consider the various ways in which self-isolation can induce costs to individuals and how compensation may best occur, while avoiding to incentivise individuals to actively seek infection.

Increasing benefits

Knowing one’s own health status

Testing reduces uncertainty regarding one’s own health status, allows to benefit from healthcare at an early stage if infected, and actively prevent infecting others in their immediate personal environment.

Prosocial benefits

Increasing the benefits derived from contributing to a good health status for loved ones and other members of society.

Social image benefits

People may also benefit from doing what is regarded by others as “the right thing to do”. Research has shown that social image concerns are an important motivator for individuals.

Monetary and non-monetary benefits

A straightforward way of increasing expected benefits of test-taking would be to set monetary rewards for compliers. Access to services, such as travelling or leisure activities, increasingly require proof of a negative test.

Meet LISER’s researchers

Francesco Fallucchi

Francesco Fallucchi is a researcher in the Behavioural and Experimental Economics platform. He joined LISER in 2017 after spending three years as a Research Fellow at the University of East Anglia and CBESS. He completed his Phd in Economics at the University of Nottingham in 2014.

Francesco uses experimental methods to explore individual behaviour in strategic settings as well as individual adaptation to social norms.

Joël Machado

Joël Machado completed his PhD in October 2014 at the Université catholique de Louvain under the supervision of Prof. Frédéric Docquier. From July 2015 to June 2017, he was a FNR AFR Postdoctoral researcher at CREA, University of Luxembourg.

His current research studies the impact of policies on immigration flows and immigrants’ behaviour.

Marc Suhrcke

Marc Suhrcke heads the cross-departmental Research Programme on ‘Health and Health Systems’ at LISER and is a Professor of Global Health Economics at the Centre for Health Economics (CHE) at the University of York, UK.

His research revolves around a wide range of health economic aspects, including the socio-economic determinants and consequences of health and health inequalities, as well as the evaluation of the impact of population- and system-level policies on health and related outcomes. Most of his work seeks to use observational data to uncover relevant, ideally causal relationships.

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Covid-19 taskforce Latest news

Covid-19: Health/Wealth trade-off

Saving lives or saving the economy during the COVID-19 pandemic? Efforts to combat the COVID-19 crisis were subject to a difficult trade-off. The stringency of the lockdowns decreased the spread of the virus, but amplified the damage to the economy. Then, how to balance health/wealth concerns during a pandemic?

A study conducted by Dr Christophe Lesschaeve, Prof. Josip Glaurdić, and Dr Michal Mochtak from the Department of Social Sciences of University of Luxembourg looks into the public attitudes towards the difficult trade-off imposed by the COVID-19 pandemic. Are people willing to accept a higher death toll in an attempt to limit the damage of the economy, or is saving lives considered non-negotiable?

How does public opinion look at the Health/Wealth trade-off?

The coronavirus pandemic turns out to be the greatest public health crisis in over a century. For more than a year, the main instrument has been social distancing, which sought to limit contact between people by confining them to their homes and closing down businesses. Such measures have indeed been found to significantly reduce the spread of the virus and by extension its death toll, but at a steep economic cost. This has led many to conclude that the COVID-19 pandemic involves an inevitable trade-off between limiting the public health effects of the virus and preventing an economic collapse.


This unenviable choice has spurred on the development of policy models that balance the health and economic aspects of the crisis response. These models predominantly rely on the assumption of a utilitarian government, in which the economic cost of saving a person from COVID-19 should not outweigh the economic value of that person’s remaining life expectancy. Democratic governments, however, cannot realistically make policies based on those models. Eventually, they need to answer to their constituents for the actions taken during the COVID-19-pandemic, and public views on the trade-off between death tolls and economic performance seem to be guided by much more than economic calculation.


Given what we know about the role of emotion in people’s decision-making processes, it is highly doubtful that public opinion will conform to the utilitarian suppositions of economic models. This raises the question of how people look at this trade-off. We believe there are three recurring features of the health/wealth debate during the COVID-19 outbreak.

01

Framing of the dilemma

It became apparent that the health and economic consequences of lockdown policies differ between generations, a tendency emerged to recast the trade-off as not one between economic value and human lives, but as one between the young and the elderly.

02

Health versus wealth debate

The debate between health/wealth, especially in the UK and US, seems to be conducted alongside the classic left-right divide, with those on the right favoring the markets and those on the left prioritising saving lives. A similar ideological divide has been found with regards to adherence to social distancing measures.

