preVIEW: COVID-19

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Death (1749)

COVID-19 (1686)

Pneumonia (145)

Coronavirus Infections (140)

Diabetes Mellitus (133)


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C-reactive protein (66)

interleukin 6 (63)

angiotensin I converting enzyme 2 (39)

membrane associated ring-CH-type finger 1 (24)

solute carrier family 17 member 5 (11)


SARS-CoV-2 proteins

ProteinS (43)

ProteinN (10)

NSP5 (9)

ComplexRdRp (7)

ProteinE (7)


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    Twitter Subjective Well-Being Indicator During COVID-19 Pandemic MESHD: A Cross-Country Comparative Study

    Authors: Tiziana Carpi; Airo Hino; Stefano Maria Iacus; Giuseppe Porro

    id:2101.07695v1 Date: 2021-01-19 Source: arXiv

    This study analyzes the impact of the COVID-19 pandemic MESHD on the subjective well-being as measured through Twitter data indicators for Japan and Italy. It turns out that, overall, the subjective well-being dropped by 11.7% for Italy and 8.3% for Japan in the first nine months of 2020 compared to the last two months of 2019 and even more compared to the historical mean of the indexes. Through a data science approach we try to identify the possible causes of this drop down by considering several explanatory variables including, climate and air quality data, number of COVID-19 MESHD cases and deaths MESHD, Facebook Covid and flu symptoms global survey, Google Trends data and coronavirus-related searches, Google mobility data, policy intervention measures, economic variables and their Google Trends proxies, as well as health and stress proxy variables based on big data. We show that a simple static regression model is not able to capture the complexity of well-being and therefore we propose a dynamic elastic net approach to show how different group of factors may impact the well-being in different periods, even over a short time length, and showing further country-specific aspects. Finally, a structural equation modeling analysis tries to address the causal relationships among the COVID-19 MESHD factors and subjective well-being showing that, overall, prolonged mobility restrictions,flu and Covid-like symptoms, economic uncertainty, social distancing and news about the pandemic have negative effects on the subjective well-being.

    Authors: Roy H Rhodes; Gordon L Love; Fernanda Da Silve Lameira; Maryam Sadough Shahmirzadi; Sharon E Fox; Richard S Vander Heide

    doi:10.1101/2021.01.16.21249632 Date: 2021-01-18 Source: medRxiv

    Central nervous system (CNS) involvement in COVID-19 MESHD may occur through direct SARS-CoV-2 invasion through peripheral or cranial nerves or through vascular endothelial cell infection. The renin HGNC-angiotensin system may play a major part in CNS morbidity. Effects of hypoxia MESHD have also been implicated in CNS lesions in COVID-19 MESHD. This communication reports on ten consecutive autopsies of individuals with death MESHD due to COVID-19 MESHD with decedent survival ranging from 30 minutes to 84 days after admission. All ten brains examined had neutrophilic microvascular endotheliitis MESHD present in variable amounts and variably distributed. Importantly, this acute stage of type 3 hypersensitivity vasculitis MESHD can be followed by fibrinoid necrosis MESHD and inner vascular wall sclerosis MESHD, but these later stages were not found. These results suggest that a vasculitis MESHD with autoimmune features occurred in all ten patients. It is possible that viral antigen in or on microvascular walls or other antigen-antibody complexes occurred in all ten patients proximate to death as a form of autoimmune vasculitis MESHD.

    SARS-CoV-2 RECoVERY: a multi-platform open-source bioinformatic pipeline for the automatic construction and analysis of SARS-CoV-2 genomes from NGS sequencing data

