Pattern of SARS-CoV-2 infection among dependant elderly residents living in long-term care facilities in Marseille, France, March–June 2020
Authors: Philippe Gautret
Eric Chabriere
Helene Mendizabal
Patrick Augier
Philippe Parola
Sylvie Arlotto
Alain Midejean
Phuc Le-Dinh
Alain Coquet
Vincent Laforge
Tran Duc Anh Ly
David Morel
Gérard Daher
Priscilla Malfuson-Clot-Faybesse
Michael Finaud
Berengere Labarriere
Olivier Quenette
Anne-Marie Morel-Roux
Stephanie Gentile
Didier Raoult
Didier Zanini
Journal: International Journal of Antimicrobial Agents (2020)
Discipline: PHARMACOLOGY & TOXICOLOGY
Keywords: COVID-19; Elderly resident; Hydroxycloroquine; Long-term care facility; Mass testing
Affiliations: Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France., Hospitalisation à Domicile (HAD), Hôpital de la Conception, Marseille, France., Service d'Evaluation Médicale, Hôpitaux Universitaires de Marseille Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France; Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France., Service d'Evaluation Médicale, Hôpitaux Universitaires de Marseille Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes Saint-Barthélemy-Fondation Saint-Jean-de-Dieu, Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes Korian Perier, Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes Chevillon, Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes La Joliette Marseille Groupe Colisée, Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes Des Séolanes groupe Domusvi, Marseille, France., Etablissement d'Hébergement pour Personnes Agées Dépendantes Les Opalines La Roseraie, Marseille, France., Etablissements d'Hébergement pour Personnes Agées Dépendantes Aeria et Meissel, Marseille, France., Le Bataillon de marins-pompiers de Marseille (BMPM), Marseille, France., IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, MEPHI, Marseille, France., Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France. Electronic address: .

Abstract:  Objectives: This study aimed to report the results of SARS-CoV-2 PCR-based screening campaigns conducted on dependent elderly residents (compared with staff members) in long-term care facilities (LTCFs) in Marseille, France, and the follow-up of positive cases. Methods: Data from 1691 elderly residents and 1000 members of staff were retrospectively collected through interviewing the medical teams in 24 LTCFs and using the hospitals' electronic health recording systems. Results: Elderly residents were predominantly female (64.8%) with a mean age of 83.0 years. SARS-CoV-2 detection among residents (226, 13.4%) was significantly higher than among staff members (87, 8.7%) (P &lt; 0.001). Of the 226 infected residents, 37 (16.4%) were detected on a case-by-case basis due to their COVID-19 symptoms and 189 (83.6%) were detected through mass screening. Most (77.0%) had possible COVID-19 symptoms, including respiratory symptoms and signs (44.5%) and fever (46.5%); 23.0% were asymptomatic. A total of 116 (51.4%) patients received a course of oral hydroxychloroquine and azithromycin (HCQ-AZM) for ≥ 3 days; 47 (20.8%) died. Through multivariate analysis, the death rate was positively associated with being male (30.7% vs. 14.0%, OR = 3.95, P = 0.002), aged &gt; 85 years (26.1% vs. 15.6%, OR = 2.43, P = 0.041) and receiving oxygen therapy (39.0% vs. 12.9%, OR = 5.16, P &lt; 0.001) and negatively associated with being diagnosed through mass screening (16.9% vs. 40.5%, OR = 0.20, P= 0.001) and receiving HCQ-AZM treatment ≥ 3 days (15.5% vs. 26.4%, OR = 0.37, P = 0.02). Conclusion: The high proportion of asymptomatic COVID-19 patients and independent factors for mortality suggest that early diagnosis and treatment of COVID-19 patients in LTCFs may be effective in saving lives. 

Retracted: No

PubPeer comments:
 1) You showed that mortality is significantly associated with age 85 years, with an OR 2. But your  control group is mostly 85 years old (55.5% against 43.1% for the  treatment group, p = NS). Same remark for the LMWH, which is quite  asymmetric (7.2% against 15.5% in the  treatment group, while the impact on mortality has been shown. Don t you think this could have an impact on the mortality data? 2) In the characteristics of the population, when you mention  oxygen therapy , can you specify whether these patients were already on O2 at the time of inclusion, or if O2 was needed because of the evolution of the patient (regardless of the group)? Thx , 
 Keep in mind that the journalu2019s EiC is an employee of the penultimate author. It would be reassuring to readers if this group of authors were to submit their research to more independent scrutiny. Discussed [here] and elsewhere. , 
 Considering the French Law, the article described a prospective research in humans of level 3 (RIPH3). Per french law, RIPH3 must obtain an approval from a Comitu00e9 de Protection des Personnes (CPP) before to start. Starting a RIPH3 without a CPP approval is a serious breach to the french law. The Ethics committee of the IHU is not a CPP. Authors must clarify why they do not request a CPP approval for a prospective study in humans. The study even includes children which requires stricter ethics consideration. ,