What general conclusion do you retain after six months of parliamentary work and 56 hearings?
France, with more than 52,000 dead, is the fourth country most affected by the epidemic in Europe. The average death toll per 1 million inhabitants is 532 in Europe, France’s death toll is 727 while it is reduced to 170 in Germany. Very clearly our record is not good. Our country was ill-prepared to face a health crisis of such magnitude and this poor preparation was not recent. We had let our guard down too much. Our commission was not intended to be a people’s tribunal or a judicial tribunal. We offer an objective inventory that establishes more weaknesses than strengths and ranks our country among the international bad students, but personally I also wanted to make proposals to rearm our country in the face of a major crisis. Because if unfortunately we were to be struck again, we would have to be better prepared, more efficient and more coordinated.
What happened to the masks?
Quite clearly, there was a failure in the supply of masks at the start of the crisis. This is arguably one of the most visible aspects of the difficulties, if not mistakes, in managing this epidemic. During the hearings, we measured how France, in terms of management of strategic stocks, did not know how to take the right decisions in 2013. At the start of the crisis, our country had only 97 million people. surgical masks when there were 933 million in 2011. As for FFP2 masks, we had 483 million in 2012 but none from 2017. As a result, during the first quarter of 2020, at the height of the crisis, we we found ourselves totally helpless.
Was this shortage an isolated flaw?
Unfortunately, we also measured how drastically all strategic stocks have weakened. I am thinking in particular of antiviral drugs. We had more than 300 million in 2015 and more than 50 million at the start of 2020. The number of antibiotics has also dropped dangerously, from 86 million to just under 13 million. Finally, the number of antidotes fell by 500 million between 2015 and 2019. Our country has not given the preparation for a major crisis the necessary forward-looking vision. Too often we decide when the crisis is coming or has already happened. Long time is no longer a political priority. This is undoubtedly one of the major lessons from which all the consequences must be drawn. In a form of unbridled globalization, we have abandoned entire sectors. This raises the question of relocation and long-term management. We have also seen how we are deprived of vital equipment, such as the respirators that arm the resuscitation beds. This is why I am proposing that we define products and equipment of vital interests as it already exists for organizations of vital interests. The EPRUS, the health emergency preparedness and response facility, should also be recreated. It was absorbed by Public Health France and this deprived us of its responsiveness and effectiveness. Above all, I propose the creation of a delegate ministry to the Prime Minister in charge of anticipating, preparing for crises and relocating the production of these vital products. This ministry could benefit from the support of the General Secretariat for Defense and National Security, the General Directorate of Civil Security and the Cyprus.
The delay in testing was the second symbol of this crisis. What do you remember from the auditions?
In March, at the start of the crisis, when the epidemic can still be contained, we test very weakly compared to Germany where 250,000 tests are carried out compared to 13,000 here, ie 20 times more. During the first confinement, there were 2.9 million tests across the Rhine against 514,000 in France. Beyond the figures, we pointed to the administrative slowness and the weight of bureaucracy. Representatives of private laboratories told us that these blockages cost us a month when the Institut Pasteur was one of the first in the world to develop these tests. The sidelining of private laboratories and departmental veterinary laboratories at the start of the crisis was a big mistake. Likewise during the second wave, when we had a very large number of tests, the appointment and result delay made these tests completely inoperative and thwarted the test-trace-isolate strategy which remains the hallmark of the countries. most successful in the face of the crisis.
What clarifications can you bring to the EHPAD tragedy?
Like home help services, EHPADs are the big ones forgotten at the start of this crisis. We even had to wait late for the announcement of the deaths in these establishments. They were not counted until April 2. Obviously, they did not benefit from sufficient protective elements at the start of the crisis. More seriously, as we pointed out in our report, the elderly patients of these structures have had more difficult access to the hospital. 16,000 people died there and 5,000 from EHPADs died in hospital. According to the DGOS (Directorate General for Healthcare), there is a drop in the proportion of people over 75 years of age in intensive care during the most critical period of the crisis. The figures have fallen from 24% at the start of March to just 14% during the week of March 30 to April 5, and only 6% in Ile-de-France, even as the elderly are more likely to develop severe forms of the disease. In nursing homes, we noted a delay in support, a significant lack of protective equipment and the tests were very limited, triggered only from two suspected cases. And staff did not have priority access to testing until April 9. All of this has cost us precious time. This crisis deeply calls into question the EHPAD system, which is insufficiently medicalized. They were considered to be medical establishments but this is not the case because they do not have the means of the hospital in any way.
