Karine Lacombe is the head of the infectious disease department at Saint-Antoine hospital (Paris). She has also become a familiar face on television sets since the first wave of theCovid-19 epidemic. She is the main character of a graphic tale recounting those trying months. While the second wave is here and general containment reinstated, she says what could have possibly avoided it. And ensures that it is important not to wait any longer.
You co-sign with a designer a graphic story telling the first wave (1). You already mention the second.
At the beginning of September, many specialists said that we would have an early second wave. It only arrived a week earlier than we had modeled. It was difficult to predict its intensity. The impact of measures that were not taken or poorly applied.
You signed a forum asking for masks to be worn for 6-year-old children. Are you satisfied?
It was difficult to get across. Children hardly ever get sick and are more infected than infectious. But they can be a vector of the virus and infect their parents. It is a complementary measure, which is not sufficient in itself. I often quote the Emmental strategy. Adding up the relevant measurements is like stacking slices of Emmental, you end up plugging all the holes. If we had done it right, we might not have needed a general reconfinement.
What did we miss?
A whole series of things. We had the tools, but some were poorly applied. Teleworking should have continued on a massive scale in September. Apart from the big American companies, no one has. Contamination in companies over the past two months has not occurred during work itself but during lunch breaks or moments of conviviality. In the hospital, too, the staff become infected especially during lunch breaks. It’s normal, the day is hard, we take off the mask, we talk with colleagues. It’s the same thing in universities, contaminations take place during intercourse… or during festivals.
What else ?
It would probably have needed a curfew during the summer but that would have been difficult to accept. The policy of non-prescription tests has clogged the labs, it would have been necessary to prioritize and test on a larger scale the contact cases of symptomatic people.
You have emerged as one of the rare female figs of the crisis. Do you regret it?
Many scientists and medical professors refuse to appear in the broadcast media out of self-censorship or to protect their personal and family life. We live in a very aggressive media world. When we dare to give a scientific opinion that we hope is enlightened; we get attacked. I have been attacked a lot on my physique while men were attacked on their ideas.
Who had the idea of playing the main character of a graphic novel?
The editors of Stock offered me the project in mid-March. I had already refused two book proposals to be released too quickly. I didn’t want to do hot reflections. I thought the idea of a graphic novel was great. When we chose the illustrator, we wanted it to be a woman. I knew Fiamma Luzatti’s blog. She often evokes medical issues. We contacted her, she was free. Fiamma came to the hospital very frequently until mid-April. She was really on board with the team. She met a lot of people, talked to the patients, including in sheaves. For my part, I took daily notes.
You do not only speak of the hospital, but also of your children, of your privacy.
We are not siled people. Especially not in a health crisis where the staff and the professional mix. It was important to show that we lived the crisis 24 hours a day.
One of the characters in your story is Livia, a fictitious patient, young but immunocompromised …
We hear this ambient speech which says that the patients in intensive care are old people who would perhaps have died a month later. This speech revolts me. But I also wanted to show that 80 is just an average. Someone with a hectic professional life can be affected or even shot down by Covid. This character, who is a mixture of real patients, no one knows that she has a weakness.
What is the current situation in your hospital?
We currently have the same figures for hospitalization and resuscitation as in mid-March. 75% of resuscitation capacities are occupied by Covid patients in Paris. We hoped not to exceed 50%. We send patients to private clinics. Surgical procedures are deprogrammed.
How is the morale of the nursing staff?
Many paramedics quit after the first wave, but the AP-HP also hired a lot. Those who lived the first wave are fed up, would like to find a normal life. In a way, the atmosphere is still less anxiety-provoking, we know how to take better care of patients. But we know that there will always be some who unscrew at an impressive speed. On the positive side, city medicine and the liberal system are much better organized. We can discharge patients who are still on oxygen and have home monitoring.
Do you expect the applause to return?
I do not believe it at all. We feel a great weariness and a little mistrust in the families of the patients. There can be a lot of aggression.
Will we pass the second wave without a cataclysm?
We have treatments that we didn’t have in March-April. We have all the equipment we need. If our capacities are overwhelmed, we may have to call in the military. But we will find the solutions. I cannot believe that in France we will see people die in the street or in the emergency room. Yes, a national re-containment was needed, to protect the less impacted areas which will be able to continue to welcome patients from elsewhere. It would have been very difficult if we had waited a little longer. We’re probably doing it two or three weeks late.
Could we still wait?
If we had waited three more weeks, we would have found ourselves in the dramatic situation that South America has known. We are already forced to deprogram non-urgent interventions for other pathologies, as for the first wave. We do not yet realize the impact that this has. We won’t know until next year, when the mortality data will be consolidated. But it does have an impact.
(1) The doctor, Karine Lacome and Fiamma Luzzatti, Stock editions, 160 pages. Released on November 4.
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