When studying the deconfinement scenarios, it must be borne in mind that no one knows the ideal recipe. To face this collective test, we will have to count with the French. In order to regain their confidence, nothing will have to be hidden from them.
What can happen? Nothing or everything. Unimmunized individuals will exit and may become infected. Some will be at the origin of “clusters”, and they will have to be detected quickly. Others will make serious forms, and it will be necessary to be able to treat them. Considering an incubation of 2 to 14 days plus ten days so that the serious forms are born, we can theoretically fear a wave at the end of May – beginning of June. Authorities may also have to reconfigure if our system is overwhelmed. And if wild deconfinements multiply, the wave may even occur earlier.
Can we prevent such a scenario? Since we are not allowed to bet (on a drug, a seasonality of the virus) when it comes to health, we must prepare. Conditions must be set for deconfining, hoping that they avoid the wave or limit its effects.
The first condition is that the country finally has a single pilot on the plane, invested with great powers over all public means. The enemy remains non-decision, dissonance, the multiplication of validation circuits, sous-chefs, orders and counter-orders.
The second condition is to do everything to slow down the inevitable transmission that will appear after deconfinement. You must wear a mask every time you go out. In transport of course, which accounts for 34% of the origins of clusters in China (medRxiv, Hua Qian, April 7, 2020), but everywhere too, including at home at the slightest sign. Failing to provide them with masks, the public authorities should at least clearly teach the French to make their own. There is an urgent need to provide an effective, simple and standardized official tutorial to the general public, as the Atlanta Center of Disease Control has done since the start of the epidemic. Part of the French drama is illustrated in this difficulty in providing clear and stable information to the public.
The third condition is to be able to detect emerging clusters very quickly to prevent them from thriving until they become uncontrollable. It will require tests, epidemiological investigation teams and all the tools that artificial intelligence can offer us. Do we have them? Who organizes what?
The fourth condition is not to send the positives back to their families and without a mask. Unfortunately, we have done so far, at the risk of infecting those around them (80% of “clusters” in China were born at home). For this, it is urgent to organize
a wide range of accommodation (hotel rooms, holiday centers) with all the logistics that go with it.
The fifth condition should have been settled long ago. It is necessary to test by PCR all the “compulsory confined” persons (nursing homes, psychiatric or handicapped establishments, prisons).
The government continues to pretend that you should only test if a symptomatic case develops without actually doing so. This attitude is illogical when we know that 50% of cases are asymptomatic, and that these asymptomatic are responsible for 44% of contagions. In other words, waiting for the appearance of a first symptomatic case to test the entire community means taking the risk of missing almost three quarters of the emerging “clusters”, and always falling behind on the epidemic . The same strategy should apply in all places essential to the smooth functioning of the country (police, hospitals, firefighters, nuclear power plants). What will happen if half of the fire station gets sick? A negative PCR one day certainly does not guarantee the absence of infection the next day. But it allows, by separating the positives from the negatives at a given time, to slow down the transmission circuits.
The sixth condition is that it is necessary to urgently replenish all the stocks currently empty (medicines, overcoats) and to make sure that the caregivers, who have just suffered several trying weeks, have been able to rest. We are far from it.
The seventh condition is even more fundamental. To deconfinate, we will have to make sure that our intensive care units will have enough places to accommodate serious patients. Our resuscitation capacities may even have to be greater than those already considerable, which the hospitals had implemented in March. Because at the end of March, we only dealt with the Covid patients. After deconfinement, the wave of Covid patients may be joined by a wave of non-Covid patients, who are those whose state of health deteriorated during confinement. In other words, the situation could be even more difficult in June than in March. Let’s arm now a strategic reserve of resuscitation beds, using the 10,000 respirators of which Emmanuel Macron spoke. In China, fresh medical teams have been massively brought to epidemic regions to arm such units. Let’s prepare to do the same on a European scale.
We are entering a period of great danger. With less than 10% of the population having encountered the virus, we already have 30,000 dead. Where will we be when 50% of us are infected? Uncontrolled, a second wave can overwhelm the health system and cause very many deaths.
Are the medical conditions for deconfinement fulfilled today to avoid this catastrophic scenario? Clearly not. Will they be on May 11? It’s up to the government to assure us. If they are not, we will have to have the courage to explain it to the French and to push back the date, or to deconfinate less than expected. The battle is far from won.