PMC:7160441 / 6599-9811
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7160441","sourcedb":"PMC","sourceid":"7160441","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7160441","text":"Discussion\nThis is the first time that an increase in ILI cases was observed simultaneously in several regions after the peak of the annual influenza epidemic in the last 30 seasons of routine surveillance in France with the Sentinelles network [9]. Several processes may have contributed to this observation, including, among others, characteristics of the influenza season, change in population behaviour or increase in COVID-19 incidence.\nInfluenza A (H1N1)pdm09 and influenza B viruses co-circulated in 2019/20 in France [10] (see Supplement). Seasons with type B virus circulation can lead to a slow decay in incidence but a renewed increase is atypical [1]. The 2-week-long normal school holidays started between mid-February and early March depending on the region. While holidays may change the dynamics of influenza [9], this generally has an effect in the ascending phase of the epidemic rather than after the peak.\nThe COVID-19 pandemic may have changed the health-seeking behaviour of patients and, to some extent, the reporting of the contributing GPs although they conform to a case definition. In the crowdsourced surveillance system grippenet.fr [10], there was no evidence of increasing consultations: 30% consulted with a GP in for ILI during week 10, compared with 38% in week 9. As information regarding the coronavirus risk is widespread, a uniform increase in all regions could have been expected in this scenario rather than only in a few regions. We however acknowledge that increased consultation rates in regions where COVID-19 is the most reported may be possible.\nThe similarity between COVID-19 and influenza symptoms makes it possible that the excess ILI cases were due to COVID-19 cases. The presence of SARS-CoV-2-positive swabs in the patients supports this possibility. The correlation between the number of confirmed cases and the computed excess is also consistent with this scenario. In this case, the excess in cases is compatible with an exponential growth at an estimated rate of ca 0.7 per week. Interestingly, this estimate was very similar in the four most affected regions (GRE, IDF, OCC, HDF). It may prove useful to help calibrate models for studying the impact of the COVID-19 pandemic.\nEstimating the true number of COVID-19 cases can only be tentative at this early stage of the epidemic with data from a non-dedicated surveillance system. It is likely that the case definition of ILI does not allow identifying all COVID-19 cases. In addition, only a few cases were virologically tested, adding uncertainty in the estimates. Yet, the rate of excess ILI consultations applied to the French regions yielded a number of cases far in excess of confirmed cases, with 12,840 cases in IDF and around 10,000 cases in the regions GRE and HDF. Likewise, the extrapolated number of COVID-19 presenting as ARI was 760 in those older than 65 years in the two eastern regions (GRE and BFC): this was already twice the number of reported cases in these regions at the time (n = 379), all ages combined.\nAs we enter a period of generalised circulation of SARS-CoV-2, surveillance based on clinical description and swabbing by GPs will prove essential in assessing the 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