The first wave of the Covid-19 epidemic is "behind us", judge Antoine Flahault. Professor of public health, this epidemiologist has gained international renown for his work on influenza and then on emerging diseases, such as chikungunya, and now heads the Institute of Global Health (ISG) at the University of Geneva, in Switzerland. .
Five days before the scheduled start of deconfinement in France, May 11, he judges that the onset of the epidemic's decline "is final." But, he warns, "the authorities must anticipate the future, including to avoid a new strict confinement in the fall".
The deconfinement cards are increasingly green. Where did the virus go?
ANTOINE FLAHAULT . The started flood is clear and without appeal: the first wave is behind us. According to the eight-day forecast that we update every evening, we must expect to have daily between 400 and 450 new patients, far from the 5,000 to 6,000 cases per day that France has reached. But beware, the virus continues to circulate at low noise. It should be wary, because containment was its brake. Its lifting can lead to a resurgence, even if it is, for the moment, not very observable in countries which have started their deconfinement, like Austria.
In France, how do we explain regional disparities?
It is clear that the virus had a completely different path from that of the flu, for example. It was housed heterogeneously in specific places where chains of transmission developed: the evangelical gathering of Mulhouse (Haut-Rhin), the National Assembly ... Homes have spread regionally, but there is no had this phenomenon of "tablecloth" which covers the territory. At the peak of the flu epidemic, all of France is red. Not there, any more than in Italy, Iran, China… My hypothesis: the proportion of asymptomatic is, for the coronavirus, lower than what we imagined at the start, around 15%, against 50% for the influenza.
With what impact?
It is people without symptoms who spread, without knowing it, the virus on the territory. Their small share was able to prevent a hidden and silent dynamic across the country in January and February. However, it is possible that this seeding occurs at the time of deconfinement. People will circulate and travel during the summer, making epidemiology close to the flu favorable this fall.
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How do we keep the virus in our sights?
The risk is that it will temporarily disappear and be forgotten, without taking advantage of this respite to prepare for a new wave. Caregivers must rest, the population must take advantage of its summer, by going to the beach or to the mountains, but the public authorities must anticipate the continuation, including to avoid a new strict confinement in the fall. Whether for morale or economically, the country will find it difficult to accept it. The second wave will have to be answered differently from the first.
What do you recommend?
To study the models where it worked - even if I am not saying that it will not be necessary to cancel certain events or to temporarily close schools - like in Taiwan, Hongkong, Singapore… They have succeeded in attacking to the virus in a more personalized way, by identifying the chains of transmission to break them at the root. The strategy is to test, trace, isolate.
What would be the ideal deconfinement for you?
A supervised deconfinement, in the epidemiological sense, with very precise surveillance of what is happening. We must be able to know each new case and explore it: does it come from the hospital, the nursing home (Editor's note: accommodation establishment for dependent elderly people) , school, family? The better the photography, the easier it will be to control the deconfinement and to remove other brakes: the limitation of one hundred kilometers, bars and restaurants ... At the slightest spot on the picture, we can reintroduce more stringent measures.
Can we afford such surveillance?
Yes, because the decline has largely started. This is possible in France, Switzerland, Germany. I would not say the same for Canada, the United States or England where the number of new patients remains too high to calmly deconfinate.