Covid, where will we be in five years? “We must anticipate the worst in order to avoid it”

From dark gray to very black.

Covid, where will we be in five years? “We must anticipate the worst in order to avoid it”

From dark gray to very black... The scenarios presented in the latest report from the High Council for Public Health (HCSP) on the possible evolutions of the Covid-19 epidemic in the next three to five years do not encourage to optimism. Scenario 1, "living with the virus", undoubtedly the most favorable, would be a continuation of the current situation, with regular epidemic outbreaks and still many victims among the most at risk. Scenario 5, the “ultra-crisis”, with the arrival of a variant that escapes vaccine immunity, would bring us back to a situation similar to that of March 2022, with the weariness of the population and caregivers in addition. The country would then quickly find itself blocked, especially since the economic crisis would prevent the implementation of measures of the "whatever the cost" type.

Between these two extremes, another hypothesis would see the appearance of a variant that would mainly affect children. Are these futures plausible? Do we have the means to protect ourselves from it? Professor Didier Lepelletier, new president of the HCSP, explains. Recently appointed head of this body, this doctor from Nantes took the opportunity to detail his plans for the coming months.

L'Express: The possible evolutions of the pandemic listed in your report are particularly bleak. Do you see any way out of the crisis in the medium to long term?

Pr Didier Lepelletier: The World Health Organization (WHO) presented slightly more optimistic scenarios. For our part, we have voluntarily placed ourselves in pessimistic hypotheses. Our objective is not to describe the future: the idea of ​​this exercise is really to anticipate the worst, to prevent it from happening. It is a question of proposing to our rulers recommendations for anticipation within eighteen months, so that they take the necessary measures to avoid finding ourselves later in one of the situations described.

Knowing all the same that our first scenario, "living with the virus", finally already summarizes the current state of the epidemic. Unfortunately, we see that society is getting used to enduring very high infection rates.

You also mention the possibility of seeing variants appear which would particularly target children, or which would completely escape acquired immunity, both by infection and vaccination... Is this plausible?

This report was written by a working group including sociologists, anthropologists, prevention specialists, virologists, infectiologists, researchers, representatives of health agencies, veterinarians, public health specialists... They tell us that it is entirely possible for these scenarios to occur. Regarding children, no one has thought of this eventuality, and we are absolutely not prepared for it. Children under 12 prove to be much less vaccinated than the rest of the population. Emergency rooms and pediatric hospitals are not sized for a crisis of this type. This eventuality would deeply destabilize society, because beyond the human tragedies, many parents would no longer be able to work. The country could encounter great difficulties in managing this situation.

As for a total immune escape variant, who's to say that won't happen? In June 2020, many thought the epidemic was almost over, and it started up again in mid-July... We don't have a crystal ball, and the goal is not to make short-term forecasts term, but to propose tools for prevention and foresight in the medium and long term. As we indicate in the report, these different possible evolutions of the crisis could also each occur at different horizons. The future could also be a combination of some of them. But we can also hope that none will come true.

Of the 28 recommendations issued by the HCSP, which do you think are the most urgent?

In particular, we recommend deploying a population-based public health strategy to protect vulnerable people, with increased vaccination campaigns, rapid access to diagnosis and treatment, especially in cities. To do this, we must not centralize everything, but let the regional health agencies organize themselves according to the needs in their territory. In addition, antiviral drugs should be communicated to the general public, as well as to players in the field such as doctors and pharmacists, to facilitate their prescription to patients who may need them.

At the start of the crisis, the authorities wondered whether it was not necessary to isolate only those who were fragile and at risk of infection, but this quickly proved impossible with 18 million people concerned. Now, with the availability of vaccines, drugs and masks, it is entirely possible to adopt this type of pragmatic strategy. Thus, it is necessary to insist on the fact that fragile people continue to wear the mask in closed places.

It's very stigmatizing...

This means that it is necessary to do pedagogy so that it is not experienced as such. In reality, we should all continue to wear the mask in public places. Whatever their age, no one has an interest in having a Covid. The High Council for Public Health has said it on several occasions: in a situation where this barrier measure is no longer mandatory, people who wish to protect themselves will have an interest in continuing to wear a surgical mask type mask, or even a device. respiratory protection type FFP2 depending on the circumstances, as they are more effective than surgical masks for personal protection. This is a recommendation that remains important.

Furthermore, we are calling for European reflection on the anticipation of crises - but I know that the Directorate General for Health is working on this - and on the coordination of research, in particular to find a vaccine which offers longer-lasting protection than those to messenger RNA. We should also continue the reform of the healthcare system, beyond the Ségur de la santé. This includes facilitating access to consultations for patients with chronic illnesses, and also strengthening pediatric reception capacities.

You do not say a word, in this report, on the improvement of indoor air quality, which many epidemiologists nevertheless present as essential to control the risks linked to Covid in the medium term...

This is because we have already written at least five opinions on this subject and this measure is one of the seven of the doctrine of the High Council for Public Health relating to barrier gestures. Ventilation is essential, and not only against the Covid. Studying in a well-ventilated room has been proven to improve children's learning abilities, for example. Not to mention, of course, the prevention of winter infectious diseases. We have already indicated, for example, that in bars and restaurants, rooms without windows and without effective ventilation should not be allowed in epidemic times.

But the recommendations relating to ventilation fall within a broader framework, with the monitoring of CO2 emissions by sensors, the existence and performance of a ventilation system (already covered by departmental regulations) and the possibilities of ventilation through the openings. These recommendations of the High Council for Public Health are the result of reflection by scientists. Now, they must be translated into regulatory texts for their practical application in the field, in companies or in schools, for example.

Precisely, do you think that the proposals resulting from your prospective work will find a concrete translation?

Sure. Imagine that one of the five scenarios occurs and nothing has been done. This report makes it possible to anticipate what we would not like to see happen and to give political leaders food for thought. It would be interesting to meet the public authorities to see with them how they think of taking this work into account. It is true that this forward-looking exercise is relatively innovative for France, but we intend to perpetuate it through the creation of a dedicated working group within the High Council.

What will be the role of the HCSP in relation to the future scientific committee that the government wishes to create to replace the scientific council?

The Council of State said in an opinion dated July 5 that it was not necessary to create another national committee on the management of health crises because of the missions already entrusted to the HCSP - to provide scientific expertise to policies during crises and foresight in health. We believe that the High Council for Public Health can play this role in the territory by bringing together the expertise of other health agencies.

We are waiting to see if this new committee sees the light of day, but it is the responsibility of politicians to ensure coordination between the various bodies that already exist in this area. The High Council for Public Health has also already planned to create a body within it dedicated to anticipating health crises and forward planning, in the logical continuation of its expertise, its role in the management of the pandemic crisis. and his foresight skills.

What will the next publications of the HCSP be about?

We are in the process of finalizing a new doctrine relating to universal hygiene measures for the prevention of the main infectious diseases occurring in the general population. We work on many pathologies and health promotion and infection prevention measures. With the aim of explaining how to avoid contracting them, or spreading them if you are still infected, in order to protect those around you. This work in progress is original and has no equivalent in France or abroad. It should be available next fall.

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