Health between prudence and hope, what should we think of...

between prudence and hope, what should we think of the decline in indicators?

Resuscitation, death, contamination… Almost 15 days after deconfinement in France, these indicators are rather positive. Authorities are cautious and believe it is too early to draw conclusions, but some scientists no longer hesitate to say that the Covid-19 epidemic is behind us.

Downward trend

First crucial indicator, admissions to intensive care. Their “daily number (…) is still decreasing since April 8,” said the health agency Public Health France in its latest bulletin, published Thursday.

Currently, some 1,700 patients are hospitalized in intensive care for a severe form of Covid-19, according to the latest figures from the Ministry of Health. They were 2,200 a week earlier, and 7,148 on April 8 for the highest total ever reached (we were then in full containment, applied from March 17 to May 11).

Likewise, deaths are steadily declining. Between Wednesday and Thursday, 83 Covid-19 patients died, 58 in hospitals and 25 in nursing homes and establishments for the disabled. We are very far from the daily reports in early April: between April 5 and 6, there were more than 600 dead in the hospital alone.

In total, more than 28,000 people died in connection with the Covid-19.

All over France, this epidemic has been accompanied by excess mortality, underlines Santé publique France. This was “particularly marked in the Grand Est and Ile-de-France regions” and during the period from March 16 to April 26, with a peak during the week from March 30 to April 5.

This excess mortality “tends to return to usual levels”, according to the health agency.

She also observed a decrease in emergency visits to Covid-19, which “reflects a decrease in new contaminations”.

Caution of the authorities

According to health authorities, it is premature to rejoice.

“All we can say is that today we have no warning signal but that it is too early to draw from this observation that everything will be fine,” says Daniel Lévy. -Bruhl, head of the respiratory infections unit at Public Health France.

“There is a gap between what we measure today and what it corresponds to: what we measure today is still the benefits of confinement”

Mechanically, the lifting of the containment on May 11 will necessarily lead to an increase in the number of infections since contacts between people will multiply, warn the authorities.

“The whole point is to keep this increase within the limits of what is acceptable,” said Dr. Lévy-Bruhl.

The government’s dread is a return to the pre-containment scenario, with an explosion in the number of cases that would overwhelm the healthcare system.

To avoid this, he relies on a device combining tests, identifying people in contact with a positive case (or “contact tracing”) and isolating the patients.

For the time being, Public Health France has identified 46 outbreaks of infection (or “clusters”) across the territory. For the most part, the first cases date from before the containment was lifted.

“The optimistic vision is that the identification of a cluster is good news because it confirms the device’s ability to identify them and break the transmission chains,” comments Daniel Lévy-Bruhl, emphasizing the importance of “physical distancing and barrier measures”.

“The risk of a second wave exists, it is up to all of us collectively to ensure that it does not happen”

For some, it’s almost the end

Contrary to the dominant discourse, some scientists, minority but more and more numerous, judge that the epidemic is coming to an end.

“Eventually some sporadic cases will appear here or there (but) the epidemic is ending”, assured the controversial Professor Didier Raoult in a video posted on May 12.

A view held by others that the epidemic affected everyone she could touch. Their central argument: it is wrong to consider that the entire population is a target.

“A significant part of the population may not be susceptible to the coronavirus, because non-specific antibodies to this virus can stop it,” says epidemiologist Laurent Toubiana.

This opinion was shared by Professor Yonathan Freund, an emergency doctor at the Paris Pitié-Salpêtrière hospital. He was struck by the drastic drop in the number of infections among his colleagues compared to the start of the epidemic.

“In the emergency room and in the hospital, we are particularly exposed. If the virus circulated as much as before and we were all likely to be affected, we would have been infected between us or we would have been by the sick” , he explains.

“Now, the vast majority of doctors have not been affected at all. This is pure speculation but it could mean that people have natural or acquired immunity”

This hypothesis was raised by American researchers in the specialized journal Cell: according to them, 40 to 60% of the population could be immunized against Covid-19 without even having been exposed to it. These individuals may have acquired this protection by being exposed in the past to other coronaviruses that cause common colds (this is called “cross-immunity”).

In this hypothesis, the new coronavirus would no longer have many people to infect.

“This virus is not a marathon runner, it is a sprinter: it runs out very quickly”, sums up Professor Jean-François Toussaint, director of the Institute for Biomedical Research and Epidemiology of Sport (Irmes), who also does not believe in a second wave.

When are the answers?

Since the containment was lifted, the government has reiterated that it will take at least two weeks to start seeing more clearly.

“Maybe next week we will have elements,” says Dr. Lévy-Bruhl.

“The sword of Damocles” of a “resumption of the epidemic dynamic is still present and could even lead in a worst-case scenario to a need to reconfigure”

This is why he considers it “premature to base hope on cross-immunity”, a hypothesis “far from being unanimous and far from being comforted”.

According to him, “above all, we should not send the message to the population that everything is fine because we realized that everyone was protected”.

“I understand that we are very cautious about the idea of ​​making a new prophecy, because everyone was so wrong at the start and me first,” argued Professor Freund for his part.

After having detailed on Twitter his hypothesis of an end of the epidemic, he scans the trials in irresponsibility:

“It is not a question of giving truths but I say my impression as a scientist, researcher, professor, and I do not see why I would not say it”.

“We must stop infantilizing everyone,” he said. “If I am ever wrong and there is a new circulation of the virus, well we will see it and we can take action.”

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