In recent days, the government has been alerting to the indicators for monitoring the Covid-19 epidemic, which are going up.
The last point of surveillance of Public Health France confirms these signals, without revealing an epidemic which would become exponential again.
Many parameters will play out in the coming weeks to know whether we will have to face a fifth wave or a light plateau: vaccination of the most fragile, vaccine reminders, barrier gestures better respected ...
The coronavirus has not finished playing on our nerves.
We imagined, two weeks ago, that the tunnel was behind us.
But in recent days, warnings have multiplied.
Wednesday, Gabriel Attal spoke of "a slight but sensitive recovery" of the epidemic.
An impression confirmed by the last point of surveillance of Public Health France (SPF), published Thursday evening.
What to prepare for a new winter in hell for overwhelmed hospital workers?
Or, for the French, to new restrictions?
Incidence and hospital visits on the rise
"For the second consecutive week, we have seen an increase in the incidence rate: 55 cases per 100,000 inhabitants, with 5,276 cases diagnosed per day on average, or + 14%," specifies Nicolas Methy, epidemiologist at Public Health France. We were at + 11% the previous week. Another cause for concern: this increase is more marked among those aged 60 and over. But this monitoring is undoubtedly to be put into perspective: since tests are no longer reimbursed for unvaccinated adults, it lacks reliability. “Another telling indicator is the reproduction rate (how much a person with the virus infects other people). It is increasing and greater than 1 for the second week in a row, ”he continues.
And it is not only the incidence that worries: the figures are also to be monitored on the side of the hospital.
“There was more use of SOS doctors (+ 24%), a slight increase in emergency room visits (more marked among those over 75: + 18%), and hospital and critical care admissions have moved a little, with + 12% admissions in critical care ”, adds Isabelle Parent, head of the respiratory infections and vaccination unit of SPF.
“Currently, more people are arriving at the hospital for Covid-19, and the number of deaths has stopped falling for more than two weeks,” adds Catherine Hill, epidemiologist.
Towards a plateau or a fifth wave?
Alerts to qualify all the same: the number of new hospitalizations has increased very slightly (+ 2%). And according to the latest Covidtracker figures, there is an average of 61 critical care admissions for Covid-19 each day (+ 34% compared to last week), compared to 206 admissions on August 23. These indicators therefore start from fairly low: there are around thirty deaths each day, against more than 100 last August. Likewise, as of October 26, 6,506 Covid-19 patients were hospitalized, including 1,062 in critical care. Far, therefore, from the threshold of 5,000 beds in sheaves reached during the first waves.
The fourth wave this summer, with a limited effect on hospitals, is hopeful.
Moreover, the term “fifth wave” cannot be used at this stage.
"A wave is really an increasing increase that we observe over several weeks, so it is too early to say so, to predict its magnitude and its impact on the hospital," says Isabelle Parent.
“We are coming out of the post-fourth wave trough,” adds his colleague.
Whatever the name, this signal is worrying.
From there to say that we risk a tense autumn?
Many parameters will come into play in the coming weeks.
Many parameters will affect this recovery
In this equation with many unknowns, what has not changed is the season. "It's winter, soon back to school, the virus is circulating", list Catherine Hill. A coronavirus that still appreciates indoor meetings in poorly ventilated places ... Especially since during these All Saints holidays with poor weather, schools are closed but travel, family reunions and stays with grandparents can multiply transmissions.
However, when it comes to the differences between the second wave, in autumn 2020, and the current recovery, there are three specificities. The huge asset is of course the vaccination coverage - 85% of French people who can are vaccinated -. “There are enough people vaccinated to prevent 700 daily arrivals of Covid patients in intensive care! », Reassures Catherine Hill. A threshold that had been reached in April 2020. Vaccination is a firewall, but in a relative way. "We can not know what it will give, nuance the epidemiologist. We have 16 million French people not vaccinated. »Many of them are elderly or those suffering from co-morbidities. "About 13% of those 80 and over are not vaccinated," she continues. For Isabelle Parent, “there are a lot of uncertainties.If the most fragile people not yet vaccinated resort to it, if more French vaccinated and eligible are recalled - because we know that the effectiveness on the infection decreases with time -, this can slow down the impact on hospitalizations , especially in critical care. "
Second "game changer": if we know the barrier gestures inside out, they are not as well respected as before.
This is why doctors insist that the mask is worn over the nose and under the chin.
And that we do not embrace his diabetic aunty with a gout in the nose… “According to the latest studies on adherence to barrier gestures, we see that over the last three months, the indicators are stable.
But this follows a decrease after the third confinement, notes Nicolas Methy.
There is weariness, but also room for improvement.
"
Hospitals already in difficulty
Finally, a third data that could tip the scales in the wrong direction: the state of hospitals has deteriorated further. A report, which caused a stir this week, points to the fact that 20% of hospital beds have closed for lack of caregivers ... "What will be problematic is our capacity at the hospital, confirms Rémi. Salomon, president of the Medical Commission for the Establishment of Public Assistance in Paris Hospitals. The difficulties are more marked in some hospitals, but they affect the whole country and both the public and private sectors. We have struggled to recruit and keep teams for years, but this is unheard of. It would therefore be much more difficult to increase the beds if we had to face a new wave. However, what has always motivated the restrictions and confinements,it is the saturation of critical care. "
All the more so as hospital workers would have to take up a double challenge.
“There are also winter epidemics to manage: bronchiolitis currently, influenza soon, adds the AP-HP doctor the day after a conference to warn about pediatrics, already at the end of their rope.
However, last winter, these viruses circulated little, so the French are less well immunized for this winter ”.
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