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International audience; OBJECTIVES: The overall death toll from COVID-19 in Africa is reported to be low but there is little individual-level evidence on the severity of the disease. This study examined the clinical spectrum and outcome of patients monitored in COVID-19 care centres (CCCs) in two West-African countries. METHODS: Burkina Faso and Guinea set up referral CCCs to hospitalise all symptomatic SARS-CoV-2 carriers, regardless of the severity of their symptoms. Data collected from hospitalised patients by November 2020 are presented. RESULT: A total of 1,805 patients (64% men, median age 41 years) were admitted with COVID-19. Symptoms lasted for a median of 7 days (IQR 4-11). During hospitalisation, 443 (25%) had a SpO2 < 94% at least once, 237 (13%) received oxygen and 266 (15%) took corticosteroids. Mortality was 5% overall, and 1%, 5% and 14% in patients aged

La République démocratique du Congo (RDC) connaît depuis août 2018, dans les provinces du Nord-Kivu et l’Ituri, la plus dévastatrice et la plus prolongée des épidémies de maladie à virus Ebola (MVE) de son histoire avec plus de 3 320 cas et 2209 décès en date du 7 décembre 2019. La stratégie de prise en charge de la MVE s’inscrit dans un scénario de crise humanitaire complexe grevé par un conflit armé et qui doit tenir compte de considérations ethniques et culturelles, des mesures de précautions drastiques imposées aux soignants ainsi que de limitations diagnostiques et thérapeutiques particulières. Le management médical repose en premier sur la prise en charge intensive et précoce des patients dans les centres de traitement Ebola (CTE). Elle est renforcée par le déploiement de l’évaluation de thérapeutiques spécifiques de l’infection par virus Ebola. Son objectif principal reste la performance du niveau de soins de support et renvoie à un remplissage liquidien massif avec un suivi drastique et évalué visant la compensation des pertes hydro-électrolytiques qui constitue l’invariant de la MVE. Ces mesures permettent souvent d’éviter l’évolution péjorative et le recours à une escalade du niveau de soins, comme l’épuration extra-rénale, la ventilation invasive ou le recours à des drogues inotropes, de réalisation non aisée dans le contexte du terrain épidémique. Nous rapportons le cas d’un patient hospitalisé présentant une forme sévère de la MVE et hospitalisé dans le CTE de Béni (Nord-Kivu),RDC au cours de cette épidémie, afin d’illustrer le projet de soin du patient atteint de fièvre hémorragique virale sévère à l’horizon 2020.

Introduction: With the development of therapeutics and vaccine against Ebola virus disease (EVD), the question of post-exposure prophylaxis for high-risk contact has emerged. Immunotherapies (monoclonal antibodies [mAbs]) recently validated for treating infected patients appear to be a good candidate for protecting contacts. Design: During the tenth EVD outbreak in the Democratic Republic of the Congo, we have administrated mAbs (Mab114 or REGN-EB3) to high and intermediate-risk contacts of EVD patients. Results: : Overall, 23 non-vaccinated contacts received mAbs after a median delay between contact and post-exposure prophylaxis of 1 day (interquartile range 1–2). All contacts were free of symptoms, and all had negative reverse transcriptase-polymerase chain reaction 14 days after the contact. Conclusion: Immunotherapies appear to be promising candidates to protect EVD contacts. Interaction with vaccine needs to be analyzed and a larger study on efficacy conducted.

Although several experimental therapeutics for Ebola virus disease (EVD) have been developed, the safety and efficacy of the most promising therapies need to be assessed in the context of a randomized, controlled trial.We conducted a trial of four investigational therapies for EVD in the Democratic Republic of Congo, where an outbreak began in August 2018. Patients of any age who had a positive result for Ebola virus RNA on reverse-transcriptase-polymerase-chain-reaction assay were enrolled. All patients received standard care and were randomly assigned in a 1:1:1:1 ratio to intravenous administration of the triple monoclonal antibody ZMapp (the control group), the antiviral agent remdesivir, the single monoclonal antibody MAb114, or the triple monoclonal antibody REGN-EB3. The REGN-EB3 group was added in a later version of the protocol, so data from these patients were compared with those of patients in the ZMapp group who were enrolled at or after the time the REGN-EB3 group was added (the ZMapp subgroup). The primary end point was death at 28 days.A total of 681 patients were enrolled from November 20, 2018, to August 9, 2019, at which time the data and safety monitoring board recommended that patients be assigned only to the MAb114 and REGN-EB3 groups for the remainder of the trial; the recommendation was based on the results of an interim analysis that showed superiority of these groups to ZMapp and remdesivir with respect to mortality. At 28 days, death had occurred in 61 of 174 patients (35.1%) in the MAb114 group, as compared with 84 of 169 (49.7%) in the ZMapp group (P = 0.007), and in 52 of 155 (33.5%) in the REGN-EB3 group, as compared with 79 of 154 (51.3%) in the ZMapp subgroup (P = 0.002). A shorter duration of symptoms before admission and lower baseline values for viral load and for serum creatinine and aminotransferase levels each correlated with improved survival. Four serious adverse events were judged to be potentially related to the trial drugs.Both MAb114 and REGN-EB3 were superior to ZMapp in reducing mortality from EVD. Scientifically and ethically sound clinical research can be conducted during disease outbreaks and can help inform the outbreak response. (Funded by the National Institute of Allergy and Infectious Diseases and others; PALM ClinicalTrials.gov number, NCT03719586.).

