Science

Covid, where will we be in five years? “We must anticipate the worst in order to avoid it”

From dark gray to very black… The scenarios presented in the latest High Council of Public Health (HCSP) report on the possible development of the Covid-19 epidemic in the next three to five years are not encouraging. Scenario 1, “living with the virus”, undoubtedly the most favorable one, would be a continuation of the current situation with regular epidemic outbreaks and still a large number of victims among those most at risk. Scenario 5, the “ultra-crisis”, with the emergence of an option that eludes vaccine immunity, will return us to a situation similar to that of March 2022, with population and caregivers fatigue to boot. Then the country would quickly find itself blocked, especially since the economic crisis would not allow the implementation of measures such as “by all means”.

Between these two extremes, another hypothesis suggests the emergence of a variant that will mainly affect children. Are these futures likely? Do we have the means to protect ourselves from it? This is explained by Prof. Didier Lepeltier, the new President of the HCSP. Recently appointed head of this body, this Nantes-based doctor took the opportunity to detail his plans for the coming months.

L’Express: The possible scenarios for the pandemic listed in your report are particularly bleak. Do you see a way out of the crisis in the medium and long term?

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Didier Lepeltier: The World Health Organization (WHO) has presented somewhat more optimistic scenarios. For our part, we voluntarily engaged in pessimistic hypotheses. Our goal is not to describe the future: in fact, the idea of ​​this exercise is to anticipate the worst, to prevent it. The point is to offer our rulers recommendations for preemption within eighteen months so that they take the necessary measures so as not to end up in one of the situations described later.

Knowing, however, that our first “living with the virus” scenario finally sums up the current state of the epidemic. Unfortunately, we see that society is getting used to very high infection rates.

You also mention the possibility of options emerging that would specifically target children or that avoid acquired immunity entirely, both through infection and vaccination… Is that plausible?

This report was written by a working group that included sociologists, anthropologists, prevention specialists, virologists, infectious disease specialists, researchers, public health officials, veterinarians, public health professionals… They tell us that these scenarios are quite possible. As for children, no one thought of such a possibility, and we are absolutely not ready for it. Children under 12 are much less vaccinated than the rest of the population. Emergency rooms and children’s hospitals are not equipped for this type of crisis. This possibility is deeply destabilizing to society because, in addition to human tragedies, many parents will no longer be able to work. The country may face great difficulties in managing this situation.

As for the option of completely escaping immunity, who said it wouldn’t happen? In June 2020, many thought that the epidemic was almost over, and in mid-July it started again… We do not have a crystal ball and the goal is not to make short-term forecasts, but to offer tools to prevent and forecasting in the medium and long term. As we point out in the report, these different possible scenarios for the development of the crisis can also occur on different horizons. The future may also be a combination of some of them. But we can also hope that none of them come true.

Which of the 28 recommendations issued by the HCSP do you find most relevant?

In particular, we recommend deploying a population-based public health strategy to protect vulnerable people, with intensified vaccination campaigns, rapid access to diagnosis and treatment, especially in cities. To do this, it is necessary not to centralize everything, but to allow regional health authorities to organize themselves in accordance with the needs in their territory. In addition, antivirals should be brought to the attention of the general public, as well as players in the field such as physicians and pharmacists, to make it easier to prescribe them to patients who may need them.

At the start of the crisis, authorities wondered if only those who were weak and at risk of infection should be isolated, but that quickly proved impossible when 18 million people were at stake. Now that there are vaccines, drugs and masks, it is entirely possible to adopt such a pragmatic strategy. Thus, frail people should be urged to continue to wear a mask indoors.

It’s very stigmatizing…

This means that it is necessary to engage in pedagogy in such a way that it is not experienced as such. In fact, we should all continue to wear a mask in public. Regardless of age, no one is interested in getting Covid. The High Council of Public Health has stated this on numerous occasions: in a situation where this barrier measure is no longer mandatory, people who want to protect themselves will have an interest in continuing to wear a mask like a surgical mask or even a device. type FFP2 respiratory protective equipment, as appropriate, as they are more effective than surgical masks for personal protection. This is a recommendation that remains important.

In addition, we urge Europeans to think about anticipating crises – but I know that the General Health Authority is working on this – and on coordinating research, in particular, to find a vaccine that provides longer-term protection than those that messenger RNA. We must also continue with the reform of the health care system, beyond the Ségur de la santé. This includes facilitating access to consultations for patients with chronic diseases, as well as strengthening the capacity of pediatric admissions.

In this report, you don’t say a word about improving indoor air quality, which many epidemiologists nevertheless consider important to control Covid-related risks in the medium term…

This is because we have already written at least five opinions on the subject and this measure is one of the seven doctrines of the Higher Council of Public Health regarding barrier gestures. Ventilation is essential, and not only against Covid. For example, it has been shown that exercising in a well-ventilated area improves children’s learning abilities. Not to mention, of course, the prevention of winter infectious diseases. We have already pointed out, for example, that rooms without windows and without effective ventilation should not be allowed in bars and restaurants during epidemics.

But recommendations for ventilation are broader, including monitoring CO2 emissions with sensors, the availability and efficiency of a ventilation system (already mandated by departmental regulations), and venting options. These recommendations from the Higher Council of Public Health are the result of thought by scientists. Now they have to be translated into normative texts for their practical application, for example in companies or schools.

Are you the one who thinks that the proposals arising from your future work will find a specific translation?

Of course. Imagine that one of the five scenarios happens and nothing is done. This report allows us to anticipate what we would not want to see and gives political leaders food for thought. It would be interesting to meet with government authorities to see how they feel about accounting for this work. It is true that this promising undertaking is relatively innovative for France, but we intend to perpetuate it by creating an ad hoc working group within the High Council.

What will be the role of the HCSP in relation to the future scientific committee that the government wants to replace the scientific council?

The State Council said in a July 5 opinion that there is no need to create another national health crisis management committee because of the missions already entrusted to the HCSP – to provide scientific expertise to policy during crises and to predict health. We believe that the High Council of Public Health can play this role in the Territory by bringing together the experience of other health institutions.

We are waiting for this new committee to see the light of day, but the responsibility for ensuring coordination between the various bodies that already exist in this area lies with the politicians. The High Council of Public Health has also already planned to establish a health crisis forecasting and forward planning body, a logical extension of its experience, its role in pandemic crisis management and its foresight skills.

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What will the next HCSP publications be about?

We are in the process of finalizing a new doctrine concerning universal hygienic measures to prevent major infectious diseases occurring in the general population. We are working on many pathologies and health promotion and infection prevention measures. To explain how to avoid getting them or spreading them if you are still infected, to protect those around you. This unfinished work is original and has no analogues either in France or abroad. It should appear next fall.

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