11:30 pm, October 8, 2022
The increase in contamination (+ 27%) and also in hospitalizations related to Covid-19 (almost 16,800 patients) continued this week. If the eighth wave that began in early September doesn’t worry the authorities, they still call on frail people to urgently receive a fifth (or new) dose of the vaccine. This position is obviously shared by the professor of infectiousness Anne-Claude Crémieux. In a book published Wednesday (see below), this acute health crisis analyst explains why frequent reminders are needed. He also offers several scenarios for the evolution of the epidemic.
In your book, you shed light on the causes of the previous seven waves of Covid-19. How to explain the eighth, which we face?
The first seven were related to the emergence of variants or sub-variants, hence a large number of reinfections. This crisis has highlighted the speed of light with which a pandemic virus can mutate. Three different variants in 2021, no virologist had foreseen it! The current wave, on the other hand, at least so far, is not related to the appearance of a new strain. The Omicron BA.4 and BA.5 sub-lineages that originated the seventh wave remain largely in the majority in Europe. Three factors can explain the increase in the number of cases: the return to school and the multiplication of social contacts; the increase in gatherings in closed places with the lowering of the temperature; and the decline in immunity – vaccine and / or linked to previous infections – in the population, in particular protection against infections, which is faster than that against severe forms of the disease.
Should we be worried?
If no new variant arrives, we can hope for a moderate impact on health, provided, however, we persuade those over 60 to make regular reminders. Because the protection against severe forms wears off after six months, making these reminders essential to avoid a wave of hospitalizations. But beware: last year, around the same time, we had been dealing with the same Delta variant for three months; then Omicron arrived in December. And the remarkable genetic variant surveillance system shows that the coronavirus continues to evolve into Omicron descendants who escape immunity even better. It is not yet known whether these, or others, will replace the current strains.
Read also – Vaccination against influenza and covid: “There is a relaxation in the perception of contagion risk”
Do you still have to isolate yourself in the event of Covid-19?
Yes, of course, it is the only way to stop the transmission of the virus, one of the pillars of the fight against this infectious disease, with vaccination, the use of masks and the massive use of tests, in particular self-tests, a small revolution. of prevention at home.
The Covar, who succeeded the scientific council, are evaluating the possibility of restoring the obligation to wear a mask in closed places. You understand it?
I understand that the authorities are thinking about it. In 2020-2021, to protect the population, the virus had to be stopped at all costs. But today the fragile population is protected by the vaccine and the situation is better. Fatigue awaits. It is more complicated to impose an obligation. One certainty: a surgical mask reduces the risk of infection by two thirds and an FFP2 by 80%. It is also a very effective tool against the flu.
You dispelled the “herd immunity myth”. Is it really out of range?
Above all, I tell the story of our hopes and disappointments. The hope was January-February 2021: RNA vaccines arrived with a promise of protection against infections in the order of 90%. We thought we were dealing with “sterilizing” vaccines, that is, very effective against virus transmission and therefore against transmission. The disappointment dates back to the summer of 2021, when a rapid decline in protection against infections was identified. The emergence of more vaccine-resistant variants then ended up demonstrating that collective immunity was inaccessible. Vaccines are not protective enough and this protection is not long enough.
Also build different scenarios for the future of the pandemic. Which do you think is more likely?
The very optimistic scenario of a virus eradication is ruled out. For such a feat, achieved only with the smallpox virus, highly effective vaccines would have been required, conferring long-lasting protection; a massive vaccination campaign around the world; the absence of asymptomatic forms that are difficult to identify; and the absence of an animal reservoir for the virus. Even the second scenario – that of collective immunity, sketched in 2020 with the arrival of RNA vaccines, as for measles – seems out of reach. It therefore seems more likely an endemic scenario, with new waves of infections, more marked in autumn or winter as for the flu or other respiratory viruses. We live with the virus. Without trying to stop its circulation as in the time of childbirth, but protecting fragile people from severe forms of the disease.
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The very optimistic scenario of a virus eradication is ruled out
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Why are frequent recall campaigns needed?
