Introduction New-Caledonia, an island located in the South-Pacific, was the first (overseas) French country hit by the coronavirus disease-2019 (COVID-19) pandemic to come out of lockdown. The epidemic was rapidly controlled. Analyzing the impact of an epidemic only makes sense if it is compared with a zone with a similar health care system. Objective To compare epidemic evolution in New-Caledonia and Paris suburb. Methods Health care organization is similar in New-Caledonia and Seine-Saint-Denis, based on an Emergency Medical System call center. We recorded the numbers of patients managed by SAMU (Service d’Aide Médicale Urgente)-Emergency Medical System, transferred to the emergency department and managed in prehospital setting by mobile intensive care unit. We compared these parameters during the reference (February 1-23, 2020) and the COVID-19 (February 24, 2020, to April 19, 2020) periods. Primary end-point: number of days over the 95th percentile of the reference period. Results Number of patients managed was over the 95th percentile during 27 and 47 days in New-Caledonia and Seine-Saint-Denis, respectively. Number of emergency department transfers was more than the 95th percentile during 4 and 31 days, respectively. Number of mobile intensive care unit sent was over the 95th percentile during 3 and 14 days, respectively. Peaks were similar. Conclusion The duration of the critical period rather than its spread affected the health care system.

COVID-19 pandemic has dramatically impacted the world. Health systems were not the only ones being disturbed. Many collateral effects have been reported, such as familial, academical, social, political and economic troubles.1Paes-Sousa R. Millett C. Rocha R. Barreto M.L. Hone T. Science misuse and polarised political narratives in the COVID-19 response.Lancet. 2020; 396: 1635-1636Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar In contrast, scientific research has never been so dynamic, allowing to create effective vaccines in less than one year.2Jackson L.A. Anderson E.J. Rouphael N.G. et al.An mRNA vaccine against SARS-CoV-2 — preliminary report.N Engl J Med. 2020; 383: 1920-1931Crossref PubMed Scopus (2241) Google Scholar However, we hypothesized that there was a price to pay even in the field of scientific research. Thus, we aimed to evaluate the debt induced on medical publications getting out of the field of COVID-19 pandemic. We chose to analyze the main journals publishing in medical specialties that were the most directly facing the COVID-19 pandemic, i.e., internal/general, emergency, critical care, respiratory and infectious disease medicine. Therefore, we selected the three journals from each specialty with the highest impact factor (2018), regardless of their potential specific scopes. We compared the total number of papers indexed in the last 6 months (Pubmed – June 1st to November 24th, 2020) with those indexed in the same period in 2019. The goal was to study the changes in the number of papers, the space dedicated to COVID-19 pandemic in each specialty, and the remaining space allocated to non-COVID-19 papers. In all medical editions, we recorded 718,367 papers published in 2019 and 865,567 (+20%) in 2020. The number of COVID-19 ones reached 60,600 (8%). Among selected journals, the total number of articles was highly variable in both, specialties and journals (p < 0.0001), same as the ratio of COVID-19 papers (p < 0.0001). The global increase was maximal in critical care medicine (+75%) and infectious diseases journals (+113%), peaking at 163%. The respiratory medicine journals group had the highest ratio of COVID-19 articles (53%), peaking at 75%. After data weighting, a drastic decrease in non-COVID-19 papers appeared in emergency, generalist, and respiratory medicine journals (−22%, −34% and −43%, respectively). Results are detailed in Table 1.Table 1Number of papers published in 2019 and 2020 (Pubmed – June 1st to November 24th) by specialties directly facing COVID-19 pandemic; ratio of COVID-19 papers and impact on non-COVID-19 ones.SpecialtyJournalImpact factor (2018)2019 (n)2020 (n (% vs. 2019))COVID (n (%))Weighted for non-COVID papersGeneral medicineNew Engl J Med70.7742889 (+20%)272 (31%)−17%Lancet59.1874735 (−16%)269 (37%)−47%JAMA51.3869882 (+1%)313 (35%)−35%Total24852506 (+1%)854 (34%)−34%Emergency medicineAnn Emerg Med5.3305278 (−9%)38 (14%)−21%Resuscitation4.6328340 (+4%)66 (19%)−16%Emergencias3.44246 (+10%)11 (24%)−17%Total675632 (−6%)108 (17%)−22%Critical care medicineIntensive Care Med19280313 (+12%)113 (36%)−29%Am J Respir Crit Care Med16.5355695 (+96%)152 (22%)+53%Chest9.7338694 (+105%)92 (13%)+78%Total9731702 (+75%)357 (21%)+38%Respiratory medicineLancet Respir Med16.5186153 (−18%)113 (74%)−78%J Thorac Oncol12.5240204 (−15%)152 (75%)−78%Eur Respir J11.8282500 (+77%)150 (30%)+24%Total708857 (+21%)452 (53%)−43%Infectious diseasesLancet Infect Dis27.5285399 (+40%)157 (39%)−15%Lancet HIV14.8203276 (+36%)33 (12%)+20%Clin Infect Dis97221906 (+164%)492 (26%)+96%Total12102581 (+113%)682 (26%)+57%All together48418278 (+71%)2453 (30%)+20% Open table in a new tab In many journals among those selected, the global increase in the number of papers published did not compensate the place specifically dedicated to COVID-19 papers. Consequently, the publication of non-COVID-19 papers might have been slowed down, or even stopped, particularly in emergency, generalist or respiratory medicine editions. The result seems to be much more related to journal policy than to specialty strategy.3The Lancet null COVID-19: a stress test for trust in science.Lancet. 2020; 396 (19): 799Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Physicians, researchers and editors should be aware of the effect of the COVID-19 pandemic on medical research, and should not underestimate its impact.3The Lancet null COVID-19: a stress test for trust in science.Lancet. 2020; 396 (19): 799Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 4Benjamens S. de Meijer V.E. Pol R.A. Haring M.P.D. Are all voices heard in the COVID-19 debate?.Scientometrics. 2020; : 1-4PubMed Google Scholar None.