03

Social distancing and lockdown policies

The health/wealth debate, and of social distancing and lockdown policies in general, has been the concern for the loss of civil liberties and an expansion of the surveillance state. After all, many social distance measures constitute levels of government control over society seen only in authoritarian regimes, and fears have emerged about whether governments will relinquish this control once the outbreak is over.

Are people willing to accept a higher death toll in an attempt to limit the damage to the economy? Or is saving lives considered non-negotiable? Can the public be swayed by how the choice is framed and formulated? Are preferences regarding this trade-off related to people’s ideological worldviews? And what is the role of trust in the government?

Putting health over economy generally had strong public support

The results show that public opinion generally favored saving lives even at a steep economic cost. However, the willingness to trade lives for the economy was greater when the different health and economic consequences of lockdown policies for the young and the elderly were emphasised. Free market views also make people more acceptant of higher casualties, as do fears that the instituted measures will lead to a permanent expansion of government control over society.


The results shed light on the drivers behind the variation in public reactions to social distance measures, especially between Europe and the United States. With attempts at reframing the trade-off, a greater reliance on the free market, and a cultural tradition of skepticism towards government control, it should come as no surprise that the public response to social distancing measures in the United States was so polarised. In contrast, public opinion in Europe was largely acceptant of efforts to stop the virus’ spread.

A year later, are people still willing to rejects any concession in the effort to save lives, even if it means economic harm? To understand the impact of time on the perception of the trade-off of heath versus wealth, the researchers are currently collecting a second wave of data.

For this study, a representative sample of over 7000 citizens of Bosnia-Herzegovina, Croatia and Serbia answered a survey between 27 April and 16 May 2020. With their economies in flux and politics balancing between democracy and authoritarianism, the region shares many characteristics with other European societies in Central and Eastern Europe. Therefore, the three countries serve as excellent case study to the health versus wealth trade-off in a non-western context.

The study was recently accepted for publication in the journal Public Opinion Quarterly.

Meet the researchers

 Prof. Josip Glaurdić

Associate Professor Department of Social Sciences University of Luxembourg

Dr. Christophe Lesschaeve

Postdoctoral researcher Department of Social Sciences University of Luxembourg

Dr. Michal Mochtak

Postdoctoral researcher Department of Social Sciences University of Luxembourg

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Launch of FNR COVID-19 funding instrument

Following the fast-track FNR COVID-19 Call in 2020, the Luxembourg National Research Fund (FNR) has opened a new FNR COVID-19 funding instrument. There is no Call per se – projects can be submitted anytime from 21 April 2021 to 15 October 2021. Retained projects will be funded with up to 125,000 EUR for a maximum of 12 months. 

In the past year, the global COVID-19 pandemic has drastically changed our society, and has impacted humanity on individual, economic, and social levels. All countries have been affected by this crisis and are starting to band together in order to fight the spread of this disease and minimise its devastating effects.

This specific FNR instrument to address COVID-19 is based on a fast-track “mechanism” that allows the support of research projects requiring an immediate start, e.g. in view of data collection or other work during the current crisis.

Projects are expected to directly impact the management of the crisis in the coming months, e.g. in the area of public health or monitoring of the pandemic. Thereby, projects should result in new, tangible insights concerning the current status of the crisis and/or provide actionable means to deal with it in the short-term.

FNR project selection and funding are carried out within a short period of time but without deviating from the principles of peer review.

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COVID-19: Survey on the Socio-Economic impacts of the crisis

Phase 2 of the survey examines the long-term impacts on the experiences and expectations of residents and cross-border workers

Within the framework of the Task Force Research Luxembourg, Luxembourg Institute of Socio-Economic Research (LISER) and the University of Luxembourg have decided to join their efforts to study the socio-economic impacts of the COVID-19 crisis in Luxembourg and in the Greater Region. This project, supported by the Luxembourg National Research Fund (FNR), began to study in spring 2020 the short-term impacts suffered by individuals and families in the beginning of the lockdown and is now looking at their long-term expectations and concerns.

Similar to the Phase 1 previous survey launched, this large online survey is aimed at all residents in Luxembourg aged 16 and over, whether they are workers, students, retirees, high school students, …because all opinions count and all information is valuable.  The survey is also accessible to cross-border workers, who have also been affected by this crisis.

The survey covers health (physical and mental), employment and working patterns, daily activities, mobility, family interactions, etc.

