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Motivated by the potential devastating effect of a COVID-19 outbreak in retirement homes and long-term facilities for dependent elderly, we present the impact of worst-case scenarios in French institutions using a specific age structure and case–age fatality ratios. The death toll could equal the yearly death toll caused by seasonal influenza in those older than 65 years or could largely exceed that, depending on the final attack rate and proportion of infected institutions.


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  1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239.  https://doi.org/10.1001/jama.2020.2648  PMID: 32091533 
  2. Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;S1473-3099(20)30243-7.  https://doi.org/10.1016/S1473-3099(20)30243-7  PMID: 32240634 
  3. Santé Publique France. COVID-19: point épidémiologique du 15 mars 2020. [COVID-19: data from 15 March 2020]. Paris: Santé Publique France; 18 Mar 2020. French. Available from: https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/documents/bulletin-national/covid-19-point-epidemiologique-du-15-mars-2020
  4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020. [Epub ahead of print].  https://doi.org/10.1001/jama.2020.1585  PMID: 32031570 
  5. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.  https://doi.org/10.1016/S0140-6736(20)30211-7  PMID: 32007143 
  6. Institut national de la statistique et des études Économiques (INSEE). Capacité d’accueil des personnes âgées selon la catégorie d’établissement au 31 décembre 2017. [Housing capacity for elderly people by type of institution on 31 December 2017]. Paris: INSEE; 2017. French. Available from: https://www.insee.fr/fr/statistiques/2012690#table
  7. Bonmarin I, Belchior E, Lévy-Bruhl D. Impact de la vaccination contre la grippe saisonnière sur la mortalité des personnes âgées en France, de novembre 2000 à avril 2009. [Impact of flu vaccination on mortality in the French elderly population, from November 2000 to April 2009]. Bull Epidémiol Hebd. 2015;32-33:612-6. French. Available from: http://beh.santepubliquefrance.fr/beh/2015/32-33/2015_32-33_4.html
  8. Vaux S, Poujol I, Bonmarin I, Lévy-Bruhl D, Desenclos JC. Surveillance of lower respiratory tract infections outbreaks in nursing homes in France. Eur J Epidemiol. 2009;24(3):149-55.  https://doi.org/10.1007/s10654-009-9315-1  PMID: 19199055 
  9. Durand C, Guinard A, Sabatier P, Mourlan C, Vandesteene S, Mouly D. Impact, prévention et gestion du risque infectieux épidémique (infections respiratoires et gastro-entérites aiguës) dans les Établissements d’hébergement pour personnes âgées d’Occitanie au cours de la saison hivernale 2016-2017. [Impact, prevention and management of epidemic infectious risk (acute respiratory infections and acute gastroenteritis) in the Occitanie (France) long-term care facilities for the elderly during the 2016-17 winter season]. Bulletin Epidémio Hebd. 2018;(37):719-25. French. Available from: http://beh.santepubliquefrance.fr/beh/2018/37/2018_37_2.html
  10. Cheng H-Y, Chen W-C, Chou Y-J, Huang AS-E, Huang W-T. Containing influenza outbreaks with antiviral use in long-term care facilities in Taiwan, 2008-2014. Influenza Other Respir Viruses. 2018;12(2):287-92.  https://doi.org/10.1111/irv.12536  PMID: 29341490 
  11. Perrin-Hayne J. Les pathologies des personnes âgées vivant en établissement. [Pathologies of elderly people living in institutions]. Solidarité Santé n°22 DRESS. 2011;22:4-15. French. Available from: http://drees.social-sante.gouv.fr/IMG/pdf/dossier201122.pdf
  12. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020;25(4):2000058.  https://doi.org/10.2807/1560-7917.ES.2020.25.4.2000058  PMID: 32019669 
  13. Atlani-Duault L, Brown L, Fried L. The elderly: an invisible population in humanitarian aid. Lancet Public Health. 2018;3(1):e14-23.  https://doi.org/10.1016/S2468-2667(17)30232-3  PMID: 29307382 
  14. Hofman MR, van den Hanenberg F, Sierevelt IN, Tulner CR. Elderly patients with an atypical presentation of illness in the emergency department. Neth J Med. 2017;75(6):241-6. PMID: 28741583 
  15. Ministère des Solidarités et de la Santé. Preparation a la phase épidémique de Covid-19. [Preparation for the epidemic phase of COVID-19]. Paris: Ministry of Social Affairs and Health; 16 Mar 2020. French. Available from: https://solidarites-sante.gouv.fr/IMG/pdf/guide-covid-19-phase-epidemique-v15-16032020.pdf
  16. Santini ZI, Jose PE, York Cornwell E, Koyanagi A, Nielsen L, Hinrichsen C, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):e62-70.  https://doi.org/10.1016/S2468-2667(19)30230-0  PMID: 31910981 

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