23h30, le 1 mai 2021
Author of recent Conquer epidemics (Hugo et Cie), Didier Pittet, Swiss epidemiologist and hygienist, famous for having co-invented the hydroalcoholic gel, of which he is the tireless promoter, is completing a mission on the evaluation of the health, social and economic management of the crisis in France during the first two waves. His report will be submitted in a few days to Emmanuel Macron. He responds to the JDD on the state of health of the country and on the deconfinement schedule announced by the Head of State.
How do you analyze the situation of the epidemic in France?
The country is still on a high plateau. This is explained by the choice that was made during the second wave to arbitrate in favor of social, psychological and economic criteria, to bet on the curfew, to leave the schools open – they are not hotbeds of over-contamination. but their frequentation nourishes social exchanges. Because of this high plateau, there is a risk of a fourth wave, even in summer. If the population slackens too much, if compliance with barrier measures drops, the rebound will be faster. With always vigilance on saturation in intensive care: the rate of hospitalization and the protection of health systems remain the key criteria. The vaccines will work wonders, but not right away. Because by adding the number of people infected and vaccinated, who have acquired natural or vaccine immunity, we do not reach 30% of the population on average, although this group immunity may be higher in some regions. However, because of the new variants, it would be necessary to arrive at 80%. The virus therefore still has a large playing field.
Is it relevant to reopen the country in a graduated manner?
The program proposed by your government makes sense. Most European countries are doing this gradually, in stages, with gauges and health protocols. There is no scientific proof that one method is better than another. But it is consistent: the contaminations are never mysterious, the virus is transmitted gradually, when there is no mask, no frost, or social distancing, as in families where most often everyone falls. sick at the same time. We know that we get infected more in nightclubs than in restaurants, and more in bars than in cinemas. This is why the discotheques remain closed… In France, the reopening plan in stages is conditioned on a threshold of 400 new cases per 100,000 inhabitants. There may therefore be disappointments if certain departments or regions have to wait before such or such reopening.
“
Some public events such as concerts or festivals will need to have strict screening protocols
“
Is the vaccine a lethal weapon?
The data from Israel and the United Kingdom are clear: fewer deaths among vaccinated people, fewer hospitalizations and less transmission of the virus. Even among young people between the ages of 18 and 25, as a pre-publication study conducted in Israel shows. Another, British, proves that a vaccinated person in an infected family escapes the virus. The strategy of prioritizing the most vulnerable is relevant but, once the shortage of doses affecting Europe – apart from the United Kingdom – is completely absorbed, the injections will concern everyone and therefore be able to further slow down the circulation of the virus. because young adults have more social contact. Vaccination will help us get off this high plateau. But we cannot bet everything on it to prevent a fourth wave, because, in the light of the British data, we see that the brake does not start to be really powerful until the moment when 50% of adults have received at least dose [En France, 3 adultes sur 10 ont reçu une injection, NDLR]. Then, when a majority of the population has been vaccinated, only a small proportion of those vaccinated will become infected. [les vaccins ne sont efficaces qu’à 90 ou 95 %, et chez certaines personnes fragiles ils le sont moins]. There will remain small residual clusters that are easy to define.
What other tool should we bet on?
For at least a year, we will have to respect the barrier measures and continue to test massively to understand and break the chains of transmission, to identify the new variants. We forget to say that the current success of the United Kingdom is also due to the massive use of tests. In France, we test a lot more than in other countries, in particular because the tests are free; we must keep this pace, otherwise it will ruin the efforts of recent months. Some public events such as concerts or festivals will need to have strict screening protocols. The self-tests are not an absolute game changer but an additional tool, to be repeated before each party or visit to an elderly parent; and even once or twice a week at school or in companies, or even by pooled PCR tests. The self-test can only work if the positive people then isolate themselves carefully and a confirmation by PCR test is obtained, in particular to track down the variants. And the fact of testing oneself allows citizens to take responsibility, a major axis of any prevention policy.
“
Autumn will not be easy, without being as painful as last year
“
Will we be able to revive normally in the fall?
Fall will not be easy, without being as painful as last year. Many people will be vaccinated, but group immunity will not have been achieved. Not to mention that the flu is likely to circulate more this year than last year, when containment in Australia had prevented it from thriving in the Southern Hemisphere. The population’s immunity against this virus is therefore less than a normal year; we will have to vaccinate more against him.
When can we return to normal life?
Many were angry with me when I said that it would certainly not be possible before 2022. But it is a new family of coronavirus that is settling among us! At age 20, we are all immune to the four families of coronaviruses that cause colds. This gives an order of magnitude of the time it takes for our body to gradually become immune to Sars ‑ CoV ‑ 2. Each new person vaccinated reduces the pathogen’s playing field and therefore the duration of the crisis. I believe in the intermediate scenario of an end to the epidemic in Europe in ten to twelve months, thanks to vaccination, tests, respect for isolation, and the application of barrier measures. Then, Sars-CoV-2 will be one of the coronaviruses we have lived with for hundreds of years.
Do you fear the dark scenario of vaccine failure due to variants?
This disaster scenario is not the most likely, but it must be considered to guard against it. Today, it is the English variant that worries the most in Europe, even if it does not hinder the effectiveness of vaccines.
Betting on adherence to barrier measures in France, isn’t that naive?
Changing behavior takes a long time. The real refractories are as few as the repeat offenders. As we have seen with the mask, people gradually understand that they have to be careful, to protect themselves and also out of good citizenship, to avoid transmission and protect the most vulnerable. Like the communication campaigns, the role of certain opinion leaders is capital: the surgeon boss who systematically rubs his gel hands in front of the interns indirectly reduces nosocomial infections in his department by his example; such a great football champion who would commit to defending barrier measures would have a significant impact throughout the country.
WHO launches clean hands operation on Wednesday
Co-inventor of the hydroalcoholic gel for which he has transferred the patent free of charge, Didier Pittet imagined World Hand Hygiene Day in 2009. Goal ? Promote the fight against nosocomial infections in hospitals, responsible for around 5 million annual deaths worldwide. This Wednesday, May 5, the event organized under the aegis of the WHO and Unicef aims to mobilize caregivers but also the general public. “Rubbing your hands for a few seconds when getting out of the metro or returning to a loved one is enough to save lives,” insists Professor Pittet, who recalls that it took twenty years to convince hospital staff to give up water and soap less effective than gel. “Admittedly, many people still find it difficult to comply with barrier measures against the virus, but prevention is still a long and difficult road.”
—