The responses collected will provide a better understanding of the extent of the socio-economic impacts of the pandemic, provide a portrait of the people hardest hit, and thus help to inform the important policy decisions that will still have to be taken in the coming weeks and months.

Copyright: LISER

This study is being conducted on a voluntary and anonymous basis, and is carried out in two phases:

The questionnaire, translated into French, German and English, takes about 20 minutes to complete. The more numerous and precise the answers, the more reliable the results of the analysis will be.

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COVID-19: CON-VINCE study enters homestretch

Originally launched in April 2020 under the aegis of the Research Luxembourg COVID-19 Taskforce, the CON-VINCE study aims to evaluate the prevalence and dynamics of the spread of COVID-19 within the Luxembourgish population, with a specific focus on asymptomatic and mildly symptomatic individuals. The last round of testing of the CON-VINCE participants is due to start in April 2021, approximately one year after the first set of visits upon inclusion in the study. The final wave will provide a comprehensive insight into the evolution and transmission of the disease over an extended timeframe, particularly from an immunity perspective.     

Under the leadership of Prof Rejko Krüger, Director of Transversal Translational Medicine (TTM) at the Luxembourg Institute of Health (LIH), CON-VINCE aims to detect asymptomatic and mildly symptomatic (oligosymptomatic) carriers by testing a panel of over 1,800 individuals, representative of the Luxembourgish population, for the presence of the SARS-CoV-2 virus and monitoring them over 12 months through a series of follow-up visits.

The annual follow-up testing phase under the project will begin on April 19th and is set to run over 5 to 6 weeks. As with the previous rounds of testing, all participants will be subjected once to a nasopharyngeal swab. Blood and stool samples will also be collected once as part of these follow-up visits, with the support of the laboratories Ketterthill, Laboratoires Réunis, BioneXt Lab, as well as of LIH and Laboratoire National de Santé (LNS) as associated partners for biospecimen collection. Biological sampling will be complemented by collecting additional information on confinement measures and vaccination through short follow-up questionnaires.

“From an operational perspective, participants will be asked to fill out the questionnaire provided through our partner TNS-Ilres. Upon completion, they will receive a voucher for sample collection at one of our partner laboratories. Collected samples will then be sent to the Integrated Biobank of Luxembourg (IBBL) for further analysis and storage”, explains Prof Rejko Krüger, coordinator of CON-VINCE.

Specifically, the collected nasopharyngeal swabs will undergo PCR testing to detect the presence of the SARS-CoV-2 virus, while blood samples will be analysed for antibodies (serological testing) to assess whether the participants have mounted an immune response following exposure to the virus or after vaccination.

We are expecting to obtain crucial information from this annual follow-up, particularly as pertains to the persistence of the antibody response over a full year. Moreover, this last visit will also allow us to analyse cell-based immunity, thereby giving us a more complete picture of the global immune response against the novel SARS-CoV-2”, adds Prof Krüger.

“For this reason, we would like to express our heartfelt gratitude to our partners, and specifically to the diagnostic laboratories and TNS-Ilres, for their unfaltering support and seamless collaboration throughout the past year, as well as to all volunteers who agreed to participate in the study. I take this opportunity to stress again the importance of their renewed participation, particularly in the context of this final wave, without which we would not be able to generate meaningful data and research outcomes for patients and the population in general”, he concludes.

About CON-VINCE

CON-VINCE was launched in April 2020 as one of the several initiatives put in place under the aegis of the Research Luxembourg COVID-19 Taskforce to help contain the current pandemic. By screening a statistically representative panel of volunteers for the presence of the SARS-CoV-2 virus, CON-VINCE will identify asymptomatic and mildly symptomatic individuals and follow them up for a year. Ultimately, the study aims to generate accurate data on the prevalence and transmission of the disease within the Luxembourgish population.

CON-VINCE is led by a consortium of Luxembourgish research institutions, including LIH, its Integrated Biobank of Luxembourg (IBBL), the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg and the Laboratoire National de Santé (LNS), with the support of the market research company TNS-ILRES for the selection of participants and of the national diagnostic laboratories Ketterthill, Laboratoires Réunis and BioneXt Lab as associated partners for sample collection. The study is co-funded by the Luxembourg National Research Fund (FNR) with an amount of EUR 1.4 million and by the Fondation André Losch through a financial commitment of EUR 800,000.  

