Positive caregivers will be able to continue working under certain conditions, “a transitory plastering to allow to pass the acute course” with this explosion of contaminations in France, says Professor Bruno Mégarbane, head of the intensive care unit at Lariboisière hospital in Paris.
Guest of franceinfo, he reacts to the “good strategy” announced by the government by relaxing the isolation rules for positive people and contact cases. Bruno Mégarbane believes “that today we have on the territory a million people carrying the Omicron variant and therefore, in fact, almost 10% of the population who could be contact”. “In practice, it is realism that takes precedence”.On the other hand, he says to himself more “Reserve” on the return of the mask outdoors from 6 years old.
franceinfo: Positive caregivers will be able to continue working under certain conditions. Which ones?
Bruno Mégarbane: The conditions are extremely drastic to allow contaminated, and therefore positive, nursing staff to be able to work. First, of course, it must be asymptomatic. In addition, the agreement of the department head and management is required. There must be a real need, that is to say that all other possibilities have been explored and that, ultimately, there is a shortage of staff and the absence of this caregiver leads to the closure of the beds, and of course, he has to take care of patients who do not have any particular risk for him to take care of them himself. So, in practice, the positive caregiver will only be able to work in a positive Covid sector. The risk is extremely measured. At the hospital, we work with strict compliance with barrier measures and caregivers wear FFP2 masks, especially when dealing with Covid patients. In fact, contamination is reduced, if not zero. Of course, there is always a risk, but it is a minimal risk strategy between putting a positive but asymptomatic caregiver to work and closing beds. I believe it is even better to be able to take care of patients who need it.
Will this resolve the staffing issues within the public hospital?
It is one solution among others to be able to overcome this difficult course, the possible influx of Covid patients linked to the Omicron wave. Obviously, that does not solve the basic problem at all, which is a deprived public hospital, a flight of nursing staff who are no longer motivated, who no longer find satisfaction in working at the public hospital. It is a transitory plastering to allow to pass the acute course. Afterwards, we are of course waiting for a structural reform of the public hospital, we hope as soon as possible, in any case very clearly, the future President of the Republic will have to take it up immediately after his election.
The Minister of Health has also announced the isolation of positive people vaccinated, which will be of the same duration, whatever the variant, seven days, or even five, if the test is negative. It was ten days before for the Omicron variant. Is this measure consistent?
Yes, it is consistent in the sense that symptoms appear faster with Omicron because by being vaccinated, therefore immune, your immune system reacts very quickly when the virus is present. Also, the viral load peaks earlier and the viral load decreases faster, so the symptoms are shorter over time. And the virus is eliminated more quickly, thus perfectly allowing a reduction in the duration of isolation of positive people. In addition, when you go to five days, you must have a negative PCR or antigen test to be able to come out of isolation. Otherwise, you will do seven days in a systematic way. So, obviously, in the next two or three days, we will have to be extremely careful. In the United States, for example, the duration of isolation was shortened to five days, but it is recommended to wear an FFP2 mask.
Second scenario, the contact cases in the event of zero or incomplete vaccination will now be seven days of isolation, but the vaccinated contact cases will be able to work with a PCR test and then free self-tests. Do you think this presents an additional risk of contamination?
We are in a risk reduction strategy, given the extremely large number of infected people and therefore of people in isolation for contact. It has been estimated that today we have on the territory a million people carrying the Omicron variant and therefore, in fact, almost 10% of the population who could be in contact. Obviously, if we put all these people in isolation, we can stop large companies, industry, hospitals. So I think it’s a good strategy.
But is it more of an economic than a health concern?
Yes quite. If you don’t have a metro to go to the hospital to treat patients, what do you do? If you don’t have caregivers in the hospital because they are in isolation, what do you do? If you don’t have ministers or administration to run the country, what do you do? In practice, realism takes precedence. And it is true that the fact of doing a repeated test, that is to say this iterative testing strategy that we were also calling for in schools, in my opinion, will make it possible to minimize as much as possible the possibility of disseminating the test. virus, although obviously it is very clearly inferior to systematic isolation.
The mask from the age of 6, will it really be a plus to limit contamination?
There, I am more reserved. The balance of interests and disadvantages may be more in favor of the disadvantage, especially in open spaces. We have all said that contaminations take place in a closed, poorly ventilated environment and therefore requiring a mask in a child, in open space, in the street, seems to me of extremely low interest. I believe it is better, on the contrary, to let them breathe in the open air. Now, we understand that in this difficult period, it is necessary to give signals to the population of the potential gravity of the situation.
Olivier Véran says that “this fifth wave will perhaps be the last”. What makes it possible to say that today?
The virus in its natural history wants to find a balance with its host, which is humans. This one gains in immunity because of the various natural infections and of the vaccination, especially with the booster doses. And so, the virus will try to adapt, that is to say, give humans the fewest possible signs, the least possible morbidity, but at the same time be able to replicate and spread without any concern. In fact, future variants will be able to take on these characteristics, that is to say have a very high transmissibility like Omicron and, conversely, a more reduced virulence. However, this cannot be said definitively. We are not immune to a new mutation which may not yet have appeared and which causes a new variant to appear and which, again, leads to a cycle of pathologies. Today in hospitals, we are still in the Delta wave, but it is very clearly starting to level off. For example, in the service, for 48 hours, I have had no entry for serious Covid infection showing that the Delta wave is starting to level off, or even already to regress. The whole question is to know now if there will be entrants in intensive care at the hospital from Omicron contaminations. It takes another fortnight to be sure that this Omicron is really benign.