Hospital and Population-Based Evidence for COVID-19 Early Circulation in the East of France

Abstract

Background: Understanding SARS-CoV-2 dynamics and transmission is a serious issue. Its propagation needs to be modeled and controlled. The Alsace region in the East of France has been among the first French COVID-19 clusters in 2020. Methods: We confront evidence from three independent and retrospective sources: a population-based survey through internet, an analysis of the medical records from hospital emergency care services, and a review of medical biology laboratory data. We also check the role played in virus propagation by a large religious meeting that gathered over 2000 participants from all over France mid-February in Mulhouse. Results: Our results suggest that SARS-CoV-2 was circulating several weeks before the first officially recognized case in Alsace on 26 February 2020 and the sanitary alert on 3 March 2020. The religious gathering seems to have played a role for secondary dissemination of the epidemic in France, but not in creating the local outbreak. Conclusions: Our results illustrate how the integration of data coming from multiple sources could help trigger an early alarm in the context of an emerging disease. Good information data systems, able to produce earlier alerts, could have avoided a general lockdown in France.

Evidence of early circulation of SARS-CoV-2 in France: findings from the population-based “CONSTANCES” cohort

“…By April 4, 2020, local community transmission was reported in all continents and over 1 million cases of COVID-19 had been confirmed worldwide. Although dedicated surveillance and contact tracing did not identify local transmission before the second half of February in Europe, there is accumulated evidence that SARS-CoV-2 circulated in early January 2020 in the East of France [2] and environmental studies suggest that the virus could have been present in December 2019 in Northern Italy [3]. A recent investigation of the presence of SARS-CoV-2 antibodies in 959 adults participating to a trial in Italy with blood samples collected between September 2019 to February 2020 identified 111 (11.6%) samples with a positive receptorbinding protein specific enzyme-linked immunosorbent assay (ELISA), among which 4 samples collected in October, 1 in November and 1 in February were also positive in a qualitative microneutralization assay [4].…”

“Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study”

“…MGEs cover different types of event and contexts such as public and private celebrations, festivals, religious events and pilgrimages, sporting and touristic events, and political meetings. The crucial role of MGEs in the global propagation of the disease has been evidenced in several countries, including China [ 3 ], Iran [ 4 ], Malaysia [ 5 ], Italy [ 6 ], Spain [ 7 ], France [ 8 ], Germany [ 9 ], Jordan [ 10 ], Malta [ 11 ], Switzerland [ 12 ], and Malawi [ 13 ]. Significant international efforts have been made to implement specific measures, risk assessment and surveillance, and event cancellations in order to prevent the spread of SARS-CoV-2 from MGEs [ 14 – 17 ].…”

Linked transmission chains of imported SARS-CoV-2 variant B.1.351 across mainland France, January 2021

“…Religious and other large gatherings have played a significant role in SARS-CoV-2 spread since 2020 [ 15 - 18 ]. Imported cases serve as sentinel events for affected countries which are unable to monitor emerging variants.…”