    Authors: Luca De Sabato; Gabriele Vaccari; Arnold Knijn; Giovanni Ianiro; Ilaria Di Bartolo; Stefano Morabito

    doi:10.1101/2021.01.16.425365 Date: 2021-01-18 Source: bioRxiv

    Background: Since its first appearance in December 2019, the novel Severe Acute Respiratory Syndrome Coronavirus type 2 MESHD (SARSCoV2), spread worldwide causing an increasing number of cases and deaths MESHD (35,537,491 and 1,042,798, respectively at the time of writing, https:// covid19 MESHD.who.int). Similarly, the number of complete viral genome sequences produced by Next Generation Sequencing (NGS), increased exponentially. NGS enables a rapid accumulation of a large number of sequences. However, bioinformatics analyses are critical and require combined approaches for data analysis, which can be challenging for non bioinformaticians. Results: A user friendly and sequencing platform-independent bioinformatics pipeline, named SARSCoV2 RECoVERY (REconstruction of CoronaVirus gEnomes & Rapid analYsis) has been developed to build SARSCoV2 complete genomes from raw sequencing reads and to investigate variants. The genomes built by SARSCoV2 RECoVERY were compared with those obtained using other software available and revealed comparable or better performances of SARSCoV2 RECoVERY. Depending on the number of reads, the complete genome reconstruction and variants analysis can be achieved in less than one hour. The pipeline was implemented in the multi usage open source Galaxy platform allowing an easy access to the software and providing computational and storage resources to the community. Conclusions: SARSCoV2 RECoVERY is a piece of software destined to the scientific community working on SARSCoV2 phylogeny and molecular characterisation, providing a performant tool for the complete reconstruction and variants analysis of the viral genome. Additionally, the simple software interface and the ability to use it through a Galaxy instance without the need to implement computing and storage infrastructures, make SARSCoV2 RECoVERY a resource also for virologists with little or no bioinformatics skills. Availability and implementation: The pipeline SARSCoV2 RECoVERY (REconstruction of COronaVirus gEnomes & Rapid analYsis) is implemented in the Galaxy instance ARIES (https://aries.iss.it).

    WHO vaccination protocol can be improved to save more lives MESHD

    Authors: Marcelo Moret; Tarcisio Rocha Filho; José Mendes; Thiago Murari; Aloísio Nascimento Filho; Antônio Cordeiro; Walter Ramalho; Fulvio Scorza; Antonio-Carlos Almeida

    doi:10.21203/rs.3.rs-148826/v1 Date: 2021-01-16 Source: ResearchSquare

    Coronavirus disease 2019 MESHD ( COVID-19 MESHD) pandemic, a virus infection MESHD caused by the severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) virus, has impacted all countries of the world, and the main 2021’s challenge is clearly vaccinating the greater number of persons, in the shortest time span, for a maximal reduction in the number of deaths MESHD and in the significant economic impacts. Large-scale vaccination aimed to achieve herd immunity poses many logistic and social difficulties [1], with different vaccine candidates and designs [2,3], and vaccination priorities will determine the evolution of the current COVID-19 pandemic MESHD. In this paper we explicitly propose an alternative vaccination protocol that can be more effective than those already being deployed, as the ones in the European Union [4] and in the United States [5]. We report strong evidence based on an epidemiological model for the importance of contact hubs (or superspreaders), having a much larger average number of contacts than in the rest of the population [6-11], on the effectiveness of the vaccination strategy. We show that carefully choosing who will be in the first group to be vaccinated can significantly impact on both health services demand and total death toll, by increasing the overall numbers of lives saved and of hospitalizations. We argue that the approach here considered, which does not coincide with current proposals, and given the current conditions with a lack of basic resources for proper vaccination in several countries, and with a significant reduction in mobility and social isolation restrictions, should be considered by all authorities participating in the design of COVID-19 MESHD vaccination with the intent of maximising the number of human lives saved.

    Estimating and forecasting the burden and spread of SARS-CoV2 first wave in Colombia.

