Pregnancy, childbirth and postpartum experience in pregnant women infected with SARS-CoV-2 in 2020 in Paris: a qualitative phenomenological study.

BACKGROUND: The COVID-19 pandemic and the resulting lockdowns triggered social discontent on an unprecedented scale. Descriptive phenomenological studies showed that pregnant women were under intense stress during the COVID-19 outbreak, even though they remained uninfected. The purpose of this study was to report on the experiences of pregnant women affected by mild COVID-19 during the first wave of the pandemic. METHODS: In this non- interventional qualitative study, we analyzed pregnant women's experiences using an interpretive phenomenological analysis approach. We conducted semi-structured interviews with women who had had a mild COVID-19 during their pregnancy, and gave birth or planned to give birth in the maternity units of Sorbonne University in Paris, France. RESULTS: Participants reported that at the time they had COVID-19, they were not afraid of being seriously ill, but of transmitting COVID-19 to their close relatives. Their main concern was being pregnant and becoming a parent in a world where the pandemic deeply altered social environment. This included uncertainty about the future and an acute feeling of isolation related to lockdown. The idea that their partner might not be allowed to attend childbirth was almost unanimously felt as intolerable. In contrast, women had positive feelings regarding the fact that lockdown resulted in a de facto paternity leave leading to a certain degree of equality in the couple regarding baby care and household chores. Unexpectedly, the pandemic social distancing measures helped participants escaping from behavioral constraints, including the unspoken rule that they should welcome greetings from friends and family, despite being exhausted by the recent birth. CONCLUSIONS: Our results suggest that avoiding separation from their partner is a key to benevolent medical care for pregnant women in times of health crises. The unexpected benefits women reported in a world of lockdown cast a new light on their expectation regarding parenthood today.

A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife.

Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil. Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities. Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources. Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.

Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area.

Importance: The COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse. Objective: To investigate the trend of abusive head trauma (AHT) incidence and severity in infants during the COVID-19 pandemic. Design, Setting, and Participants: In a time-series analysis of a longitudinal, population-based, cohort study, all consecutive cases of AHT in infants younger than 12 months old referred between January 2017 and December 2021 to Necker Hospital for Sick Children, the single regional pediatric neurosurgery center for the Paris metropolitan area, were included. AHT was defined as 1 or more subdural hemorrhage and a positive multidisciplinary evaluation after a social, clinical, biological, and radiological workup. Data were analyzed from January to March 2022. Main Outcomes and Measures: The primary outcome was the monthly incidence of AHT, which was analyzed using Poisson regression modeling. Secondary outcomes included mortality and severe morbidity and were studied with logistic and linear regressions. The monthly incidence of neurosurgical interventions for hydrocephalus was used as a control series. Results: Among the 99 included infants with AHT (median [IQR] age, 4 [3-6] months; 64 boys [65%]), 86 of 99 (87%) had bridging vein thrombosis, 74 of 99 (75%) had retinal hemorrhages, 23 of 72 (32%) had fractures, 26 of 99 (26%) had status epilepticus, 20 of 99 (20%) had skin injuries, 53 of 99 (54%) underwent neurosurgical interventions, and 13 of 99 (13%) died. Compared with the prepandemic period (2017-2019), AHT incidence was stable in 2020 (adjusted incidence rate ratio, 1.02; 95% CI, 0.59-1.77) and then significantly increased in 2021 (adjusted incidence rate ratio, 1.92; 95% CI, 1.23-2.99). The severity of AHT worsened in 2021 in terms of mortality (odds ratio 9.39; 95% CI, 1.88-47.00). Other secondary outcomes and the control series were not significantly modified. Conclusions and Relevance: In this cohort study, a marked increase in AHT incidence and severity occurred during the COVID-19 pandemic in the Paris metropolitan area. These results suggest the need for clinical awareness and preventive actions.

Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments : A Retrospective Cohort Study.

