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In March 2020, the COVID-19 pandemic started to spread among the Belgian territory. Our university hospital was confronted to the very need of specific reorganizations guided by the implementation of the Hospital Emergency Plan.This article aims to describe the experience of the University Hospital of Liège (CHU Liège) during the COVID-19 outbreak and demonstrates the efficiency of advanced triage centers to regulate hospital admissions from the emergency department (ED).since the beginning of March 2020, the CHU of Liège has implemented specific advanced triage centers to manage patients with SARS-CoV-2 suspected symptoms. The first center was organized inside the hospital but the need of outside structures led to the creation of two centers by the end of March. From March 2 to May 3, data from the different visits at the COVID-19 centers were collected (numbers of admissions, rationale for coming, work up and outcome).during the study period, 3,094 patients were admitted to the specific COVID-19 centers of the CHU Liège. This represents 3,431 visits among which 337 were classified as readmission visits. The sensitivity and specificity of the triage centers to determine the need for hospitalization were, respectively, estimated at 87,9 % and 93,4 %.our experience tends to demonstrate the role of specific COVID-19 triage centers located very close to the EDs aimed at managing COVID-19 suspected patients in order to actually determine their need for subsequent hospitalization.La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institutions hospitalières à une série de réorganisations singulières soutenues par l’activation du Plan d’Urgence Hospitalier. Cet article a pour objet de décrire l’expérience du Centre Hospitalier Universitaire de Liège (CHU de Liège) durant la pandémie de COVID-19 et de relater l’efficience de la mise en place d’un centre de tri avancé en amont des services d’urgences pour la gestion des admissions hospitalières. Méthodes : dès le 2 Mars 2020, le CHU de Liège a mis en place une infrastructure d’accueil des patients suspects d’infection par le SARS-CoV-2. D’abord initiée au sein de l’institution hospitalière, la nécessité d’une infrastructure indépendante s’est rapidement révélée indispensable et a, dès lors, vu le jour dès la fin du mois de mars, sur les deux sites hospitaliers universitaires. Du 2 mars au 3 mai 2020, l’ensemble des données relatives aux visites au sein des centres de tri avancé ont été collectées (nombre d’admissions, motif des visites, examens complémentaires et évolutions cliniques). Résultats : sur la période de l’étude, 3.094 patients ont transité par les centres de tri du CHU de Liège. Cette fréquentation était constituée d’un volume global de 3.431 contacts dont 337 représentaient des réadmissions. La sensibilité et la spécificité des centres de tri en regard de la nécessité d’une hospitalisation étaient, respectivement, de 87,9 % et 93,4 %. Conclusion : notre expérience suggère une efficience optimale des centres de tri avancé, en amont des structures hospitalières traditionnelles, pour orienter de manière appropriée le flux des patients suspects d’infection par le SARS-CoV-2.

International audience; Objectives: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France.Methods: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey.Results: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions.Conclusions: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions.

The COVID-19 outbreak grows exponentially in our country. Despite most of patients develops benign symptoms, cancer patients are at risk of a severe form of the disease. Radiotherapy centres are a potential contamination place due to the number of patients treated and staff present. Their organization during the outbreak period aims to ensure continuity of care while limiting the risk of death from COVID-19. In the radiotherapy department of Mulhouse hospital (France), we pointed five points out: protection of medical and paramedical staff, protection of patients undergoing treatment, detection of patients suspected of being infected by SARS-CoV-2 and their management, reorganization of the patient circuit and measures regarding the quality management. This reflection, which began at the beginning of the outbreak in our city, allows us to preserve the access to radiotherapy treatments by anticipating the risk of spreading the virus. Through biweekly meetings, we continue to adapt to the epidemic in our department, considering our material resources. The ability to perform diagnostic tests in all suspect patients would also allow us to refine our procedures.