Shifting the Paradigm As the treatment paradigm for patients with Ebola virus disease shifts from isolation to aggressive supportive care and antiviral therapy, the global health community can work...

BackgroundGlobally, critical illness results in millions of deaths every year. Although many of these deaths are potentially preventable, the basic, life-saving care of critically ill patients are often overlooked in health systems. Essential Emergency and Critical Care (EECC) has been devised as the care that should be provided to all critically ill patients in all hospitals in the world. EECC includes the effective care of low cost and low complexity for the identification and treatment of critically ill patients across all medical specialties. This study aimed to specify the content of EECC and additionally, given the surge of critical illness in the ongoing pandemic, the essential diagnosis-specific care for critically ill patients with COVID-19.MethodsIn a Delphi process, consensus (>90% agreement) was sought from a diverse panel of global clinical experts. The panel iteratively rated proposed treatments and actions based on previous guidelines and the WHO/ICRC’s Basic Emergency Care. The output from the Delphi was adapted iteratively with specialist reviewers into a coherent and feasible package of clinical processes plus a list of hospital readiness requirements.ResultsThe 269 experts in the Delphi panel had clinical experience in different acute medical specialties from 59 countries and from all resource settings. The agreed EECC package contains 40 clinical processes and 67 requirements, plus additions specific for COVID-19.ConclusionThe study has specified the content of care that should be provided to all critically ill patients. Implementing EECC could be an effective strategy for policy makers to reduce preventable deaths worldwide.

Introduction En Afrique, bien que le nombre total de décès dus a la COVID-19 semble plus faible quand dans les pays du nord, il existe peu de données sur la gravité de la maladie. Nous rapportons ici le tableau clinique et l’issue chez les malades infectés par le SARS-CoV-2 et suivis dans les centres de traitement COVID-19 (CTC) de deux pays d’Afrique de l’Ouest. Matériels et méthodes Le Burkina Faso et la Guinée ont mis en place trois CTC de référence pour hospitaliser tous les malades infectés par le SARS-CoV-2, quelle que soit leur gravité. Nous présentons les données recueillies auprès de ces patients symptomatiques hospitalisés dans ces trois CTC, entre mars et novembre 2020. Les données ont été collectées à l’aide du formulaire de déclaration des cas de COVID-19 de l’OMS. Une régression logistique a été réalisée pour analyser l’association entre l’évolution défavorable et les caractéristiques cliniques à l’admission. Résultats Au total, 1805 patients (1151 [64 %] hommes, âge médian 41 ans, 22 % [388] ≥ 60) ont été admis avec un COVID-19 confirmé. La durée médiane entre le début des symptômes et l’admission en CTC était de 7 jours (IQR : 4–11). Les symptômes principaux à l’admission était l’asthénie (748, 41 %) et la toux (833, 46 %) et près de la moitié des patients (867, 48 %) présentaient une forme légère de la maladie. Au cours de l’hospitalisation, 443 (25 %) patients ont présenté au moins une fois une SpO2

We report 4 cases of Health Workers (HW) suspected of having contracted Ebola Virus Disease (EVD), transported from the Alliance for International Medical Action (ALIMA) Ebola Treatment Centre (ETC) in N’Zerekore, Guinea to the Treatment Centre for Carers run by the medical corps of the French army in Conakry, the capital of Guinea, which was established on 17 January 2015 and closed on 7 July 2015. In total more than 500 HWs have died from EVD since the epidemic began. This mortality has had significant effects on the ability of local services to respond appropriately to the disaster. The HWs were transported by air in the “Human Stretcher Transit Isolator-Total Containment (Oxford) Limited” (HSTI-TCOL) negative pressure isolation pod. Medical evacuation of patients with suspected, potentially fatal, infectious diseases is feasible with the use of a light isolator for patients without critical dysfunctions.