From the first palpable signs of improvement on the peak of the Omicron wave, the executive announced not without lucidity as to the current assessment of the strong hospital pressure and its clinical reality – no Omicron is not just a cold! – effective relief measures on February 2 and 16. Measures that the French, harassed by two years of pandemic, the efforts made in terms of vaccination, teleworking or screening and the upheavals of coercive measures, legitimately expected. It is politically coherent. However, it is difficult to measure the scientific coherence and the impact of this choice taken, once again, between two risks: that of not exhausting the French more versus that of anticipating too early on an “after Omicron” which should inexorably happen.
An “after” which no one can predict what will happen: “beginning of the end” with some epidemic wavelets due to a high level of composite collective immunity (vaccines + massive infections) and the arrival of direct antiviral treatments or monoclonal antibodies that play with mutations? Evolution towards a new variant that is even more transmissible but even less severe, alleviating the hospital filling by the same amount but shifting the problem to city medicine? Or, on the contrary, the emergence of a vaccine escape variant from non-vaccinated regions of the world, for lack of patents raised and vaccine acceptability, a variant that would reshuffle the cards of the pandemic?
“What is the rebound observed since mid-January the name of?”
For some, the advanced calendar is intended to be “pragmatic” and “proportional”. For others it’s a bit like the Advent calendar, where behind each open door is an enigma, even a risk-taking. One question, for example, weighs heavily on the health analysis of the lifting of restrictions announced Thursday evening by the executive: what is the name of the epidemic recovery observed since mid-January? Is it a rebound that precedes a rapid South African-style decline? Or as the Scientific Council quietly suggests in its latest opinion dated January 19, is this rebound “possibly linked to the resumption of school life”?
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The Scientific Council also recommends “allocating additional resources to strengthen health protocols for the prevention and screening of infections in schools and nurseries”, where the executive advocates the opposite. In the words of the Prime Minister, the current protocol, moderately “reinforced” at the beginning of January to deal with the fifth wave and the high contagiousness of Omicron, “will probably be lightened when the February holidays begin”. Choice assumed, it seems, of stratospheric viral circulation, particularly in schools or nurseries, as evidenced by the figures for new daily cases in the lower age groups: 4% (4,012 cases per 100,000 inhabitants) among 0-9 years old and 5.5% (5,506 cases per 100,000 inhabitants) among 10-19 year olds, according to data scientist Germain Forestier. Which in college mathematics means that if the wave continued at this rate, the entire age group would be contaminated in a few weeks.
This rebound in mid-January could also be linked to the fact that the French have already anticipated the decline by relaxing barrier measures, isolation and screening, which for the first time since November fell in the week from 10 to January 16, including self-tests. Or could it already be the fault of the variant of the Omicron variant (BA2) detected for the first time in China on December 27, 2021 and already present in more than 40 countries? Variant BA2 does it seem even more highly contagious and which in Denmark would already represent 70% of cases while the number of daily contaminations which stagnated around 23,000 has suddenly climbed in recent days to 40,620 incident cases on January 20 .
To govern is to foresee. To treat is to prevent. But everything is more complex with the unpredictability of a pandemic which has constantly taken modellers, epidemiologists… and public authorities on the wrong foot.
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*Pr Gilles Pialoux is head of the infectious diseases department at Tenon Hospital (AP-HP) in Paris (20th). Member of the PandemIA collective and of the health center of Terra Nova, he is also the author of We weren’t ready. Logbook in times of coronavirus (ed. JC Lattès) and Like a slight tremor (Mialet Barrault), to be published on February 2.
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