The current epidemic of SARS-CoV-2 infection poses new challenges in the management of patients with gastrointestinal or liver disease. Consultations with patients with chronic diseases should ideally be done via telemedicine and treatments administered at home if possible. The latter should be maintained in non-infected subjects to limit the risk of decompensation of their underlying disease. In the event of proven infection, immunomodulatory or biological treatments will tend to be reduced or discontinued unless the disease is in a severely active phase. Elective endoscopy should be postponed, and urgent procedures should be performed with appropriate personal protective equipment.L’épidémie actuelle d’infection par le SARS-CoV-2 pose de nouveaux défis dans la prise en charge des patients avec pathologies gastroentérologique ou hépatologique. Les consultations avec les patients atteints de maladies chroniques devraient se faire idéalement par télémédecine et les traitements administrés à domicile si possible. Ces derniers doivent être maintenus chez les sujets non infectés pour limiter le risque de décompensation de leur maladie de base. En cas d’infection avérée, on aura tendance à diminuer voire interrompre les traitements immunomodulateurs ou biologiques sauf si la maladie est en phase sévèrement active. Les examens endoscopiques électifs doivent être reportés. Les interventions urgentes doivent être effectuées en appliquant des mesures de protection adéquates.

Due to COVID-19 outbreak, the Belgian Association of Urology recommended limiting non-emergency surgical care. The aim of this study was to analyze if a preoperative screening for COVID-19 was key to select optimal operative candidates and its impact on surgical outcomes.we present a retrospective analysis of all consecutive patients who underwent oncological high-risk and emergency urological surgeries in a Belgium tertiary center from March 30 to April 30, 2020. The screening protocol was based on clinical assessment and chest-CT to identify COVID-19-positive patients.a total of 32 patients underwent elective oncologic (n = 17; 53 %) and emergency (n = 15; 47 %) operations. Screening by chest-CT revealed three cases of COVID-19 (9 %) having led to postpone two interventions. The third positive COVID-19 patient died of respiratory complications after bladder perforation urgent procedure. Two patients developed compatible post-operatively symptoms with one positive chest-CT but no positive RT-PCR and successful recovery. Adapted safety measures were followed to mitigate in-hospital transmission.this report suggests feasibility and efficacy of systematic, preoperative screening for COVID-19 by chest computed tomography only. This strategy could allow to perform the majority of scheduled high-risk oncologic interventions safely for both the patients and the surgical staff.Avec l’épidémie de COVID-19, l’Association Belge d’Urologie a recommandé de limiter les soins chirurgicaux non urgents. Le but de cette étude était d’analyser si un dépistage préopératoire de la COVID-19 était essentiel pour sélectionner les candidats opératoires optimaux et son impact sur les résultats chirurgicaux. Matériel et méthodes : nous présentons une analyse rétrospective des patients qui ont subi des chirurgies urologiques oncologiques à haut risque et d’urgence dans un centre tertiaire belge du 30 mars au 30 avril 2020. Le protocole de dépistage était une évaluation clinique plus CT thoracique pour identifier les patients COVID-19 positifs. Résultats : 32 patients ont bénéficié d’opérations oncologiques (n = 17; 53 %) et urgentes (n = 15; 47 %). Le dépistage par CT thoracique a révélé trois cas de COVID-19 (9 %) conduisant à deux reports de la chirurgie. Le troisième est décédé de complications respiratoires après procédure urgente pour perforation vésicale. Deux patients ont développé des symptômes postopératoires compatibles avec la COVID-19. Un CT thoracique était suspect, les RT-PCR négatives et les récupérations favorables. Des mesures de sécurité ont été instaurées pour atténuer la transmission intra-hospitalière. Conclusion : nous rapportons la faisabilité et l’efficacité du dépistage systématique préopératoire de la COVID-19 uniquement par CT thoracique. Cette stratégie pourrait permettre d’effectuer la majorité des interventions oncologiques à haut risque en toute sécurité pour les patients et le personnel chirurgical.

