It is now a daily ritual, solemn. The Director General of Health, Jérôme Salomon shows up every evening, facing the camera, to present an updated report on the Covid-19 epidemic. It's always the same method. An international point before getting to the French figures. Hospitalizations, then the number of admissions to intensive care, before the number of deaths.
If this last figure undoubtedly grabs the attention of the French posted in front of their television screens, specialists and services of the ministry have their eyes riveted on another statistical element, much more crucial according to them to study the evolution of the epidemic: the number of patients admitted to the intensive care unit.
When speaking on Sunday evening, Jérôme Salomon himself considered it "the most important element" in order to "predict our ability to take care of the most serious patients".
The number of people infected: to be excluded immediately
This is the simplest criterion to rule out, for a very simple reason: since the start of the epidemic, France has absolutely not been able to detect all people infected with the virus. The country is just starting to make the densification of tests an objective in anticipation of a gradual exit from containment measures.
Since the transition to stage 3, screening tests are no longer systematic in case of suspicion. Only those hospitalized with signs suggestive of the disease are tested, beyond the specific cases (medical staff, the first two suspected cases in social medical centers and frail people).
In other words, it is guaranteed that most people with coronavirus have never been screened and may not have even been aware of being infected. What Frédérique Vidal, Minister of Higher Education, Research and Innovation, explained this Monday on France Info: "There are a lot of people who have probably been infected with very few symptoms, if not at all […] It is believed that a large part of the population has potentially already been infected, sometimes without knowing it. "
Lack of precision on deaths
We could therefore look at the number of deaths, also announced every day by Jérôme Salomon. Except that there again, the figures are biased.
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"Regarding the number of deaths, the figures presented daily only take into account deaths that occurred in the hospital setting," details a health source. Until now, we had no tool allowing us to accurately record the number of deaths in nursing homes or those occurring at home. "
The authorities promise to deploy means "this week" to take better account of the situation in retirement homes. A survey must therefore be carried out via an application, which will allow the mortality and contamination rates in establishments to be counted more precisely and in a declarative manner. The tests will still not be systematic, the rule of stage 3 of the epidemic remaining in force. The first two suspect patients will be tested. For the others, it is the doctor who will establish or not a contamination according to the symptoms presented by such or such patient.
Resuscitation, the nerve of war
And here is why the evolution of the number of people hospitalized, and even more so that of the number of people cared for in intensive care units, become so decisive.
“Resuscitation is the fateful moment, for several reasons, we confirm within the regional agency of Ile-de-France. On the one hand, because the number of places is limited, even if all efforts are focused on increasing the number of beds, which is currently being implemented. But also because from a medical point of view, at this level, it passes or it breaks . Patients can stay in intensive care for 15 days or three weeks, so they need assistance to continue breathing. It's a critical moment. "
The more the number of people in intensive care, the more hospitals are likely to be overwhelmed in care. "The other important point is that patients come directly to intensive care from nursing homes or their home, the degree of analysis is more precise," continues one within the ARS.
Jérôme Salomon took the time to explain on Sunday that the evolution of admissions to intensive care "reflects the kinetics of the epidemic and its most worrying impact". What prompted him to take note: "If, as of the strict confinement observed, there has been less contact between people, if the virus is therefore less transmitted thanks to barrier gestures and the minimum distance from a meter between us, then, after the average incubation period of seven days and the average duration of symptom evolution of around seven days too, we should observe a reduction in the number of people requiring admission to intensive care from the end of this week. In summary: it is above all by observing the number of new cases in intensive care that we can assess the evolution of the epidemic and its consequences.