Learn more on the CON-VINCE study

Scientific Contact:
  • Prof Rejko Krüger
  • Luxembourg Institute of Health
  • Tel: +352 26970-800 (8am – 5pm)
  • con-vince@lih.lu
Press Contacts:

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COVID-19: The socio-economic impact of the pandemic and related (de)confinement measures in Luxembourg on individuals and households

Based off the results of Phase 1 of a large-scale survey, two major socio-economic impacts of the COVID-19 pandemic has been identified: one related to work and the other one related to daily life.

The Socio-Economic Impact (SEI) project focuses on data collection to support research on the short- and medium-term impact of the COVID-19 pandemic and related (de)confinement measures in Luxembourg on individuals and their households in terms of work and living conditions, daily activities and mobility, and (not directly COVID-19 related) health and health behaviours.

Such a data collection will allow designing appropriate policy measures to avoid or mitigate detrimental wider impacts of the COVID-19 outbreak, to combat social inequalities and to tailor policy responses.

An interdisciplinary project team composed of economists, geographers, sociologists and psychologists from the University of Luxembourg and all research departments of LISER, is responsible for the data collection. The project is aligned with the WHO’s ‘Coordinated Global Research Roadmap: 2019 Novel Coronavirus’, which emphasizes the importance of social sciences in this crisis, to be able to understand and act upon the economic, social, behavioral and contextual dimensions of the pandemic’s impact.

A large-scale survey has been developed which forms the basis for monitoring the impact of the outbreak and associated policy measures on (a) work and living conditions, (b) daily activities and mobility, (c) time use and household interactions and (d) health and health behaviors.

Two major socio economic impacts of the COVID-19 pandemic can be identified: one related to work and the other one related to daily life. First, due to all kind of economic measures the impact of the pandemic on unemployment and financial situation of households was limited. Nevertheless, employees did experience some fear of loss of jobs and of incomes, which might become stronger in future when combatting the pandemic takes more time than the financial situation of the country allows. Working from home became the default work situation for high-educated employees with professions that afford working at home using digital tools. As such, they could protect themselves against the risk of exposure to a COVID-19 infection. However, this was less the case for lower educated employees, which were not able to work remotely.

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COVID-19: Predi-COVID study extended to children

Originally launched in April 2020 with the aim of identifying risk factors and biomarkers associated with COVID-19 severity in the adult population, Predi-COVID has now officially been extended to children. The study, coordinated by the Luxembourg Institute of Health (LIH) and carried out under the aegis of the Research Luxembourg COVID-19 Task Force, will particularly benefit from the collaboration with the Centre Hospitalier de Luxembourg (CHL) for the recruitment of younger children.

Current research around COVID-19 has so far predominantly focused on disease evolution and treatment in adults, due to the higher incidence, severity and mortality observed. Although children typically develop the asymptomatic or milder variants of COVID-19, recent evidence suggests that the SARS-CoV-2 virus may be involved in the onset of more severe manifestations, leading for instance to multiple organ inflammation and failure (Pediatric Inflammatory Multisystem Syndrome) and even cardiac complications, such as myocarditis and coronary artery dilations as in Kawasaki disease.


“Since the clinical characteristics and symptoms of COVID-19 in children may differ considerably from those observed in adults, there is the need to elucidate the main risk factors associated with the cases of critical illness in children, whether they pertain to immunity or environmental causes. The aim of the paediatric extension of Predi-COVID is therefore to identify such factors and define the clinical, biological and microbiological characteristics of COVID-19 in younger patients”, explains Dr Guy Fagherazzi, Director of the LIH Department of Population Health (DoPH) and Principal Investigator of Predi-COVID.

Specifically, a minimum of 100 COVID-19 positive children and adolescents aged between 0 and 17 years will be included in the Predi-COVID cohort between February and June 2021, while a minimum of 30 asymptomatic children and adolescents from the households of COVID-19 positive adult participants will be recruited under the ancillary study Predi-COVID-H. CHL – and specifically its Paediatric Clinic “Kannerklinik” – will be responsible for the inclusion of severe cases of hospitalised children under the age of 15, while the recruitment of older children will fall under the remit of the Clinical and Epidemiological Investigation Centre (CIEC) of LIH. The children to be included in the study will be identified directly by the Health Inspection Department of the Ministry of Health and their legal guardians contacted to obtain their consent.

