Abstract
BackgroundSARS-CoV-2 emergence was a threat for armed forces. A COVID-19 outbreak occurred on the French aircraft carrier Charles de Gaulle from mid-March to mid-April 2020.AimTo understand how the virus was introduced, circulated then stopped circulation, risk factors for infection and severity, and effectiveness of preventive measures.MethodsWe considered the entire crew as a cohort and collected personal, clinical, biological, and epidemiological data. We performed viral genome sequencing and searched for SARS-CoV-2 in the environment.ResultsThe attack rate was 65% (1,148/1,767); 1,568 (89%) were included. The male:female ratio was 6.9, and median age was 29 years (IQR: 24-36). We examined four clinical profiles: asymptomatic (13.0%), non-specific symptomatic (8.1%), specific symptomatic (76.3%), and severe (i.e. requiring oxygen therapy, 2.6%). Active smoking was not associated with severe COVID-19; age and obesity were risk factors. The instantaneous reproduction rate (R t ) and viral sequencing suggested several introductions of the virus with 4 of 5 introduced strains from within France, with an acceleration of R t when lifting preventive measures. Physical distancing prevented infection (adjusted OR: 0.55; 95% CI: 0.40-0.76). Transmission may have stopped when the proportion of infected personnel was large enough to prevent circulation (65%; 95% CI: 62-68).ConclusionNon-specific clinical pictures of COVID-19 delayed detection of the outbreak. The lack of an isolation ward made it difficult to manage transmission; the outbreak spread until a protective threshold was reached. Physical distancing was effective when applied. Early surveillance with adapted prevention measures should prevent such an outbreak.
Keywords: Aircraft Carrier; Outbreak; SARS-CoV-2, COVID-19; Ship, Herd immunity.
【저자키워드】 outbreak, Aircraft Carrier, SARS-CoV-2, COVID-19, Ship, Herd immunity., 【초록키워드】 COVID-19, SARS-CoV-2, Risk factors, severe COVID-19, obesity, severity, Sequencing, Infection, oxygen, smoking, risk factor, virus, Spread, Cohort, Asymptomatic, COVID-19 outbreak, Surveillance, clinical picture, attack rate, symptomatic, herd immunity, Effectiveness, Isolation, Oxygen therapy, France, age, physical distancing, epidemiological data, preventive measures, circulation, threshold, acceleration, non-specific, Protective, aircraft, strain, Aircraft Carrier, Charles de Gaulle, Reproduction rate, Armed Forces, median age, measure, Viral genome sequencing, French, active smoking, Prevent, effective, performed, lack, collected, occurred, examined, proportion, applied, adjusted, searched, introduced, suggested, reached, prevented, instantaneous, 【제목키워드】 investigation, Aircraft Carrier, retrospective cohort study,