Covid-19: lessons and challenges of an extraordinary epidemic

A man walks past a mural honoring Covid-19 pandemic caregivers in Acapulco, Mexico, May 1, 2020. © Francisco Robles / AFP

Text by: Anoushka Notaras

15 mins

Appearing in China at the end of 2019, the Covid-19 virus caused an epidemic as dazzling as it was brutal, spreading across the entire planet in a few months.

Two years later, successive waves due to the appearance of new variants of the virus have infected more than 405 million people and claimed 5.8 million victims according to official figures.

The latest, Omicron, gives hope for a possible evolution of the epidemic towards an endemic, that is to say a seasonal virus.

Patrick Zylberman, Emeritus Professor of Health History, helps us understand the mechanisms, issues and consequences of this extraordinary epidemic.

Advertising

Read more

RFI: How does an epidemic work?

Patrick Zylberman

An epidemic is a waltz at several times between the virus on the one hand and the immunity in the host on the other.

The more the virus circulates, the more the immunity increases.

The higher the immunity, the harder it is for the virus to circulate.

After a while, the immunity is such that the virus is completely suppressed.

And then he withdraws.

We don't really know where - it doesn't disappear, no virus disappears - but we don't really know where it will hide.

The virus disappears stifled by the immunity of the host until it reappears in the form of a variant or in another form.

This is the case with the flu, for example.

►

Thus, an epidemic is caused by the circulation of a new virus or a virus that has not circulated for a very long time and against which humanity is no longer immune.

When immunity is insufficient or when populations are said to be “naïve”, that is to say that they have no immunity for this virus, there is a new epidemic.

And we have to be careful of the term “pandemic” that people sometimes mistakenly use today.

The definition is purely geographical: a pandemic is an epidemic that affects more than one WHO region.

It is a purely geographical concept.

A pandemic is a large-scale epidemic.

What was the role of globalization in the spread of the Covid-19 epidemic?

We already find this phenomenon in ancient plague epidemics, as in the plague of the Middle Ages from 1348 to 1352. The world population was certainly much smaller than today, but there were already many contacts between the different continents and therefore, with the circulation of humans, a strong circulation of viruses.

As Stephen Morse, an American epidemiologist, explains, “humanity is the engineer of microbial circulation”.

We have, at that time, a first globalization - which is obviously unrelated in terms of intensity or scale to what is happening today - but which has ensured that the virus circulates.

He traveled with armies, with Genghis Khan, he traveled with ships like the one that touched the port of Caffa in the Black Sea,

causing the epidemic of the Middle Ages in Europe.

The increased movement of people is one of the triggering mechanisms of an epidemic.

Despite their a priori

efficient health systems

, how do we explain the great vulnerability of rich countries in the face of the meteoric spread of Covid-19?

There are two things.

First, the comparison is difficult because in reality, we have seen the vulnerability of rich countries, but we do not know much about low-income countries.

Secondly, the great vulnerability of Western countries could be measured because the health statistics information is quite efficient.

This is not the case in poor countries.

If you look at the first half of 2020, you see the difficulty of a world that is supposedly extremely technologically efficient in fighting the epidemic.

We knew very little.

We had no means, no vaccine, no therapy.

We were very helpless.

However, we relatively resisted the first two waves which were still quite virulent, especially the second.

If we look at what happened in the hospital, the hospital was extraordinarily shaken.

In some cases, we were even quite close to collapse.

And yet, the hospital resisted.

Have the lessons learned from previous epidemics enabled us to understand the current pandemic?

The problem is that we never learn a lesson because once the epidemic has subsided, we are in no hurry to forget it.

The health policies put in place are immediately dismantled.

Take for example the people demonstrating to demand an end to coercive measures.

What they are asking is that we forget all these problems as quickly as possible.

It is an extraordinarily recurrent phenomenon.

Take the case of

which nevertheless caused nearly 50 million deaths worldwide between 1918 and 1919. In 1921, people had completely forgotten this episode which only reappeared in memory in 1957 during the second influenza pandemic of the XXth century.

And it happened again in 2020 in China after the end of the Wuhan confinement.