© Markus Spiske

As with adults, the health evolution and symptoms of children participating in Predi-COVID will be regularly followed through different remote digital tools, depending on whether they are at home or at the hospital. Short evaluations will be also performed monthly for up to 12 months to assess potential long-term consequences of COVID-19. In addition, for every child tested positive and if parents consent, blood samples, nasal swabs, oro- and naso-pharyngeal swabs, saliva and stool will be collected by an experienced nurse upon inclusion and after three weeks. For the asymptomatic children in Predi-COVID-H, clinical and socioeconomic data, as well as blood, stool, nasopharyngeal and oropharyngeal swabs will also be collected. The analysis of stool samples from both COVID-19 positive and household contact children will increase the understanding of how the virus is shed in the stool and how the gut microbiome influences COVID-19 infection in children.

“Based on the encouraging results obtained thus far with the adult cohort, we believe that the paediatric extension of Predi-COVID will provide additional insights into the pathophysiology and dynamics of COVID-19 in the younger population. This will in turn support the development of relevant public health measures to optimise the safeguard of the most vulnerable children”, states Dr Carine de Beaufort, paediatrician within the Pediatric Endocrinology-Diabetology department of CHL.


“We are very grateful to the Health Inspection Department of the Ministry of Health and to all other partners involved in the study for the excellent collaboration thus far. We believe this highly cooperative approach will keep contributing to the smooth running of the project and of this additional phase specifically”, concludes Prof Markus Ollert, Director of the LIH Department of Infection and Immunity and co-Principal Investigator of Predi-COVID.

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COVID-19: Why is it possible to protect yourself and others by using vaccines and what are the underlying principles?

Pathogens such as viruses have always existed together with mankind. In this interview, Paul Heuschling, cell biologist and full Professor at the Department of Life Sciences and Medicine, explains the process of vaccine development. He elucidates how they can protect us due to immunisation and what are the underlying principles of the new mRNA vaccination technology.

This article was originally published by the University of Luxembourg

By now, several COVID-19 vaccines have been released. How can we be sure that they are working?

The strategies that are used to design any vaccine aim to achieve the highest possible immune outcome. That means, already at a very early stage in development researchers check the immune response of the body and will reject the vaccine if it is not good enough. So, the fact that a vaccine reliably generates an immune response is one of the prerequisites during vaccine development. Since viral protein structures as well as weakened or dead viral particles are typically used for this, the mounted immune response can be expected to be very similar to the one generated by the pathogen itself.

In quantitative terms, the functionality of the vaccine is expressed by its efficacy which is determined in clinical studies. The commonly reported efficacies of more than 90% for most of the COVID-19 vaccines show that they indeed succeed in mounting a specific immune response against SARS-CoV-2.

How is such an immune response generated in the body?

When an immune reaction is generated by the body, it recognises something that the virus exposes – in most cases these are proteins. Proteins are among the most important building blocks of life and can acquire many different shapes and functions. Ultimately, we are also to a large extend made out of various proteins. However, every organism and also viruses have a specific set of proteins with typical patterns and structures that differentiate them. This is why our immune system is able to recognise a viral protein structure, which is also called antigen in this context, as foreign: That protein does not have a shape or constitution that is known or typical for the own body.

Is this also the principle used in vaccine development?

Generally speaking, yes. The traditional way to create a vaccine is to cultivate the virus in the laboratory, harvest it and inactivate its function to infect cells, for example by chemical treatment. What remains are virus particles including viral proteins, that are not harmful to the body anymore, but still can trigger an immune reaction upon injection. This can prime the immune system to the specific pathogen and will induce the production of specific antibodies neutralising the antigens as well as other immune cell reactions. If then in the future a contact with the real virus occurs, the immune system is prepared already and can immediately initiate the production of specific antibodies necessary to fight the virus.

A drawback in this approach of vaccine development is the rather time-consuming process in production and the low throughput. Culturing the virus in the laboratory is not easy and requires some time for the virus to grow and also to treat it afterwards for inactivation. That means producing high amounts of vaccine using this method is challenging and both expensive and time-consuming.

Which other approaches exist to develop a vaccine?

Instead of injecting inactivated viral particles, it is also possible to produce parts of a viral protein directly inside the human cell by introducing the blueprint for that particular antigen. This approach is commonly used in vaccinations against tuberculosis, for example. A part of the genetic information of the pathogen is introduced into a carrier-vessel, typically an adenovirus. That virus which normally causes a form of common cold in some primates, is also modified so that it cannot cause disease anymore. As a result, only in a defined area cells of our body are infected: The vessel delivers the genetic material of the virus in these cells and they then produce desired antigen, which triggers the immune system. The advantage is that the adenovirus containing the blueprint for the antigen can easily be produced in the lab while at the same time it cannot cause an infection. The vaccines against SARS-CoV-2 developed by AstraZeneca and the Russian Gam-COVID-Vac, also known as Sputnik V, use this approach.