The COVID-19 outbreak has raised numerous attempts of diverse pharmacological interventions to improve the prognosis of the infection, especially among hospitalized patients due to an acute respiratory distress syndrome (ARDS). Initially, these interventions used known medications capable to directly target SARS-CoV-2 by investigating several antiviral therapies already applied with some success in other viral infections. Among them remdesivir appears to be the most promising drug against SARS-CoV-2. Then, owing to the deleterious impact of the cytokine storm, medications that more specifically inhibit proinflammatory cytokines (especially interleukin-1 and interleukin-6) were tested. Hydroxychloroquine, sometines combined with azithromycin, has benefited for a while from a media buzz. However, hopes initially founded in all such drugs turned into disappointments because the specificities of SARS-CoV-2 make this virus resistant to most pharmacological interventions. Only glucocorticoids, dexamethasone and hydrocortisone, were associated with a significant reduction in mortality of patients with ARDS due to COVID-19, most probably via non-specific anti-inflammatory effects. These corticosteroids are currently recommended by the World Health Organisation. An intensive research is ongoing worldwide to find effective combined therapies or innovative drugs which could unequivocally improve the prognosis of COVID-19 at the different stages of the infection.La pandémie COVID-19 a suscité de nombreuses tentatives d’intervention pharmacologique, diverses et variées, pour améliorer le pronostic de l’infection, en particulier chez les patients hospitalisés pour un syndrome de détresse respiratoire aiguë (SDRA). Ces essais ont d’abord fait appel à des médicaments connus, susceptibles d’agir directement sur le virus SARS-CoV-2, en testant divers agents antiviraux déjà utilisés avec un certain succès dans d’autres infections virales. C’est le remdésivir qui a montré les résultats les plus prometteurs. Ensuite, au vu du rôle néfaste attribué à l’orage cytokinique, des médicaments enrayant plus spécifiquement l’action de cytokines proinflammatoires (notamment, interleukine-1 et interleukine-6) ont été essayés. L’hydroxychloroquine, éventuellement associée à l’azithromycine, a fait l’objet, un moment, d’un véritable buzz médiatique. Au total, cependant, les espoirs fondés dans tous ces médicaments se sont plutôt mués en déceptions face au SARS-CoV-2 qui présente des particularités insoupçonnées, le rendant résistant à la plupart des médicaments testés. Seules la dexaméthasone et l’hydrocortisone, sans doute par une action anti-inflammatoire non spécifique, ont montré une réduction significative de la mortalité des patients COVID-19 avec SDRA. Dès lors, ces glucocorticoïdes sont maintenant recommandés par l’Organisation Mondiale de la Santé. Une recherche intense est actuellement en cours à l’échelle mondiale pour trouver des combinaisons thérapeutiques ou des médicaments innovants qui pourraient améliorer, de façon incontestable, le pronostic de l’infection COVID-19 aux différents stades de la maladie.

Coronavirus disease (COVID)-19 is an emerging pandemic infection whose significant ability to spread in a naïve population is well established. The first response of states to the COVID-19 outbreak was to impose lock-down and social barrier measures, such as wearing a surgical mask or social distancing. One of the consequences of this pandemic in terms of public health was the suspension or slowdown of infant vaccination campaigns, in almost all countries. The indirect effects of COVID-19 may therefore weigh on mortality from measles and polio in developing countries. In this pandemic chaos, the only hope lies in the rapid development of an effective vaccine against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, acceptance of this vaccine has not yet been won, as beyond the many unknowns that will inevitably weigh around such rapid development, skepticism among vaccine hesitants is growing.COVID-19 et vaccination : une dérégulation globale.La COVID-19 est une infection pandémique émergente dont l’importante capacité à se propager dans une population dénuée d’immunité n’est plus à prouver. La première réponse des États à la flambée de COVID-19 fut d’imposer un confinement et des mesures barrières, telles que le port du masque et la distanciation sociale. Une des répercussions de cette pandémie, en matière de santé publique, fut la suspension ou le ralentissement brusque des campagnes de vaccination des nourrissons, un peu partout dans le monde. Un des effets indirects de la COVID-19 est donc le risque de peser sur la mortalité mondiale, principalement via une recrudescence de la rougeole et de la poliomyélite, principalement dans les pays en voie de développement. Dans ce chaos potentiel, le seul espoir réside dans le développement rapide d’un vaccin efficace contre le SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2). Cependant, l’acceptation de ce vaccin par la population n’est pas évidente, car outre les nombreuses inconnues qui vont peser inévitablement dans le cas d’un développement très rapide du vaccin, le scepticisme des hésitants vaccinaux va à nouveau se développer.

The covid-19 outbreak prompted many health care providers to use video consultation for the first time. While it is particularly useful in times of pandemic, a number of patients wish to continue using video consultation as it allows easy access to their physician. However, many physicians may be uncomfortable communicating with new technologies and without performing a traditional physical examination. Training in communication and virtual physical examination in telemedicine appears to be necessary, making it possible to make videoconsultation sustainable into daily practice while guaranteeing quality of care.La crise liée au Covid-19 a poussé de nombreux soignants à utiliser pour la première fois la vidéoconsultation. Si celle-ci est particulièrement utile en temps de pandémie, elle est également sollicitée au quotidien par certains patients, leur permettant un contact facilité avec leur médecin. Pourtant, ce dernier est parfois peu à l’aise pour communiquer avec les nouvelles technologies et du fait de l’absence d’examen physique traditionnel. Une formation à la communication et à l’examen physique virtuel en vidéoconsultation apparaît nécessaire, permettant d’inscrire la télémédecine dans la pratique quotidienne tout en garantissant une prise en charge de qualité.

