Like a mountain stage on the Tour de France, the three peaks followed one another at a hellish pace, leaving no respite to caregivers. Bronchiolitis peaked in early December, Covid-19 in mid-December and flu at Christmas. The end-of-year celebrations did not generate the rebound that we might have feared. The descent is well underway, according to the latest reports from Public Health France: -49% from one week to the next on emergency visits for flu symptoms, -43% for suspicions of Covid-19 and -32 % for bronchiolitis. The triple epidemic seems well and truly behind us. For how long ?
Epidemiologist Antoine Flahault, director of the Institute of Global Health in Geneva (Switzerland), does not imagine a return of the viral trifecta before next winter: “The flu, since we have known it and since we have been monitoring it, only makes one epidemic peak per winter season”. For bronchiolitis, its usual rhythm would rather indicate a return to next winter – but now nothing is certain in a landscape disrupted by the Covid.
Never claim victory too early with the Covid
As for the coronavirus, recent history teaches us, we must never declare victory too soon. “The Covid returned five times in the year 2022. I will not venture to say that it will not sign its return soon. There are so many candidates to succeed the BQ.1.1 sub-variant currently plaguing France, particularly the highly transmissible US candidate XBB.1.5, that it is feared the respite will be short-lived”, tempers Antoine Flahault. Covid-19 cases have been falling sharply since mid-December, but the pace of decline is stalling this week, which often in the past heralded the future surge.
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Unpublished, the triple epidemic aroused many concerns among specialists. A relative peaceful coexistence between the viruses was finally observed. “ This is a question that we asked ourselves: might co-infections generate more serious cases? From the first elements that we can have, even if we must remain cautious, frequent coinfections have not been observed, for example influenza-Covid ”relates infectious disease specialist Anne-Claude Crémieux, author of the book Citizens have the right to know (Fayard).
Bacterial infections that we didn’t see coming
On the other hand, this landscape saturated with viruses has generated an upsurge in bacterial infections with streptococcus A, with nine deaths to be deplored in children. “It is a serious form of infection with a bacterium that is well known since it is the cause of angina, but, ordinarily, it rarely gives serious infections. We did not expect it at all, and this partly explains the shortage of antibiotics ”, notes Anne-Claude Crémieux. In 56% of cases, the children were co-infected with a virus, most often RSV or influenza.
The human toll of the triple epidemic remains to be established. “The flu season has been severe. But as the virus is little tested, it will be very difficult to know the exact number of deaths., believes Antoine Flahault. This figure is usually estimated using excess mortality. This year, the data will be difficult to read because the Covid has also caused many deaths.
Sign of the times, the executive did not respond to the triple epidemic with barrier gestures – the mask remained optional – but by gestures in favor of caregivers . Because it is the hospital that emerges the most damaged from this epidemic sequence. “It exceptionally overflowed in December because there were more sick patients, perhaps a little sicker than usual, but above all because there were not enough beds”, deplores Rémi Salomon, president of the medical commission of the AP-HP. If the first Covid waves, by their extreme virulence, might undermine all hospital systems in the world, the triple epidemic should not be an impassable mountain in a healthy hospital.
Saturated emergencies, rather than resuscitation
Unlike the first Covid waves which had brought intensive care units to their knees, the triple epidemic above all put a strain on the emergency room. For Anne-Claude Crémieux, the explanation is simple: “It is the consequence of vaccination. The vaccine has a limited effect in preventing infections, however, and fortunately, it retains, with boosters, very good efficacy once morest severe forms. » In these post-vaccination times, the hospital is overcrowded with slightly less severe cases.
However, we must not forget the hidden toll of this epidemic season, these 150 “unexpected deaths” emergencies estimated by the professional union Samu-Urgences de France. Often very fragile patients who wait endless hours on a stretcher in the emergency room, for lack of available beds in the hospital due to the lack of staff. “We reached record levels at the AP-HP on our emergency room saturation indicator”notes Rémi Salomon.
“Around Christmas, there were nearly 200 patients on a stretcher waiting for a hospital bed. An exceptional level: at 100, we are already in a critical situation. In a normal epidemic season, we are rather around 50 ”. The list of hospitals on the verge of rupture – not to say having reached this rupture – is endless: Châteauroux, Fréjus, Thionville, Pontoise, Bordeaux, Sarreguemines, Périgueux, Mayenne, Saint-Calais… A major crisis which culminated in a peak of fed up of caregivers in early January. In several hospitals, caregivers, exhausted, have collectively placed themselves on sick leave.
The same for next winter?
How to better prepare for next winter? First, by recruiting nursing staff. “ Even with an epidemic a little less strong than the one we have known, if we do not increase the capacity, we risk having great difficulties once more. We are in an infernal spiral from which we must emerge urgently. We must not wake up next October to prepare for winter”warns Rémi Salomon.
Rather than bailing out in the hospital, better prevention might limit the damage. “It seems that people hate wearing the mask”regrets Antoine Flahault. “Perhaps the least drastic solution that would be at least as effective – and maybe even more – would be an ambitious ventilation plan. When you have very good ventilation in a room or on public transport, you no longer need to wear a mask. » Purify the air or wear a mask, effective measures once morest the Covid, but also once morest the flu and bronchiolitis. For the epidemiologist, the strong flu epidemic this winter appears to be proof of the effectiveness of preventive measures. “Until now, when we had the Covid, we no longer had the flu because the barrier measures were very effective once morest the flu. This time, we had three epidemics because prevention, and particularly the wearing of masks, was abandoned”.
On the vaccine front, good news arrived this week: Moderna announcement of positive preliminary results in the elderly (84% efficacy) for its new messenger RNA vaccine once morest RSV, responsible for the majority of bronchiolitis. The laboratory’s ambition: to launch this vaccine on the European market next winter. The triple epidemic might be coupled with a triple vaccination.