People were in no hurry than to rush to nightclubs to have fun.

What is very characteristic is the will to forget.

It is not simply forgetting as an automatic or unconscious phenomenon, it is the will to forget.

And why ?

As Nietzsche said, “without forgetting, there is no present”.

If you just dwell on your misfortunes for days, months, years, you're not moving forward.

In terms of prevention, today we often hear doctors say that the epidemic is regressing - this is a very good thing - but that we must continue to observe barrier measures.

Barrier measures are observed when people are afraid.

Once the danger is gone, they don't care and that's pretty understandable.

It's not very hygienist or very consistent with what many doctors would like, but it's the reality of things.

Wearing a mask is another example: if there is no immediate risk, people will not wear it.

It may be accepted in the Far East, but certainly not here.

It is also a cultural issue.

© FMM Graphic Studio

Despite the progress of science in general and the acquisition of increasingly precise knowledge, the population's distrust of scientists is very strong.

How do you explain it?

It is a difficult problem.

To understand this, you have to go back to the work of Jean-François Lyotard,

, a report that the author had submitted to the Government of Quebec in 1979. In this report, Lyotard said that the great stories that had supported scientific effort, especially from the 17th century, were no longer effective today. today.

The great stories were about infinite progress, the progress of knowledge, the progress of science, the progress of humanity.

It was also the progress of the absolute spirit, that is to say the idea that reason would finally prevail over any kind of unreason.

It's not very convincing like that, but in reality it's very important because it means that today, science is no longer based on an idea, the kind of base that legitimized it from the start has disappeared.

It only authorizes itself, as they say.

► Also to listen: Vaccines: why so much distrust?

Today, science is seen as something to be wary of.

Look at what is happening with GMOs, with nanotechnology, artificial intelligence.

There is a distrust of science and it expresses itself in quite bizarre ways.

It's not a rejection at all, it's simply the idea of ​​replacing the scientific method with something else, a pseudo science.

This is what is happening at the moment and particularly in France where science education is relatively poorly done.

And this is a problem that absolutely must be remedied.

The world we live in is totally artificial, the environments are artificial, the technologies are artificial.

A world like this cannot be a world where science is rejected, it is not possible.

We are facing a huge problem.

Whether we agree or not with the language Lyotard, who died in 1998, we must recognize that he pointed out important things.

If science is no longer legitimate, all information on the health crisis becomes illegitimate and anything can be substituted for it.

Two years after the start of the pandemic, what lessons can we draw from it?

It is still too early.

This epidemic has generated a lot of things and sorting it out is essential.

But some deserve to be studied more closely and listing the problems to be treated would seem to me very useful.

A first track would be to seek what lessons can be drawn from

.

How did they experience the hospital crisis that the epidemic triggered or over-triggered since the hospital was already in poor condition?

Have we decided yes or no to reform the hospital and to eliminate all this over-administration which encumbers caregivers, to ensure that the care professions are valued?

For the moment, we are making friends with the hospital because we need it.

But when we don't need it less, will people agree to invest?

Because we will have to invest in the hospital.

Then, was the governance of the epidemic satisfactory?

No.

Did the ARS (Regional Health Agencies) work well?

Not everywhere.

All this concerns only the political aspect of the crisis.

There are also health aspects.

For example, we know very well today that quantitatively, the psychological problems were very serious during the confinements.

But we do not know more for the moment.

We have not yet dissected what these psychological problems were, for which age group, for which type of population, for which type of confinement, etc.

The search has only just begun.

This is a very important question because if a society, which is already crazy enough as it is, is weakened on the psychic level, we risk going straight into the wall.

The question is therefore whether this research will have an impact on public health policies in the fight against epidemics or not.

►

The question of the long Covid is also not to be neglected.

Even if it is not a question of public health in the strict sense of the term and that it is research for clinicians, why are we not going to question them to try to understand the long Covid today?

With the latest Omicron variant, we are beginning to say that this epidemic could become endemic.

How can the situation evolve?

It has already evolved.

In France, we are no longer in the same type of epidemic as in 2020-2021.

