Anne-Claude Crémieux is an infectious disease specialist at the Saint-Louis hospital in Paris. For this pandemic specialist, deconfinement first involves identifying healthy carriers.
There are more and more asymptomatic patients among the elderly. Is this a surprise for you?
ANNE-CLAUDE CRÉMIEUX. “The Center for Disease Control and Prevention in the United States published an article on this subject on March 25, after systematic screening in a retirement home in Washington. Of the 76 residents, 30 were positive for Covid-19 and half were asymptomatic. Until then, we tended to think that this phenomenon rather affected young subjects. It is the first study to show that older people can develop asymptomatic forms of the disease. This is a major reason for organizing systematic screenings in nursing homes.
That is to say ?
Patients without apparent symptoms are a source of considerable contamination for health care workers. And therefore a multiplication of cases among this staff, already largely affected, with 30,000 cases identified (note: 30,443 between confirmed and possible cases) . Not to mention that caregivers can also infect other residents but also their relatives when they return home. Retirement homes and hospitals are places where routine screening is necessary if the epidemic is to be controlled, as they are considerable accelerators of the virus. These are places of super contamination.
How much time do we have left to conduct these tests?
The day (Editor's note: from May 11) when we will “deconfinate” the population, it will be too late. Now is the time to control these chains of transmission, because the French are confined and the number of contacts between people is limited. It is a time to reassemble the chains of contamination and break them. Infected people should be isolated, whether symptomatic or asymptomatic.
Does this only concern asymptomatic people in nursing homes and hospitals?
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This poses the problem of asymptomatic patients in general. It will be essential when we have identified a positive Covid-19 case to go up the chain of contacts. It is the only way today to be able to identify them.
There are no other methods?
The population that is not taken into account, because it is not identified by our diagnostic methods, is people who are very symptomatic and asymptomatic. Identifying them therefore constitutes an emergency, otherwise we will allow ourselves to be overwhelmed as during the first wave. And we will have to "reconfigure" everyone. There is no alternative but to isolate infected people and quarantine their contacts if they have asymptomatic forms.
Why didn't we do it before?
We couldn't do it a month ago, because the urgency was to face the wave and not let people die. Now we change the objective, and the priority is the control of the transmission chains. It is as urgent as was the adaptation of the hospital health system in early March.