    Authors: Jaime Enrique Cascante Vega; Juan Manuel Cordovez; Mauricio Santos-Vega Sr.; Grzegorz Rempala; Joseph H Tien; David P. Kao MD; Bonnie Adrian PhD; Matthew E. Levine BA; Ryan Mooney MS; Lenny Larchick BA; Jean S. Kutner MD, MSPH; Matthew K. Wynia MD; Jeffrey J. Glasheen MD; Tellen D. Bennett MD, MS

    doi:10.1101/2021.01.15.21249818 Date: 2021-01-15 Source: medRxiv

    AO_SCPLOWBSTRACTC_SCPLOWFollowing the rapid dissemination of COVID-19 MESHD cases in Colombia in 2020, large-scale non-pharmaceutical interventions (NPIs) were implemented as national emergencies MESHD in most of the municipalities of the country starting by a lockdown on March 20th of 2020. Using combinations of meta-population models SEAIIRD (Susceptible-Exposed-Asymptomatic-Infected-Recovered-Diseased) which describes the disease dynamics in the different localities, with movement data that accounts for the number of commuters between units and statistical inference algorithms could be an effective approach to both nowcast and forecast the number of cases and deaths MESHD in the country. Here we used an iterated filtering (IF) framework to fit the parameters of our model to the reported data across municipalities from march to late October in locations with more than 50 reported deaths MESHD and cases historically. Since the model is high dimensional (6 state variable by municipality) inference on those parameters is highly non-trivial, so we used an Ensemble-Adjustment-Kalman-Filter (EAKF) to estimate time variable system states and parameters. Our results show that the model is capable of capturing the evolution of the outbreak in the country and providing estimates of the epidemiological parameters in time. These estimates could become the base for planning future interventions as well as evaluate the impact of NPIs on the effective reproductive number ([R]eff) and the key epidemiological parameters, such as the contact rate or the reporting rate. Our approach demonstrates that real-time, publicly available ensemble forecasts can provide robust short-term predictions of reported COVID-19 MESHD deaths in Colombia. This model has the potential to be used as a forecasting and prediction tool to evaluate disease dynamics and to develop a real time surveillance system for management and control.

    Epidemiology of the early COVID-19 MESHD epidemic in Orange County, California: comparison of predictors of test positivity, mortality, and seropositivity

    Authors: Daniel M. Parker; Tim Bruckner; Veronica M. Vieira; Catalina Medina; Vladimir N. Minin; Philip L. Felgner; Alissa Dratch; Matthew Zahn; Scott M. Bartell; Bernadette Boden-Albala; Katherine Perofsky MD; Samantha Perera N/A; Lauren Ma BS; Josephine Pham N/A; Mark Rolfsen MD; Jarod Olay MS; John Shin BS; Jennifer M. Dan MD PhD; Robert Abbott PhD; Sydney Ramirez MD PhD; Thomas H. Alexander MD MHSc; Grace Y. Lin MD; Ana Lucia Fuentes MD; Ira N. Advani BS; Deepti Gunge BS; Victor Pretorius MBChB MD; Atul Malhotra MD; Xin Sun PhD; Jason Duran MD PhD; Shane Crotty PhD; Nicole G. Coufal MD PhD; Angela Meier MD PhD; Laura E. Crotty Alexander MD; Aidan T Hanrath; Ina CD Schim van der Loeff; Andrew S Barr; Amada Sanchez-Gonzalez; Laura Bergamaschi; Federica Mescia; Josephine L Barnes; Eliz Kilich; Angus de Wilton; Anita Saigal; Aarash Saleh; Sam M Janes; Claire M Smith; Nusayhah Gopee; Caroline Wilson; Paul Coupland; Jonathan M Coxhead; Vladimir Y Kiselev; Stijn van Dongen; Jaume Bacardit; Hamish W King; Anthony J Rostron; A John Simpson; Sophie Hambleton; Elisa Laurenti; Paul A Lyons; Kerstin B Meyer; Marko Z Nikolic; Christopher JA Duncan; Ken Smith; Sarah A Teichmann; Menna R Clatworthy; John C Marioni; Berthold Gottgens; Muzlifah Haniffa