With Omicron, we are in a kind of vast epidemic of infectious cold which, indeed, is much less virulent, no less unpleasant, but which is different from the Delta variant which could lead directly to intensive care.

It makes a hell of a difference.

Endemization, meaning the seasonality of the virus that would eventually strike in the winter and – unless it occurs in pandemic form – leave us alone during the summer, is something found in the general history of viruses.

It is believed, with good reason in my opinion, that this is the mechanism that has been in operation since the end of 2021 and that therefore the transformation of the coronavirus from epidemic disease to endemic disease is underway.

And it's a perfectly ordinary process.

Even if the risk of appearance of new variants remains intact, Omicron has the advantage of allowing

on a large scale.

This will probably never be enough to completely paralyze the virus, but the more people there are infected, the more the epidemic comes up against the wall of immunity.

It circulates a lot, but in a less virulent form.

Vaccination inequality between rich and poor countries is sometimes described as one of the brakes on emerging from the crisis.

Is the lifting of patents a solution?

No.

The idea of

good sounds like a good idea.

But in reality, this means that companies are not interested in it and manufacturers will refuse to work under these conditions.

The public authorities themselves, whether in France or elsewhere, do not have the means to manufacture these vaccines on the extraordinary scale that is necessary.

Only private companies can do it with the lure of profit.

A good idea would be for rich countries to buy large quantities of vaccines which they would then redistribute at cost price to low-income countries.

It would be a good thing because it would make the States of the former Third World responsible, which are not all very responsible, and at the same time it would allow them access to vaccines, which is not the case today. today.

Currently, the risk is twofold: risk for the populations of these countries which are not protected and risk for the world population to see the return of new variants, as was the case with Omicron.

There is a philanthropic motivation in the idea of ​​buying quantities of vaccines and redistributing them to poor countries.

Then there is a selfish motivation which is “we protect ourselves”.

Given the context of globalization, climate and environmental degradation, what are the challenges we must face?

The challenges are many, they are extremely serious and one wonders if we will ever be able to overcome them.

There are those who think technology can do everything, and there are those who think technology can't do anything, like environmentalists, for example, who are on the whole quite conservative.

Faced with climate problems, we see that politicians but also companies refuse to implement the necessary means to try to counteract the degradation of the environment, degradation which generates the appearance of new epidemics which risk reproducing in a closer and closer, like hurricanes.

We need to change farming methods, for example.

Why are

more important today?

Because humans have moved closer to reservoirs of viruses, especially bats and other rodents that carry them.

If, as in Malaysia for example, we tolerate pig farms going deeper and deeper into the forest, bringing animals, people and bats into direct contact, we must be aware that we are contributing to the risk of new epidemics.

It's all very difficult and that's why people don't want to talk about it.

We do not swim in optimism.

I would not say that we should not be pessimistic, but attentive to the means available to us because there are some.

But above all, you must not be so naive as to believe that things will happen by themselves and that everything will go back to the way it was.

That's not how you fight epidemics.

You have to be ready to look reality in the face, identify the problems in order to try to solve them.

Patrick Zylberman

is Emeritus Professor of Health History at the School of Advanced Studies in Public Health (EHESP).

He is the author of

, published by Gallimard, 2013;

Odile Jacob 2020 and

La Fabrique 2021.

Our selection on the subject:

• 

→ Covid-19: the transition to an endemic form, a scenario not without danger, warns the WHO

→ Covid-19: where are we with treatments?

→ Covid-19: they privileged their convictions at the risk of moving away from their loved ones

→ Vaccination: a 200-year-old mistrust

• 

→ What origins for Covid-19?

→ Mourning, after-effects, exhaustion... Covid-19 has changed my life

→ The coronavirus, a global affair

→ Long Covid: when the symptoms of Covid-19 persist

→ [SERIES] Coronavirus: the response, country by country

• 

Infographic: The coronavirus in 7 points

Newsletter

Receive all the international news directly in your mailbox

I subscribe

Follow all the international news by downloading the RFI application

google-play-badge_EN

• Health and medicine

• Coronavirus