BACKGROUND: At the end of 2021, the B.1.1.529 SARS-CoV-2 variant (Omicron) wave superseded the B.1.617.2 variant (Delta) wave. OBJECTIVE: To compare baseline characteristics and in-hospital outcomes of patients with SARS-CoV-2 infection with the Delta variant versus the Omicron variant in the emergency department (ED). DESIGN: Retrospective chart reviews. SETTING: 13 adult EDs in academic hospitals in the Paris area from 29 November 2021 to 10 January 2022. PATIENTS: Patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test result for SARS-CoV-2 and variant identification. MEASUREMENTS: Main outcome measures were baseline clinical and biological characteristics at ED presentation, intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality. RESULTS: A total of 3728 patients had a positive RT-PCR test result for SARS-CoV-2 during the study period; 1716 patients who had a variant determination (818 Delta and 898 Omicron) were included. Median age was 58 years, and 49% were women. Patients infected with the Omicron variant were younger (54 vs. 62 years; difference, 8.0 years [95% CI, 4.6 to 11.4 years]), had a lower rate of obesity (8.0% vs. 12.5%; difference, 4.5 percentage points [CI, 1.5 to 7.5 percentage points]), were more vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), had a lower rate of dyspnea (26% vs. 50%; difference, 23.6 percentage points [CI, 19.0 to 28.2 percentage points]), and had a higher rate of discharge home from the ED (59% vs. 37%; difference, 21.9 percentage points [-26.5 to -17.1 percentage points]). Compared with Delta, Omicron infection was independently associated with a lower risk for ICU admission (adjusted difference, 11.4 percentage points [CI, 8.4 to 14.4 percentage points]), mechanical ventilation (adjusted difference, 3.6 percentage points [CI, 1.7 to 5.6 percentage points]), and in-hospital mortality (adjusted difference, 4.2 percentage points [CI, 2.0 to 6.5 percentage points]). LIMITATION: Patients with COVID-19 illness and no SARS-CoV-2 variant determination in the ED were excluded. CONCLUSION: Compared with the Delta variant, infection with the Omicron variant in patients in the ED had different clinical and biological patterns and was associated with better in-hospital outcomes, including higher survival. PRIMARY FUNDING SOURCE: None.

Cumulative incidence of SARS-CoV-2 infection and associated risk factors among frontline health care workers in Paris: the SEROCOV cohort study.

With the COVID-19 pandemic, documenting whether health care workers (HCWs) are at increased risk of SARS-CoV-2 contamination and identifying risk factors is of major concern. In this multicenter prospective cohort study, HCWs from frontline departments were included in March and April 2020 and followed for 3 months. SARS-CoV-2 serology was performed at month 0 (M0), M1, and M3 and RT-PCR in case of symptoms. The primary outcome was laboratory-confirmed SARS-CoV-2 infection at M3. Risk factors of laboratory-confirmed SARS-CoV-2 infection at M3 were identified by multivariate logistic regression. Among 1062 HCWs (median [interquartile range] age, 33 [28-42] years; 758 [71.4%] women; 321 [30.2%] physicians), the cumulative incidence of SARS-CoV-2 infection at M3 was 14.6% (95% confidence interval [CI] [12.5; 16.9]). Risk factors were the working department specialty, with increased risk for intensive care units (odds ratio 1.80, 95% CI [0.38; 8.58]), emergency departments (3.91 [0.83; 18.43]) and infectious diseases departments (4.22 [0.92; 18.28]); current smoking was associated with reduced risk (0.36 [0.21; 0.63]). Age, sex, professional category, number of years of experience in the job or department, and public transportation use were not significantly associated with laboratory-confirmed SARS-CoV-2 infection at M3. The rate of SARS-CoV-2 infection in frontline HCWs was 14.6% at the end of the first COVID-19 wave in Paris and occurred mainly early. The study argues for an origin of professional in addition to private life contamination and therefore including HCWs in the first-line vaccination target population. It also highlights that smokers were at lower risk.Trial registration The study has been registered on ClinicalTrials.gov: NCT04304690 first registered on 11/03/2020.