    doi:10.1101/2021.01.13.21249507 Date: 2021-01-15 Source: medRxiv

    COVID-19 MESHD is one of the largest public health emergencies in modern history. Here we present a detailed analysis from a large population center in Southern California (Orange County, population of 3.2 million) to understand heterogeneity in risks of infection, test positivity, and death MESHD. We used a combination of datasets, including a population-representative seroprevalence survey, to assess the true burden of disease as well as COVID-19 MESHD testing intensity, test positivity, and mortality. In the first month of the local epidemic, case incidence clustered in high income areas. This pattern quickly shifted, with cases next clustering in much higher rates in the north-central area which has a lower socio-economic status. Since April, a concentration of reported cases, test positivity, testing intensity, and seropositivity in a north-central area persisted. At the individual level, several factors (e.g., age, race/ethnicity, zip HGNC codes with low educational attainment) strongly affected risk of seropositivity and death MESHD.

    Detection of SARS-Cov-2 RNA in serum is associated with increased mortality risk in hospitalized COVID-19 MESHD patients.

    Authors: Diego A. Rodriguez Serrano; Emilia Roy-Vallejo; Nelly D. Zurita Cruz; Alexandra Martin Ramirez; Sebastian C. Rodriguez-Garcia; Nuria Arevalillo-Fernandez; Jose Maria Galvan-Roman; Leticia Fontan Garcia-Rodrigo; Lorena Vega Piris; Marta Chicot Llano; David Arribas Mendez; Begona Gonzalez de Marcos; Julia Hernando Santos; Ana Sanchez Azofra; Elena Avalos Perez-Urria; Pablo Rodriguez-Cortes; Laura Esparcia; Ana Marcos-Jimenez; Santiago Sanchez-Alonso; Irene Llorente; Joan B. Soriano; Carmen Suarez Fernandez; Rosario Garcia-Vicuna; Julio Ancochea; Jesus Sanz; Cecilia Munoz-Calleja; Rafael de la Camara; Alfonso Canabal Berlanga; Isidoro Gonzalez-Alvaro; Laura Cardenoso; John R Bradley

    doi:10.1101/2021.01.14.21249372 Date: 2021-01-15 Source: medRxiv

    Background COVID-19 MESHD has overloaded national health services worldwide. Thus, early identification of patients at risk of poor outcomes is critical. Our objective was to analyse SARS-CoV-2 RNA detection in serum as a severity biomarker in COVID-19 MESHD. Methods and FindingsRetrospective observational study including 193 patients admitted for COVID-19 MESHD. Detection of SARS-CoV-2 RNA in serum (CoVemia) was performed with samples collected at 48-72 hours of admission by two techniques from Roche and Thermo Fischer Scientific (TFS). Main outcome variables were mortality and need for ICU admission during hospitalization for COVID-19 MESHD. CoVemia was detected in 50-60% of patients depending on technique. The correlation of Ct in serum between both techniques was good (intraclass correlation coefficient: 0.612; p < 0.001). Patients with CoVemia were older (p = 0.006), had poorer baseline oxygenation (PaO2/FiO2; p < 0.001), more severe lymphopenia MESHD (p < 0.001) and higher LDH (p < 0.001), IL-6 HGNC (p = 0.021), C-reactive protein HGNC ( CRP HGNC; p = 0.022) and procalcitonin (p = 0.002) serum levels. We defined "relevant CoVemia" when detection Ct was < 34 with Roche and < 31 for TFS. These thresholds had 95% sensitivity and 35 % specificity. Relevant CoVemia predicted death during hospitalization (OR 9.2 [3.8 - 22.6] for Roche, OR 10.3 [3.6 - 29.3] for TFS; p < 0.001). Cox regression models, adjusted by age, sex and Charlson index, identified increased LDH serum levels and relevant CoVemia (HR = 9.87 [4.13-23.57] for TFS viremia MESHD and HR = 7.09 [3.3-14.82] for Roche viremia MESHD) as the best markers to predict mortality. ConclusionsCoVemia assessment at admission is the most useful biomarker for predicting mortality in COVID-19 MESHD patients. CoVemia is highly reproducible with two different techniques (TFS and Roche), has a good consistency with other severity biomarkers for COVID-19 MESHD and better predictive accuracy. AUTHOR SUMMARY COVID-19 MESHD shows a very heterogeneous clinical picture. In addition, it has overloaded national health services worldwide. Therefore, early identification of patients with poor prognosis is critical to improve the use of limited health resources. In this work, we evaluated whether baseline SARS-CoV2 RNA detection in blood (CoVemia) is associated with worse outcomes. We studied almost 200 patients admitted to our hospital and about 50-60% of them showed positive CoVemia. Patients with positive CoVemia were older and had more severe disease; CoVemia was also more frequent in patients requiring admission to the ICU. Moreover, we defined "relevant CoVemia", as the amount of viral load that better predicted mortality obtaining 95% sensitivity and 35% specificity. In addition, relevant CoVemia was a better predictor than other biomarkers such as LDH, lymphocyte count, interleukin-6 HGNC, and indexes used in ICU such as qSOFA and CURB65. In summary, detection of CoVemia is the best biomarker to predict death MESHD in COVID-19 MESHD patients. Furthermore, it is easy to be implemented and is reproducible with two techniques (Roche and Thermo Fisher Scientific) that are currently used for diagnosis in nasopharyngeal swabs samples.

