Home » Health » Living with the virus or trying to get rid of it? France at the time of the debate on the “zero Covid” strategy

Living with the virus or trying to get rid of it? France at the time of the debate on the “zero Covid” strategy

The emergence of new variants has revived the debate: should we be content to limit and mitigate the Covid-19 epidemic – with the desire to spare economic activity and preserve the psychological health of the French – or else should it put in place much firmer measures in a logic of suppression? The first strategy requires a very rapid adaptation of the measures to the health situation (“stop and go”), while tolerating a certain threshold of virus circulation. The second envisages drastic measures in anticipation, without waiting for an outbreak in the intensive care units, as well as very close tracing of cases using different tools. In The world, a collective of doctors, economists and political scientists signs a platform and pleads for this solution.

France believes that it is able to maintain control over the epidemic. No new generalized containment. Here is the course. At least for the moment. “The objective that we must set ourselves is not to delay this deadline, it is to do everything possible to avoid it“, declared the Prime Minister, Jean Castex. The measures will be reinforced “whenever it is necessary”, he added. Implied: when the indicators are bad. This tough choice offers a variety of answers depending on the state, but Germany seems to be accelerating, keeping schools and non-essential businesses closed or by closing some of the Bavarian borders (Czech Republic, Austrian Tyrol).

Several German virologists now want to use the recipes applied at the start of the epidemic in some Asian countries. Australia and New Zealand are also cited as examples. New Zealand Prime Minister Jacinda Ardern did not hesitate to declare three days of confinement for the 1.7 million inhabitants of Auckland, after the discovery of three positive cases. These situations, it is true, are sometimes difficult to compare with France, both for geographical reasons (insularity, population density, etc.) and for the acceptability of the tools mobilized (South Korea has very heavily resorted to location data, for example, and even credit card statements).

While the situation remains tense in French hospitals, without so far reaching the outbreak of March or November, several members of the Scientific Council have recently defended the idea of ​​preventive confinement. But always on an individual basis, without these positions being the subject of a joint proposal or an official opinion sent to the government. Interrogates by The world on the “zero Covid” strategy, epidemiologist Arnaud Fontanet was satisfied with the following formula: “A little too far from the current arbitrations. Interesting subject moreover. “

In mid-December, around twenty scientists had co-signed an appeal, in the review The Lancet (in English), to put in place stronger measures. The expected health benefit was not the only argument put forward. While mitigation strategies aim to maintain activity, the authors emphasized on the contrary that “the economic cost of confinements increased with their duration” and that it was therefore counterproductive to allow such a deleterious situation to take hold. Taking 300 new daily cases per million, and ten contacts per case, they estimated that 3% of the population should remain in isolation. With, as a consequence, a very strong reduction of the “Workforce”.

Relaxing restrictions, and therefore accepting a higher number of cases, is a short-term strategy that will lead to another wave, and therefore at higher costs for society as a whole.

Collective of researchers

in “The Lancet”, December 18, 2020

In addition, the implementation of drastic measures would make it possible to reduce the number of cases and make tracing efforts effective again. Controlling the spread becomes difficult, if not impossible, when the epidemic reaches too high thresholds. For the tracking to be effective, it would be necessary “ideally” less than 1,000 new cases per day, estimates epidemiologist Antoine Flahaut, interviewed by the AEF agency, and “in any case below 5,000”. France is far from it. In February, the cruising speed is around 20,000 new cases per day.

“The more strict and general the confinement, the shorter and more effective it will be”, adds the researcher, great promoter of this strategy. He expects a reduction in R0 [le nombre moyen de personnes pouvant être infectées par un malade] to 0.7 which could allow, each week, to halve the number of daily cases. If France chooses strict containment “for a few weeks”, even before entering “acute crisis”, she can again commit to a sustainable ‘zero Covid’ strategy ” which will reopen bars, restaurants and cultural venues. It is also the analysis of Bruno Riou, medical director of the AP-HP crisis, author of a recent article published. in The world.

Let’s confine quickly, hard, but as little time as possible and better manage our deconfinement. Let us give ourselves the means to meet together on the terraces in the spring.

Bruno Riou, APH-HP crisis medical director

in a forum at the “World

With the prospect of a new exit from confinement, there is no point in reducing the number of cases without then having appropriate tracing tools. Some specialists also regret a missed opportunity last summer, after two months of confinement (March 17 to May 11). The number of cases had then fallen to its lowest point, to less than a thousand cases per day. It was first possible to identify and trace the new cases “for a certain time”, explained infectiologist Anne-Claude Crémieux on France Culture, but during the clusters episode in Mayenne, we were “unable to break the chains of transmission”.

The tests were very long, we did not have the teams trained in sufficient numbers and we did not have a public health strategy. This is what we missed.

Anne-Claude Crémieux, infectious disease specialist

on France Culture

Early containment is therefore not sufficient. And if the testing capacities are now much higher than last year, we also need efficient tracing tools and large teams. After having drawn up the report of this failure of July 2020, Anne-Claude Crémieux therefore considers that we should rather “to put our efforts in vaccination which is also a suppression “. This also seems to be the government’s bet, but we will have to wait a little longer to see the first effects of the campaign. “Vaccination coverage of 50% of the population could prevent a rebound”, explain to Figaro Samuel Alizon, research director at CNRS. “But in some densely populated areas, it will be necessary to go beyond”, he adds.

The barrier gestures, the curfew and the closures of certain places are therefore the only measures to limit the cases, while waiting for the vaccination campaign to bear fruit. A year after the start of the pandemic, collective immunity acquired “naturally” still seems so remote. To date, France has in fact recorded 3.5 million cases, which corresponds to 5.22% of the population. And while this number may be underestimated (reported cases), the threshold required to achieve this hypothetical group immunity (60% or more?) Still seems unattainable.

For this strategy to work, Europe would have to behave like an island, and not an addition of countries, because of the physical borders and traffic between member states. “It would not work at the level of France only but it would take the agreement of the 27 European countries to get there”, summed up at the end of January the epidemiologist Mahmoud Zureik, hardly convinced, in The Parisian. A international petition in favor of the “zero Covid” strategy, which has already collected 100,000 signatures in one month, therefore underlines the need “to act quickly and simultaneously in all European countries “ to avoid “a ‘ping pong effect’ between countries and regions”.

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