After the lifting, at the beginning of February, of compulsory teleworking, outdoor masks and gauges in public places, this Wednesday marks the end of seated concerts, seated drinks and the reopening of dance floors. It will also be possible to eat in transport, stadiums and cinemas. Like an air of (epidemic) spring before its time. So certainly, for more than two years that this epidemic has lasted, the Covid-19 and its variants have taught us to be careful. But even provisional, let’s not sulk the good news: the situation for a month is clearly improving.
Declining traffic
First reason for hope: a circulation of the virus in free fall. After having progressed dazzlingly since the end of December and the domination of the omicron variant, Sars-CoV-2 began an even faster descent three weeks ago. From 365,000 daily contaminations detected during the peak of January 21 (by date of sampling and on average over seven days), we are now at 140,000 on February 8. That is a drop of 60% in just over two weeks. In Ile-de-France, where the fall was earlier, the circulation of Sars-CoV-2 is only 20% of its peak. And this improvement is not only due to the drop in the number of tests. Because the positivity rate is also decreasing, from 34% at the end of January to less than 29% ten days later.
This sudden improvement could be explained by the difficulty encountered by the virus in finding new hosts. Indeed, since December 1, more than 13 million people have been officially infected in France, surely double in reality. Moreover, even if omicron partly escapes the protection against transmission conferred by the vaccine, the latter, by covering more than 90% of those over 12 years of age, also acts as a brake. In short, between people already infected – some several times – and the vaccination campaign, the virus – in any case this variant – sees its playing field dwindle.
Still, even in sharp decline, Sars-CoV-2 is still at a much higher level than in all previous waves. But what allows the government to lower its guard is, here too, vaccination, which by drastically reducing the serious forms, has made the hospital situation much more bearable.
Uncrowded hospitals
Fifteen days after the start of the ebb of contamination, fears of submersion aroused by the ultra-contagious omicron variant are dissipating. Across France, health establishments are preparing to resume normal activity. In Ile-de-France, it is now obvious. On Friday, the Assistance Publique-Hôpitaux de Paris (AP-HP) decided to stop the crisis meetings, reactivated in the fall to deal with a possible influx of patients. “There are closed beds everywhere for lack of staff, but we are not overwhelmed by the Covid, confirms a member of the establishment medical commission of the AP-HP. Coverage is falling, including in emergencies. The crisis cells were no longer useful.
Particularly noticeable relaxation in intensive care units: “We are no longer wondering where we are going to put Covid patients. We have roomtestifies Professor Stéphane Gaudry, deputy head of the intensive care unit at the Avicenne hospital in Bobigny (Seine-Saint-Denis). We’ve had very few admissions in the past few days. Of our 24 resuscitation and critical care beds, we only have five serious Covid patients, two of whom have been there for several weeks.
And Ile-de-France is not the only one to project itself into the future. “We change the sequenceconfirms Raymond Le Moign, director general of the Hospices Civils de Lyon, the second university hospital center in France. Today, the subject for us is to manage the disarmament of intensive care beds and the return to normal functioning of medical services. And the same to anticipate a quick return to current affairs: “Before the end of February, we will have returned to the number of intensive care beds which prevailed before the epidemic, namely 138. The Covid pressure is certainly still felt on the medical beds, certain specialized units such as rheumatology or endocrinology will not can still resume normal activity. But hospitalizations are no longer increasing.
This “sequence change” is it premature? A glance at the statistics of hospitalizations published by Public Health France might suggest so. Even down since February 7, the number of Covid patients hospitalized in conventional care remains very high: Monday evening, they were still 31,532. This is to forget that the characteristics of omicron, more contagious and less virulent than its predecessors, distort comparisons. Thus, unlike previous waves, a third of hospitalized Covid patients are not hospitalized today because of the virus (we are talking about fortuitous or incidental Covid). Clearly, even if they had not been contaminated, these patients would have occupied a medical bed for another reason…
In addition, hospitalizations for Covid more rarely result in severe forms of lung damage. This results in lighter care and shorter lengths of stay. But the optimism of hospital management has another basis: with a three-week lag on the peak of contamination in the general population, hospitalizations for Covid are starting to take a nosedive (-26% in the second week of February). At the same time, the hospital stay being on average shorter with omicron than with delta, the outflow should also accelerate. “Within a month, the number of hospitalized Covid patients should have decreased considerably, predicts Professor Gaudry. Once the movement is started, it goes very quickly.
Towards an endemic?
However, Omicron does not sign the disappearance of Covid-19. According to danish governments, British and Swedish, the current wave marks the transition from a pandemic disease to an endemic one. It is therefore a question of managing this virus without resorting to exceptional measures. Therefore, governments find themselves faced with a tension: to relax health rules that weigh on the entire population without abandoning to themselves the people most at risk of serious forms, in particular the immunocompromised. Letting the number of cases slip away presents another risk, since the range of cardiological or neurological sequelae that Covid-19 can cause is just beginning to be understood. And no one can say what the characteristics of a probable future variant will be. Will it cause more or less severe forms? What escape capacity will the immune system present?
Facing the senators on February 9, Alain Fischer, the president of the Council for the orientation of the vaccine strategy, recalled that the eradication of this virus was “illusory”. He sketched out a future «probable» with “seasonal waves, of unknown intensity”. The idea of a winter virus is almost optimistic, since the delta variant began its ascent as early as mid-summer 2021. Faced with this threat still full of uncertainties, there is a certain element. Covid-19 is a respiratory disease that is transmitted in poorly ventilated enclosed spaces. On February 28, vaccinated French people should be able to go to the cinema without a mask. But the question arises of the ventilation of the rooms. If Covid-19 becomes endemic, indoor air quality must become a major issue in order to live with the virus.