Recherche Clinique (Clinical Research) - Organisation de la prise en charge de l'infection COVID-19 et spécificité de présentation clinique, immunologique et pronostique chez les patients drépanocytaires au Mali Organization of the management of COVID-19 infection and specificity of clinical, immunological and prognostic presentation in patients with sickle cell disease in Mali

Objectives: 1) Reduce COVID-19 dissemination at the Reference Center for Sickle Cell Disease in Mali (CRLD) and in patients' families, and optimize the management of sickle cell disease (SCD) patients infected with COVID-19, 2) describe the initial clinical specificities of COVID-19 infection in these patients and their evolution in time, 3) determine the immunological specificities of COVID infection in SCD patients. Current situation: The COVID-19 epidemic is rapidly progressing in sub-Saharan Africa where SCD is a major public health problem (defined by WHO as a health priority). As of 04/13/2020, Mali has deplored 105 cases of confirmed COVID infection and 9 deaths, these figures are probably highly underestimated due to undiagnosed cases. A massive epidemic wave is expected, to which the health system will not be able to cope adequately. Three centers have been designated for the management of COVID+ patients. On the other hand, the CRLD in Bamako is following a cohort of 12,000 SCD patients. Specific issues: Viral infections in SCD patients, particularly with pulmonary tropism, are known to trigger severe complications (vaso-occlusive crisis and/or life-threatening acute thoracic syndrome). Therefore, these patients may be considered as more fragile or at least to constitute a distinctive population in the context of a COVID infection. Thus, it is an urgency for the CRLD to establish a suitable procedure for the early identification and specific management of its COVID+ patients. At the same time, the medical teams at COVID centers are not trained to the specificities of the SCD patients' management. SCD patients present with a chronic baseline inflammation, that worsens during acute complications. It is not known whether this characteristic represents a detrimental factor during COVID infection. The implementation of dedicated strategies by highly competent multidisciplinary teams and the definition of the specificities of COVID infection in SCD patients are a priority. Methods: Collaborative research/action project between the CRLD and the 3 COVID Centers in Bamako, and in Paris: the Internal Medicine Dept. of the European Georges Pompidou Hospital, one of the French SCD Reference Centers and equipped with a dedicated COVID sector, and the UMR 1134 Inserm/University of Paris/National Institute of Blood Transfusion (INTS). Project composed of three components: 1) organizational: training of the CRLD medical staff (doctors, nurses, biologists, laboratory technicians) to identify SCD patients at the various stages of COVID infection and, conversely, training the staff of the COVID Centers in the specific aspects of patients' management, 2) clinical research: recruitment of 3 groups, matched in age +/- 5 years: 200 SCD patients admitted to CRLD emergency ward identified as suspect of COVID infection and therefore isolated in a dedicated sector (100 PCR COVID+ patients and 100 PCR COVID-), 100 non-SCD patients PCR COVID +, hospitalized at the COVID Center of the Mali Hospital, 3) translational research: characterization of the inflammatory parameters in COVID+ SCD patients in comparison to the control groups (non-infected SCD patients and non-SCD COVID+ patients ) by measuring cytokines in frozen plasmas air-shipped in dry ice to the INTS in Paris. Work schedule: July 2020 (M8): ethics committee, construction of the database, M9-M11: recruitments, standard clinical and biological monitoring, implementation of the database, creation of the plasma library; M12: measurement of plasma cytokines, analysis and exploitation of the results. Expected results: 1) Control the spread of the COVID-19 epidemic and reduce mortality in the particularly fragile population of SCD patients in Mali, 2) Demonstration of the epidemiological and clinical features linked to COVID-19 infection of SCD patients in the African context, 3) Define the inflammatory profiles of the 3 groups studied in Africa where the population is permanently exposed to high infectious pressure.