Tribune. Reconfigured regions and cities in Germany, the United Kingdom and Spain, clusters in Mayenne, presence of Sars-CoV-2 in wastewater in Paris … Numerous signals indicate that, this summer, the coronavirus continues to be active in Europe and worldwide. Summer brewing may reinforce its presence in areas previously little affected and therefore weakly immune.
Doctors, caregivers, researchers, we alert the authorities to the fact that if we do not immediately use all of the means at our disposal to slow down this transmission, including the compulsory wearing of masks in closed public places (shops, workplaces, public transport, cinemas and theaters, etc.), there is a great risk of having to pay a health, social and economic price that is out of all proportion to the reasonable constraint represented by these new habits. Unfortunately, our leaders, quick to recommend these measures, cheerfully get rid of them in their public activities. It is enough to have attended the transfers of power in the ministries and in the town halls, to look at the photographs taken in meetings or to see them go in contact with the public without protection, to understand why the French are reluctant to apply a measure as simple as wearing a mask in a closed public place.
Why impose the mask in a closed place? The risk of aerosol transmission – a cloud of viral particles in lasting suspension in non-renewed air – was highlighted in a column of July 4, published in the New York Times and signed by 239 researchers from 32 countries asking WHO to revise its position on the routes of transmission of Sars-CoV-2. This route, different from that concerning transmission by microdroplets and by contaminated hands, is known and proven for Sras 2002, as well as for Mers. She was finally admitted by WHO Thursday for the Sars-CoV-2.
Until now, barrier gestures were thought to protect from direct or indirect contact with an object or a person contaminated by microdroplets. This latter mode of transmission is now considered marginal by the Atlanta Center for Disease Prevention and Control (CDC) and by the scientific community. Indeed, cluster studies are struggling to identify objects that are sources of contamination. In addition, in the event of transmission by contaminated objects, the tracing of contact cases and the control of clusters would be much more difficult than what we observe today. Another argument pointing in the same direction, public transport strongly participated in the epidemic before the obligation to wear a mask: for example, the New York subway had 81 deaths among its employees (incidence of cases three times higher to the local population) and a study highlights the driving role of public transport in spreading the epidemic.
Transmission by aerosol, therefore only by the air breathed in a room, seems to be now recognized as one of the major routes of transmission of the virus in the general population, a route which is not affected by washing hands or surfaces, nor by respecting the distance between people. This new knowledge implies an important review of prevention measures: great attention must now be paid to the ventilation of the premises and to the air conditioning and filtration systems. It also makes clear the obligation to wear a mask for frequenting all closed public and even private places (in the context of festivals which seem to be a major source of clusters). The rule of the distance of more than 1 meter in closed place is not enough, it has the consequence of making people believe wrongly that they are protected.
Even before this aerosol risk is validated by the WHO, Germany imposed the generalization of the wearing of the mask from the end of April in a closed public place, a measure currently acclaimed by a majority of Germans who oppose its lifting (87%, ZDF survey on Friday). A study on the city of Jena (Thuringia) establishes a reduction of 40% to 60% of the epidemic growth rate following this introduction of the wearing of masks. In the countries which adopted the wearing of masks during the peak of the epidemic in the spring, per capita mortality increased “only” by 7.2% per week, against 55% in those who did not recommend it (study on 198 countries).
Thus, multiple data, case studies and scientific experiments tell us that we are no longer in the application of a precautionary principle, but in a health emergency, an emergency that has already led many countries or regions – Belgium, Spain , Germany, and even yesterday Scotland – to impose the wearing of masks in confined spaces. The latter is our best protection against the spread of Sars-CoV-2. On behalf of people at risk of severe forms (who sometimes remain confined), on behalf of caregivers who have already suffered too much from the spring crisis, we ask that it be made compulsory, for all, in all enclosed public places , without waiting for a possible second wave.
We also ask all public figures to compel to set an example in all their activities, systematically and without exception. We are making a date with this forum: we will have warned the health authorities of the fundamental importance of this measure well before things take a dramatic turn, as many caregivers have done since the beginning of this crisis, and as many of us have done so since the beginning of the epidemic, emphasizing the usefulness of wearing a mask in the general population.
Many patients, after contracting Covid-19, and others with chronic or more fragile illnesses have not returned to normal life and we barely see the consequences of this epidemic in everyone’s life. Let us give ourselves every chance to avoid reliving what we have been through: a second wave, probably more geographically extensive, would be dramatic and not only by the lasting economic consequences of a new general confinement.
First signatories: Dr Franck Clarot radiologist, vice-president of the National Federation of Radiologist Doctors (FNMR) Seine-Maritime, Dr Christian Lehmann general practitioner, writer, Pascale Mathieu President of the National Council of the Order of Physiotherapists (Cnok), Dr Stéphane Korsia-Meffre veterinary, Dr François Trémolières honorary hospital practitioner, Pr Laurent Lantieri professor and head of department at the Georges-Pompidou European Hospital (Paris), Dr Yvon Le Flohic general practitioner, Dr Jérôme Marty general practitioner, president of the French Union for Free Medicine (UFML), Pr Eric Caumes head of the infectious diseases department at Pitié-Salpêtrière (Paris), Pr Thierry Baubet head of department at Avicenne hospital (Bobigny), Dr Bruno Rocher addictologist psychiatrist, Nantes University Hospital, Pr Guillaume Gorincour, radiopediatrician (Marseille), vice-president of the Bouches-du-Rhône departmental council of the national order of doctors, Dr Jean-Daniel Flaysakier doctor, journalist, Dr Matthieu Calafiore general practitioner, lecturer, Dr Camille Pascal-Gorincour general practitioner (Aix-en-Provence), Dr Gilles Boccara liberal cardiologist (Aix-en-Provence), Dr Laurent Fignon hospital doctor (Cannes), Dr Annic Jarnoux general practitioner, Pr Elisabeth Leca-Colonna pharmacologue, Pr Jean-Laurent Casanova Professor of Pediatrics, Necker-Enfants Malades Hospital, University of Paris and AP-HP, Collective Stop postillons (Dr Jonathan Favre, Dr Michael Rochoy, Dr Antoine Hutt and Dr Thibault cans), Pr Mahmoud Zureik Professor of epidemiology and public health at the University of Versailles-Saint-Quentin-en-Yvelines (UVSQ).