The peak of contaminations has passed and that of hospitalizations should not delay. France foresees an ebb of the seventh wave of Covid-19. But she came to remind us that we were not done with this pandemic, which continues to kill, cause after-effects and clog hospitals already in a recruitment crisis.
>> Deaths, hospitalizations… Follow the evolution of the epidemic in France
While most of the health measures have ended, many French people were no doubt hoping to enjoy a summer vacation without having to worry about it, and to start “living with the virus”. Is this a possibility or a mirage? What will it take to change lastingly in our lives to live safely with Covid-19? Franceinfo interviewed epidemiologist William Dab, who was director general of health from 2003 to 2005.
France info: The wave of contaminations which began in June is paradoxical: it reminds us that we are not done with the epidemic, but its consequences in the hospital seem more limited. Do you find it alarming?
William Dab: When I look at the numbers [au 13 juillet, date de cette interview]we are at 1,500 hospitalizations every day, 130 daily admissions to critical care, nearly 80 deaths… I don’t call that a return to normal.
“For me, we are in a trench war. It is illusory to think that this pandemic is behind us. Where are we? The truth is that we do not know. Its evolution is totally unpredictable.”
William Dab, epidemiologistat franceinfo
The favorable scenario would be for contagious variants to impose themselves, but of a fairly banal virulence. The catastrophic scenario would be the appearance of a more contagious variant which circumvents the immunity acquired by vaccination or disease. We cannot draw trends for the future from observations of the past, we see that the Covid-19 does not work like that.
In this context, many cling to the idea that it is or will soon be possible to “live with the virus”, according to the expression popularized by Emmanuel Macron. What do you think about this idea ?
“Living with the virus” is a meaningless slogan. Obviously we’re going to live with the virus, since we’re not going to destroy it. No one (even the Swedes) is counting on collective immunity against a virus with such potential for mutation. But what does that mean? That we do nothing out of fatalism? Or on the contrary that it would be necessary to return to freedom-killing measures? I believe we can be smarter.
“The current pedagogy is completely deficient.”
William Dab, epidemiologistat franceinfo
First of all, it must be said that the pandemic is not over, that it remains a serious threat in the face of which we cannot remain passive. And people need to be told how to adapt their behavior to protect their health and empowered to do so.
In your view, what are the means that are not mobilized today?
We have individual tools, such as vaccination. I don’t know why we are down on the booster doses, not to mention the vaccination of children, when we have shown that we are capable of having a real mobilization in France. Then there are the barrier measures. It does not seem complicated to me to explain to people that there are circumstances in which the risk of contamination will be higher, such as in very busy and closed places – stations, airports, planes, trains, public transport… There, it is still not an unbearable constraint to ask people to wear the mask.
It all depends on their perception of the risk they run. Are there also messages to convey so that the French do not let their guard down?
We have studies that show that having been infected twice, three times, increases the risk of heart and lung complications, stroke or kidney problems. However, I do not hear the authorities warning the population that Covid-19 is not a mild infection.
“We can also remember that it is estimated that 2 to 3% of infected people have a long form, what is called a long or chronic Covid, the evolution of which we do not know at all.”
William Dab, epidemiologistat franceinfo
Brain imaging shows that the virus modifies certain structures of the brain. Is it temporary or does it foreshadow more serious complications? We don’t know anything today. This uncertainty, people have to know about it. If they are not told anything, they will not integrate this risk into their protection decision.
Finally, we can remember that there are hundreds of thousands of people in France whose immunity is weakened, in particular cancer patients whose chemotherapy is immunocompromising. They deserve to be protected. We have to think about it when we decide to wear the mask or not. If this altruistic reasoning is not enough, there is also a selfish reason to do so: we know that it is also in these immunocompromised people that new variants are most likely to emerge.
In other words, you see that living with the virus does not mean doing nothing. I know people have had enough. But they have to weigh the risk of them or their loved ones being hospitalized this summer, when there are places where the situation is extremely tense. If they do not want to protect themselves, it is true that it is partly a matter of individual choice. But our authorities could help people make choices and not just say: “What do you want? You have to live with the virus.” It is a defeatist message.
In your opinion, should this call for caution be accompanied by measures of obligation?
