Are the most critical moments of the second wave of the Covid-19 epidemic behind us? “We see (…) that health indicators are improving”, declared the Prime Minister, Jean Castex, Saturday, November 21, during a discussion with a trader in Dijon (Côte-d’Or). The head of government announced “hope” a reopening “in a few days” businesses deemed non-essential, in this context of a better health situation.
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These comments come two days after the publication ofa statement of Public Health France, mentioning for the first time “the crossing of the epidemic peak of the second wave”. “Even if the indicators remain at high levels, their observation suggests that the epidemic peak of the second wave has been crossed”, notes the health agency in its press release, published in parallel with its last weekly epidemiological update. The text evokes a “decrease in all indicators”. However, has this peak been crossed both in terms of contamination and the number of hospitalizations and deaths? Response elements.
A “decrease” in the circulation of the virus
What the numbers say. The decline is clear. Between November 9 and 15, 182,783 new cases of Covid-19 infection were identified in France (by PCR or antigen tests), against 305,135 cases confirmed the previous week. This marks a drop of 40%, notes Public Health France in its weekly epidemiological update. The health agency thus evokes a “traffic decrease” virus. The positivity rate of PCR tests is in parallel down by 3.5 points, to 16.2% between November 9 and 15 against 19.7% the previous week. “For the past week, all virology laboratories have noted a decrease in the percentage of positives among the tests they perform”, notes Astrid Vabret, head of the virology service at the CHU de Caen (Calvados).
This “decay phase” is also confirmed by the number of SOS Médecins acts for a suspected Covid-19 infection: Public Health France identified 4,571 between 9 and 15 November, against 6,275 the previous week, a decrease of 27 %. Regarding emergency visits linked to a suspicion of Covid-19, the decline from one week to the next is 19%.
Why we must remain cautious. However, “I don’t know if the antigenic tests are still well counted”, tempers Astrid Vabret. At the same time, Public Health France underlines the “keeping all indicators at a high level”. Between 9 and 15 November, the incidence rate remained above the alert threshold of 100 per 100,000 inhabitants in a large majority of the departments, except Charente-Maritime, Finistère and Corse-du-Sud. No less than 38 departments have rates higher than 250 cases per 100,000 inhabitants, even if this number rose to 87 departments the previous week. In the Auvergne-Rhône-Alpes region, incidence rates remain particularly high, reaching up to 648 cases per 100,000 inhabitants in Haute-Savoie. And if the incidence rate is clearly declining in metropolitan areas, it is increasing in Guyana, as is the positivity rate.
With this clear drop in the number of new cases but a still high level of virus circulation indicators, can we speak of a peak in terms of contamination? “The feeling is that we have probably crossed the peak. We can say that we are in a decline phase because it has been several days already”, comments to franceinfo Emmanuel Rusch, president of the French Society of Public Health. “It’s still a contagious disease that has some surprises in store for us”, he tempers.
“As long as the traffic is so active, we are not immune to a possibly rapid recovery.”Emmanuel Rusch, President of the French Society of Public Health
“We remain on the classic message: we must not relax the caution”, recalls Emmanuel Rusch.
“The top of the plateau” for hospitalizations
What the numbers say. The decrease observed for cases of contamination “is also observed in the hospital”, continues Public Health France, “with for the first time in week 46 (between November 9 and 15) a decrease in hospitalizations ” for a Covid-19 infection. These hospital admissions are down 13% (from 19,940 to 17,390 new hospitalizations) from one week to the next.
The agency also notes, for the first time from one week to another, a drop in intensive care admissions – however more moderate. Admissions to these wards were down 9% between the week of November 2-8 and the following week. Saturday, Public Health France identified 4,493 patients with Covid-19 in intensive care, including 220 new admitted. A figure in decline for the 5th consecutive day. The day before, 4,566 Covid-19 patients were in intensive care in France, including 264 who entered these services.
Why we must remain cautious. At a time when 31,365 people with Covid-19 were still hospitalized on Saturday, does the downward trend in indicators already allow us to speak of a hospital peak crossed? We are rather “on top of the plateau for now”, believes Emmanuel Rusch, recalling that admissions to hospital and intensive care are “out of step with the circulation of the virus”.
“The fact that there is a decrease in the circulation of the virus suggests that we will not have overfeeding in intensive care and hospital admissions in the coming days.”Emmanuel Rusch, President of the French Society of Public Health
However, the public health specialist notes disparities between the territories. Hospitalizations thus continued to increase in the Grand Est (+ 18%), Center-Val de Loire (+ 7%) regions as well as in the Pays de la Loire (+ 2%). Intensive care admissions are also on the rise in the Grand Est (+ 17%), Brittany (+ 12%) and New Aquitaine (+ 4%).
During an online press conference on Friday, Daniel Lévy-Brühl, head of the respiratory infections unit at Public Health France, admitted that he was still “too early” to speak of a peak crossed in the hospital, underlines The world. “It’s only the beginning of winter”, continues Astrid Vabret. If it evokes “a beginning of decrease” at the hospital, the head of the virology department at the CHU de Caen recalls that “the period of respiratory viruses covers at least the first three months of the year”. “This is good news, but it is not over yet.”
A decline in hospital deaths yet to be confirmed …
What the numbers say. According to Public Health France, the number of deaths linked to the Covid-19 epidemic “seems to stabilize for the first time after several weeks of increase”. Between November 9 and 15, 3,756 people died from Covid-19 (in hospital and in medico-social establishments), compared to 3,817 people the previous week. This represents a decline of 2%. The epidemic has killed a total of 48,518 people in France, saccording to official statistics.
Saturday, the health agency identified 276 deaths related to Covid-19 in 24 hours in hospitals, against 386 Friday and 436 Thursday. A downward trend … which still needs to be confirmed. Public Health France notes that “the weekly number of declarations of death” during hospitalization for Covid-19 “was increasing” 12% the week of November 9 to 15, compared to the week before. The agency recorded 2,898 declarations between 9 and 15 November, against 2,591 the previous week. However, this increase is lower than that observed in early November.
Why we must remain cautious. If hospital indicators appear to be “on the right slope”, Emmanuel Rusch believes that he “will have to wait a few more days” before noting a clearer evolution, in terms of hospital deaths. “The fluctuations are important from one day to another”, he emphasizes.
… and a “still very fragile” situation in nursing homes
What the numbers say. The “stagnation” of deaths observed by Public Health France “could be partly explained by the delay in consolidating death data” in medico-social establishments, including nursing homes. A decrease in deaths is observed from one week to the next in these establishments (863 in week 46, against 1,226 the previous week), but it “will most certainly be reassessed in the next epidemiological point after consolidation”. In these establishments, the number of deaths linked to Covid-19 has increased significantly recently, from 11,651 on November 1 to 15,287 on November 21.
Why we must remain cautious. “We can have a different dynamic between the hospital and the medico-social establishments”, explains Emmanuel Rusch, while calling for “to be careful” on the evolution of deaths in these establishments. The president of the French Society of Public Health judges the situation in nursing homes “still very fragile”. “The nursing homes are community environments, with concentrations of people at risk”, recalls Astrid Vabret.