Can the second wave of coronavirus be worse than the first?

Caregivers going to intensive care, illustration -

• The Prime Minister warned this Thursday that the month of November would be "trying" in the face of the coronavirus.

• Even more trying than the months of March or April?

  This is the hypothesis advanced by several doctors, who fear a second wave even worse than the first.

• With the help of two epidemiologists, "20 Minutes" explains the possible reasons for a particularly formidable second wave.

The figures of Public Health France this Sunday had enough to convince the last skeptics.

With more than 50,000 positive cases recorded in twenty-four hours, to which are added 116 deaths, the second wave of coronavirus is here.

On average, the number of cases is now increasing by 30% every week, while the occupancy rate of resuscitation beds and the number of deaths are also increasing worryingly.

And even more alarmingly than expected, according to the Scientific Council on Monday, which declares to be "surprised by the brutality of what has been happening for ten days.

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To the point that doctors are warning about the risks of a second wave so strong that it would become even more deadly than the first, which swept through France between February and May.

The director general of Public Assistance-Hospitals of Paris Martin Hisch thus declared this Friday on RTL: “The second wave may be worse than the first.

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National spread of the coronavirus

Questioned by

, Mahmoud Zureik, hospital practitioner in epidemiology and public health, refuses to play the game of forecasts but warns of a second wave "which will certainly be very very harsh, for several reasons different from March".

At the head, the circulation of the virus much more diffuse on the whole of the French territory, where the first wave had mainly spilled on the Grand-Est and the Ile-de-France.

Antoine Flahault, epidemiologist, spins the metaphor: “A bit like forest fires, when an epidemic is generalized, it is more difficult to fight it than when it is contained.

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As a result of this national distribution, patient transfers between regions will be made much more difficult.

“There will be no respite zone, each region will be left to itself,” worries Mahmoud Zureik.

And the reasoning can even be transferred internationally.

During the worst of the first wave, multiple transfers of patients to Germany, Switzerland or Luxembourg in particular, had allowed to unload a little of the French hospitals on the verge of rupture.

In November, with the epidemic which will strongly affect all European countries, it seems complicated to imagine.

The fear of saturation and a hospital crash

Admittedly, the Covid-19 is much better treated than at the beginning of the year.

The mortality of people hospitalized for coronavirus has been reduced by 30 to 50% in the space of a few months, recalls Antoine Flahault, and resuscitations are much better supported.

If the progress is indisputable, will it still be applicable in the event of total saturation of the hospital system?

This is what is at stake in the second wave for Mahmoud Zureik: “We fear that the health system will fail and completely crash as it will be overwhelmed.

We saw in Italy and Spain during the first wave images with serious Covid-19 patients installed in the corridors of emergencies for lack of space for ten days.

We fear to experience this in France.

Under these conditions, all the progress made in the treatment of patients will be null and void, for want of being able to practice them.

Two phenomena make this hypothesis particularly fearful.

By focusing partly on Ile-de-France, the first wave hit the region of the country best equipped in terms of health.

The fear is that this time, regions with very few health resources will be unable to cope.

Added to this is the impact of the first wave, which "strongly shook the French healthcare system, already weakened before February", testifies Mahmoud Zureik.

For Antoine Flahault, if the French hospital system is already under tension, it remains “one of the best suited in Europe to face the winter storm.

Its staff are highly qualified, the infrastructure is mostly well maintained and benefits from the latest technological advances.

What worries more is the lassitude, sometimes burn-out, of the nursing staff who are exhausted by months of fighting this pandemic under difficult conditions.

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The effectiveness of barrier gestures

And the masks and barrier gestures in all of this?

They are playing their roles, and if the numbers of the last few days are staggering, they would be much worse without.

Currently, the reproduction rate of the virus is 1.34 in France.

Roughly, this means that a sick person will infect 1.34 people on average so that the virus continues to circulate actively (since each patient infects more than one person, the number of patients increases).

On the eve of confinement in March, this reproduction rate was estimated at 2.8, a figure more than twice as high.

Likewise, if the number of cases increases by 30% per week, at the height of the crisis in March, it doubled every three days.

"Masks and barrier gestures are doing their job of reducing epidemic acceleration correctly", assures Antoine Flahault.

The whole problem is that the epidemic continues to climb at breakneck speed.

Less strong than in March therefore, but at an exponential rate despite everything.

What sound the alarm for Mahmoud Zureik: “To avoid a second wave worse than the first, if we can avoid it, it is necessary to take very strong, very strict measures and very quickly.

»And already thinking about tomorrow.

Because for the practitioner, what is also playing out today, “is how are we going to prevent ourselves from the third wave?

“In times of health crisis, each day is no longer enough.

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