The Coronarovirus disease 2019 (Covid-19) outbreak strongly affected nursing and was responsible for a high mortality rate During the pandemic of March-May 2020, 17 French nursing homes organized staff confinement periods with residents 24 hours a day and 7 days a week, to reduce the risk of entry of the SARS-CoV-2 virus into their facilities,in a context where visits to residents were prohibited By means of a telephone survey of their directors, we observed that 16 nursing homes (94%) had no cases of COVID-19 among the residents, and that mortality from COVID-19 was very low compared to that recorded at the national level by Sante publique France (p < 10-4) Moreover, the number of cases of Covid-19 among the staff of these nursing homes was also lower than that recorded by Sante publique France (p < 10-4) These establishments experienced certain difficulties which the directors managed to overcome and the investment of these teams was widely appreciated by the families of the residents and through the press (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) L'epidemie de Coronarovirus disease 2019(Covid-19) a fortement touche lesetablissements d'hebergement pour personnes agees dependantes (Ehpad) et a ete responsable d'une forte mortalite Durant la pandemie de marsmai 2020, 17 Ehpad en Franceont organise des periodes de confinement du personnel avec les residents 24 heures sur24 et 7 jours sur 7, pour diminuer le risque d'entree du virus SARS-CoV-2 dans leurs eta-blissements, dans un contexte ou les visites aux residents etaient interdites Au moyend'une enquete telephonique aupres des directeurs de ces Ehpad, nous avons observe que16 Ehpad (94 %) n'ont eu aucun cas de Covid-19 parmi les residents, et que la mortalitepar Covid-19 a ete tres faible par rapport a celle enregistree au niveau national par Santepublique France (p

Patient suffering from autoimmune diseases (AID) typically have an increased risk of infection, which is attributed to the disease itself, but also to immunosuppressive drugs (IS) and comorbidities. During the current COVID-19 outbreak, the way to manage these diseases remains elusive. Limited data is currently available on AID and IS in the context of this new coronavirus infection. To date, there is no evidence to support an increase in complications of COVID-19 in these patients. In addition, certain drugs that are commonly used to treat AID could be part of the therapeutic arsenal used in COVID-19. The purpose of this article is to review the unique aspects of patients with AID during the COVID-19 outbreak.Les patients atteints de maladies autoimmunes (MAI) présentent classiquement un risque accru d’infections, qui est attribué à la maladie en tant que telle, mais aussi aux traitements immunosuppresseurs (IS) et aux comorbidités. Durant l’épidémie COVID-19, l’attitude à adopter par rapport à ces maladies et à leur traitement reste incertaine. En effet, les données concernant les MAI et l’IS dans le cadre de cette nouvelle infection à coronavirus restent encore très limitées. À l’heure actuelle, il n’y a pas d’évidence indiquant une augmentation des complications sévères en lien avec le COVID-19 chez ces patients. De plus, certains médicaments utilisés pour traiter les MAI pourraient faire partie de l’arsenal thérapeutique utilisé en cas d’infection par le COVID-19. Cet article passe en revue les aspects particuliers des patients souffrant de MAI durant l’épidémie COVID-19.

Children infected with SARS-CoV-2 are underrepresented during the current COVID-19 outbreak. Unlike other respiratory viruses, SARS-CoV-2 rather infects adults who subsequently infect their children. From recent Chinese and Italian data, children commonly present mild to moderate disease, a large proportion of them being asymptomatic. In particular, children present significantly less fever, cough and pneumonia compared to adults. However, more cases of pneumonia were reported from children infected with SARS-CoV-2 compared to those infected with H1N1. No vertical transmission of SARS-CoV-2 has been described so far.Les enfants sont sous-représentés durant la pandémie COVID-19 actuelle. Contrairement aux autres virus respiratoires, dans la majorité des clusters familiaux, ce sont les parents qui infectent les enfants. Les évidences cliniques chinoises et italiennes suggèrent que les enfants présentent souvent un tableau clinique peu sévère et qu’ils sont fréquemment asymptomatiques. Notamment, les enfants présentent moins de fièvre, de toux et de pneumonies comparés aux adultes. Toutefois, plus de cas de pneumonies ont été reportés chez des enfants infectés par SARS-CoV-2 que chez ceux qui le sont par H1N1. Aucun cas de transmission verticale de SARS-CoV-2 n’a été démontré récemment.

