Evaluation of Strategies to Fight COVID-19: The French Paradigm

Giraud-Gatineau, Audrey; Colson, Philippe; Chaudet, Hervé; Raoult, Didier

doi:10.3390/jcm10132942

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…23 Leaving patients untreated leads to high mortality. 24 Quarantine alone cannot guarantee a reduction in the number of deaths. In countries where healthcare is not warranted and medical costs are to be borne on their own, the mortality would be higher because of those who could not access health care.…”

Section: What Is Health Care For?mentioning

confidence: 99%

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A reflection on health and disease amid COVID‐19 pandemic

Park

2022

Evaluation Clinical Practice

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Coronavirus disease 2019 pandemic is persisting for more than a year and it's still far from being controlled. It is making a big impact not only on physical illness but also on mental and social aspects. In this situation, we need to reflect on current medical society's view of disease and health. The dominant paradigm in contemporary medicine is the reductionist view of disease and the biomedical model of health. As a result, the healthcare system seems to be more focused on virus eradication than on patient care. We need to look back on this position in view of humanities and ethics and broaden our perspective to an ecological view of disease and the sociomedical model of health. The quarantine and health care policy also needs to be re‐built with more focus on patient care.

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Section: What Is Health Care For?mentioning

confidence: 99%

“…To reduce this rate, proper allocation of medical resources is critical 23 . Leaving patients untreated leads to high mortality 24 . Quarantine alone cannot guarantee a reduction in the number of deaths.…”

Section: What Is Health Care For?mentioning

confidence: 99%

A reflection on health and disease amid COVID‐19 pandemic

Park

2022

Evaluation Clinical Practice

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Early Treatment with Hydroxychloroquine and Azithromycin: A ‘Real-World’ Monocentric Retrospective Cohort Study of 30,423 COVID-19 Patients

Million

Cortaredona

Delorme

et al. 2023

Preprint

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Objective To estimate the comparative effectiveness of combination therapy with hydroxychloroquine (HCQ) and azithromycin for coronavirus disease 2019 (COVID-19)-related death based on a large monocentric cohort independent of investigators putative biases in a real-world setting. Design Retrospective monocentric cohort study, with comprehensive data collection authenticated by an external bailiff and death reports from a national database (French National Death Registry). Setting Institut Hospitalo-Universitaire Mediterranee Infection Center in Marseille, France. Participants All adults older than 18 years with PCR-proven COVID-19 who were treated directly in our centre between 2 March 2020 and 31 December 2021 and did not refuse the use of their data. Interventions HCQ and azithromycin (HCQ-AZ) as a reference treatment were compared to other regimens containing HCQ, ivermectin and azithromycin alone, combined, or none of these three drugs. The effect of vaccination was also evaluated. Main outcome measures 6-week all-cause mortality. Multivariable logistic regression estimated treatment effectiveness with adjustments for age, sex, comorbidities, vaccination, period of infection or virus variant, and outpatient or inpatient care. Results Total 30,423 COVID-19 patients were analysed (86 refused the analysis of their data) including 30,202 with available treatment data, and 535 died (1.77%). All-cause mortality was very low among patients < 50 years (8/15,925 (0.05%)) and among outpatients treated with HCQ-AZ (21 deaths out of 21,135 (0.1%), never exceeding 0.2% regardless of epidemic period). HCQ-AZ treatment was associated with a significantly lower mortality rate than no HCQ-AZ after adjustment for sex, age, period and patient care setting (adjusted OR (aOR) 95% confidence interval (CI) 0.55, 0.45-0.68). The effect was greater among outpatients (71% death protection rate) than among inpatients (45%). In a subset of 16,063 patients with available comorbidities and vaccinations status, obesity (2.01, 1.23-3.29), chronic respiratory disease (2.93, 1.29-6.64), and immunodeficiency (4.01, 1.69-9.50), on the one hand, and vaccination (0.29, 0.12-0.67) and HCQ-AZ treatment (0.47, 0.29-0.76), on the other hand, were independent factors associated with mortality. HCQ, alone or in any association, was associated with significant protection from death among outpatients (0.41, 0.21-0.79) and inpatients (0.59, 0.47-0.73). Conclusions HCQ prescribed early or late protects in part from COVID-19-related death. During pandemic health crises, financial stakes are enormous. Authentication of the data by an independent external judicial officer should be required. Public sharing of anonymized databases, ensuring their verifiability, should be mandatory in this context to avoid fake publications.

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Sistema de saúde e vigilância na França e a resposta à pandemia de COVID-19

Angeli-Silva

Santos

Esperidião

2023

Ciênc. saúde coletiva

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Resumo A França foi o primeiro país europeu a confirmar casos de COVID-19, sendo um dos mais afetados pela pandemia na primeira onda. Este estudo de caso analisou as medidas adotadas pelo país no enfrentamento à COVID-19 em 2020 e 2021, relacionando com as características de seu sistema de saúde e de vigilância. Como um Estado de bem-estar social, apostou em políticas compensatórias e de proteção da economia, bem como aumentou investimentos em saúde. Houve fragilidade na preparação e atraso na implantação do plano de enfrentamento. A resposta foi coordenada pelo poder Executivo nacional, adotando bloqueios rígidos nas duas primeiras ondas, flexibilizando as medidas restritivas nas demais ondas, após o aumento da cobertura vacinal e diante da resistência da população. Enfrentou problemas com testagem, vigilância dos casos e contatos e assistência aos doentes, principalmente na primeira onda. Necessitou modificar as regras do seguro de saúde para ampliar cobertura, acesso e melhorar a articulação das ações de vigilância. Indica aprendizados sobre os limites do seu sistema de seguro social, mas também as potencialidades de um Estado com capacidade de resposta forte no financiamento de políticas públicas e na regulação dos demais setores para enfrentar a crise.

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Evaluation of Strategies to Fight COVID-19: The French Paradigm

Cited by 4 publications

References 30 publications

A reflection on health and disease amid COVID‐19 pandemic

A reflection on health and disease amid COVID‐19 pandemic

Early Treatment with Hydroxychloroquine and Azithromycin: A ‘Real-World’ Monocentric Retrospective Cohort Study of 30,423 COVID-19 Patients

Sistema de saúde e vigilância na França e a resposta à pandemia de COVID-19

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