One potential COVID-19 treatment, hydroxychloroquine has been the focus of much debate since its first publication by a French research team. To an unusual degree, this debate has extended outside of the medical community into the public sphere. To know if this interest, which conceals the reality of scientific debate, occurred worldwide. Methodological use of the Google-Trends was standardized. We researched the web queries for "hydroxychloroquine" and "chloroquine" and "amoxicillin" and "acetaminophen" as reference. Analysis was detailed by country. The relationship between these queries and the COVID-19 epidemic was supported by analysis of the main "related queries". Google-Trends provided results on a relative value basis, on a scale from 0 to 100, with a value of 100 indicating the most researched criterion over the study period. Web queries for "amoxicillin" never exceeded the value of 1. Searches for "acetaminophen" peaked on March 13 with a value of 13. "Hydroxychloroquine" was the most frequently researched term. It reached its peak value of 99 on April 7. Queries for "chloroquine" peaked (value 100) on March 24. Searches for "hydroxychloroquine" came essentially from Asia and the United States, with France in 22nd position (value of 21). Searches for "chloroquine" came essentially from Africa, with France in 8th position (value of 55). The five main related searches were in both cases associated with the COVID-19 epidemic. Interest in chloroquine is not specific to France. Results of ongoing studies have been and will be scrutinized attentively in all corners of the globe.

We portray the evolution of the Covid-19 epidemic during the crisis of March-April 2020 in the Paris area, by analyzing the medical emergency calls received by the EMS of the four central departments of this area (Centre 15 of SAMU 75, 92, 93 and 94). Our study reveals strong dissimilarities between these departments. We show that the logarithm of each epidemic observable can be approximated by a piecewise linear function of time. This allows us to distinguish the different phases of the epidemic, and to identify the delay between sanitary measures and their influence on the load of EMS. This also leads to an algorithm, allowing one to detect epidemic resurgences. We rely on a transport PDE epidemiological model, and we use methods from Perron-Frobenius theory and tropical geometry.

Abstract Background The aim of our retrospective study was to evaluate the earliest COVID19-related signal to anticipate requirements of intensive care unit (ICU) beds. Although the number of ICU beds is crucial during the COVID-19 epidemic, there is no recognized early indicator to anticipate it. Methods In the Ile-de-France region, from February 20 to May 5, 2020, emergency medical service (EMS) calls and the response provided (ambulances) together the percentage of positive reverse transcriptase polymerase chain reaction (RT-PCR) tests, general practitioner (GP) and emergency department (ED) visits, and hospital admissions of COVID-19 patients were recorded daily and compared to the number of ICU patients. Correlation curve analysis was performed to determine the best correlation coefficient, depending on the number of days the indicator has been shifted. Primary endpoint was the number of ICU patients. Results EMS calls, percentage of positive RT-PCR tests, ambulances used, ED and GP visits of COVID-19 patients were strongly associated with COVID-19 ICU patients with an anticipation delay of 23, 15, 14, 13, and 12 days respectively. Hospitalization did not anticipate ICU bed requirement. Conclusion The daily number of COVID19-related telephone calls received by the EMS and corresponding dispatch ambulances, and the proportion of positive RT-PCR tests were the earliest indicators of the number of COVID19 patients requiring ICU care during the epidemic crisis, rapidly followed by ED and GP visits. This information may help health authorities to anticipate a future epidemic, including a second wave of COVID19 or decide additional social measures.