Today, with the Omicron variants, the protection against infection offered by the original vaccines is limited and short-lived. The one against severe forms is longer lasting, but begins to decline after a hundred days and the decline becomes very significant at six months. Hence the need for a recall every six months in people at risk.
How big is this drop?
Twenty studies have attempted to evaluate it. Their results vary according to the definition adopted for severe forms and the countries studied but, roughly, after three doses it goes from 85% efficacy to 65% after six months.
Does the number of people who received a second recall as part of the revaccination campaign launched in March seem sufficient to you?
Only 35% of 60-79 year olds and 48% of over 80s admitted to the fourth dose received it: this is largely insufficient. This is not a French problem: the European average is 15% among the over 60s. People did not quite understand the meaning of this second reminder because, in the spring of 2022, the communication from health authorities and governments was not clear enough. However, in order to protect yourself, you have to understand.
What would be the clear message to convey to the population?
Protection against severe forms is very good with all vaccines currently available, but it is declining. At the end of the six months, it must be reconsolidated by redoing a reminder to be well protected again.
Why are only people over 60 and young people at risk invited to receive a fifth dose this fall 2022?
It is real life that drives health recommendations. Today, in hospitals, patients are elderly and suffer from various comorbidities.
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Are the bivalent vaccines – second generation -, which are arriving in GP’s pharmacies and clinics these days, really more effective?
By re-stimulating the immune response, the booster with the original vaccines restores excellent protection against severe forms. Studies dedicated to boosters with the bivalents adapted to the Micron show that against BA.4 and BA.5 the level of neutralizing antibodies is a little higher but it is not yet known whether this translates into better efficacy in real life. . The US authorities pushed companies to produce vaccines directed against BA.4 and BA.5 in the hope that the closer we got to the circulating strain, the better our protection would be. This is a strategy used for the flu.
Why have the messages often been difficult to decipher since the start of the pandemic?
Having worked a lot on prevention, I know that we can and must say everything, not to hide worrying or apparently too complex information. The clearer, more fluid, transparent and unfiltered the information, the better the public can understand what is happening, face dangers and protect themselves. The truth is reassuring; concealment concerns. In March 2020, at the time of the first confinement, citizens suddenly discovered the gravity of the situation while the speech of the authorities, in France, but also in the United Kingdom or the United States, had been reassuring until then. This has led to a breach of trust between much of the population and governments.
This is a systematic trend that can be observed in many crises. The reflection of leaders in the face of a phenomenon that disturbs them is to reassure themselves and reassure the population at all costs, which leads them to minimize the gravity of the situation and to react late. Are the Chinese and then the Italians seriously affected? It is because of their healthcare system or their decentralized organization, we are told. It’s like the flu, we were also told when the Chinese Center for Disease Control wrote in mid-February that 20% of patients needed oxygen. We preferred to assume that 80% of them had “benign” forms.
Has France learned the lesson of the crisis?
Not yet and I hope it will. The crisis has exposed the flaws in the health system but also the failure of public health on the ground. In 2020, unlike South Korea or other Asian countries, we found we don’t have the means to stop an epidemic. We were sorely lacking tests and teams capable of breaking the chains of contamination. The other lesson would be to prepare our leaders for large-scale health crisis management to prevent the same mistakes from happening again. After two years, current leaders have learned to govern in the fog of crisis, but what about tomorrow’s? Firefighters or army training for fire or war. Who wants to live in a country where firefighters don’t train?
A critical x-ray of the management of the health crisis
It is an excellent science popularization book to better understand the current evolution of the epidemic. It is a scalpel X-ray, but without a polemical spirit, of the management of the health crisis. In Citizens have the right to know (Fayard, Wednesday in the bookstore), Anne-Claude Crémieux, professor at the Saint-Louis-Université Paris Cité hospital, continues the transparency work begun in the media. His reinterpretation of the failure of masks, in light of the scientific uncertainty surrounding their usefulness, is one of the book’s salient moments. As well as the part dedicated to the four errors, due to cognitive bias, frequently committed by Western political leaders since 2020. To close it, one does not feel serene – the lessons of the crisis have not been learned – but more capable of protecting one’s health. This was precisely the intention of the author, who he likes to say: “The truth is reassuring, even when it is worrying. ”
