Covid-19 in France: the four scenarios of the Scientific Council for the coming months

The Scientific Council, responsible for supporting the public authorities in the management of the Covid-19 crisis, issued a new opinion to the government on June 2, posted online on Thursday, June 4. "The purpose of this opinion is to identify the various likely scenarios in the post-containment period", explains the Council in the preamble.

These “four possible scenarios” aim to “prepare and anticipate the measures to be put in place” to avoid further containment.

• An epidemic "under control"

This scenario, the most optimistic among the four exposed, is also the one that seems to be favored by the public authorities: as of May 29, the Public Health agency France affirmed that there were "no signals in favor of 'a resumption of the epidemic "of Covid-19. In the same vein, the president of the Scientific Council Jean-François Delfraissy explained, Friday June 5, that the virus was “under control”.

This scenario requires health indicators which “must be stabilized over a sufficiently long period” - at least two months - to be able to affirm that the situation is under control, according to the Council.

Number of emergency visits for Covid-19, new hospital patients, emergency hospital patients, intensive care patients, number of daily PCR tests, etc. These indicators, used for some of them since last March, must be “the signals of 'a control of the spread of the epidemic ”indicating a“ low level of circulation ”of the virus in France,“ with a stable or decreasing trend, without problematic clusters ”, estimates the Scientific Council.

The opinion recommends in this scenario the maintenance of two measures “at their current level”: the application of barrier gestures by the entire French population and the “test-trace-isolate” strategy of the health authorities.

• A local recovery of the epidemic with “critical clusters”

This intermediate scenario is “likely in the coming weeks”, estimates the Scientific Council which is based on “what has been observed in Germany and in certain countries of Asia” in recent weeks.

The Council evokes the particular vigilance that the public authorities should have vis-à-vis “critical clusters”, pockets of localized contamination with “a very fast, almost explosive dynamic”. In this scenario, “depending on the risk assessment”, the Board proposes an “early, quick, massive and targeted response to a geographic area.”

Several levers should then be activated in a “combined” way: the reinforcement of barrier gestures, a massive “test-trace-isolate” strategy - “the practice of tests cannot be limited to symptomatic cases of populations in the perimeter of the cluster” , estimates the Council -, a proactive approach towards the precarious populations, as well as a localized containment sufficiently early.

The imperative in this scenario is to “control the circulation of the virus and limit the number of cases exported from the identified critical cluster” to avoid a resumption of the epidemic at the national level.

• A resumption of the “low noise” epidemic

This scenario is possible for “a sufficiently large territory” such as a French region or the whole country, explains the Scientific Council. It would consist of a “diffuse recovery” of the epidemic in this given geographical area, coupled with a lack of monitoring of the chains of transmission of Covid-19.

"This resumption of the epidemic rather reflects a relaxation of the measures to control the circulation of the virus by the population allowing an active resumption of the transmission of the virus and in a diffuse way", estimates the Council, for which the progressive resumption of displacements of people from one region to another could “encourage the spread of the virus” in this scenario.

Two indicators could prefigure this situation: the rapid increase in the number of tests performed per day in the geographic area affected, as well as the significant and observed increase in the number of positive tests over time compared to the number of tests performed.

Anxious to avoid a reconfiguration similar to that which France experienced for weeks, the Scientific Council recommends in this scenario “a change of approach” with the activation of several measures of a reinforced prevention and protection plan (or all, depending on the severity of the situation): strengthening of barrier measures, strengthening of “test-trace-isolate”, protection of nursing homes, strengthening of the response capacity of public and private hospital structures ...

If these measures had no effect on the situation of epidemic recovery, “the question of generalized containment and the conditions under which it will have to be reactivated will arise” then, estimates the Council.

• “Critical moment” of the epidemic and reconfiguration

This scenario is the most pessimistic and results from the failure of the measures detailed in scenario 3, intended to stem the spread of the epidemic. In this perspective, "the number of cases continues to increase and we arrive at the" critical moment "where, explains the Scientific Council, the authorities must decide if they wish to establish a second confinement to avoid overflow of the intensive care services".

The possibility of reconfiguring the whole of the French population is, however, considered by the Council “neither desirable nor feasible for reasons of health, societal and economic issues”. But in scenario 4, the authorities have to take decisions to “avoid overflowing” the intensive care services, as was the case in the Grand Est or in Île-de-France several weeks ago.

The “serious decision” of a new containment should be taken by considering, on the one hand, “the health impact” of the Covid-19 epidemic and, on the other hand, “the impact of a second confinement on French society ”, according to the Council.

In this scenario, the authorities should also be aware of the objective pursued in the event of new containment: if it is “only to reduce the mortality linked” to the virus, confinement “permanent or extremely early will always be preferable”, estimates the Scientific Council. And he specifies: “An alternative objective is to assume while limiting the excess Mortality Covid-19 hospital associated with the setting in tension of the services of reanimation.”

The Council finally recalls “the importance of anticipating” “to better protect” and avoid arriving at a new critical situation, which “must absolutely be avoided”.

This anticipation is based on the Enhanced Prevention and Protection Plan. In seven parts, this plan makes it possible to prepare measures that the authorities can activate gradually or massively depending on the characteristics of the epidemic in the coming weeks. These measures must be "drawn up now", "with actors, in particular territorial ones", in order to be able to "activate them as quickly as possible" "when necessary", insists the opinion of the Scientific Council.

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