Possible impact of the COVID-19 pandemic on the recreational use of nitrous oxide in the Paris area, France.

INTRODUCTION: Recreational use of nitrous oxide (N2O) is increasing in Western countries, including France. During the COVID-19 pandemic, some authors warned that recreational N2O use could increase further as the supply of illicit drugs was impacted by various containment measures. METHODS: We retrospectively analyzed N2O exposures reported to the Paris Poison Control Center (France) from 2010/01/01 to 2021/04/15. The Poison Severity Score was used to grade severity. RESULTS: During the study period, 93 cases of N2O recreational exposures were reported (male/female ratio: 1.1; median age: 20.9 years range: [14.8-49.0]). The first case was reported in 2012, 84/93 (90%) and 65/93 (70%) were reported since 2019 and March 17th 2020 (first lockdown in France) respectively. Most of the patients were symptomatic (88/93; 95%) and developed neurological symptoms (78/93; 84%). Among the fourteen patients who developed moderate to severe symptoms, eleven were reported after March 2020. CONCLUSION: Despite a marked increase in recreational N2O exposures during the COVID-19 pandemic, the exact impact of COVID-19 on this increase remains to be determined as it was observed from 2019.

Evolution of hospitalized patient characteristics through the first three COVID-19 waves in Paris area using machine learning analysis.

Characteristics of patients at risk of developing severe forms of COVID-19 disease have been widely described, but very few studies describe their evolution through the following waves. Data was collected retrospectively from a prospectively maintained database from a University Hospital in Paris area, over a year corresponding to the first three waves of COVID-19 in France. Evolution of patient characteristics between non-severe and severe cases through the waves was analyzed with a classical multivariate logistic regression along with a complementary Machine-Learning-based analysis using explainability methods. On 1076 hospitalized patients, severe forms concerned 29% (123/429), 31% (66/214) and 18% (79/433) of each wave. Risk factors of the first wave included old age (≥ 70 years), male gender, diabetes and obesity while cardiovascular issues appeared to be a protective factor. Influence of age, gender and comorbidities on the occurrence of severe COVID-19 was less marked in the 3rd wave compared to the first 2, and the interactions between age and comorbidities less important. Typology of hospitalized patients with severe forms evolved rapidly through the waves. This evolution may be due to the changes of hospital practices and the early vaccination campaign targeting the people at high risk such as elderly and patients with comorbidities.

Nosocomial transmission clusters and lineage diversity characterized by SARS-CoV-2 genomes from two large hospitals in Paris, France, in 2020.

France went through three deadly epidemic waves due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing major public health and socioeconomic issues. We proposed to study the course of the pandemic along 2020 from the outlook of two major Parisian hospitals earliest involved in the fight against COVID-19. Genome sequencing and phylogenetic analysis were performed on samples from patients and health care workers (HCWs) from Bichat (BCB) and Pitié-Salpêtrière (PSL) hospitals. A tree-based phylogenetic clustering method and epidemiological data were used to investigate suspected nosocomial transmission clusters. Clades 20A, 20B and 20C were prevalent during the spring wave and, following summer, clades 20A.EU2 and 20E.EU1 emerged and took over. Phylogenetic clustering identified 57 potential transmission clusters. Epidemiological connections between participants were found for 17 of these, with a higher proportion of HCWs. The joint presence of HCWs and patients suggest viral contaminations between these two groups. We provide an enhanced overview of SARS-CoV-2 phylogenetic changes over 2020 in the Paris area, one of the regions with highest incidence in France. Despite the low genetic diversity displayed by the SARS-CoV-2, we showed that phylogenetic analysis, along with comprehensive epidemiological data, helps to identify and investigate healthcare associated clusters.

Changes in air quality in-taxis and in working conditions of taxi drivers pre- and post-lockdown, during the COVID-19 pandemic in the Paris area.

