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. 2020 Sep 30;17(19):7175.
doi: 10.3390/ijerph17197175.

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

Laurent Gerbaud  1 , Candy Guiguet-Auclair  1 , Franck Breysse  2 , Joséphine Odoul  3 , Lemlih Ouchchane  1 , Jonathan Peterschmitt  4 , Camille Dezfouli-Desfer  2 , Vincent Breton  5
Affiliations

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

Laurent Gerbaud et al. Int J Environ Res Public Health. .

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.

Keywords: COVID-19; SARS-Cov-2; emerging infectious disease; epidemic surveillance; epidemic threshold.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Dynamics of possible COVID-19 cases: seven-day moving average of daily incidence and epidemic threshold. The figure shows data from the population-based survey (blue line), emergency care services (yellow line), and corresponding epidemic thresholds (dashed blue and dashed yellow lines).
Figure 2
Figure 2
Fraction (expressed in %) of the Diaconat-Fonderie emergency care service weekly visitors retrospectively diagnosed as probable or confirmed COVID-19 cases from 30 December 2019 to 17 May 2020.
Figure 3
Figure 3
Time evolution of the proportion of influenza PCR positive (green) and negative (red) tests conducted at the Diaconat-Fonderie biology laboratory (a) and documented in the population-based survey (b). The rate of negative tests as a function of time is documented on each bar.
Figure 4
Figure 4
Seven-day moving average of daily incidence of possible COVID-19 cases based on the onset day of the first COVID-19 symptoms for children less than 15 years old (orange line) and adults and children above 15 (green line) from the population-based survey of Haut-Rhin households.
Figure 5
Figure 5
Seven-day moving average of daily incidence of possible COVID-19 cases that documented anosmia with intensities from 1 (modified smell) to 3 (total loss) (from survey data).
Figure 6
Figure 6
Seven-day moving average of daily incidence for possible COVID-19 cases among Haut-Rhin households. Orange line corresponds to households in which at least one member participated to the POC gathering in Mulhouse (17–21 February 2020) and grey line to households without participants to the POC gathering.
Figure 7
Figure 7
Seven-day moving average of daily incidence for possible COVID-19 cases that documented anosmia among Haut-Rhin households. Orange line corresponds to households in which at least one member participated to the POC gathering in Mulhouse (17–21 February 2020) and grey line to households without participants to the POC gathering.
See this image and copyright information in PMC

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