Can you explain why this health crisis is also illustrated by a fracture within the medical profession?
During these hearings, I was shocked by the virulence of the battles that swept through the scientific world. In politics, we are used to conflict and opposition, but I expected less in the medical world. These conflicts have caused the loss of confidence in public and scientific words for our fellow citizens who continue to doubt the gravity of this crisis.
How did you analyze the media war on treatments, especially around chloroquine?
Our committee does not have the competence to decide the question of the appropriateness of medical treatment. What is certain is that the management of the second wave and the survival rates of patients, especially in intensive care, are higher and therefore, treatments have improved. For my part, I believe that the politicization of medical treatment has no place in such a crisis. The form and tone of this conflict has been inappropriate and unnecessary on both sides. It will take more perspective and less passion to shed light on Chloroquine, which was not our mission. But to mention Professor Raoult, it is undeniable that his IHU was very efficient and very fast in terms of tests. Moreover, I propose that this model be generalized in each region.
What can you say about access to the hospital?
This crisis is marked by hospitalocentrism. Everything has been focused on the public hospital with a complete exclusion of city medicine and very limited recourse to the private hospital. This generated an embolism of the public hospital system, which had already been structurally weakened for many years. We are told: “the hospital has held.” He held on because he was able to adapt and count on the extraordinary mobilization of healthcare staff. But the truth leads me to say that he also held out at the cost of two provisions with very negative consequences. The first is the deprogramming of all medical acts outside of Covid. We will measure the long-term consequences, but we have received very strong warnings in committee. The Unicancer federation estimates a projection of 5,000 to 10,000 deaths due to delays in screening or treatment for cancers. It is estimated that three months of delay equals a reduction in the chances of recovery by 5-10% in the long term. The postponement of non-essential medical activities raises fears of a worsening of certain pathologies, knowing that emergencies coming out of the first confinement, were faced with an influx of cardiovascular patients. The second provision is the reduced access of the elderly to the hospital. A form of regulation that has not spoken its name has been practiced to the detriment of our elders.
From the perspective of vaccination campaigns, how do you see things?
The French will remember that the first wave was that of the failure of the masks, then the second was that of the failure of the tests. I wish we avoided the third wave by the success of the vaccine. At this point, I remain quite worried about our level of preparation. There are no concrete elements of a clear strategy on the part of the government. I hope we will be able to be at the same level as Germany in this matter. The errors observed in the management of this crisis raise questions among our fellow citizens when we need complete confidence, even more so in the field of vaccination. For my part, I trust vaccines.
How do you see the action of the executive?
Emmanuel Macron’s interventions were regular, but to wage this “war” our country lacked, it seems to me, a commander-in-chief. What raises questions is the multiplication of decision-making bodies. The interministerial cell was activated very late and the steering was managed by the Ministry of Health rather than by the Ministry of the Interior, which by nature was to be the ministry of the crisis. Also, there has been a lot of confusion at the local level with the role of the regional health agencies, which is very uneven depending on the region. Sometimes these ARS were even in conflict with the prefects. This form of bureaucracy delayed decisions. This is why I am proposing the disappearance of the ARS in favor of departmental health directorates placed under the authority of the prefects. I also note that ideological considerations weighed on the maintenance of a fully open borders. What appears to be irresponsible and quite distant from the choice made by other countries which have closed them from the risk areas.
What was your biggest surprise during this work?
We had looked at Italy with a form of contempt, but in the end our record is comparable, if not worse in many ways. France has lost some of its status. Believing that she had the best hospital system in the world, she lived on a pipe dream because this system was in fact weakened by a very strong sprawling bureaucracy. As we devote considerable resources to health, we find that these resources have been diluted in this bureaucracy. This is also why the governance of hospitals should preferably fall to doctors.
A judicial inquiry was opened by the Court of Justice of the Republic against Edouard Philippe and several of his ministers. What do you expect from it?
We have no comments to make on this matter, but in the report of the Parliamentary Inquiry Committee I personally express my doubts about the conduct of proceedings at the heart of the crisis. I also wonder about the increasingly strong judicialization of public action. Edouard Philippe told us, before the committee, that he saw it as a brake on decision-making. One day, we will certainly have to reflect on this to avoid this pitfall.