We evaluated the impact of the lockdown restriction measures in the Paris area on the variation of in-vehicle ultrafine particle (UFP) and black carbon (BC) concentrations between the pre- and post-lockdown period and professional drivers' working conditions and practices. The study was conducted with 33 taxi drivers. UFP and BC were measured inside their vehicles with DiSCmini® and microAeth® , respectively, on two typical working days pre- and post-lockdown. Job characteristics were self-reported. Our results showed that post-lockdown, both the number of clients and journey duration significantly decreased. Taxi drivers opened their windows significantly more and reduced the use of air recirculation. UFP decreased significantly by 32% and BC by 31% post-lockdown, with a weaker positive correlation compared to pre-lockdown. The reduction of in-vehicle UFP was due mainly to the reduction of traffic flow and ventilation settings, though the latter probably varied according to traffic conditions. The variation of in-vehicle BC also tended to be related to the decrease in traffic flow post-lockdown. We emphasize the role of traffic emissions on in-vehicle air pollution and that preventive measures such ventilation settings would help to minimize the exposure of professional drivers and passengers to air pollutants.

Superspreading events of SARS-CoV-2 in Paris: A retrospective analysis of data from the first wave of COVID-19 in 2020.

BACKGROUND: The 2020 COVID-19 pandemic led to a strict lockdown in France from March 17 to May 11, 2020. After the lockdown, the French strategy to mitigate the impact of SARS-CoV-2 relied partly on investigations of all confirmed cases. Monitoring collective settings is particularly important since SARS-CoV-2 seems prone to superspreading events (SSEs). METHODS: Our study is based on data gathered in Paris from May 11 to December 31, 2020, by the Ile-de-France Regional Health Agency (RHA) to investigate cases occurring in collective and high-risk settings. Specific events in high-risk settings were systematically transmitted to the RHA, and screenings were organized by the facilities, while other settings were reported when three cases were identified within a short period. These settings were more difficult to identify through the surveillance system since no systematic screening was organized by the facility, leaving screenings to rely on the national contact-tracing programme. No official superspreading threshold has been set for SARS-CoV-2. We defined a SSE as an event involving ten cases. RESULTS: We analysed 15,706 events associated with 38,670 cases, representing an average of 2.70 cases per event. Most clusters occurred in educational facilities, workplace environments, social care settings, and healthcare facilities. SSEs represented 3.4% but accounted for 28% of all cases reported. The highest number of SSEs occurred in college settings (12.6%), followed by hospitals and retirement homes. Educational facilities had the lowest number of SSEs, with around 1% in preschools and elementary schools. CONCLUSIONS: We observed different SSE rates in each setting. Preschools and primary schools represented the majority of events but experiencing very few SSEs. Colleges were prone to SSEs and were associated with a high number of secondary cases. These findings provide some insights on contact tracing activities and SARS-CoV-2 transmission in different settings.

Effect of lockdown on digestive system cancer care amongst older patients during the first wave of COVID-19: The CADIGCOVAGE multicentre cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and treatment. Most patients newly diagnosed with digestive system cancer are aged 65 and over. METHODS: We performed a retrospective, observational, multicentre cohort study based on prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer between January 2018 until August 2020 were enroled. RESULTS: Data on 7882 patients were analysed. The first COVID-19 lockdown period led to a 42.4% decrease in newly treated digestive system cancers, and the post-lockdown period was associated with a 17% decrease. The decrease in newly treated digestive system cancer did not differ as a function of age, sex, comorbidities, primary tumour site, and disease stage. The proportion of patients admitted to an emergency department increased during the lockdown period. We do not observe a higher 3-month mortality rate in 2020, relative to the corresponding calendar periods in 2018 and 2019. CONCLUSION: To avoid a decrease in newly treated cancers during future lockdown periods, access to healthcare will have to be modified. Although 3-month mortality did not increase in any of the patient subgroups, the 2020 cohort must be followed up for long-term mortality.

Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. METHODS: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. RESULTS: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods. CONCLUSIONS: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.

Impact of public health measures on the post-COVID-19 respiratory syncytial virus epidemics in France.

