10:25 p.m., January 22, 2022
A voice listened to by the French authorities since he piloted an independent mission on the management of the first months of the health crisis, the famous Swiss professor Didier Pittet, infectiologist and epidemiologist at the University Hospitals of Geneva, co-inventor of the hydroalcoholic gel, believes in the JDD that the “absolute emergency phase” is behind us, despite the slight epidemic recovery in recent days.
The peak of contamination expected this week is moving away, do you understand why?
The peak was reached in Île-de-France but not throughout the country. Before Omicron, there were approximately two people infected for every one tested positive. Today, an even larger proportion of contaminations – mainly asymptomatic – pass under the radar. Maybe four or five cases are skipped for one positive case. It limits our ability to screen and diagnose. Hence the difficulty in properly understanding the dynamics of the epidemic in the very short term. It will go down, that’s for sure. It is even likely that the descent will be rapid, as in the United Kingdom, even if in Denmark the trend is rather towards recovery after a brief decline.
In Denmark, a new sub-variant of Omicron, the BA.2, is spreading. Should we fear another wave just after this one?
This Omicron wave is certainly not the last. In Denmark, a variant derived from Omicron [également identifié au Royaume-Uni] spectacularly transmissible is spreading, to the point of being able to overtake Omicron. It was expected that other variants would arise, but the progressive immunity barriers will limit both the size of the waves and their ability to disrupt our daily lives.
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One day more than 99% of the population will have sufficient immunity and it will be no more dangerous than the other four coronaviruses.
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Does the vaccination pass, in force from Monday, have a real health interest?
The Covid is not a disease “fatal enough” to justify compulsory vaccination. On the other hand, the policy launched in July in the form of the health pass and today deepened with the vaccination pass has pushed the French to be vaccinated with a vaccine which, alas, is not perfect but protects magnificently against serious forms. . It is imperative: in my hospital in Geneva as in yours, 90% of patients who end up in intensive care because of Covid are not vaccinated. The virus remains dangerous for poorly protected or fragile people and therefore for the community. The proof is that conventional services are filling up, and more than 50% of surgeries are deprogrammed: we are reaching the peaks of the first waves.
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Was the government right to unveil a reopening schedule?
The mistake would have been to say that the epidemic was over. We cannot say that this wave is the last even if we all hope that it is. We are entering a second phase of the epidemic. In the first phase, which was a period of absolute emergency, the wild virus sowed death in its path. Solid dykes had to be erected to stop it. Today, it is becoming hyper-endemic, that is, it is present permanently, chronically, without causing as much damage because many people have been infected and/or vaccinated. It will continue to circulate until the whole population has enough antibodies. Little by little, over injections, reminders and infections, successive layers of immunity are superimposed to build an immune barrier, individually and collectively. As with paint, one coat is not enough. Three is better. In this second phase, Sars-CoV-2 domesticates itself. One day, more than 99% of the population will have sufficient immunity and it will not be more dangerous than the other four coronaviruses with which we have lived for hundreds of years, responsible for colds and sore throats in winter.
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Continue to be cautious for a few weeks
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How do you see the next three months?
In April, the incidence should be very low, unless a new variant takes us by surprise. Previously, it will be impossible to live a little more normally: we are still dealing with a very transmissible and sneaky respiratory virus because it is also spread by asymptomatic people. And, because of its affinity for the blood vessels of the brain, kidneys and other organs, it causes undervalued chronic diseases. The time has not come to say “we let go of everything”. We are reaching the crest of the wave but it is impossible as long as hospitals are under such strain. We must continue to be careful for a few weeks. While preparing for the sequel and finally thinking about how to live with the virus.
What do you recommend?
To give science time to answer these key questions: is the fourth dose necessary? For who? What is the immunity level of the population? Are people who had already been infected abused by Omicron or mostly asymptomatic? We need to conduct serology studies on cohorts to obtain recent and reliable data on immune protection. Another question: under what conditions is isolation at home feasible? What mechanism should be put in place if a more dangerous virus appeared?
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In 40 flu seasons, I have never seen an epidemic disrupt the functioning of my hospital or bring society to a standstill.
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And meanwhile, how do we live?
We continue to practice barrier gestures. We get vaccinated if it is not already done without forgetting the essential booster dose. We isolate ourselves when necessary. In some countries, the quarantine period is reduced to five days. That’s reasonable, but let’s be careful: Japanese data shows that Omicron, which reproduces a lot in the mouth, causes highly contagious explosive infections for more than five days. As soon as the wave has subsided, we can start tracking the clusters again to better understand the risk factors for transmission and adapt the recommendations: maintain certain measures if necessary, reduce others as soon as possible. And then you have to test, test and test again. To track new variants and identify positive cases. The self-test in particular is essential before a party or a family meal. It’s a question of respect for others, a tool for raising awareness.
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The Blanquer protocol is very smart. I don’t understand why it is so decried
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Is it really a relevant tool? The mass screening of children at home is causing controversy!
The Blanquer protocol is however very intelligent. I don’t understand why it’s so decried. Or rather if: everything new is scary; humans resist change. This is why it is necessary to tirelessly explain. In terms of health, the device is relevant: the child tested positive at breakfast will stay at home and will not spit the virus on his friends in the playground! Tactically, if I may say so, it’s an epidemiologist’s dream. Ideally, everyone would be asked to test themselves every morning. Self-testing for all students for each positive case in a class is a bit boring for parents but much less than closed schools. And then it will only last a few weeks, until the wave ebbs.
Some say that, thanks to vaccination and past infections, Covid-19 is no more dangerous than the flu. What do you answer them?
I find this analogy a bit ridiculous. But it also has educational virtues! The flu will still bother us in fifty years while, in a few years, the Covid-19 will only be a bad memory… The flu can make you very sick, it kills every year, including some unlucky young people. But in forty years of medical practice, so in 40 flu seasons, I have never seen an epidemic disrupt the functioning of my hospital or block society!