Covid-19: the French are now solely "responsible" for the waves, by Professor Pialoux

We have once again entered a “pivotal period” of the “war against Covid”. War less visible with regard to the international situation, but which is not for all that over, as recalled by the Covid 19 Scientific Council in its opinion of March 11, 2022. Weapons (vaccines, immunity, treatments) such as viruses have changed, but as these lines are being written (March 19) the figures for the resumption of the epidemic are parading on the banners of the continuous news channels, under the images of the Ukrainian disaster.

More than 180,000 new cases, 1,605 patients in intensive care, a transmission rate of the BA.2 sub-variant at 1.29 (R0), 928 new cases per 100,000 inhabitants at the national level (2,000 in Martinique… ), a positivity rate of 26.9% and an increase in the number of screenings. Above all, the “cold” sold to us by a handful of TV studio “epidemiologists” still kills 140 people a day. Real Covid deaths, as demonstrated by a recent German study published in The Lancet Public Health : 86% of autopsies confirm that the people died because of the Covid and not “with” the Covid.

This indisputable epidemiological inflation, a real variant factory, should remain “under control” or at least “controlled” in the long term in hospitals, according to models from the Institut Pasteur. This sixth wave would be much smaller than the fifth. This is good news and we believe in it. Note all the same that the Pasteurian models do not (yet) integrate certain variables, such as the possibility of reinfection, which is greater with Omicron, and the existence of another sub-variant, BA.1.1, which presents the ability to spread even faster and to better circumvent the immune system. They also do not include the decline in immunity acquired over time (de facto too optimistic scenario) or the arrival of sunny, airy days (too pessimistic scenario).

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The end of the obligation is not an incentive to let our guard down

In the hospital field, where the decline of the Covid has stabilized, the flight of nursing staff (mainly nurses) amplifies pessimism. In my own department of 28 beds at Tenon Hospital, next June there will be 36% vacant nursing positions – a first in twenty years – there it is true where other departments are at 70%. The hospital context changes from one wave to another. Worse. Lack of attractiveness and exhaustion on top of that.

But the debate shifts. France in its lack of public health culture, if we compare ourselves to Denmark for example, has never been ready to develop and gain acceptance of a “population-based” approach, or targeted measures for certain populations. Because we consider that when we target, we stigmatize. Therefore, lifting the obligations (mask outside then inside, vaccination pass) imposed on everyone to protect the most vulnerable (the oldest, the immunocompromised, the unvaccinated, etc.) is experienced as the end of forbids it. Like a tacit incitement to let your guard down completely.

During these months of February and March, we therefore moved from management by obligation to management by accountability. Without in-between. As if every Frenchman had the cognitive means to choose whether or not to be sick, or whether or not to participate in a chain of transmission that can lead someone to intensive care. As if public health prevention were a binary system: on/off, all or nothing. Eric Favereau, in his column of Release of March 22, summed it up well: “As if there was only the obligation as a barometer of our attitudes,” even though the authorities had the means to “promote adult, citizen and measured public health.” .

The European director of the World Health Organization, Hans Kluge, recently denounced “those countries where we observe a particular increase such as the United Kingdom, Ireland, Greece, Cyprus, France, Italy and the ‘Germany […] countries that have suddenly lifted the restrictions from ‘too much’ to ‘not enough'”, while recalling the challenges ahead to “get rid of the pandemic”: “protecting the vulnerable, strengthening surveillance and sequencing, providing access more countries to new antiviral drugs and tackle the post-Covid or long-Covid burden. No, definitely, the epidemic is not over.

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Professor Gilles Pialoux is head of the infectious diseases department at the Tenon hospital (AP-HP), in Paris, member of the health center of Terra Nova and vice-president of the French Society for the Fight against AIDS. He just published Like a slight tremor (Editions Mialet/Barrault).