Oxygen home therapy after discharge of hospitalized patients with COVID-19

Introduction: Patients hospitalized with COVID-19 may have many healthcare needs after hospital discharge. Providing transitional care in pandemic circumstances, must adapt to specific needs and limitations. Aim(s): Define the profile of patients with COVID-19 who needed oxygen home therapy after discharge. Method(s): Retrospective study including patients infected with COVID-19 ;confirmed either by RT-PCR or Rapid Antigen Test and hospitalized in COVID-19 unit from September 2020 to June2021. Patients who deceded and those who were transferred to ICU without any data about evolution, were excluded. We defined 2 groups: G0: Patients discharged without oxygen home therapy G1 : Patients who required oxygen home therapy Results: A total of 528 patients were included: G0: 491 patients (93%), G1: 37 patients (7%). The mean age was significantly different between both groups (G0: 61,4 ;G1:68,0 p=0,003). There was no significant correlation regarding the extent of the lesions on the chest CT scan (G0:45%, G1:47% p=0.698), however maximum oxygen needs were higher in G1 (G0:7L, G1: 11L;p=0.001). Smoking, COPD, and hypercapnia were significantly related to prolonged oxygen need (G0: 30%, G1: 50%;p=0,026);(G03,7%, G1:24,3%;p=0,000) and (G0:34, G1:43;p=0.003) respectively. Conclusion(s): Chronic hypoventilation seems to be a predictive factor of prolonged oxygen needs. Oxygen home therapy can be a transitional solution to shorten hospital stay.

Chest CT scan features in COVID-19 pneumonia according to duration of symptoms

Introduction: High-resolution chest CT is considered as an early screening and diagnostic tool in COVID-19 pneumonitis. A wide variety of CT findings in COVID-19 have been reported, which differ according to the stage of the disease and its severity. Aim(s): Assessment of CT scan features among patients with COVID-19 pneumonia according to duration of symptoms. Method(s): Retrospective study including patients infected with COVID-19;confirmed either by RT-PCR or Rapid Antigen Test and hospitalized in COVID-19 unit from September 2020 to June 2021. In total,among 626 patients,567 CT data were available and classified according to the time of CT scan after symptoms onset: Stage 1 (0-7 days);Stage 2 (8-15 days);Stage-3 (>15 days). In each CT report, the following information was specified: extent of the lesions, presence of ground glass lesions, condensations, pleural effusion and pericardial effusion, as well as the distribution of the lesions. Result(s): We included 567 patients: Stage1: 276 patients (48%), Stage2:248 patients (44%) and Stage 3:43 patients (8%). Mean age was 62,6 years [23-94] and sex ratio was 1,3. Mean extent of lesions has increased from stage 1 to stage 3 (43%, 48%, 56%;p=0.000). The frequency of ground glass lesions was significantly higher in stage 2 (91%,95%, 86%)(p=0.038). Consolidations were mainly present in G2 and G3 (64%, 68%, 70%;p=0.02). The presence of pleural and pericardial effusion was not significantly different between stages (7,2%;6,8%;9,3%;p=0.745) and (8,6%;10,3%;19,4%;p=0.128) respectively. Conclusion(s): Chest CT can highlight abnormalities even during early phases of infection and provide an analysis of the extent and severity of lung lesions according to different stages.

Drepadom - Establishment of Home Care Services and Hospitalizations for Sickle Cell Disease Patients As Standard Care Since the Covid-19 Pandemic