Since the beginning of the COVID-19 pandemic, other respiratory illnesses decreased worldwide. This study described the consequences of public health measures on respiratory syncytial virus (RSV) severe infections in France, where an interseasonal resurgence of RSV occurred recently. All patients admitted to Necker Hospital (Paris) between August 2018 and April 2021 with a diagnosis of RSV-associated acute lung respiratory infection (ALRI) were enrolled. Characteristics of subjects with RSV-associated ALRI in 2020/2021 were compared to those infected during the two previous outbreaks. Overall, 664 inpatients were diagnosed with RSV-associated ALRI: 229, 183, and 252 during the 2018/2019, 2019/2020, and 2020/2021 outbreaks, respectively. During autumn 2020, a national lockdown began in France but schools remained open. A 3-month delayed RSV epidemic occurred at the end of this lockdown. Compared to previous outbreaks, the 2020/2021 epidemics involved more children aged 6 to 11 months (25.8% versus 13.1%, p < 0.0001), but less infants aged < 6 months (41.3% versus 56.6%, p < 0.0001) and less adults (0.0 versus 2.7%, p < 0.0001). Shorter length of stay at hospital, less frequent requirement of admission to intensive care unit, use of non-invasive ventilation, and/or high-flow nasal oxygen were observed in 2020/2021 than during previous epidemics (p < 0.0001). Delayed RSV outbreak was associated with more hospitalizations for ALRI, higher age of pediatric inpatients, but milder median clinical phenotype. Reinforced public health measures (even while keeping nurseries and schools open with mandatory face masks since six years of age) could impact, at least transiently, the burden of RSV-related hospitalizations.

Low-income neighbourhood was a key determinant of severe COVID-19 incidence during the first wave of the epidemic in Paris.

BACKGROUND: Previous studies have demonstrated that socioeconomic factors are associated with COVID-19 incidence. In this study, we analysed a broad range of socioeconomic indicators in relation to hospitalised cases in the Paris area. METHODS: We extracted 303 socioeconomic indicators from French census data for 855 residential units in Paris and assessed their association with COVID-19 hospitalisation risk. FINDINGS: The indicators most associated with hospitalisation risk were the third decile of population income (OR=9.10, 95% CI 4.98 to 18.39), followed by the primary residence rate (OR=5.87, 95% CI 3.46 to 10.61), rate of active workers in unskilled occupations (OR=5.04, 95% CI 3.03 to 8.85) and rate of women over 15 years old with no diploma (OR=5.04, 95% CI 3.03 to 8.85). Of note, population demographics were considerably less associated with hospitalisation risk. Among these indicators, the rate of women aged between 45 and 59 years (OR=2.17, 95% CI 1.40 to 3.44) exhibited the greatest level of association, whereas population density was not associated. Overall, 86% of COVID-19 hospitalised cases occurred within the 45% most deprived areas. INTERPRETATION: Studying a broad range of socioeconomic indicators using census data and hospitalisation data as a readily available and large resource can provide real-time indirect information on populations with a high incidence of COVID-19.

How Did Institut Pasteur's NGS Core Facility, Biomics, Manage the Coronavirus Disease 2019 Crisis?

In 2020, research entities at the Institut Pasteur (IP) in Paris, as elsewhere around the world, were closed because of the coronavirus disease 2019 (COVID-19) pandemic. However, IP core facilities, laboratories, services, and departments working on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and priority projects were authorized to continue working both on site and remotely. Given the importance of its role in SARS-CoV-2 genome-sequencing initiatives, the IP Biomics core facility was fully functional during the first (i.e., March-June 2020) and second (i.e., November-December 2020) national lockdowns. We describe here how Biomics successfully implemented an emergency management plan to deal with this health crisis. We highlight the internal deployment of the institutional business continuity plan (BCP) through a series of actions. We also address the impact of the COVID-19 crisis on Biomics staff and collaborators. The added value of quality management and the limitations of risk management systems are discussed. Finally, we suggest that the Biomics infrastructure and the BCP described here could be used for benchmarking purposes, for other next-generation sequencing core facilities wishing to implement/improve their processes, and for future major crisis management.