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Prof. Gilles Pialoux: Managing a pandemic is not a game of dice

The reopening of schools, then the announcement by the President of the Republic of a deconfinement plan in mid-May, rang painfully in the ears of caregivers. Of course, the national incidence rate is decreasing, and the constraints must be lifted at some point. But the day after the announcements, in the various Covid crisis cells, no allusion to the said “plan”. The time has come for the immediacy of the pressure and the uncertainty of the days to come, in a context of saturation of services, and a high level of contamination. Never, since the start of the pandemic, had release measures been taken or announced to such a degree virus circulation. Very few countries have allowed this. In the field, the words of medical and nursing executives have a completely different tone than the optimism displayed by the executive: “Our organization is only held by transfers”, “The teams are on their knees”, “Until when should we deprogram? “… In what way do the current political choices constitute a risk-taking, a” bet “for France? Six point answer.

1)The improvement observed remains fragile

Several models including those of Vittoria Colizza (Inserm) show the possibility, among other more optimistic ones, of maintaining the occupation of intensive care units on a plateau at a high level, of a slow decline, then of a resurgence. There are several reasons for this. The anticipation of the French (more trips and regroupings, less barrier measures, less teleworking, less screening …) as soon as the next reopening is announced, as was the case during the first and the second wave. The tracer-isolator abandoned due to too many contaminations. The surge of new, more transmissible, and even more morbid variants. The insufficient vaccination coverage that penalizes Europe …

2) Vaccination alone will not be enough to get us out of the crisis

Under the pressure of the English variant, 90% of the adult population would have to be immune to imagine loosening certain restrictions. Unthinkable objective in the country of vaccine-skepticism, especially since the current vaccine craze, slowed down by criticism against adenovirus vaccines, could well also experience a plateau.

3) The government has not yet seized the opportunity to promote combination prevention

The vaccine will not replace the mask or physical distancing anytime soon. The self-tests will not be a parade for unvaccinated. Border control will not cease once half of the population is vaccinated. The health passport will not replace barrier gestures. While the crisis promises to be lasting, combined approaches should be supported: vaccine + screening + trace / isolate + barrier measures + treatments + self-tests + study of wastewater … control of viral circulation.

4) The school remains the weak point in the management of the pandemic

Where Austria imposes work-linked schooling and 1 million self-tests for 9 million inhabitants, France provides for 300,000 to 600,000 of these tests, which moreover are optional. The last weeks of May will be crucial to assess the impact of the reopening of establishments with the current protocol.

5) Uncertainties remain around the deployment of self-tests

The scientific council (opinion of April 19) sees it as a means of securing the most vulnerable people in the face of the virus, and of removing the asymptomatic from the chains of transmission. But many questions remain open as to the appropriation of these “real life” self-tests. Starting with the level of supply, acceptability, as well as the “tracing” for case positive.

6) The security threat is not taken into account

While hospitals are saturated, what would happen in the event of attacks similar to those of November 2015? Let us hope that this confrontation of health and security threats will only be encountered in the electoral debate.

Prof. Gilles Pialoux is head of the infectious and tropical diseases department at Tenon hospital, Paris XXth. He is part of the PandemIA collective, and is a member of the Terra Nova health center.


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