INTRODUCTION Vaso-occlusive crisis (VOC), hallmark of sickle-cell disease (SCD), is the first cause of patients' emergency room (ER) admissions and hospitalizations. Acute chest syndrome (ACS) is a life-threatening complication that can occur during VOC and prolong hospitalization and is one of the main causes of death in SCD patients. The PRESEV score, established by team members and colleagues, assesses the risk of developing ACS (Bartolucci et al., 2016). In addition, the score has been validated by an international multicenter study, involving 13 centers, distributed in five different countries (PRESEV 2 - ASH 2020). Throughout the first wave of the Covid-19 pandemic, VOC management for SCD patients was a major concern. Our sickle cell referral center set up a hotline to monitor patients suffering from VOC daily, and organized the deployment of home-care services when required. The success of this system during the first wave of the pandemic led to the establishment of DREPADOM, a home-care and hospitalization protocol for VOC management in patients who are at a low risk of developing ACS, as standard care. DESCRIPTION OF SETTING Patients eligible for DREPADOM are patients that arrive at the ER for a VOC with a low PRESEV score, meaning low risk of developing ACS;or patients that are discharged early following hospitalization for VOC. After physical examination and calculation of the PRESEV score, DREPADOM home hospitalization is systematically offered to patients arriving to the ER with a PRESEV score ≤ 5. If the patient agrees, the DREPADOM nurse coordinator then acts as a link between the pharmacist, the oxygen supplier, the homecare provider, and the DREPADOM medical platform to activate the home hospitalization protocol. This entails the delivery of oxygen supply at the patient's house, dispatch of a medical prescription of opioids and parenteral treatments, twice/thrice-daily visits from homecare nurses, and an on-call SCD expert. DREPADOM relies on a system of daily telephone calls with three levels of expertise and warning and a decision-making algorithm. This is supervised by SCD experts, who arbitrate according to the evolution of the situation (stopping the follow-up, continuing the follow-up as an outpatient, hospitalization) (Fig.1). Furthermore, nurses enter patient vitals in real-time during their daily visits on a dedicated online platform (Link4Life) that contains an integrated automatic alert system. Additionally, a daily phone update between the DREPADOM coordination and the homecare provider's coordination concerning status and evolution of the patient's global condition takes place. RESULTS Over a 6-month period, 39 patients were included in the DREPADOM home hospitalization protocol, 3 of which were included multiple times for a total of 42 inclusions. Mean age was 40 years old [±9], sex ratio was 14/25 (male/female), ER vs early discharge ratio was 21/22, and mean homecare follow-up was 3 days (±1) for both, patients arriving from the ER and early discharge patients. Throughout the third wave of the pandemic, when hospital saturation was a major concern, patients with PRESEV scores 5 ≤ 11 were also offered DREPADOM. Three patients were hospitalized (7%): one for an ACS, who was included during the 3 rd wave of the pandemic with a PRESEV score of 8;one for pyelonephritis unrelated to the VOC;and one for difficulties with venous access. No death was reported. PERSPECTIVES Preliminary satisfaction surveys show a great enthusiasm for DREPADOM, partly due to the high standard of care received, but also due to the shorter length of hospitalization. In fact, median hospital stay for VOC is 4 [3-7] days (Bartolucci, 2016) whereas median homecare follow-up was 3 [1-6] days. [Formula presented] Disclosures: Bartolucci: Hemanext: Consultancy;Jazz Pharma: Other: Lecture fees;AGIOS: Consultancy;F. Hoffmann-La Roche Ltd: Consultancy;Emmaus: Consultancy;GBT: Consultancy;INNOVHEM: Other: Co-founder;Bluebird: Consultancy, Research Funding;Novartis: Consultancy, Membership on an entity's B ard of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding;Addmedica: Consultancy, Other: Lecture fees, Research Funding;Fabre Foundation: Research Funding.

Taux de vaccination contre la COVID-19 chez le personnel de santé dans un Centre hospitalo-universitaire à Tunis (Tunisie)

Introduction Le personnel soignant représente depuis le début de la pandémie de la Covid-19 le corps professionnel le plus exposé à l’infection virale. Durant les différentes campagnes vaccinales menée en Tunisie depuis le mois de mars 2021, il a été priorisé pour garantir une meilleure protection aussi bien pour lui que pour les patients. Le but de notre étude était de déterminer le taux de vaccination contre la COVID-19 chez le personnel de santé, dans le CHU Mongi Slim La Marsa à Tunis, six mois après le démarrage de la campagne vaccinale en Tunisie. Méthodes Il s’agit d’une étude transversale menée durant les mois de juillet et août 2021 auprès de tout le personnel affecté au CHU Mongi La Marsa à Tunis en Tunisie. Sur un total de 901, 472 personnels ont été interrogés par deux investigateurs (questionnaire Google Forms sur le téléphone de chacun). Les secteurs de l’hôpital étaient répartis entre les deux investigateurs qui sont passés au moins deux fois/secteur pour colliger les personnes. La participation à l’enquête était basée sur le bénévolat, l’anonymat et le biais du hasard à chaque visite (personnes rencontrées au moment t de la visite). Résultats Sur les 472 personnes interrogées, 455 ont accepté de répondre au questionnaire. Leur âge moyen était de 42±10 ans et étaient de sexe féminin dans 71,6 % des cas. Leur ancienneté moyenne dans leur fonction à l’hôpital était de 12±10 ans. La majorité (83,5 %) avaient reçu au moins une dose du vaccin anti-COVID-19 (72,5 % avait un schéma complet dont 14 % ayant reçu une seule dose en raison d’une infection antérieure à COVID-19 et 11 % avaient eu une dose du vaccin et attendaient la 2ème dose), 4,8 % attendaient d’atteindre le délai entre leur infection par la COVID-19 et la vaccination, 4,2 % étaient inscrits et en attente de la convocation, 2,6 % ne sont pas inscrits mais comptent le faire et 4,8 % refusent la vaccination. Ceux qui refusent la vaccination sont d’âge moyen de 38 ans avec une ancienneté moyenne dans leur fonction à l’hôpital de 12 ans. Il s’agissait essentiellement d’infirmiers dans 50 % des cas et d’agents de sécurité dans 18,2 % des cas. Le personnel refusant la vaccination travaille dans 50 % des cas dans un service de spécialité médicale. Conclusion Six mois après le début de la campagne vaccinale, 83,5 % du personnel du CHU Mongi Slim la Marsa avaient au moins reçu une dose de vaccin anti-COVID-19. Des campagnes de sensibilisation et d’éducation sont nécessaires pour une meilleure adhésion à la vaccination.