Ile-de-France is "facing a real rebound in the coronavirus epidemic"

Aurélien Rousseau, director of ARS in Ile-de-France -

• The incidence of the epidemic, that is to say the number of cases per 100,000 inhabitants, is around 100 in Ile-de-France.

  Well above the alert threshold set at 50.

• The positive cases in Ile-de-France schools do not only concern students or teachers, it concerns all agents, some are not in contact with students.

• The director of ARS Ile-de-France calls on Ile-de-France residents to be careful during family gatherings.

  “There are very few cases of clusters in public transport when people are stuck to each other, but there are many in family units.

  "

Do everything to prevent the situation of last spring from happening again.

This could be the watchword of Aurélien Rousseau, the director of the Ile-de-France regional health agency.

On paper, however, the indicators are not optimistic: exponential increase in contaminations, slow but continuous increase in hospitalizations, queue in front of laboratories ... If the region is undoubtedly facing a rebound in the coronavirus epidemic, the situation remains very different.

Interview.

Since August and even more so in September, the incidence of the epidemic has increased exponentially.

There are now nearly 100 cases per 100,000 inhabitants where the alert threshold has been set at 50. Are we seeing this famous "second wave" break out?

The term “wave” primarily refers to the impact of the epidemic on hospitals.

It is real today even if it is still slow.

Every day, between 10 and 20 patients are hospitalized in intensive care in the region.

Last week, it was around 30.

Other patients, who would have been taken care of in intensive care in the spring, are now in conventional hospitalization departments because our knowledge of the virus now allows us to better anticipate respiratory problems that require intubation.

We are undoubtedly facing a real rebound in the epidemic.

The flow is accelerating - 2,000 cases are identified every day - even if we are far from the situation we experienced in the spring.

Yet when we look at the data on the number of patients in intensive care, it seems surprisingly stable.

On August 11, 189 patients were in critical care.

Yesterday, they were 204 ...

Entries are accelerating, whether in intensive care or conventional hospitalization elsewhere.

But every day patients come out.

The average length of stays in intensive care is lower than in March and April because we know the pathology better, we have more perspective on the clinical signs which allow us to better anticipate the evolution of the situation.

But unlike last spring, some levers to relieve hospital pressure are now inaccessible.

We cannot, for example, postpone all surgeries again.

Has the start of the school year worsened the health situation?

How many classes are closed in the region?

The reports of sensitive situations have exploded for a week but it is not always about cases of Covid-19.

The symptoms of the coronavirus are sometimes very similar to those of mild re-entry infections.

There are less than ten clusters in educational establishments in the region but we have identified at least one positive case in 241 establishments in Ile-de-France, including 151 in Paris.

It is not only a question of pupils or teachers, it concerns all the agents, some of them are not in contact with the pupils.

A total of 20 classrooms had to be closed in the region.

The queues in front of the laboratories are getting longer, and so are the deadlines for the results.

In some cases, they are now longer than 5 days.

Are the laboratories outdated?

At the end of June, we were doing 45,000 tests per week, today we are at 220,000 and we intend to maintain this quantitative effort.

Since May 11, we have been in constant contact with the laboratories to identify the blocking factors: swabs, samplers ... But we are aware that the situation is sometimes very complicated.

At the regional level, the time to obtain a result is 36 hours, but this climbs locally to 6, 7 or even 8 days.

However, it is impossible for people with symptoms or being in contact to wait more than 24 or 48 hours.

Theoretically, laboratories should prioritize the people to be tested, but this remains very difficult to set up.

It is a real difficulty for us.

At the end of last week, we took the decision to install around twenty permanent barnums to relieve the laboratories while maintaining the quantitative effort.

They will test people with symptoms or contact cases every morning until 2 p.m.

At the start of the week, Olivier Véran indicated the deployment of rapid antigenic tests.

They are currently only used within the AP-HP.

Will this improve the situation?

They will be very useful in guiding the diagnosis and having a general idea of ​​the epidemic situation, but they will not replace PCR tests.

Antigenic tests - which are also performed by a nasopharyngeal swab - are relatively accurate in saying that a person does not have Covid.

On the other hand, if the result is positive, it is necessary to repeat a PCR test behind.

But they can be very useful in airports for example.

If a person is positive, they isolate themselves until the second test.

Do the hazards associated with the tests make it possible to effectively break the chains of transmission?

Are people playing the tracing game?

It is sometimes very difficult to enforce isolation in a contact subject who has no symptoms or even in a positive but asymptomatic person.

It is for this reason that we now recommend a 7-day isolation, easier to respect.

But we must also do educational work: either we collectively respect the measures and we manage to limit the epidemic rebound, or we allow the situation to deteriorate and we risk more indiscriminate measures.

But I am optimistic: at all stages, we wondered if the French were going to play the game and they did.

Is the generalization of the mask, first indoors and then outdoors, paying off?

The barrier gestures - of which wearing a mask is a part - work.

The R0 [virus reproduction rate] has declined in recent days: after rising to 1.5, it is now around 1.2 [a positive person infects an average of 1.2 others].

But there is still work to be done in terms of awareness, on family reunions for example.

Today, there are very few cases of clusters in public transport when people are glued to each other, but there are many in family units.

People still have the feeling that they are not afraid of anything in the family.

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