Tribune. In November, we warned of the risks of “stop and go”, alternating confinements and contemporary deconfinements of multiple waves, such as the one beginning before our eyes. Have we failed yet? Is the pandemic still a wave ahead? The magnitude of the second wave surprised us, because of several factors: a relaxation, obvious this summer, barrier measures, then the seasonal cooling conducive to the spread of the virus, more resistant to cold and humidity, with a greater probability of finding it in a confined environment.
The pandemic has changed in nature as well. The 25,000 Covid mutants described so far had no obvious consequences for the history of the disease. However, two new mutants have appeared (UK and South Africa), much more contagious, apparently without consequences on virulence. These mutations facilitate the entry of the virus into cells and increase the quantities produced in saliva, the main vector of transmission. Do they also change the resistance of the virus in the environment? Its ability to evade the immune system? The emergence of these variants also poses the problem of the sensitivity of PCR tests, the effectiveness of our strategies to identify them and limit their dissemination, and above all the potential consequences on the effectiveness of vaccines.
Wastewater monitoring
While the improvement in resuscitation techniques (less invasive oxygenation) and specific treatments (corticosteroids, anticoagulants) made it possible to reduce mortality from 40% to less than 25% in severe patients, excess mortality was observed during the second wave , raising many questions. Could this be an “accounting” effect, since many deaths from the first wave were not recognized as Covid because they were not diagnosed, or a consequence of its longer duration?
Our inability to better manage deconfinements, by anticipating the recirculation of the virus, is also in question. Our group had shown that monitoring the presence of the virus in increasing quantities in wastewater made it possible to announce the rise in the incidence of the disease, and its consequences on hospital influx and deaths. The work carried out within the framework of Obépine network in particular warned about the return of the virus, as of June 20, the “individuals-centered” indicators not having noticed this recirculation until a month later.
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