France – Vaccination campaign, main modes of contamination, targeted screening, antigen tests in the run-up to the end of the year holidays, remuneration for pre-vaccination consultations… All these issues were discussed this Thursday, December 10 during the press conference of MG France, which mainly focused on the role that general practitioners should play in deconfinement, prevention and vaccination.
Home and work as the main places of contamination
What are the two main modes of contamination in France today? Home (family circle) and business, according to the latest survey by MG France, which interviewed 900 general practitioners. They asked their patients (4,500 in total) how they thought they had become infected. More than 35% of them replied that they had been infected at home, which is not surprising Dr Jacques Battistoni, president of MG France, “because we eat together in the family circle, because we share a lot of moments, because we live in relatively confined spaces. This asks us about what will happen at the end of the year with the holidays… ”. As for the company, it is also a place “where we have lunch or dinner together, and that’s when we take the mask off …”, continued Jacques Battistoni, who started from results of this survey to reflect on how France could set up an effective screening strategy.
What about a targeted screening strategy?
When asked whether it is necessary to continue to test indifferently people who come forward because they are worried or to adopt a strategy of targeted screening of the population, the president of MG France considers that: “our survey leads us to believe that it is certainly in the interest of testing around the most frequent places of contamination. When you telecommute from home, you don’t necessarily need to get tested. But if you share time with your colleagues, if you are in a place where you are relatively confined, you probably do well to make a strategy of targeted screening within the framework of the workplaces. “
On a larger scale, a targeted testing strategy could be applied to places that have been identified as being the most contaminating, according to Jacques Battistoni: “If, for example, in a region or a municipality, we realize that there are more positive tests than elsewhere, we may be interested in doing fairly massive tests in those places. ”
Is performing an antigen test before Christmas of any interest?
Another important issue discussed during the press conference. What can doctors say to their patients who tell them “my family and I are going to have an antigen test on December 23 so we can wake up peacefully”? If we know that the antigen test is less efficient than the reference test (RT-PCR), it has a significant interest, recalled the president of MG France: “It makes it possible to identify the patients who will be the most contaminants. We know that it is relatively efficient when someone has a high viral load. And we know that it has low sensitivity if the patient is not very contaminating, or even if it is asymptomatic. “This therefore means that, in the event of a positive antigen test, people are” a priori contaminants, so they must remain in isolation throughout the period of contagion and must not go to meet their families. They can’t just put the mask on their nose ”.
If the antigen test is positive, people should not go to meet their families.
If, on the other hand, the antigen test is negative, the person will have to remain cautious, because that will not mean “there is no problem, I take off the mask and I am not contagious.” This will simply indicate that this person was not very contaminating when they took the test. But “she may have been contaminated after or taken the test at the wrong time, so this test is by no means a patent that allows them to do whatever they want, and get through the Christmas holidays without take precautions. “
If the antigen test is negative, the person will need to be careful.
How to respond to patients who wonder about vaccination?
General practitioners are also faced with a patient population that has many questions about vaccination. “Does the vaccine protect those around me when I am vaccinated? Should we be vaccinated if we have already been sick (positive for Covid-19, Editor’s note)? When should a recall be made? “. These are the questions that come up often, according to Jacques Battistoni, who adds that many patients are “suspicious” of vaccination. The mission of general practitioners will therefore be “to help shed light on the debate, in particular by informing ourselves as much as possible”. On this point, the ministry has promised a question and answer for physicians to help them answer the most frequent questions.
The mission of general practitioners will therefore be “to help shed light on the debate, in particular by informing ourselves as much as possible”.
The president of MG France also believes that the general practitioner will have an important role in prescribing vaccination. But also that its presence will be “essential to guarantee the safety of vaccination.” After that, whether it is a doctor, a nurse or a pharmacist doing the injection himself, it is not a problem. It is not complicated to give the injection ”. On the other hand, what is more important in his eyes, “is the presence of a doctor, so as to be ready to intervene in the event of a somewhat significant allergic reaction. So if a nurse is giving the injection, it is prudent for the doctor to be nearby. ”
The presence of a general practitioner will be “essential to guarantee the safety of the vaccination.
Finally, concerning the schedule, general practitioners will intervene in two ways during the first phase of vaccination which should start in January in nursing homes. First, as coordinating doctors, who will themselves be in contact with the treating doctors to organize the vaccination modalities. Then general practitioners can then vaccinate in their practices from February with the Moderna vaccine, with the characteristics that we know: “a vaccine that can be stored in the cold, a booster after three weeks”, according to Jacques Battistoni . Its storage conditions are a little easier and more flexible than that of Pfizer “which needs to be used within 5 to 6 days, against 3 to 4 weeks for the Moderna vaccine, which will make our job easier”. In addition, the Pfizer vaccine will be preferred in phase 1, specified the general secretary of MG France, the Dr Jean-Louis Bensoussan, which is still awaiting clarification on vaccines from the ministry. Another question mark: the remuneration of the pre-vaccination consultation which has not yet been the subject of negotiation with the government, nor with health insurance.
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