July 12, 2021

Updates from the University Health Institute “Méditerranée Infection”, Marseille

Early treatment with hydroxychloroquine and azithromycin in 10,429 covid-19 outpatients: a monocentric retrospective cohort study — Million et al., May 12, 2021 

Results: Among 10,429 patients (median age, 45 [IQR 32-57] years; 5,597 [53.7%] women), 16 died (0.15%).The median delay from symptoms to day hospital was 4 days [IQR 2-6],and that fromapositive PCR test to day hospital was 1 day [1-3]. The infectionfatality rate was 0.06% among the 8,315 patients treated with HCQ+AZ. No deaths occurred among the 8,414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06–0.48]) was associated with a lower risk of death, independently of age, sexand epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients – odds ratio 0.31 [0.20–0.47], I² = 0%). Conclusions: Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens. Zinc and anticoagulants are likely to further improve outcomes. Most COVID-19–associated deaths are preventable with early detection and outpatient treatment.

Outcomes of 2,111 covid-19 hospitalised patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: a monocentric retrospective analysis — Lagier et al., June 4, 2021

Results: Of the 2,111 hospitalised patients (median age, 67 [IQR 55-79] years; 1,154 [54.7%] men), 271 were transferred to the intensive care unit (12.8%) and 239 died (11.3%; the mean age of patients who died was 81.2 (±9.9)). Treatment with HCQ-AZ, used in 1,270 patients, was an independent protective factor against death (0.68 [0.52–0.88]). Zinc was independently protective against death (0.39 [0.23–0.67]) in a subgroup analysis of patients treated with HCQ-AZ. Dexamethasone was an independent factor associated with death for patients with C-reactive protein <100 mg/L (3.36 [2.09–5.40]) while no difference was observed for patients with CRP >100 mg/L. The use of high-flow oxygen therapy in elderly patients who were noneligible for intensive care unit transfer saved 19 patients (33.9%). Conclusions: Treating COVID-19 with HCQ-AZ is associated with lower mortality. The quality of care over time and analysed in large monocentric studies remains more valuable than randomised multicentric trials during new epidemics.

Evolution of the management of covid-19 — Lagier et al., February 8, 2021

Since February 2020, in IHU Méditerranée Infection, Marseille, France, we managed more than 11,000 patients in our day-care hospital and more than 2,000 in our complete hospitalization wards. From day 1, we have been offering early massive PCR screening for patients suspected of having COVID-19 and for their contacts. Here, we propose a brief review of the therapeutic management of COVID-19 including literature data as well as our personal experience based on the observation of our cohort and our previous reports. We systematically proposed to evaluate patientsin our day-care hospital (clinical examination, SpO₂, standardized biological assessment including D-dimers ± low dose CT-scan). We advised outpatients to buy pulse oximeters to detect “happy” hypoxemia, and proposed hospitalization if SpO₂ <95%. Treatment was proposed using hydroxychloroquine (200 mg, 3 times a day, 10 days), azithromycin (500 mg day 1 then 250 mg during 4 days) after eliminating the contraindications, and elemental zinc (15 mg, 3 times a day, 10 days). For patients with a NEWS-2 score >5, broad-spectrum antibiotic therapy was prescribed (ceftriaxone or ertapenem). Anticoagulation treatment was considered depending on risk factors and D-dimer levels. After a couple of months, low dose of dexamethasone was prescribed (avoiding early stages of high viral load infection) for patients who had an increase in inflammatory parameters and a worsening of oxygen dependence. Finally, we recently used high-flow oxygen therapy devices for patients not eligible for intensive care unit transfer because of their age and/or comorbidities. This step-by-step strategy allowed us to obtain one of the worldwide lower mortality rates of COVID-19. Long-term follow-up will be the next challenge of COVID-19 management.