key: cord-0846374-rqlwz6vk
authors: Jourdes, A.; Lafaurie, M.; Moulis, G.; Delobel, P.; Faruch, M.; Sommet, A.; Martin-Blondel, G.
title: Comparison of the first and second waves of coronavirus disease in Toulouse, France
date: 2021-10-01
journal: Infect Dis Now
DOI: 10.1016/j.idnow.2021.09.005
sha: 48c1818b0c2bed61e158e18dc4134987bc56b55c
doc_id: 846374
cord_uid: rqlwz6vk

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 Use of invasive mechanical ventilation was less frequent.

 Mortality rate was similar to that of the first wave, which may be explained by the different demographic characteristics of the patients in the second wave.

We conducted a retrospective Covid-clinic-Toul cohort study at Toulouse university hospital, in southern France (2800 beds, tertiary hospital covering an area of about 3 million inhabitants) and selected hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia from September 1 st , 2020 to October 31 st , 2020. We compared their demographics, clinical, biological and radiological features, as well as unfavorable outcome (admission in an intensive care unit, mechanical ventilation, death) at Day 14 after admission to those of hospitalized patients during the 1 st wave (March 11, 2020 to April 20, 2020).

Like many other European countries, France faced a second wave of Coronavirus 2019 (COVID-19) pandemic from September to November 2020 [1] . A number of studies have compared the epidemiological and clinical features of hospitalized patients with COVID-19 during the first and second wave, mostly in Italy [2] [3] [4] [5] [6] . In addition, a few studies have assessed whether the characteristics and outcomes of hospitalized patients with COVID-19 changed in the second phase of the epidemic due to the evolution of healthcare system organization, patient demographics, and/or progress in disease management in France/other European countries. In particular, several randomized controlled trials conducted during the first wave highlighted the beneficial effects of early administration of glucocorticoids for critically ill COVID-19 patients [7] . We collected demographics, clinical, laboratory, radiological (description of chest computed tomography -CT scans), treatment data within the first 24 hours after admission, exposure to corticosteroids during the first 14 days after admission, as well as outcome at Day 14 after admission. The primary outcome was composite, including admission to ICU, need for mechanical ventilation and death occurring during the 14 days after admission to the hospital.

The results of comparison between the first (n=263) and the second (n=340) wave regarding patient characteristics, comorbidities, biological data and outcome are detailed in Table 1 .

During the second wave, patients were older (median age: 73 vs 65 years, p<0.0001). They were also more likely to have comorbidities (92.9% had at least 1 comorbidity vs 86.3%, p=0.007), such as hypertension (58.5% vs 39.5%, p<0.0001), diabetes (30.3% vs 19.8%, p=0.003) and cardiovascular diseases (25.9% vs 13.3%, p=0.0001). Duration of symptoms from onset to admission was shorter in the second phase of the epidemic (median duration likely to be treated with steroids and more likely to receive antivirals that may not have been effective against COVID-19, and could have been harmful [9] . Similarly, the use of high-flow nasal oxygen therapy was less prevalent in the first wave [10] and prevention of blood clots had changed. All these factors may have improved survival in COVID-19 patients and led to a stable mortality rate despite increased admission of older and more vulnerable patients.

This cohort exhibits a number of epidemiological results: higher frequency of comorbidities and older patients in comparison with the first wave. Interestingly, the need for mechanical ventilation and ICU admission was less frequent, but due to the aforementioned demographic shift, no decrease of mortality was observed.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 

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Clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 infection at Toulouse University hospital

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WHO Solidarity Trial Consortium. Repurposed Antiviral Drugs for Covid-19 -Interim WHO Solidarity Trial Results

High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

Body Mass Index, n=19; current smoker, n = 148; time from first symptoms to admission, n = 2; temperature, n = 7; respiratory rate, n = 12; oxygen saturation, n = 2; platelet count, n = 10; C-reactive protein, n = 9; creatinine level, n = 6. Missing values: For patients included between 1 st