Teleconsultation in family medicine amid the Covid-19 pandemic: An adequate tool?

INTRODUCTION: Teleconsultation is an emerging tool whose utilization dramatically increased during the Covid-19 pandemic. Our aim was to determine its clinical accuracy. METHODS: This prospective study was carried out during the first wave of Covid-19. Patients were teleconsulted by either general practitioners or emergency doctors reporting clinical exam results to the ID physicians by phone. Five signs were specifically checked: dyspnea, fever, cough, anosmia and flu-like illness. Data collected by remote consultation were compared to face-to-face examination in an ID Department. RESULTS: From March to April 2020, 149 patients were seen by remote medical care. Dyspnea was found in 14.1% of the teleconsultation patients vs 3.4% in face-to-face consultation; fever in 47.0 vs. 15.4%; cough in 69.1 vs. 16.1%; anosmia in 3.4 vs. 1.3%; flu-like illness in 53.0 vs. 7.4% (all differences significant: P<0.001). CONCLUSION: We observed incongruency between remote and face-to-face consultation for the main clinical signs of Covid-19.

Successful high flow nasal cannula therapy for severe COVID-19 pneumonia is associated with tocilizumab use.

INTRODUCTION: Our aim was to determine the rate of success of HFNO and its relationship with current treatments for severe COVID-19. METHOD: This was a cohort study including patients admitted for HFNO because of respiratory failure despite oxygen therapy through a facial mask. Care was standardized, with systematic use of steroids and prevention or treatment of thromboembolic complications, and tocilizumab when deemed useful. HFNO failure was defined by the requirement for mechanical ventilation and/or death. RESULTS: In August 2021, among 1397 patients with COVID-19 admitted in the emergency department, 110 (7.8%) received HFNO (mean age 55 years, sex-ratio M/F 1.4). Thirteen patients (12%) had received a steroid treatment before hospital admission. At least one comorbid condition was observed in 57% of the patients. Mean duration of the disease at admission was 8.8 days and mean respiratory rate was 34/min. A CT scan was performed for 101 patients (92%), among whom 13 had a pulmonary embolism. All patients received a steroid treatment, and tocilizumab was prescribed in 79 cases (72%). Failure of HFNO was observed in 54 cases (49%); the only risk factor was the absence of tocilizumab administration: AOR [IC95%] 3.50 [1.40-8.69]. We observed a trend toward failure with steroid use before hospital admission: AOR 3.83 [0.96-16.66]. CONCLUSION: Success of HFNO, when all therapeutic means of treatment for severe COVID-19 pneumonia were applied, was associated with tocilizumab administration. Our data suggest the interest of a randomized study to determine whether HFNO is the right signal for prescription of anti-IL6 drugs.

Seroprevalence of SARS-CoV-2 IgG antibodies among workers in the University Hospital of Guadeloupe.

OBJECTIVE: The Covid-19 pandemic is the major global health crisis of our time. The purpose of this study is to estimate the seroprevalence of IgG against SARS-CoV-2 among workers in the University Hospi-tal of Guadeloupe and to assess this seroprevalence in asymptomatic personnel as well as the proportion of asymptomatic agents among seropositive agents. SETTING AND METHODS: We carried out a seroprevalence study in the staff of the University Hospital of Guadeloupe. The presence of IgG anti SARS-CoV-2 was determined by a micro-particulate immunolo-gical assay using the chemiluminescence technique (CMIA, Architect i2000SR, Abbott). Data on the previous presence of symptoms sugge-stive of COVID-19, were identified using a standardized questionnaire. Statistical analyses were performed using Epi Info® software. RESULTS: From 07/05/2020 to 28/10/2020, 892 serologies were performed, 45 of which were positive for SARS-CoV-2 : a prevalence of 5.0% [95% CI: 3.6% - 6.5%]. Seroprevalence was 1.5% [95% CI: 0.6% - 2.3%] among agents who reported being asymptomatic. Among seropositive individuals, 24.4% [95% CI:12% - 36%] was totally asymptomatic. CONCLUSION: Our results highlight the importance of continuing seroprevalence studies for SARS-CoV-2 in hospital staff, which can provide important information on the level of exposure in healthcare workers and asymptomatic transmission of SARS-CoV-2 in clinical set-tings.