Introduction Worldwide, the COVID-19 epidemic has put health systems to the test. The excess mortality is partly due to the influx of patients requiring hospitalization and intensive care. We propose that the chronology of epidemic spread gives a window of time in which hospitals can act to prevent reaching capacity. Methods The out-of-hospital SAMU Emergency Medical System in an entry point into the French health care system. We recorded the number of patients managed, of patients transferred to emergency departments (ED), and of mobile intensive care units (MICUs) dispatched. Each criterion was compared to the mean of the same criterion over the previous 5 years. The alert threshold which indicated a public health crisis was defined as a 20% increase compared to the 5-year mean. Results The reference period, from January 2015 to December 2019, included 3 381 611 calls, and 1 137 856 patients. The study period, from 17 February to 28 March 2020, included 166 888 calls, and 56 708 patients. The daily numbers of patients managed crossed the threshold on February 25, and increased until the end of the study period. The daily number of patients transferred to ED crossed the threshold on March 16, and increased until the end of the period. The daily number of MICUs dispatched crossed the threshold on March 15, and increased until the end of the period. Conclusion The COVID-19 epidemic reached our department in three consecutive waves which overwhelmed the health care system. The first wave preceded by 30 days the massive arrival of critical patients. Health care systems must take advantage of this delay to prepare for the third wave.

Clinical features of COVID-19 have been mostly described in hospitalized patients with and without ICU admission. Yet, up to 80% of patients are managed in an outpatient setting. This population is poorly documented. In France, health authorities recommend outpatient management of patients presenting mild-to-moderate COVID-19 symptoms. The aim of this study was to describe their clinical characteristics. The study took place in an emergency medical dispatching center located in the Greater Paris region. Patients included in this survey met confirmed COVID-19 infection criteria according to the WHO definition. We investigated clinical features and classified symptoms as general, digestive, ear-nose-throat, thoracic symptoms, and eye disease. Patients were included between March 24 and April 6 2020. 1487 patients included: 700 (47%) males and 752 (51%) females, with a median age of 44 (32-57) years. In addition to dry cough and fever reported in more than 90% of cases, the most common symptoms were general symptoms: body aches/myalgia (N = 845; 57%), headache (N = 824; 55%), and asthenia (N = 886; 60%); shortness of breath (N = 479; 32%) and ear-nose-throat symptoms such as anosmia (N = 415; 28%) and ageusia (N = 422; 28%). Chest pain was reported in 320 (21%) cases and hemoptysis in 41 (3%) cases. The main difference between male and female patients was an increased prevalence of ear-nose-throat symptoms as well as diarrhea, chest pains, and headaches in female patients. General symptoms and ear-nose-throat symptoms were predominant in COVID-19 patients presenting mild-to-moderate symptoms. Shortness of breath and chest pain were remarkably frequent.

Abstract Background Access to an Emergency Medical Communication Centre is essential for the population in emergency situations. Handling inbound calls without delay requires managing activity, process and outcome measures of the Emergency Medical Communication Centre to improve the workforce management and the level of service. France is facing political decisions on the evolution of the organisation of Emergency Medical Communication Centres to improve accessibility for the population. First, we aim to describe the variation in activity between Emergency Medical Communication Centres, and second, to explore the correlation between process measures and outcome measures. Methods Using telephone activity data extraction, we conducted an observational multicentre study of six French Emergency Medical Communication Centres from 1 July 2016 to 30 June 2017. We described the activity (number of incoming calls, call rate per 1000 inhabitants), process measure (agent occupation rate), and outcome measure (number of calls answered within 20 s) by hourly range and estimated the correlation between them according to the structural equation methods. Results A total of 52,542 h of activity were analysed, during which 2,544,254 calls were received. The annual Emergency Medical Communication Centre call rate was 285.5 [95% CI: 285.2–285.8] per 1000 inhabitants. The average hourly number of calls ranged from 29 to 61 and the call-handled rate from 75 to 98%. There are variations in activity between Emergency Medical Communication Centres. The mean agent occupation rate was correlated with the quality of service at 20 s (coefficient at − 0.54). The number of incoming calls per agent was correlated with the mean occupation rate (coefficient at 0.67). Correlation coefficients varied according to the centres and existed between different process measures. Conclusions The activity dynamics of the six Emergency Medical Communication Centres are not identical. This variability, illustrating the particularity of each centre, must be accurately assessed and should be taken into account in managerial considerations. The call taker occupation rate is the leverage in the workforce management to improve the population accessibility.

