“The re-containment signals a double failure, that of controlling the epidemic, but also that of democratic debate, which urgently needs to be opened.” Several academics and doctors are signing a vitriolic forum in the world to, finally, have an informed debate on the management of the epidemic.
“We are starting to take a step back from this epidemic. Scientific articles give us information on the effectiveness of the various measures against Covid ”, explains to Liberation Mircea T. Sofonea, researcher in modeling of infectious diseases in Montpellier.
Indeed, scientific literature is beginning to flourish. A study published in Nature Human Behavior analyzes by statistical means the comparative effect of 6,000 measures taken by 79 states between March and April. The same kind of approach has been published in The Lancet Infectious Diseases. Another study, published in Nature, identifies the most risky places by studying the movements of millions of Americans using data from mobile phones.
This work deserves to be discussed and to feed the public debate in France. Mircea T. Sofonea gives us the current state of her thoughts.
The vaccines, the first results of which are encouraging, will they stop the epidemic?
In the short term, the control of the epidemic does not require the vaccine. The issue of deconfinement to come and the avoidance of a third wave do not go through the vaccine. We must regain the confidence of the population and review strategies with them in an attitude of anticipation that is much more proactive than this summer.
The first doses will arrive in early 2021, but we will not have the millions of doses needed to vaccinate the general population before the fall. This is one of the reasons that lead us in our forum to call for an open debate on the merits and limitations of each restriction measure. We must adapt the decisions to the French context and guarantee the support of the population.
You oppose, in your forum, the strategy of adaptive containment (or “stop and go” in English) to the strategy of early control of the epidemic. Can you define them?
The “stop and go” strategy consists of confining as soon as an indicator exceeds a previously set threshold. This may be the number of ICU admissions or the weekly incidence. As soon as the threshold is reached, you confine, and as soon as the indicator drops below the threshold, you release. A honeymoon follows, a period of almost normal life until the epidemic begins to rise again. In the end, you have alternating periods of confinement and relaxed phases.
The strategy of early control consists of acting in a localized manner where the virus is circulating and tracing the chains of contacts of each case. It is a race against the transmission of the virus. Then, those identified must strictly isolate themselves. It is a question of taking strong measures, but localized and very early in the epidemic dynamic.
The countries that are doing best today are aiming for zero cases. In China, New Zealand, Vietnam, the authorities’ goal is to have no positive cases. Each patient diagnosed generates a rigorous investigation with strong measures for contact cases.
Massive screening would therefore be useful?
Massive screening is only useful if it is accompanied by isolation or quarantine of cases and contact cases. Other strategies are possible. In Finland, in the absence of such extensive screening, there is a very strong support from the population to the digital application. This helps to reassemble the chains of transmission. In South Korea, the application is geolocated, and when you move around a neighborhood, you know the number of infected people in the area.
In France, the debate on trade openings and closings focuses on whether they are essential or not. We talk very little about the health risk according to each type of situation. Do you regret it?
Yes it is really a shame. Our forum calls for a much more informed public debate on the important topics of this pandemic. We are starting to take a step back from the pandemic. We know that gatherings in poorly ventilated places are transmission areas. Cases of transmission have been documented in restaurants, gyms, choirs, etc.
The article published in Nature Human Behavior also shows that the most important measures in terms of traffic reduction are the ban on gatherings (from 50 people or less), the closure of educational and higher education institutions. , border closures. A final lever appears very strong: communication. Pedagogy is more effective than punishment or repression. Germany and Vietnam have implemented interesting measures in this direction.
You talk about school closures, it’s a hot topic. Children seem less contaminating than adults, don’t they?
It is clear that from college onwards, young people present the same risk of transmission as adults. It seems to me that many other places have been closed to keep the school system open.
If vaccines are not short term solutions, what role can they play in the long term?
We estimate that less than 10% of French people have been infected. It would therefore be necessary to vaccinate around 30 million to achieve collective immunity. It is colossal and it will not happen right away.
The first vaccines that arrive seem to be having good results, but the effectiveness is not evaluated for the moment until a few weeks after the second injection. What about six months later? As it stands, we can think that they are good first-line vaccines, to break an epidemic wave. But perhaps we will have to wait for other products for a long-term vaccination.
To put in place such a policy in France, it will require a high quality communication, well thought out and taking into account the historical reluctance towards vaccination in the country.
MediaCongo Olivier Monod
Release / MCP, via mediacongo.net