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Aim: Since beds are unavailable, we prospectively investigated whether early hospital discharge will be safe and useful in patients hospitalized for COVID-19, regardless of their need for home oxygen therapy., Population and Methods: Extending the initial inclusion criteria, 62 patients were included and 51 benefited from home telemonitoring, mainly assessing clinical parameters (blood pressure, heart rate, respiratory rate, dyspnea, temperature) and peripheral saturation (SpO 2 ) at follow-up., Results: 47% of the patients were older than 65 years; 63% needed home oxygen therapy and/or presented with more than one comorbidity. At home, the mean time to dyspnea and tachypnea resolutions ranged from 21 to 24 days. The mean oxygen-weaning duration was 13.3 ± 10.4 days, and the mean SpO 2 was 95.7 ± 1.6%. The nurses and/or doctors managed 1238 alerts. Two re-hospitalizations were required, related to transient chest pain or pulmonary embolism, but no death occurred. Patient satisfaction was good, and 743 potential days of hospitalization were saved for other patients., Conclusion: The remote monitoring of vital parameters and symptoms is safe, allowing for early hospital discharge in patients hospitalized for COVID-19, whether or not home oxygen therapy was required. Oxygen tapering outside the hospital allowed for a greater reduction in hospital stay. Randomized controlled trials are necessary to confirm this beneficial effect.

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

Background: During the COVID-19 first wave in France, the capacity of intensive care unit (ICU) beds almost doubled, mainly because of the opening of temporary ICUs with staff and equipment from anaesthesia., Objectives: We aim to investigate if the initial management in temporary ICU is associated with a change in ICU mortality and short-term prognosis., Design: Retrospective single-centre cohort study., Setting: Surgical ICU of the Bichat Claude Bernard University Hospital during the COVID-19 "first wave" (from 18 March to 10 April 2020)., Patients: All consecutive patients older than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and/or typical radiological patterns were included during their first stay in the ICU for COVID-19., Intervention: Patients were admitted to a temporary ICU if no room was available in the classical ICU and if they needed invasive mechanical ventilation but no renal replacement therapy or Extracorporeal Membrane Oxygenation (ECMO) in the short term. The temporary ICUs were managed by mixed teams (from the ICU and anaesthesiology departments) following a common protocol and staff meetings., Main Outcome Measure: ICU mortality RESULTS: Among the 59 patients admitted, 37 (62.7%) patients had initial management in the temporary ICU. They had the same characteristics on admission and the same medical management as patients admitted to the classical ICU. ICU mortality was similar in the 2 groups (32.4% in temporary ICUs versus 40.9% in classical ICUs; p=0.58). SAPS-II and ECMO use were associated with mortality in multivariate analysis but not admission to the temporary ICU., Conclusion: In an overload context of the ICU of a geographical area, our temporary ICU model allowed access to intensive care for all patients requiring it without endangering them., (© 2022. The Author(s).)

Objective: The aim of this study was to measure the perception of readiness to manage a sanitary crisis for hospital workers and to study the factors related to this perception., Methods: This study was a cross-sectional study; 408 French hospital workers responded to an online questionnaire. The variables studied concerned the perceived personal preparedness, the perception of colleagues' and hospital's preparedness, perception of the situation, and preparatory behavioral acts. Correlations, partial correlations, and multiple linear regressions were applied., Results: Based on Pearson's correlations, the higher the participants' sense of personal efficacy and control over their behavior, the more ready they feel (r p = 0.77*** and r p = 0.55***). The more participants perceive their colleagues as ready and their hospital as prepared, the more ready they feel (r p = 0.52*** and r p = 0.46***). Based on Pearson's partial correlations, upon controlling the effect of preparedness perception, declared preparedness is not significantly correlated with personal readiness perception (r p = 0.01)., Conclusion: The perception of personal readiness does not depend only on actual preparedness but also on individual and collective variables. Technically, these results confirm the value of relying on psychosocial variables during training. It would be interesting to propose empowerment in training courses. It also seems necessary to demonstrate crisis management efficacy at different levels: institutional, collective, and individual.

The SARS-CoV-2 virus changed social reality worldwide, affecting people's health and work life, particularly their anxiety levels. The purpose of this study is to verify the situation of women in terms of anxiety and social determinants in Spain during the pandemic. The sample consisted of 4686 people (3500 women and 1186 men). The tools used were the State-Trait Anxiety Inventory (STAI) and an ad hoc questionnaire to assess the work and mental situation of the participants. The results indicate a higher rate of anxiety among women than among men and reveal a relationship between higher levels of anxiety and more vulnerable work situations in terms of higher unemployment rates, contract changes, etc. Furthermore, there was a higher percentage of women than men in the sectors where the health crisis has had a greater impact and presence, with repercussions on the physical, mental, and social health of the entire population and especially on women. It is necessary to take into account the social determinants of health, not only at the structural level, in terms of the socio-economic and political contexts, to avoid and limit the axes of inequality such as gender.

Background: COVID-19 sanitary crisis is associated with emotional difficulties such as depression, anxiety and reactional post-traumatic symptoms among healthcare workers. Indeed, healthcare workers were particularly exposed to COVID-19 sanitary crisis. This study aimed to investigate the effects of exposure to COVID-19 sanitary crisis on affective symptoms (anxiety, post-traumatic stress, burnout) among French healthcare workers and the mediating role of cognitive emotion regulation strategies (positive re-evaluation and set in perspective) and coping strategies (active coping, planning, instrumental support, emotional support, emotional expression, positive reappraisal, acceptance, denial, blame, humor, religion, distraction, substance use, behavioral disengagement). Method: This cross-sectional survey-based study collected demographic data and mental health measurements from 1,010 volunteers (838 women) who consented online to participate, from March 24 to June 28, 2020, in France. Participants filled out online questionnaires and visual analogic scales that evaluate affective symptoms related to the COVID-19 sanitary crisis, namely symptoms of post-traumatic stress, burnout, emotion regulation abilities, and coping abilities. Results: The majority (57.8%) of the participants presented post-traumatic symptoms. Depending on the sub-dimensions evaluated, a proportion of participants reported moderate (25.9-31.2%) to severe (17.2-40.7%) burnout symptoms. We found a significant effect of the level of exposure to COVID-19 on affective symptoms. Being a woman, having a lower job position and having less experience were associated with higher level of affective symptoms. Moreover, coping strategies had a mediating effect on the relation between stress and burnout, supporting the coping reserve model. Conclusion: Post-traumatic and burnout symptoms were highly prevalent among French healthcare workers at the beginning of the COVID-19 crisis. Exposure to COVID-19 is a determining factor. We can thus promote both coping training and a good environment to limit the emotional consequences of exposure to COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Vancappel, Jansen, Ouhmad, Desmidt, Etain, Bergey, d'Ussel, Krebs, Paquet, Réveillère, Hingray and El-Hage.)

Recurrent venom extracts shortages as well as the COVID-19 pandemic have prompted the SFA/Anaforcal Stinging Insects Task Force to develop recommendations on venom immunotherapy (VIT), in accordance with international guidelines, to be able to offer and maintain VIT to patients with life-threatening risks. How to diagnose allergy to hymenoptera venoms, indications and duration of VIT, maintenance intervals and doses, interchangeability of venom extracts and monitoring of patients on VIT have been adapted to this time of crisis, allowing clinicians to treat their patients with the most benefit and lowest constraint. These recommendations are temporary and will be reviewed after returning to a normal situation., (© 2021 Elsevier Masson SAS. All rights reserved.)