In December 2019, a new virus of the coronaviridae family called SARS-CoV-2 emerged in Wuhan, Hubei region, China. It spread rapidly to the rest of the world and was declared a pandemic in March 2020. As of November 16, 2020, there were 1,319,267 patient deaths from COVID-19 .
The management of patients with COVID-19 has evolved over time, particularly in France. Indeed, when the first cases appeared in February/March 2020, the only individuals screened were "individuals presenting clinical signs of acute respiratory infection with documented or subjective fever and who had traveled or stayed in a high-risk exposure zone within 14 days prior to the date of clinical signs, or individuals who have had close contact with a confirmed case of COVID-19 or any person with signs of pneumonia or acute respiratory distress" . Such management did not include any recommendation for mass screening that were already in plance in countries like Iceland or South Korea [3, 4]. Indeed, the French government explicitly indicated that screening during the epidemic phase was not necessary . By March 17, the French authorities had implemented a 55-day population lockdown as a health measure. Patients with COVID were instructed to consult emergency services only in case of respiratory difficulties . During the first wave of the new virus, only one treatment was officially recommended to reduce fever in COVID-19 cases: paracetamol .
At the same time, the Institut Hospitalo-Universitaire Méditerranée Infection (IHU-MI) based in Marseilles, South-Eastern France offered an alternative management system. The IHU, created in 2011 and funded by the Ministry of Research, is the only research and care facility of this kind dedicated to the fight against infectious diseases in France (https://www.mediterranee-infection.com/). It includes a biology laboratory, 75 hospital beds and research and development teams. In March 2020, the IHU-MI set up a screening and treatment center for patients with COVID-19, a system that has been ultimately recommended by French public health authorities . The IHU offered rapid screening, with results in less than 24 hours, to any individual presenting at the center, as well as outpatient treatment for patients who were positive for SARS-CoV-2. The IHU standardized clinical protocol  included: a medical examination with measurement of pulse, blood pressure, respiratory rate and ambient air saturation to evaluate the NEWS-2 score , a biological assessment, a low-dose chest CT scan according to age and/or desaturation criteria [10, 11]. As regards drug treatment, treatment with hydroxychloroquine-azithromycin in the absence of contraindications with the addition of broad-spectrum antibiotics (ceftriaxone or ertapenem) in patients with a NEWS-2 score greater than 5 was proposed . When patients had an oxygen saturation below 95% or other clinical signs demonstrating deterioration of the individual's health status, they were then hospitalized at IHU-MI, mostly when they were contagious, to avoid the spread to non-COVID patients and staff. At the peak of the epidemic in April and bed saturation, once they were RT-PCR- negative, patients were transferred to a conventional COVID unit for their remaining care. For outpatients, follow-up was performed at the beginning of the epidemic at D2, D6 and D10 and from 03/2020 onwards only at D10, due to the large number of patients .
Patient observation and massive early diagnosis (4,021) made it possible to adapt patient management, which has evolved in line with the knowledge acquired through multidisciplinary collaboration involving cardiologists, radiologists, infectious disease specialists, intensivists and ENT specialists [11–16]. For example, the observation of ‘happy hypoxia’ has led to the recommendation of ambulatory use of pulse oximeters  and the search for high D-dimer anticoagulation levels in patients at risk . This management has been the subject of several publications on clinical and therapeutic results [11, 16].
The recent publication of the profiles of patients hospitalized in France published by the DRESS  gives us the opportunity to measure the impact of this multidisciplinary early management system coupled with screening on mortality at 90 days.