There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in the population. Sciensano collected information on 14,618 hospitalized patients with COVID-19 admissions from 114 Belgian hospitals between 14 March and 12 June 2020. The distributions of different event times for different patient groups are estimated accounting for interval censoring and right truncation of the time intervals. The time between symptom onset and hospitalization or diagnosis are similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient (longest delay in age group 20–60 years) and whether or not the patient lives in a nursing home (additional 2 days for patients from nursing home). The median LoS in hospital varies between 3 and 10.4 days, with the LoS increasing with age. The hospital LoS for patients that recover is shorter for patients living in a nursing home, but the time to death is longer for these patients. Over the course of the first wave, the LoS has decreased.

Context Ready-to-use-therapeutic foods are an important component of the effective outpatient treatment of severe wasting, however, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. Objective To evaluate the effect of a 3-month distribution of ready-to-use-therapeutic food on the nutritional status, mortality and morbidity of children 6 to 60 mo of age. Design, Settings, and Participants A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. Villages were visited monthly from August 2006 to March 2007. All children in the study villages between 6 and 60 mo of age were eligible for recruitment. Intervention Children with weight-for-height ≥ 80% of the NCHS reference median in the 6 intervention villages received a monthly distribution of one packet per day of ready-to-use-therapeutic food (500kcal / day) from August to October 2006. Children in the six non-intervention villages did not receive preventive supplementation with RUTF and comprised the control group. Active surveillance for conditions requiring medical or nutritional treatment was conducted in all twelve study villages throughout follow-up from August 2006 to March 2007. Main Outcome Measures Changes in weight-for-height Z score according to the World Health Organization Child Growth Standards and incidence of wasting (weight-for-height Z < −2) over 8 mo of follow-up. Results The number of children with height and weight measurements in August, October, December and February was 3,166, 3,110, 2,936 and 3,026, respectively. The adjusted effect of the intervention on weight-for-height Z score from baseline to the end of follow-up was 0.22 Z (95% CI: 0.13, 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 wasting events / 841 child-years) and 0.03 events per child-year (29 wasting events / 943 child-years) in the intervention villages, as compared to 0.26 events per child-year (233 severe wasting events / 895 child-years) and 0.07 events per child year ( 71 severe wasting events / 1,029 child-years) in the non-intervention villages. The intervention thus resulted in a 36% (95% CI: 17% – 50%) reduction in the incidence of wasting and a 58% (95% CI: 43% – 68%) reduction in the incidence of severe wasting. The mortality rate was 0.007 deaths per child-year ( 7 deaths / 986 child-years) in the intervention villages and 0.016 deaths per child-year (16 deaths / 1,099 child-years) in the non-intervention villages, resulting in a non-significant 49% (95% CI: 0.25, 1.05) reduction in mortality. Conclusion Short-term supplementation of non-malnourished children with ready-to-use-therapeutic food reduced the decline in weight-for-height Z score and the incidence of wasting and severe wasting over 8 mo.

Highlights Hydroxychloroquine (HCQ) 2400 mg over 5 days was used in Belgium for COVID-19. Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed. Lower mortality in HCQ-treated patients as compared to supportive care. Lower mortality was irrespective of symptom duration.

Background Several studies have investigated the predictors of in-hospital mortality for COVID-19 patients who need to be admitted to the Intensive Care Unit (ICU). However, no data on the role of organizational issues on patients’ outcome are available in this setting. The aim of this study was therefore to assess the role of surge capacity organisation on the outcome of critically ill COVID-19 patients admitted to ICUs in Belgium. Methods We conducted a retrospective analysis of in-hospital mortality in Belgian ICU COVID-19 patients via the national surveillance database. Non-survivors at hospital discharge were compared to survivors using multivariable mixed effects logistic regression analysis. Specific analyses including only patients with invasive ventilation were performed. To assess surge capacity, data were merged with administrative information on the type of hospital, the baseline number of recognized ICU beds, the number of supplementary beds specifically created for COVID-19 ICU care and the “ICU overflow” (i.e. a time-varying ratio between the number of occupied ICU beds by confirmed and suspected COVID-19 patients divided by the number of recognized ICU beds reserved for COVID-19 patients; ICU overflow present when this ratio is ≥ 1.0). Findings Over a total of 13,612 hospitalised COVID-19 patients with admission and discharge forms registered in the surveillance period (March, 1 to August, 9 2020), 1903 (14.0%) required ICU admission, of whom 1747 had available outcome data. Non-survivors (n=632, 36.1%) were older and had more frequently various comorbid diseases than survivors. In the multivariable analysis, ICU overflow, together with older age, presence of comorbidities, shorter delay between symptom onset and hospital admission, absence of hydroxychloroquine therapy and use of invasive mechanical ventilation and of ECMO, was independently associated with an increased in-hospital mortality. Similar results were found among the subgroup of invasively ventilated patients. In addition, the proportion of supplementary beds specifically created for COVID-19 ICU care to the previously existing total number of ICU beds was associated with increased an in-hospital mortality among invasively ventilated patients. The model also indicated a significant between-hospital difference in in-hospital mortality, not explained by the available patients and hospital characteristics. Interpretation Surge capacity organisation as reflected by ICU overflow or the creation of COVID-19 specific supplementary ICU beds were found to negatively impact ICU patient outcomes. Funding No funding source was available for this study.

European Centre for Disease Prevention and Control.