COVID-19 Management at IHU Méditerranée Infection: A One-Year Experience
Authors: Michel Drancourt
Didier Raoult
Philippe Brouqui
On Behalf Of The Ihu Task Force
Journal: Journal of Clinical Medicine (2021)
Discipline: CLINICAL MEDICINE
Keywords: adaptation; autonomy in decision-making; drug repurposing; leadership; pandemic
Affiliations: Aix-Marseille University, IRD, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France.

Abstract:  Background: The Hospital-University Institute (IHU) Méditerranée Infection features a 27,000 square meter building hosting 700 employees and 75 hospitalized patients in the center of Marseille, France. Method: Previous preparedness in contagious disease management allowed the IHU to manage the COVID-19 outbreak by continuing adaptation for optimal diagnosis, care and outcome. We report here the output of this management. Results: From 5 March 2020, and 26 April 2021, 608,313 PCR tests were provided for 424,919 patients and 44,089 returned positive. A total of 23,390 patients with COVID-19 were followed at IHU with an overall case fatality ratio of 1.7%. Of them 20,270 were followed as outpatients with an overall CFR of 0.17%. We performed 24,807 EKG, 5759 low dose CT Scanner, and 18,344 serology. Of the 7643 nasopharyngeal samples inoculated in cell cultures 3317 (43.3%) yielded SARS-Cov-2 isolates. Finally, 7370 SARS-Cov-2 genomes were analyzed, allowing description of the first genetic variants and their implication in the epidemiologic curves. Continuous clinical care quality evaluation provided the opportunity for 155 publications allowing a better understanding of the disease and improvement of care and 132 videos posted on the IHU Facebook network, totaling 60 million views and 390,000 followers, and dealing with COVID-19, outbreaks, epistemology, and ethics in medicine. Conclusions: During this epidemic, IHU Méditerranée Infection played the role for which it has been created; useful clinical research to guarantee a high-quality diagnostic and care for patient and a recognized expertise. 

Retracted: No

PubPeer comments:
 In the abstract, the authors claim that they did the u201c*description of the first genetic variants and their implication in the epidemiologic curves*u201d. This assumption requires a citation. They further write about the facebook page of the institution, the number of followers, the number of views. These are not relevant for a scientific publication. In the introduction, the authors state that the different waves of the Covid-19 epidemic were caused by different virus lineages. To support this assumption, the rely on reference 1 and reference 2 . These two references, from the same team, deal separately with mutation rate of SARS-Cov-2 and evolution of Covid-19 and can therefore not support the authorsu2019 hypothesis for the World, especially with data limited to one particular region of France. In paragraph 2.2, the authors enlighten us as to their u201c*capability in developing RT-PCR testing from scratch before any diagnostic test was commercially available*u201d as early as January 31st 2020. It should be noted that these tests were already routinely done worldwide, following the interim guidance instructions from WHO published on January 10th. . The same way, when they describe the equipment setup after this date, WHO interim guidance for clinical management were already mentioning these procedures since January 12th . We can therefore question the relevance of this paragraph, especially the treatment part which contains several self-references with important concerns: * Reference 29 for unanswered questions about the consistency of the data. * Reference 30 also tagged on PubPeer for unanswered bibliography concerns and high bias risk. * Reference 31 for which we can read important concerns about the significance of the results. In paragraph 3, the authors highlight a CFR of 1,7% u201c*when patients were cared at IHU*u201d. This number should be compared with the global CFR for France one can easily calculate globally from https: www.bing.com covid local france at 1.92% (On June 30, .5 772 844 cases and 111 086 deaths) taking into account that 86,6% were outpatients and that IHU does not have ICU, this number seems around the national average. Later in this paragraph, the authors mention preprints, other platforms publications, and Youtube channel and views. This is absolutely not relevant for a scientific publication. In their apologetic conclusion to their work, the authors write recommendations. These require citations to be supported. It should be noted the two following ones: * u201cpermanent adaptation of treatment protocolsu201d * u201ctreatment based on the most efficient and or the least toxicu201d The assumptions can be questioned since, as previously seen, there are important concerns on the publications from the same team they use to support the efficacy of their treatment, and they have not been answered yet. No adaptation were made. Toxicity that can be found in the literature was not taken into account either. ,