Covid: let’s finally learn lessons without betraying the past, by Professor Gilles Pialoux

According to the World Health Organization (WHO), by the end of 2021, the Covid-19 pandemic would have caused between 13 and 17 million deaths worldwide (and not 6.2). That is half of the AIDS carnage in more than forty years. And this figure even reaches 18.2 million according to a recent study published in The Lancet. This does not prevent a few reassurances from television sets, ejected after the second wave because of blatant denial, from coming back through the window. With catchphrases that defy clinical and epidemiological reality: “This epidemic was indeed minor”, or even Sars-CoV-2 being “equivalent to a flu, a simple cold”. We pinch ourselves to believe it. Especially since this revision of history is nourished by aping them from the positions of militant specialists, like the famous declaration of Great Barrington which can be summed up in one point: useless to protect (containment and vaccination) the general population when it is necessary to target the most vulnerable. Just as worrying, in the glossy salons of the ministries and in the health agencies, the time is often for satisfaction: “We couldn’t do better!”

Yet any health crisis delivers more lessons on its failures than on its successes. On the success side: the first confinement, the “whatever it costs” and the support of the economy, the opinions of the scientific council, the vaccination rate in adults, the resilience of the public hospital, the vaccination pass, etc Failed sides: the filtering by the 15 (the Samu) of suspected cases and their referrals to the so-called “reference” centers from the first wave (model modeled on that of H1N1, Ebola or the heat wave), dance masks and protective clothing in hospitals in 2020, the failure of “test-trace-isolate”, the lack of human resources in regional health agencies, the failure of combined prevention and promotion of health, the failure of the transfer of innovation which made us wait for vaccines and treatments from elsewhere, the insufficiencies of State inspections (IHU of Marseille, Ehpad…), the failure of the transitivity of public action on certain actors such as city medicine, from the first waves to treatment with Paxlovid or monoclonal antibodies, the failure to set up a cordon sanitaire around the ventilation of premises, CO2 sensors and air purification, trial and error in school policy guided by the obsession with openness at all costs and that of the implementation of vaccination in children. Not to mention the lack of prioritization of vaccine combinations by the WHO, the unpredictability of waves of variants and XD-type recombinants and the initial unpreparedness to sequence quickly and well, as Denmark or Great Britain did. .

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Deeply transforming public health

Good news, however: to avoid further tragedies, research is preparing for future pandemics that could occur in the coming years. Professor Yazdan Yazdanpanah, director of the ANRS agency for emerging infectious diseases, thus recently regretted this situation: “I think we need to change the culture according to which all funding must succeed. We need to introduce the notion of risk into funding and accept that some will not succeed.” As a first step towards better understanding, the historical ANRS budget has been revised upwards: 80 million euros per year, ie 40 million for HIV, hepatitis and tuberculosis and 40 million for emerging infectious diseases. In the same vein, Public Health France and Inserm signed an agreement on May 16 aimed at supervising, strengthening and developing their collaboration in several priority themes, including emerging infectious diseases, modelling, environmental factors as well as health and social inequalities in health.

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Recall that the Pittet report had drawn up as early as May 2021, an unflattering assessment of French public health in Covid times: “In France, public health is quite fragmented. There are magnificent schools, renowned epidemiologists, agencies … But the latter come from a Ministry of Health now stripped of its forces”, noted the professor. The real challenge, in the long term, remains to profoundly transform public health in the light of the Covid crisis.

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