“We no longer talk about deaths. It’s appalling”, is indignant Jean-Marie Robine with franceinfo. Since the start of the epidemic, this demographer has been identifying and analyzing mortality figures with a group of researchers from the National Institute for Demographic Studies (INED).
But, two years after the first cases in France, the deaths of Covid-19 no longer make the headlines. Yet the virus continues to kill. According to the latest count published by the health authorities, since November 1, more than 20,000 people have died in hospital or nursing homes after being tested positive.
But what realities do these figures cover? What are the proportions of vaccinated and non-vaccinated among these victims? Have all the dead carriers of the virus succumbed to Covid-19, or are other pathologies sometimes involved? What are the most bereaved territories? To lift the veil on the profiles of the dead of the fifth wave, franceinfo sifted through epidemic data and collected the analysis of doctors and researchers.
How many deaths “with” and “of” Covid-19?
This question arises because of the scale of the number of contaminations. Started at the beginning of November with the awakening of the Delta variant, the fifth wave was carried by Omicron from the end of December. However, the extraordinary transmissibility of this new variant and its increased capacity to escape the immunity acquired thanks to the vaccines caused an unprecedented explosion of the cases of Covid-19. More than 15 million people have tested positive since November 1.
Result: the probability of being hospitalized “with” Covid-19, and not “for” Covid-19, has also increased. According to statistics from the Ministry of Health, the proportion of patients in intensive care who are positive for the coronavirus but who have not been hospitalized because of it exceeded 20% at the beginning of February, while this rate was more around 5. % in the month of December.
What about deaths? The administration now publishes a count of Covid-19 positive patients who died in hospital according to their reason for admission. In total, 14.6% of them were hospitalized for a reason other than a Covid-19 infection between November 1 and February 6 (date of the latest figures published).
But these data remain very imperfect. They do not provide information on the medical causes of death, which is nevertheless the most relevant information for distinguishing the reasons for mortality. In reality, in hospitals, doctors call for the greatest caution when faced with this type of questioning. “It is very difficult to assess the mortality attributable or not to Covid-19. It seems to me as complicated on the form as not very robust on the scientific level”warns Professor Djillali Annane, president of the Union of Resuscitators, interviewed by franceinfo.
Did the victims die from the Delta or Omicron variant?
Throughout November and December, the Delta variant was almost the only one identified in PCR tests of Covid-19 positive people who died in hospital. But since mid-January, the Omicron variant has taken over. In the week from January 31 to February 6 (date of the latest data available), more than 80% of deceased positive patients were contaminated by Omicron.
Omicron is less dangerous than Delta, as recently confirmed in a British study conducted on nearly 1.5 million patients. But it remains fatal despite everything, in proportions similar to the first strain of the virus, responsible for the first two waves in France. “Omicron is no less virulent than the original strain of Covid-19. It is the same in fact. The only difference is that before, we had no treatment and no vaccine”explains Professor Djillali Annane.
The profile of patients who succumb to the disease remains the same as since the start of the epidemic: rather elderly people with comorbidities such as diabetes or cardiovascular problems.
“The difference is that with Omicron, we no longer see the severe lung damage caused by the previous variants. Instead, it is rather patients who decompensate for pre-existing comorbidities.”
Jean-Michel Constantin, head of the intensive care unit at the Pitié-Salpêtrière hospital in Parisat franceinfo
“The typical case is that of a diabetic patient, whose diabetes explodes”illustrated by Doctor Jean-Michel Constantin. “In this case, the patient will not die directly from Covid-19. But it is the virus that is responsible.”
What are the proportions of vaccinated and non-vaccinated?
The overrepresentation of the unvaccinated and people who had only received a first dose among the fifth wave deaths is particularly high. Between November 1 and February 6, 45% of Covid-19 positive deaths in hospital belonged to one of these two categories. This while they make up only 14% of the entire French adult population.
The distribution of deaths in hospital according to the type of vaccination schedule among people aged 60 and over (who represent more than 90% of deaths in the fifth wave) shows that among those vaccinated, these are mainly patients who have not received booster dose who have died.
Which territories are the most affected?
