The situation may seem paradoxical. While the daily number of new cases of Covid-19 is increasing sharply in France (partly due to a greater number of tests carried out), the number of beds occupied in hospitals and in intensive care units continues, even very slightly , to decrease.
It is observed by calculating, on a daily basis, the average of these indicators over the past seven days (in order to smooth the statistical effects, including under-reporting on weekends). As of August 18, 4,783 patients are hospitalized and 357 are treated in intensive care, according to the count provided by Public Health France in its Geodes database.
For several weeks now, many doctors and epidemiologists have warned that the increase in the daily number of new cases will inevitably end up having repercussions on people at risk of contracting serious forms of the disease, leading to a rebound in the number of places. occupied in the hospital.
For the moment, we do not observe such a phenomenon. Here are some possible explanations, with the necessary caution regarding a virus of which we do not yet know all the characteristics.
Younger cases
First of all, the increase in the number of positive people is mainly driven by the contaminations of young people. In week 32, from August 3 to 9, the incidence rate (ie the number of cases per 100,000 inhabitants) was 17.3 in the general population. But it climbed to 44.7 among 20-29 year olds and reached only 9.1 among 80-89 year olds.
According to the latest weekly epidemiological update from Public Health France dated August 13, “the increase in incidence concerns all age groups, but remains more marked in 15-44 year olds, more particularly young adults of 25-35 years ”.
However, "before age 40, in the vast majority of cases, Covid-19 is a banal respiratory viral infection," said epidemiologist Antoine Flahault to Le Parisien. “Most of the new cases reported today are extremely mild, some don't even have symptoms,” he adds. In week 32, 53% of the 8,516 positive cases identified were asymptomatic, according to Public Health France.
1/6 - What now? No epidemiologist understands the paradox of the current resumption in Europe of the epidemic of # COVID19 in people <40 years, without apparent passage to older people, without resumption of hospitalizations, nor in intensive care, nor of mortality. ..
- Antoine FLAHAULT (@FLAHAULT) August 15, 2020Newsletter - Most of the news
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In this context, it is not surprising that hospitals do not fill up again.
An effective strategy
If the situation does not seem, for the moment, to have repercussions in populations at risk, it would be in particular because of the strategy carried out to break the chains of transmission. Not a day goes by without a minister, the prefect of a department or the General Directorate of Health recalling the need to be tested and to isolate oneself in the slightest doubt or if one has been in contact with a positive case.
In addition, the elderly "continue to protect themselves", estimated the Minister of Health, Olivier Véran, on France 2, August 12. By scrupulously respecting barrier gestures, they would thus avoid being contaminated even if they come across - without necessarily knowing it - a positive individual.
“The real risk does not come in itself from contaminations among young people, but those among the elderly. We must therefore do everything to avoid them by continuing to encourage people over 40 to protect themselves and actively detect clusters and potential super-propagators in order to break the chains of transmission as soon as possible, ”comments Antoine Flahault.
But worrying signals
Beware of the rebound effect, however. If hospitals continue to empty, since the end of July, there has been an increase in the number of hospital admissions and intensive care units due to Covid-19. That is to say that there are more and more patients entering it, even if we remain at levels much lower than those reached in the spring.
If, at the national level, the balance remains negative because of hospital discharges which are always more numerous than admissions, the situation could quickly be reversed in certain regions.
In Île-de-France for example, "since July 27, there has been an average of nine admissions and nine discharges per day in intensive care, and 38 admissions and 34 discharges per day in hospitalizations", indicates to the Parisian the regional agency of health (ARS). “Hospitalization and critical care admissions are increasing slightly,” adds the ARS.
"We do not see today any passage of Covid-19 from young people to the elderly, but we must continue to monitor very closely this potential risk which would then constitute the start of a second wave", concludes Antoine Flahault, who however refuses to make predictions more than eight days into the future.