Crombé Amandine, Dupont Claire, Casalonga François, Seux Mylène, Favard Nicolas, Coulon Agnès, Jurkovic Thomas, Nivet Hubert, Gorincour Guillaume
IMADIS, Lyon, France.
SARCOTARGET Team, BRIC INSERM U1312 - Bordeaux University, Bordeaux, F-33000, France.
Insights Imaging. 2024 Jan 17;15(1):14. doi: 10.1186/s13244-023-01590-8.
BACKGROUND: Biological studies suggested that the COVID-19 outbreak in France occurred before the first official diagnosis on January 24, 2020. We investigated this controversial topic using a large collection of chest CTs performed throughout French emergency departments within 6 months before the 1st lockdown. RESULTS: Overall, 49,311 consecutive patients (median age: 60 years, 23,636/49,311 [47.9%] women) with available chest CT images and reports from 61 emergency departments between September 1, 2020, and March 16, 2020 (day before the 1st French lockdown), were retrospectively included in this multicentre study. In the macroscopic analysis of reports automatically (labelled for presence of ground glass opacities [GGOs], reticulations, and bilateral and subpleural abnormalities), we found a significant breakpoint on February 17, 2020, for the weekly time series with 1, 2 and ≥ 3 of these 4 radiological features, with 146/49,311 (0.3%) patients showing bilateral abnormalities and ground glass opacities (GGOs) from that day. According to radiologists, 22/146 (15.1%) CT images showed typical characteristics of COVID-19, including 4/146 (2.7%) before February 2020. According to hospital records, one patient remained without microbial diagnosis, two patients had proven influenza A and one patient had concomitant influenza A and mycoplasma infection. CONCLUSION: These results suggest that SARS-CoV-2 was not circulating in the areas covered by the 61 emergency departments involved in our study before the official beginning of the COVID-19 outbreak in France. In emergency patients, the strong resemblance among mycoplasma, influenza A and SARS-CoV-2 lung infections on chest CT and the nonspecificity of CT patterns in low prevalence periods is stressed. CRITICAL RELEVANCE STATEMENT: We proposed here an innovative approach to revisit a controversial 'real' start of the COVID-19 pandemic in France based on (1) a population-level approach combining text mining, time series analysis and an epidemiological dataset and (2) a patient-level approach with careful retrospective reading of chest CT scans complemented by analysis of samples performed contemporarily to the chest CT. We showed no evidence that SARS-CoV-2 was actively circulating in France before February 2020.
背景：生物学研究表明，法国的新冠疫情在2020年1月24日首次官方确诊之前就已发生。我们利用在第一次封锁前6个月内法国各急诊科进行的大量胸部CT检查，对这一有争议的话题展开了调查。 结果：总体而言，本多中心研究回顾性纳入了2020年9月1日至2020年3月16日（法国第一次封锁前一天）期间，来自61个急诊科的49311例连续患者（中位年龄：60岁，23636/49311[47.9%]为女性），这些患者均有可用的胸部CT图像及报告。在对报告进行宏观分析时（自动标记是否存在磨玻璃影[GGOs]、网状影以及双侧和胸膜下异常），我们发现，对于具有这4种放射学特征中1种、2种及≥3种特征的每周时间序列，在2020年2月17日出现了一个显著的转折点，自该日起有146/49311（0.3%）的患者出现双侧异常及磨玻璃影（GGOs）。根据放射科医生的判断，22/146（15.1%）的CT图像显示出新冠的典型特征，其中4/146（2.7%）出现在2020年2月之前。根据医院记录，1例患者未进行微生物诊断，2例患者确诊为甲型流感，1例患者同时感染甲型流感和支原体。 结论：这些结果表明，在法国官方宣布新冠疫情爆发之前，参与我们研究的61个急诊科所覆盖地区没有SARS-CoV-2传播。在急诊患者中，强调了支原体、甲型流感和SARS-CoV-2肺部感染在胸部CT上的高度相似性，以及在低流行期CT表现的非特异性。 关键相关声明：我们在此提出了一种创新方法，以重新审视法国新冠疫情有争议的“真正”起始点，该方法基于：（1）一种群体水平的方法，结合文本挖掘、时间序列分析和一个流行病学数据集；（2）一种患者水平的方法，通过仔细回顾性阅读胸部CT扫描，并辅以对与胸部CT同时进行的样本分析。我们没有发现证据表明2020年2月之前SARS-CoV-2就在法国活跃传播。
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