However, since several years a new technology was developed which bypasses the use of an adenovirus as a carrier vessel: Instead of introducing the blueprint into this adenovirus, it is contained in small lipid droplets as mRNA, a short-lived genetic blueprint which is chemically different from our genomic DNA. Like in the case of the adenovector-based vaccines, this genetic material can enter the cell and serve as a blueprint to produce the viral antigen. This new technology is used in the two vaccines by Pfizer/BioNTech and Moderna and allows the production of comparably large amounts of vaccine. It should be stressed that the mRNA technology has been developed already since around a decade and SARS-CoV-2 only by incident happens to be the target of the first approved mRNA vaccine. It is very likely that other mRNA-based medications will soon be available as well and might bring great progress to medicine.

Isn’t it dangerous to inject genetic material into a cell?

First of all, we should remember that this is exactly what happens upon a viral infection, including the common cold: The virus introduces its genetic material into our cells and uses the machinery of the cell to generate complete and therefore infectious copies of itself. So, the new mRNA technology as well as the long-known adenovirus-based vaccines make use of the same principle while only inducing the production of a non-infectious antigen inside the cell. The most important difference is that only a small and harmless piece of the virus, one particular part of a protein, is produced. Therefore, no infection can occur or affect other cells.

Second, the injected mRNA contains a genetic signal that a protein should be produced from it, also indicated by the ‘m’ which stands for messenger. RNA is fundamentally different from DNA which resides in the nucleus of our cells and does not get close to this mRNA. At the same time, also our own cells all the time make hundreds of different mRNAs to produce the proteins which ensure the vital functions of our cells. In other words, as our own cells anyways constantly produce proteins from many different mRNAs, there is no reason to assume any danger from this technology.

Finally, RNA generally is quite fragile. This is also one of the reasons why some of these vaccines need to be stored at very cold temperatures as low as -80°C to ensure the efficacy of the vaccine. After the injection, the RNA is typically degraded within hours and thus does not have any long-term impact, while this time is still sufficient to produce the antigen and trigger the immune system’s response.

How can it be that a vaccine against a previously unknown virus was developed so fast?

First of all, it is important to know that the SARS-CoV-2 is not the first coronavirus we encounter. We have learned a lot from the previous appearance of the SARS-1 and the MERS coronavirus, not to forget the several other types of coronaviruses causing mild infections each year, such as the common cold. Therefore, we knew the basic building blocks of this type of virus and the best leverage points for a vaccine. Also, several scientific groups worldwide focused on research on coronaviruses during the past years and readily shared their knowledge with others.

In addition to that, often a limiting factor for scientific development is the availability of resources and money. As governments and stakeholders quickly realised the threat caused by this virus, all efforts have been merged to provide any financial support required. And as unfortunately many people were rapidly infected with the virus, in turn also volunteers for clinical studies could easily be identified. At the same time, all tests and protocols to assess and determine the safety of the vaccine were kept in place. A fast and efficient exchange with the health and drug authorities additionally helped to accelerate the process. That means no tests were skipped and the COVID-19 vaccines can be expected to be as safe as any other vaccine on the market.

What would happen if we had no vaccine available?

Well, this somehow would resemble the natural process: If a virus runs free within a population, some individual will eventually become immune after an infection whereas the disease will have more severe consequences or can even be lethal for others. This would continue until a certain percentage of the population is immune, which is estimated to be around 70%. At such a turning point, the virus statistically could not be transmitted to enough susceptible individuals and thus the infection would decay.

However, until we reach such a level of herd immunity, we would lose a significant part of our population, especially in the older generation.

With the vaccination being available we do now have the chance to actively increase the overall immunity in society to arrive faster at this turning point – without having to be infected by the real virus. And in quantitative terms, the absolute number of complications such as allergic reaction simply does not compare to the damage the virus does. It is difficult to give exact numbers, but the overall damage caused by the virus without vaccination is several orders of magnitude higher than any potential harm caused by a vaccination.

I therefore can only encourage everyone to get the jab and participate in that societal effort to bring the virus under contro

Paul Heuschling is Full Professor in Cell Biology at the Department of Life Sciences and Medicine at the University of Luxembourg. His research is focused on inflammation of the central nervous system and on glia cells.

This article was originally published by the University of Luxembourg