The ongoing COVID-19 pandemic comprises a total of more than 2,350,000 cases and 160,000 deaths. The interest in anti-coronavirus drug development has been limited so far and effective methods to prevent or treat coronavirus infections in humans are still lacking. Urgent action is needed to fight this fatal coronavirus infection by reducing the number of infected people along with the infection contagiousness and severity. Since the beginning of the COVID-19 outbreak several weeks ago, we observe in GHU PARIS PsychiatrieNeurosciences (Sainte-Anne hospital, Paris, France) a lower prevalence of symptomatic and severe forms of COVID-19 infections in psychiatric patients (∼4%) compared to health care professionals (∼14%). Similar observations have been noted in other psychiatric units in France and abroad. Our hypothesis is that psychiatric patients could be protected from severe forms of COVID-19 by their psychotropic treatments. Chlorpromazine (CPZ) is a phenothiazine derivative widely used in clinical routine in the treatment of acute and chronic psychoses. This first antipsychotic medication has been discovered in 1952 by Jean Delay and Pierre Deniker at Sainte-Anne hospital. In addition, to its antipsychotic effects, several in vitro studies have also demonstrated a CPZ antiviral activity via the inhibition of clathrin-mediated endocytosis. Recently, independent studies revealed that CPZ is an anti-MERS-CoV and an anti-SARS-CoV-1 drug. In comparison to other antiviral drugs, the main advantages of CPZ lie in its biodistribution: (i) preclinical and clinical studies have reported a high CPZ concentration in the lungs (20-200 times higher than in plasma), which is critical because of the respiratory tropism of SARS-CoV-2; (ii) CPZ is highly concentrated in saliva (30-100 times higher than in plasma) and could therefore reduce the contagiousness of COVID-19; (iii) CPZ can cross the blood-brain barrier and could therefore prevent the neurological forms of COVID-19.Our hypothesis is that CPZ could decrease the unfavorable evolution of COVID-19 infection in oxygen-requiring patients without the need for intensive care, but also reduce the contagiousness of SARS-CoV-2. At this end, we designed a pilot, phase III, multicenter, single blind, randomized controlled clinical trial. Efficacy of CPZ will be assessed according to clinical, biological and radiological criteria. The main objective is to demonstrate a shorter time to response (TTR) to treatment in the CPZ+standard-of-care (CPZ+SOC) group, compared to the SOC group. Response to treatment is defined by a reduction of at least one level of severity on the WHO-Ordinal Scale for Clinical Improvement (WHO-OSCI). The secondary objectives are to demonstrate in the CPZ+SOC group, compared to the SOC group: (A) superior clinical improvement; (B) a greater decrease in the biological markers of viral attack by SARS-CoV-2 (PCR, viral load); (C) a greater decrease in inflammatory markers (e.g. CRP and lymphopenia); (D) a greater decrease in parenchymal involvement (chest CT) on the seventh day post-randomization; (E) to define the optimal dosage of CPZ and its tolerance; (F) to evaluate the biological parameters of response to treatment, in particular the involvement of inflammatory cytokines. Patient recruitment along with the main and secondary objectives are in line with WHO 2020 COVID-19 guidelines.This repositioning of CPZ as an anti-SARS-CoV-2 drug offers an alternative and rapid strategy to alleviate the virus propagation and the infection severity and lethality. This CPZ repositioning strategy also avoids numerous developmental and experimental steps and can save precious time to rapidly establish an anti-COVID-19 therapy with well-known, limited and easy to manage side effects. Indeed, CPZ is an FDA-approved drug with an excellent tolerance profile, prescribed for around 70 years in psychiatry but also in clinical routine in nausea and vomiting of pregnancy, in advanced cancer and also to treat headaches in various neurological conditions. The broad spectrum of CPZ treatment - including antipsychotic, anxiolytic, antiemetic, antiviral, immunomodulatory effects along with inhibition of clathrin-mediated endocytosis and modulation of blood-brain barrier - is in line with the historical French commercial name for CPZ, i.e. LARGACTIL, chosen as a reference to its "LARGe ACTion" properties. The discovery of those CPZ properties, as for many other molecules in psychiatry, is both the result of serendipity and careful clinical observations. Using this approach, the field of mental illness could provide innovative therapeutic approaches to fight SARS-CoV-2.