    Characteristics and outcomes of 118,155 COVID-19 MESHD individuals with a history of cancer MESHD in the United States and Spain

    Authors: Elena Roel Mrs; Andrea Pistillo Mr; Martina Recalde Mrs; Anthony G Sena Mr; Sergio Fernandez-Bertolin Mr; Maria Aragon Mrs; Diana Puente Dr; Waheed-Ul-Rahman Ahmed Mr; Heba Alghoul Mr; Osaid Alser Mr; Thamir M Alshammari Dr; Carlos Areia Mr; Clair Blacketer Mrs; William Carter Mr; Paula Casajust Mrs; Aedin C Culhane Dr; Dalia Dawoud Dr; Frank DeFalco Mr; Scott L Duvall Dr; Thomas Falconer Mr; Asieh Golozar Dr; Mengchun Gong Mr; Laura Hester Dr; George Hripcsak Mr; Eng Hooi Tan Dr; Hokyun Jeon Mr; Jitendra Jonnagaddala Dr; Lana YH Lai Dr; Kristine E Lynch Dr; Michael E Matheny Mr; Daniel R Morales Dr; Karthik Natarajan Dr; Fredrik Nyberg Dr; Anna Ostropolets Mrs; Jose D Posada Dr; Albert Prats-Uribe Mr; Christian G Reich Dr; Donna Rivera Mrs; Lisa M Schilling Mrs; Isabelle Soerjomataram Dr; Karishma Shah Mrs; Nigam Shah Dr; Yang Shen Mr; Matthew Spotnitz Mr; Vignesh Subbian Dr; Marc A Suchard Dr; Annalisa Trama Dr; Lin Zhang Dr; Ying Zhang Dr; Patrick Ryan Dr; Daniel Prieto-Alhambra Dr; Kristin Kostka Mrs; Talita Duarte-Salles Dr