INTRODUCTION The health impact of cold and hot waves is major. Nevertheless, the respective impact of extreme high and low temperatures remains controversial. METHOD The daily number of (1) patients managed by SAMU 93 dispatching centre – primary care requirement indicator, (2) Mobile Intensive Care Unit (MICU) interventions – patient severity indicator and (3) number of deaths have been recorded. Daily minimum and maximum temperatures were recorded from 2010 to 2018. The analysis covered the 10 warmest and coldest days of each year (2 × 70 days), and the 30 warmest and coldest days of the total period (2 × 30 days). RESULTS Over 2,702 days, 1,513,070 patients, 89,478 MICU interventions and 7,350 deaths were analysed. Median temperature: 16.0[10.4-21.6]°C.The coldest days were associated with a significant increase in patients managed (665[609-764] vs 538[474-619]; P < 0.001), MICU interventions (35[32-39] vs 33 [28-38]; P = 0.006) and deaths (3[2-5] vs 2[1-4]; P = 0.0008) considering the 10 days of extreme temperatures in each year and a significant increase in patients managed 615[580-698] vs 542[475-627]; P < 0.001) considering the 30-day extreme of the period.The hottest days were associated with a significant decrease in patients managed (484[443-549] vs 538[474-619]; P < 0.001), MICU interventions (31[25-37] vs 33[28-38]; P = 0.006) and deaths (2[1-3] vs 2[1-4]; P = 0.0008) considering the 10 extreme days of each year and a significant decrease in patients managed (536[479-576] vs 542[475-627]; P < 0.001) considering the 30 extreme days of the period. CONCLUSION Primary care requirement, number of severe patients and mortality increased significantly with extreme low of temperature.

Les manifestations cliniques de l’endocardite infectieuse (EI) peuvent atteindre pratiquement tous les organes et sont classiquement séparées en complications cardiaques et extracardiaques.L’infection débute au niveau cardiaque par la formation d’une végétation, et s’étend ensuite localement avec majoration de la taille et du nombre de végétations, délabrement et destruction des tissus valvulaires et extension à l’espace péri-valvulaire.Ces lésions anatomiques sont à l’origine de désordres hémodynamiques, le plus souvent à type de fuite valvulaire, et mènent fréquemment à l’insuffisance cardiaque qui est la complication la plus fréquente de l’EI.Les complications emboliques sont très fréquentes, et peuvent toucher tous les territoires, cerveau, rate et rein le plus souvent pour les EI gauches, poumons pour les EI du cœur droit.Les complications neurologiques peuvent être d’origine embolique, hémorragique et/ou infectieuse, sont souvent à l’origine du diagnostic d’EI et sont un facteur de mauvais pronostic.L’EI reste une maladie sévère avec une mortalité hospitalière de l’ordre de 20 %, une mortalité à 5 ans de 40 % et une morbidité non négligeable.Clinical manifestations of infective endocarditis may involve almost all body organs. They are usually classified as either cardiac or extra-cardiac complications.The first stage of infection is the development of intra-cardiac vegetation, which may further spread with an increase in size and number of vegetations, destructive valve lesions, and perivalvular extension of the infection.These anatomical lesions are responsible for hemodynamic disorders, mostly valvular regurgitation, and often lead to heart failure, which is the most frequent complication of IE.Embolic events may affect various vascular territories, the most frequent sites being brain, spleen and kidney for left-sided IE, and lung for right-sided IE.Cerebral complications may be of ischemic, hemorrhagic and/or infectious origin, are often the revealing symptoms of IE, and are well-recognized factors of poor prognosis.IE remains a dreadful disease with an in hospital mortality of 20%, a 5 year mortality of 40% and a significant morbidity.

