Live with the virus or get rid of it once and for all? The question may sound silly. Who wouldn’t want the Covid-19 to be just a distant memory? But the delays in vaccination and the threat of a variant-based epidemic recovery, especially if some are found to be resistant to the vaccines, preclude the prospect of rapid delivery. So what to do? In France, the objective set by the executive is to “To implement everything” to avoid confinement and its very significant economic and social impacts. But the government does not rule out using it depending on the evolution of viral circulation. A method that has so far accepted that hospitals assume part of the epidemic pressure, with around 3,000 patients currently treated in French intensive care units.
While the situation is deteriorating at the national level, the coast of the Alpes-Maritimes and its metropolis Nice, which observes an incidence rate (number of cases per 100,000 inhabitants) of 700 against 190 for the national average, will thus be again under cover the next two weekends. In the Nord department, the city of Dunkirk is also in the hot seat (see box). “This is not a policy aimed at eradicating the virus in an area, but rather trying to contain it. It is a way of operating only on the response in the event of exponential growth ”, analyzes the Swiss epidemiologist Antoine Flahault. The latter is a fervent defender of an opposite strategy, aimed at crushing the virus, even if it means going through a more drastic tightening of measures. With a collective of European researchers, he signed on February 15 a forum to this effect, published in the journal the world.
A doctrine that bet on brutal braking
Coming from Asian countries (China, South Korea, Vietnam, read below), then adopted by Australia, New Zealand or Iceland, the “zero Covid” doctrine bet on braking brutal and immediate of the epidemic before it explodes. This is the option chosen by the New Zealand city Auckland, where three days of confinement were declared in mid-February, after the discovery of three cases. Objective: to reach areas free from the virus or which do not have more than one case per day per 100,000 inhabitants, and where a return to normal life can take place (no wearing of a mask, restaurants and cultural places open ). A principle which is accompanied by a drastic application of the triptych “test-trace-isolate”.
At first glance, transposing this objective to European level does not seem easy. Most of the countries that have adopted it are indeed islands. “But one could imagine making the Schengen area a peninsula separated into green zones where the number of new cases per day would be less than 1 per 100,000 inhabitants, and in red zones where efforts should continue to be made to reduce the trend ”, explains Antoine Flahault. In other words, resort to strict re-containment. It would be possible to travel between green zones, but not from a green zone to a red zone.
Certain countries of the European Union, in particular Germany and Ireland (see below), have taken up the issue. In France, where the strategy could be applied for example by separating regions into zones, political leaders do not seem quick to take up the debate for the moment. Part of the scientific community remains skeptical. “In France, a year after the start of the epidemic, it seems impossible to me to put in place”, judged Odile Launay, on February 22, on France Info, the infectious disease specialist doubting the acceptability of a re-containment by the population. “ It works in Asian countries where the measurements are extremely astringent ”, she stressed, echoing questions raised by the strategy at the level of individual freedoms.
“Test-trace-isolate”, a necessary step
“The measures currently applied are already very restrictive and have been going on for months. It is not necessarily easier to live with for the population ”, objected epidemiologist Renaud Piarroux. The head of the infectious diseases department at the Pitié-Salpêtrière hospital (Paris) rather doubts the feasibility of such a strategy in France. A wasted effort, according to him, without the “test-trace-isolate” triptych being improved. And without necessarily betting on digital tracing. “You can define a strategy, but you also have to be able to be operational. As is done in a few places in France, it would be necessary to be able to organize branches across the country capable of receiving, detecting and informing and support, all in the same place. There is a lot to be done on the explanation, the application of barrier gestures and their adaptation, since everyone does not live in the same conditions. One could imagine the establishment of teams of mobile mediators who are trained for this ”, he argues.
For still others, the government missed the boat last summer, when viral circulation was low and could have enabled the implementation of such a strategy. . “We can no longer speak of zero Covid because the virus is endemic. Everyone will be in contact with this virus ”, estimated the epidemiologist Didier Pittet, on February 18, on France Inter. The advance of vaccination, the deployment of new screening methods and the arrival of sunny days could all the same finally reduce the epidemic. With the acquisition of immunity caused by the sustained spread of the virus, a decline could take place in the spring. A boon for the defenders of a “zero Covid” objective. “ We will then have a window of opportunity: the less contamination there will be, the more we will be able to concentrate on local measures, but taken more quickly, and to act on the latest cases and those around them ”, hopes Renaud Piarroux.
The Scientific Council, which guides the government but whose last opinion was published on January 12, has not specifically commented on this strategy. But some of its members, the immunologist Jean-François Delfraissy and the anthropologist Laëtitia Atlani-Duault, propose, in an article published on February 18 in the medical journal The Lancet Public Health, the adoption of a “New social contract” facing the “Huge impact of both the pandemic and the measures taken to respond to it”, details Laëtitia Atlani-Duault. “The youngest generations, therefore less vulnerable individually, could appropriate the constraint of undifferentiated measures (masks, social distancing, regular screening) on condition that the populations most at risk, in particular the elderly, also appropriate protective measures against the risk of infection, for example in the form of voluntary self-isolation ”, she explains. An alternative idea to “Successive confinements” to fight the epidemic.
Faced with the rise in variants that the curfew is unlikely to be able to stop sufficiently, the question of adopting new measures, global or local, will end up being clearly posed in the image of the arbitrations underway in Dunkirk. “Our zero Covid proposal is also made so that the government positions itself clearly on a strategy. The worst is the impression of not having any ”, concludes Antoine Flahault.