Unsurprisingly, the regions with the highest number of victims in relation to the population are also those with the lowest vaccination rates. The Provence-Alpes-Côte d’Azur region is the hardest hit: Bouches-du-Rhône, Var and Vaucluse are the three departments of metropolitan France where there have been the most deaths per inhabitant. They have between 47 and 50 deaths per 100,000 inhabitants. For Bouches-du-Rhône, this represents just over 1,000 deaths in total.
For Marseille epidemiologist Jean Gaudart, there is little doubt about the cause and effect relationship with the low vaccination rate in Bouches-du-Rhône. “It is likely that this under-vaccination, particularly important among the most disadvantaged, did not make it possible to stem the start of the fifth wave”analyzes this researcher from the University of Aix-Marseille.
On the side of the European hospital in Marseille, infectious disease specialist Stanislas Rebaudet shares this analysis, adding behavioral factors: “Our territory is also very urban, with a lot of mixing. Barrier gestures are also poorly respected by the population here”he says.
Finally, the Marseille doctors insist on the virulence of the Delta variant, which prevailed longer in the Bouches-du-Rhône. “Currently, half of the patients in intensive care in Marseille are still Delta patients”notes Bernard La Scola, professor at the IHU-Méditerranée Infection in Marseille.
How old were the French people who died during this fifth wave?
This has been a constant since the start of the Covid-19 epidemic: mortality is much higher among the elderly than among young people. A finding that is still true for this fifth wave, since nearly 60% of the dead are people over 80, an age group that represents less than 6% of the French population.
This share of those over 80 among the dead from the epidemic had fallen during the fourth wave, that of the summer of 2021. They were then more vaccinated against Covid-19 than the average French person. But the trend has now reversed: with 87% of people having received a first complete vaccination cycle, the over 80s are the least vaccinated age group among adults.
Those under 50 remain relatively spared, with less than 350 deaths since the beginning of November, or barely 2% of dead carriers of Covid-19 over this period. A figure, however, calls out: in metropolitan France, thirteen children under the age of 10 have died after having tested positive for Covid-19 since the start of the fifth wave, when there were only eleven in all the waves. previous ones.
Contacted by franceinfo, Christèle Gras-Le Guen, president of the French Society of Pediatrics, wants to be reassuring: “VSThis wave infected many more children than the previous ones, so we may have had children who died of something else after being tested positive. There are also children with chronic illnesses, in whom the fever due to Covid could trigger a crisis of the disease, and ultimately cause death.“
“Adult-like journeys of children, with one death linked only to Covid-19, are extremely rare, if not almost non-existent.”
Christele Gras-Le Guenat franceinfo
What proportion of deaths took place in nursing homes?
Elderly people residing in nursing homes are less affected by this fifth wave. The difference is clear compared to the start of the epidemic: while more than 35% of deaths during the first wave took place in these establishments, this share has only been 6% since November 1.
“Vaccination plays a key role in this decline“, says to franceinfo Annabelle Vêques, director of the National Federation of Associations of Directors of Establishments and Services for the Elderly. Residents of Ehpad are indeed vaccinated at more than 93% according to Public Health France, and 70% have received a booster dose Annabelle Vêques also recalls that the lack of masks at the start of the epidemic was particularly detrimental in nursing homes.
Is the mortality of the fifth wave comparable to that of the flu?
This comparison was made by some epidemiologists in January. Asked by The Parisian on February 17, Professor Jean-François Delfraissy also acknowledged that “the chronic aspect [du Covid-19] might look like the flu virus”. But the president of the Scientific Council tempered his remarks: “Just because the disease is endemic doesn’t mean it’s not serious”.
For his part, the demographer Jean-Marie Robine disagrees with this comparison. He explains that the flu episodes used to draw this parallel with the Covid are exceptional episodes, which are not trivial. “These excess mortality of 10,000 to 15,000 people per year due to influenza are serious and completely new: they reappeared in 2015 with the H3N2 variant and led to a number of deaths not seen since the Hong Kong flu. Kong in 1968”. Life expectancy in France had also decreased by three months in 2015 according to INSEE, a first since the 1960s.