Introduccion: el impacto en la salud de las olas de frio y calor es muy importante. Sin embargo, el impacto respectivo de las temperaturas extremas, altas o bajas, sigue siendo polemico. Metodo: el numero diario de (1) expedientes de regulacion medica (ERM) gestionados por la SAMU 93 [Servicio de Atencion Medica de Urgencia], un indicador de la demanda de atencion primaria; (2) de intervenciones de los equipos del SMUR [ambulancias asistenciales], un indicador de la gravedad del paciente; y (3) de pacientes fallecidos. Se registraron las temperaturas minimas y maximas diarias desde 2010 hasta 2018. El analisis se centro en los 10 dias mas calidos y mas frios de cada ano (2 × 70 dias), y los 30 dias mas calidos y mas frios del periodo (2 × 30 dias). Resultados: durante 2.702 dias, se analizaron 1.513.070 ERM, 89.478 intervenciones del SMUR y 7.350 fallecimientos. Temperatura media: 16,0 [10,4-21,6] °C. Los dias mas frios estaban relacionados con un aumento significativo de los ERM (665 [609-764] contra 538 [474-619]; p < 0,001), de las intervenciones del SMUR (35 [32-39] contra 33 [28-38]; p = 0,006) y de los fallecimientos (3 [2-5] contra 2 [1-4]; p = 0,0008) si se tenian en cuenta los 10 dias de temperaturas mas extremas cada ano y con un aumento significativo de los ERM (615 [580-698] contra 542 [475-627]; p < 0,001) si se tenian en cuenta los 30 dias mas extremos del periodo. Los dias mas calurosos estaban relacionados con una disminucion significativa de los ERM (484 [443-549] contra 538 [474-619]; p < 0,001), de las intervenciones del SMUR (31 [25-37] contra 33 [28-38]; p = 0,006) y de fallecimientos (2 [1-3] contra 2 [1-4]; p = 0,0008) si se tenian en cuenta los 10 dias mas extremos de cada ano y con una disminucion significativa de los ERM (536 [479-576] contra 542 [475-627]; p < 0,001) si se tenian en cuenta los 30 dias mas extremos del periodo. Conclusion: la demanda de atencion primaria, el numero de pacientes graves y la mortalidad aumentaron significativamente con las temperaturas extremadamente bajas.

Introduction > The atmospheric pollution is a growing public health problem. The highly urbanized regions such as Paris area seem particularly exposed. However, the overall health impact is poorly documented. Objective > To investigate the influence of air quality degradation on the demand for primary care. Method > Site: medical dispatching center SAMU 93-Center 15. Related population: 1.6 million inhabitants. Data: daily number of medical regulation records (DRM) and daily air quality index (AQI) using the Airparif (R) database from January 2014 to February 2017. The AQI is classified into five levels. Level 4 corresponds to the threshold of information and recommendations to reduce certain sources of polluting emissions and level 5 to the alert threshold setting up measures of restriction or suspension of the activities contributing to the pollution including vehicles circulation. Results > The analysis covered 1134 consecutive days and a total of 639,576 DRM. Average daily DRM number: 564 (507-643). IQA >= 4 for 56 (5%) days and >= 5 for 4 (0.4%) days. The number of DRM was very closely correlated with the IQA (R-2 = 0.91); the daily median varied from 502 (494-621) for an IQA of level 1 to 650 (540-704) for an IQA >= 4. Conclusion > Degradation of air quality was significantly correlated with demand for primary care. The environmental alert is also a health alert. The impact was major (DRM + 30%) considering all pathologies, all the pollutants on a departmental scale.

Objective We aimed to evaluate the impact of the same-day GPs’ strike and terrorist attacks on a call centre’s activity. Methods We compared the number of calls received, the number of patient’s medical files (PMFs) created and the number of mobile ICU (MICU) dispatched per hour on Friday, 13 November, to the repository established on the five previous Fridays. As previously published, the variation criterion was set to an activity variation above 20% for more than 2 h. Results On Friday, 13 November, 1745 calls were received compared with 1455 calls, on average, for the five previous Fridays. The number of calls received increased after the terrorist attacks (⩽90%) and remained above the threshold for 3 h. The number of PMFs exceeded the threshold from 10:00 a.m. to 05:00 p.m., but was not affected by the attacks. The number of MICUs dispatched exceeded the threshold (>500%) in the first hour after the attacks. Conclusion The GPs’ strike and the terrorist attacks did not impact our call centre’s activity in the same manner. The strike increased the number of PMFs without increasing the number of calls received. The attacks increased the number of calls received and MICU dispatched without increasing the number of PMFs. Many markers are at the disposal of call centres to evaluate the impact of healthcare events.