What strategies to deal with the Covid-19 epidemic?

Text by: Simon Rozé Follow

As Europe and North America face the peak of the epidemic wave, China seems to have passed it and other countries, such as South Korea, have greatly limited it. What are the various measures implemented around the world to deal with SARS-CoV-2?

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“Flatten the curve”: this is now the sole objective of the countries hit by the Covid-19 epidemic; limit the number of cases as much as possible in time so that hospital resources are not overwhelmed by an influx of patients. In Europe, but also in the United States, the solution then involves more or less strict confinement of the population and the establishment of social distancing.

The goal is to break the dynamics of exponential spread of the virus which doubles the number of cases in a few days. This strategy is nevertheless fraught with consequences, entire countries are paralyzed and the economic consequences terrible. In France, it is estimated that a month of confinement will lead to a drop of 3 points in GDP .

"A simple message to send to all countries: test, test, test"

Some countries, however, have managed to overcome this step. South Korea is often cited as an example. The calm morning country has followed the recommendation of the head of the World Health Organization, Dr Tedros Adhanom Ghebreyesus: “ We have a simple message to send to all countries: test, test, test. All countries should be able to test suspected cases. They cannot fight the pandemic blindfolded . ”

South Korea tested 15,000 people for free per day on average. However, this strategy is not enough in itself: the challenge is to quickly isolate people with Covid-19 and then trace the chain of contamination in order to identify all those in contact with the sick. This notably required the cooperation of telephone operators with the Crisis Management Center to transmit geolocation data for South Koreans. It is all these measures put end to end, as well as a rigorous civic-mindedness of a population previously struck by MERS and SARS, other respiratory pathologies, and who respected the barriers and social distancing measures, which allowed South Korea not to resort to containment.

" The 2002-2003 SARS epidemic provided many lessons, " said Benjamin Coling, professor of epidemiology at the University of Hong Kong. In addition to South Korea, Singapore, Taiwan and Hong Kong have managed not to repeat the mistakes of the past. “ At the collective level, these countries have succeeded in developing capacities to detect new viruses, while increasing the capacity of hospitals to receive patients with respiratory difficulties. An experience that has also benefited the population on an individual level: " SARS has prepared people to demonstrate a considerable level of self-discipline, to avoid crowds and to raise their level of personal hygiene." In short, " these countries were much better equipped to face the emergence of this coronavirus than many others. "

Distraught europe

Perhaps because it has not been hit recently by such epidemics, the strategy followed in Europe has differed. With France, Spain and Italy in the first place. With relatively few cases until the beginning of March, France for example tried to limit the epidemic as much as possible before it flared up. The doctrine was then based on targeted tests to limit the few epidemic foci identified on the territory by tracing the chains of contamination. An evangelical gathering in Mulhouse bringing together more than 2,000 people sounded the death knell for this strategy. Several infected people attended and then participated in the spread of the virus throughout the country.

That said, the French choice not to resort to massive screening and to be content with targeted tests was not deliberate. As noted by the Scientific Council set up by Emmanuel Macron in its opinion of March 23: “ the alternative of a policy of large-scale screening and isolation of detected persons is not currently feasible for the 'national scale '. Indeed, even if it had wanted it, France could not have generalized screening. To make one, one seeks to detect the presence of virus in a person's nasal secretions. For this purpose, a practitioner must take a sample using a long cotton swab, a swab. This sample must then be sent to a laboratory, where a reagent is then added to it to determine the presence of the virus. But the bottlenecks are numerous along this chain, and prevent the country from going up in pace; he will only perform a few hundred tests a day at the start of the epidemic, before reaching an average of 4,000 daily tests until mid-March.

For France like many other countries, there remains only social distancing pushed to the extreme, confinement. More or less strict according to the States, its adoption endorses the fact that the epidemic is present and virulent. It does not aim to definitively stop its diffusion, only to slow it down so that the hospital system does not overflow. Consequently, the issue of breaking out of confinement becomes very sensitive in order to avoid a possible second wave.

China announces that it has successfully overcome this phase, with almost the same weapons that it has used since the beginning of the epidemic: massive screening and isolation if contamination occurs. Bruce Aylward of WHO visited the country in late February to observe how the crisis was managed there. “ It was done very intensively, with extensive tracking of the infected people. The screening policy has been very extensive. "The Canadian continues:" At the foundation of these measures is extremely proactive surveillance, to immediately detect cases, make very rapid diagnoses and immediate isolation of positive patients, rigorous tracing and quarantine of close contacts. "

Deconfinement, a complex choice

More than four months after the start of the epidemic in China, now comes the time for the end of confinement. Its gradual lifting in Wuhan does not seem to have been marked by a rebound in epidemic dynamics, even if many observers doubt the veracity of the figures communicated by the Chinese authorities and believe that Beijing may have declared victory. too early. As the French director general of health, Jérôme Salomon, said during his daily press briefing on the evolution of the coronavirus on April 1: “ This is something completely new. Never in history have we confined and then deconfigured so many people ”.

However, almost everyone agrees that mass screening must be generalized for such an operation. There is also the question of masks, which are also sorely lacking in the West, unlike Asia. " Not wearing a mask to protect yourself is a big mistake, " said George Gao, the director general of the Chinese center for disease control and prevention, in an interview published in the journal Science . “ This virus is spread by respiratory droplets, from person to person. The droplets play a very important role, hence the need for the mask. Just talking can spread the virus. Many affected individuals are asymptomatic, or do not yet show symptoms: with a mask, you can prevent droplets carrying the virus from escaping and infecting others. "

But there too, as for the tests, the means are lacking in France, despite the mobilization of the productive apparatus on the territory and orders placed abroad. In early April, masks are primarily reserved for health personnel.

Africa is preparing

Asia, then Europe and North America were successively hit by the Covid-19. Africa seems to see the epidemic arrive with a little more delay. So much time taken advantage of to anticipate the wave. " All African countries are preparing, " said Dr Rebecca Moeti, the WHO regional director for Africa. “ Some countries like Senegal and South Africa have increased their diagnostic capacity. In general, there is a strong political commitment. The World Health Organization fears, however, that the epidemic is hitting smaller countries hard: "We must be very careful, because some are far from having the means or the infrastructures". But she adds on a more optimistic note: “ We still have a window of fire. Coronavirus can be contained in many countries, but for this, daily monitoring of the evolution of the epidemic is necessary. The public must also be very well informed to respect the barrier gestures. "

" Respect for confinement is very important, " adds Professor Samba Sow, the director general of the vaccine development center in Mali. “ But you have to take into account all its aspects and adapt it to Africa. In homes with lots of people, you may want to consider letting them out rather than staying locked up. But confinement remains the best method. "

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