    doi:10.1101/2021.01.12.21249672 Date: 2021-01-15 Source: medRxiv

    PurposeWe aimed to describe the demographics, cancer MESHD subtypes, comorbidities and outcomes of patients with a history of cancer MESHD with COVID-19 MESHD from March to June 2020. Secondly, we compared patients hospitalized with COVID-19 MESHD to patients diagnosed with COVID-19 MESHD and patients hospitalized with influenza. MethodsWe conducted a cohort study using eight routinely-collected healthcare databases from Spain and the US, standardized to the Observational Medical Outcome Partnership common data model. Three cohorts of patients with a history of cancer MESHD were included: i) diagnosed with COVID-19 MESHD, ii) hospitalized with COVID-19 MESHD, and iii) hospitalized with influenza in 2017-2018. Patients were followed from index date to 30 days or death MESHD. We reported demographics, cancer MESHD subtypes, comorbidities, and 30-day outcomes. ResultsWe included 118,155 patients with a cancer MESHD history in the COVID-19 MESHD diagnosed and 41,939 in the COVID-19 MESHD hospitalized cohorts. The most frequent cancer MESHD subtypes were prostate and breast cancer MESHD (range: 5-19% and 1-14% in the diagnosed cohort, respectively). Hematological malignancies MESHD were also frequent, with non-Hodgkins lymphoma MESHD being among the 5 most common cancer MESHD subtypes in the diagnosed cohort. Overall, patients were more frequently aged above 65 years and had multiple comorbidities. Occurrence of death ranged from 8% to 14% and from 18% to 26% in the diagnosed and hospitalized COVID-19 MESHD cohorts, respectively. Patients hospitalized with influenza (n=242,960) had a similar distribution of cancer MESHD subtypes, sex, age and comorbidities but lower occurrence of adverse events. ConclusionPatients with a history of cancer MESHD and COVID-19 MESHD have advanced age, multiple comorbidities, and a high occurence of COVID-19 MESHD-related events. Additionaly, hematological malignancies MESHD were frequent in these patients.This observational study provides epidemiologic characteristics that can inform clinical care and future etiological studies.

    Bacterial superinfection pneumonia MESHD in SARS-CoV-2 respiratory failure MESHD

    Authors: Chiagozie O. Pickens; Catherine A. Gao; Michael J. Cuttica; Sean B. Smith; Lorenzo Pesce; Rogan Grant; Mengjia Kang; Luisa Morales-Nebreda; Avni A. Bavishi; Jason Arnold; Anna Pawlowski; Chao Qi; GR Scott Budinger; Benjamin D. Singer; Richard G. Wunderink; - NU COVID Investigators; Natalie J Thornburg; Panayampalli S Satheshkumar; Xiaowu Liang; Richard B Kennedy; Angela Yee; Michael Townsend; Joseph J Campo; Michael W Mather; Rik GH Lindeboom; Emma Dann; Ni Huang; Krzysztof Polanski; Elena Prigmore; Florian Gothe; Jonathan Scott; Rebecca P Payne; Kenneth F Baker; Aidan T Hanrath; Ina CD Schim van der Loeff; Andrew S Barr; Amada Sanchez-Gonzalez; Laura Bergamaschi; Federica Mescia; Josephine L Barnes; Eliz Kilich; Angus de Wilton; Anita Saigal; Aarash Saleh; Sam M Janes; Claire M Smith; Nusayhah Gopee; Caroline Wilson; Paul Coupland; Jonathan M Coxhead; Vladimir Y Kiselev; Stijn van Dongen; Jaume Bacardit; Hamish W King; Anthony J Rostron; A John Simpson; Sophie Hambleton; Elisa Laurenti; Paul A Lyons; Kerstin B Meyer; Marko Z Nikolic; Christopher JA Duncan; Ken Smith; Sarah A Teichmann; Menna R Clatworthy; John C Marioni; Berthold Gottgens; Muzlifah Haniffa

    doi:10.1101/2021.01.12.20248588 Date: 2021-01-15 Source: medRxiv

    BackgroundSevere community-acquired pneumonia MESHD secondary to SARS-CoV-2 is a leading cause of death MESHD. Current guidelines recommend patients with SARS-CoV-2 pneumonia MESHD receive empirical antibiotic therapy for suspected bacterial superinfection, but little evidence supports these recommendations. MethodsWe obtained bronchoscopic bronchoalveolar lavage (BAL) samples from patients with SARS-CoV-2 pneumonia MESHD requiring mechanical ventilation. We analyzed BAL samples with multiplex PCR and quantitative culture to determine the prevalence of superinfecting pathogens at the time of intubation and identify episodes of ventilator-associated pneumonia MESHD ( VAP MESHD) over the course of mechanical ventilation. We compared antibiotic use with guideline-recommended care. ResultsThe 179 ventilated patients with severe SARS-CoV-2 pneumonia MESHD discharged from our hospital by June 30, 2020 were analyzed. 162 (90.5%) patients had at least one BAL procedure; 133 (74.3%) within 48 hours after intubation and 112 (62.6%) had at least one subsequent BAL during their hospitalization. A superinfecting pathogen was identified within 48 hours of intubation in 28/133 (21%) patients, most commonly methicillin-sensitive Staphylococcus aureus or Streptococcus species (21/28, 75%). BAL-based treatment reduced antibiotic use compared with guideline-recommended care. 72 patients (44.4%) developed at least one VAP episode. Only 15/72 (20.8%) of initial VAPs were attributable to multidrug-resistant pathogens. The incidence rate of VAP was 45.2/1000 ventilator days. ConclusionsWith use of sensitive diagnostic tools, bacterial superinfection at the time of intubation is infrequent in patients with severe SARS-CoV-2 pneumonia MESHD. Treatment based on current guidelines would result in substantial antibiotic overuse. The incidence rate of VAP MESHD in ventilated patients with SARS-CoV-2 pneumonia MESHD are higher than historically reported.

