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Background COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aimed to determine the average length of stay, occupancy bed rate and bed turnover rate for COVID-19 patients in Monastir university hospital between the 1st October 2020 and 28th february 2021. Methods This is a cross-sectional study that enrolled all hospitalizations for COVID19 in Monastir University hospital, the unique third level healthcare in this region, between the 1st October 2020 and 28th february 2021. The following indicators: the average length of stay, the occupancy bed rate and the bed turnover rate were calculated during the study period. Results We included 762 hospitalizations for COVID-19 during the study period. The average age of our population was 64,22 years (standard deviation= 14,17). Male predominance was noted with sex ratio=1,63. The median length of stay was significantly longer in the intensive care unit (ICU) than in the other departments (11 (7;16) days, versus 7(2;14) days), p = 0.008. The average number of beds available for COVID-19 patients during the study period was 13 in the ICU and 65 in the other wards. The bed turnover rate and the bed occupancy rate per month were respectively 2,66 patient/bed/month and 96,26% in the ICU versus 1,74 patient/bed/month and 62,26% in the other wards. The occupancy bed rate in the ICU exceeded the 100% during the outbreak of January and February 2021 (129,72% and 120,66% respectively). Conclusions Despite the efforts by the health services and social isolation measures in Tunisia, this study highlighted the saturation of our health system with an overload in intensive care units. Key messages Length of stay for patients with Covid-19 was significantly the longest in ICU. The occupancy bed rate, exceeding 100% in ICU, highlighted the health system collapse in managing COVID-19 patients.

Background Testing is a crucial tool in the pandemic response to identify and confirm COVID-19 in those who are symptomatic. The aim of the present study was to assess the negative predictive value (NPV) of COVID-19 Rapid Antigen Testing (RAT) according to the symptoms, test timing in relation to symptom onset and characteristics of the person. Methods We performed a prospective cohort study of patients attended the COVID-19 testing center at the university hospital of Monastir, between 23 November 2020 and 19 April 2021. In the first time we performed the COVID19 RAT. In the second time, if this result was negative we performed the reverse transcription polymerase chain reaction (rRT-PCR). The NPV was conducted with SPSS software, version 21.0. A logistic binary regression was performed to determine factors affected the NPV of COVID-19 RAT. A p value of < 0.05 was considered statistically significant. Results A total of 855 tests were performed, of which 807 were RAT and 467 rRT-PCR. Positive RAT test was found in 336 cases (39%). False negative RAT was noted in 87 cases (10.2%). The NPV of RAT was 83.6%. The NPV ranged between 80% and 88% for the following symptoms: fever, cough, myalgia, dyspnea, dizziness, asthenia, headache, myalgia, odynophagia, flu_rhume. It varied from 64.2 to 77.8 for Ageusia, Anosmia, Arthralgia, chest pain, thrill, digestive signs. The NPV was equivalent according to age and gender. The NPV varied from 80 to 100% if the test was applied between the first and the 5th day for the onset of symptoms. Beyond this duration, it decreased to 50%. A long period of symptom onset (>5 days) increased significantly the risk of false negative RAT (OR = 2.57 IC95%: [1.38-4.82], p = 0.003). Conclusions Many factors may affect the performance of COVID-19 Rapid Antigen Testing (RAT). In fact, negative RAT should be completed by a rRT-PCR according to the the type of symptoms and the time from illness onset. Key messages False negative RAT rate was high. Many factors must be taken into account in interpreting the RAT, in particular the type of symptoms and the time from illness onset.

Distancing is one of the barrier measures in mitigating epidemics. We aimed to investigate the typology, effectiveness, and side effects of distancing rules during epidemics. Electronic searches were conducted on MEDLINE, PubMed in April 2020, using Mesh-Terms representing various forms of distancing (‘social isolation’, ‘social distancing’, ‘quarantine’) combining with ‘epidemics’. PRISMA-ScR statement was consulted to report this review. A total of 314 titles were identified and 93 were finally included. 2009 influenza A and SARS-CoV-2 epidemics were the most studied. Distancing measures were mostly classified as case-based and community-based interventions. The combination of distancing rules, like school closure, home working, isolation and quarantine, has proven to be effective in reducing R 0 and flattening the epidemic curve, also when initiated early at a high rate and combined with other non-pharmaceutical interventions. Epidemiological and modeling studies showed that Isolation and quarantine in the 2009 Influenza pandemic were effective measures to decrease attack rate also with high level of compliance but there was an increased risk of household transmission. lockdown was also effective to reduce R 0 from 2.6 to 0.6 and to increase doubling time from 2 to 4 days in the covid-19 pandemic. The evidence for school closure and workplace distancing was moderate as single intervention. Psychological disorder, unhealthy behaviors, disruption of economic activities, social discrimination, and stigmatization were the main side effects of distancing measures. Earlier implementation of combined distancing measures leads to greater effectiveness in containing outbreaks. Their indication must be relevant and based on evidence to avoid adverse effects on the community. These results would help decision-makers to develop response plans based on the required experience and strengthen the capacity of countries to fight against future epidemics. Mesh words : Physical Distancing, Quarantine, Epidemics, Public Health, Scoping Review.