I think we have to try to send an intelligent message. There are a few high-risk places, such as trains and planes, where mandatory mask-wearing should be reinstated, if only to send the message that it’s not over. For the rest, you have to do what I call the ‘pedagogy of uncertainty’. Not knowing with certainty how this epidemic will evolve causes concern, it is normal.
“Telling stories, pretending that the epidemic is over and that we can move on, is preparing for a difficult tomorrow.”
William Dab, epidemiologistat franceinfo
Let’s give people epidemiological arguments, simply explained, so that everyone can learn to assess their risk and adapt their daily life decisions.
Then it’s like when you ski: you choose to ski on a green run or a black run. Some countries have adopted a color system linked to the epidemic situation. If we had one, almost all of France would be red today. This red means that when you are in closed or busy places, it is reasonable to protect yourself. I find that the French have shown that they are quite capable of responsible behavior.
Should we also hold this discourse about vaccination, when the recall campaign is not really taking off? By recalling, in particular, that the vaccine also helps to curb transmission? Part of the population seems convinced that it only serves to avoid serious cases…
The vaccine is not 0% or 100% effective. We started from a protection rate rarely seen in the world of vaccinology. Today, it remains good, around 70%. I remind you that it is rare for the flu vaccine to give us more than 50% protection.
It is true that the vaccine gives undesirable effects, for example myocarditis. But no health product has been as well monitored as this one. Almost all cases are mild, and the risk is known to be 10 times lower than that of myocarditis after Covid-19 infection. So the vaccine reduces the risk of myocarditis by 10. It’s good to take.
For the risk of contamination, it’s the same: yes, you can be vaccinated and contaminate your loved ones, but the risk is greatly reduced. If you wait for a vaccine to be 100% effective in all areas, you will not take any vaccine, against any pathology.
Do you think that regular booster doses are part of the adaptations we will need to “live with the virus”?
It seems possible to me. We are all eagerly awaiting the results of ongoing trials on bivalent vaccines, which incorporate a strain of Omicron. Hopefully, sometime in the fall, these vaccines will be available, and they will give us extra protection. We must also be aware that a new variant can completely change the game. But the scenario of having to boost our immunity once or twice a year cannot be ruled out.
Faced with the government’s discourse, part of the political opposition insists on another element: the lack of beds in the hospital. Do you think that with more resources and staff, it would be more possible to “live with the virus”?
Let’s face it: if we had not had 5,000 intensive care beds but 30,000 in 2020, we would not have been confined. We made the hospital adopt an industrial model of tense flow, in which there is almost no reserve. Are we continuing in this direction? Or does our society want to invest and leave 20,000 reserve intensive care beds, which can be mobilized in a few days? The answer is not only medical or epidemiological: when we know what the confinements have cost in terms of GDP, we can calculate a return on investment.
“If we oversize the health system compared to usual care, it is certain that we will be able to better absorb the shocks of the pandemic. I think that deserves a real debate.”
William Dab, epidemiologistat franceinfo
Is this the only investment that seems useful to you in the face of the risk of new waves of contamination?
No. No one knows what the battle plan for school air cleanliness is in view of September. It is also known that wastewater monitoring is certainly the earliest means of monitoring the emergence of new variants. And I haven’t heard any real plan about it.
And if the French, in a hurry to turn the page on the epidemic, abandon all restrictions and barrier measures, what consequences would we be heading towards?
In this case, if we again had a variant that escapes the vaccine and acquired immunity, who can say that we would not again be led to take partial or total containment measures?
We saw the previous wave. At the beginning of May, we were happy, because there was a very clear reflux. Then this decline became a plateau, the rate of reproduction [le nombre moyen de personnes à qui chaque malade transmet le virus] went back around 1, then 1.2, 1.3…
“The situation we have today was entirely foreseeable on May 15. If, at that time, people had been asked to apply again the measures which had been lifted in March, I think that we would not would not have this significant peak in the month of July.”
William Dab, epidemiologistat franceinfo
Obviously, I’m a doctor and a prevention activist, so I’m making the case. I’m ready to hear something else. But it seems to me that the balance between benefits and constraints is heavily tilted in favor of benefit. And the level of constraints seems so minimal to me…