    Magnitude, change over time, demographic characteristics and geographic distribution of excess deaths MESHD among nursing home residents during the first wave of COVID-19 MESHD in France: a nationwide cohort study

    Authors: Florence Canoui-Poitrine; Antoine Rachas; Martine Thomas; Laure Carcaillon-Bentata; Romeo Fontaine; Gaetan Gavazzi; Marie Laurent; Jean-Marie Robine; Peter Knight; Bruce Guthrie; David McAllister

    doi:10.1101/2021.01.09.20248472 Date: 2021-01-14 Source: medRxiv

    ImportanceNursing home ( NH MESHD) residents are particularly vulnerable to SARS-CoV-2 infections MESHD and coronavirus disease 2019 MESHD ( COVID-19 MESHD) lethality. However, excess deaths in this population have rarely been documented. ObjectivesThe primary objective was to assess the number of excess deaths MESHD among NH residents during the first wave of the COVID-19 pandemic MESHD in France. The secondary objectives were to determine the number of excess deaths MESHD as a proportion of the total excess deaths in the general population and determine whether a harvesting effect was present. DesignWe studied a cohort of 494,753 adults (as of March 1st, 2020) aged 60 and over in 6,515 NHs in mainland France. This cohort was exposed to the first wave of the COVID-19 pandemic MESHD (from March 1 HGNCst to May 31st, 2020) and was compared with the corresponding, reference cohorts from 2014 to 2019 (using data from the French National Health Data System). Main outcome and measuresThe main outcome was all-cause death MESHD. Weekly excess deaths and standardized mortality ratios (SMRs) were estimated. ResultThere were 13,505 excess deaths among NH residents. Mortality increased by 43% (SMR: 1.43). The mortality excess was higher among males than among females (SMR: 1.51 and 1.38, respectively) and decreased with age (SMRs in females: 1.61 in the 60-74 age group, 1.58 for 75-84, 1.41 for 85-94, and 1.31 for 95 or over; Males: SMRs: 1.59 for 60-74, 1.69 for 75-84, 1.47 for 85-94, and 1.41 for 95 or over). We did not observe a harvesting effect (up until August 30th, 2020). By extrapolating to all NH MESHD residents nationally (N=570,003), the latter accounted for 51% of the total excess deaths in the general population (N=15,114 out of 29,563). ConclusionNH residents accounted for about half of the total excess deaths in France during the first wave of the COVID-19 pandemic MESHD. The excess death rate was higher among males than females and among younger residents than among older residents. We did not observe a harvesting effect. A real-time mortality surveillance system and the identification of individual and environmental risk factors might help to design the future model of care for older dependent adults. Key pointsO_LIDuring the first wave of the COVID-19 pandemic MESHD in France, the mortality among nursing home residents increased by 43%. C_LIO_LINursing home residents accounted for 51% of the total excess deaths in France. C_LIO_LIThe excess mortality was higher among younger residents than among older residents. C_LIO_LIThe excess mortality was higher among males than among females. C_LIO_LIWe did not observe a harvesting effect during the study period (ending on August 30th, 2020, i.e., three months after the end of the first wave). C_LI

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