Jean-Dominique Michel is a medical anthropologist. He runs a blog, La tribune de Genève, on which he deciphered the day-to-day crisis. He has just published Covid: anatomy of a health crisis (humensciences editions).
FIGAROVOX.- Your explain in your book your job, medical anthropology, which consists in studying and analyzing medical care practices. How have you studied the beliefs and practices of our societies in an attempt to identify the coronavirus?
Jean-Dominique MICHEL.- Plans to deal with a pandemic have existed in their current form for about twenty years. What is fascinating here is that they were simply not implemented in France for lack of means but also of reactivity, agility and organizational capacity. The recommended actions consist of a simple sequence; barrier material for caregivers - mass screening - isolation and treatment of sick people - protection of people at risk. Instead, we implemented devices that had been abandoned for a century and a half - such as the general confinement of the population.
However, alerts had been sent to the authorities in recent years that we lacked the means necessary to deal with a possible pandemic. These reports were strikingly unfulfilled.
As much as certain countries reacted with consistency and pragmatism, the French response will have been disorderly and failing.Debates widely publicized, fascinating but harmful, have also flamed between specialists, with quarrels related to ethics, medical practice and the epistemology of scientific research. As much as certain countries reacted with consistency and pragmatism, the French response was generally disorganized and failing.
Do you think our leaders lacked education and perspective when they chose to contain them? Have we been misinformed?
I think the government has squandered a great opportunity. With transparent and honest communication, there was a way to mobilize the population and achieve a “sacred union” behind an urgent health cause. Since the risk of serious consequences in the event of infection is very low below the age of 60, the measures adopted were essentially aimed at relieving the hospital system and protecting the vulnerable. A noble cause that naturally called for responsibility and prudence, without the need to panic or distress the population excessively.
There is also every indication that generalized containment was not the best answer. Countries which have carried out semi-containment or reacted with technical means without containment (such as South Korea, Hong Kong or Taiwan) have obtained much better results. Confining without detecting, monitoring or treating infected people is problematic.
Today, 70% of French people no longer trust the authorities regarding Covid.Stubbornly denying their lack of preparation and clearing themselves of all responsibility, the authorities have multiplied the declarations and questionable decisions, to the point that today, 70% of French people no longer trust them in the face of the Covid.
In fact, we compared the management of the crisis in France to that of South Korea, but also to Italy, which experienced a massacre. Is it really appropriate to have a comparative approach?
The comparative approach is the basis of all knowledge, but it is true that we must be very careful with perspective errors. Since epidemics are ecosystem diseases, each national and even regional situation must be analyzed carefully to identify what is specific to it.
What we can observe is that the countries of East and Southeast Asia have reacted in a very pragmatic way, relying on current technologies and the disciplined mobilization of the population. However, we cannot reasonably compare our reaction to the epidemic with that of Korea or Taiwan: too many socio-cultural, geographic, political and economic variables differ. On the other hand, it can be compared with those of Germany or Switzerland. And there, the comparison does not turn to our advantage. Obviously, it is difficult to find the right answers in situations with high uncertainty. The Germans did, however, do much better than we did by simply doing the right thing quickly and well, when we got stuck in answers that were sometimes excessive, sometimes failing. The autocongratulation and the denial of responsibility of the authorities, despite a very heavy toll, is not the least cause of the distrust of the population towards them.
To read also: "Scientific research is shaken by the requirements of immediacy"
Does the use of military metaphors annoy you?
The recourse to such metaphors most often aims to mask the unpreparedness and confusion of the authorities: the spread of a virus obviously has nothing to do with the invasion by an enemy army. This speech was indeed accompanied by many denials of reality. As these assertions that screening tests or masks were useless (when the simple truth was that we did not have them), the defeat of the resources available to produce them quickly, the disqualification of the city doctors, the ban on treatment with treatments used successfully in other countries, the confusion between medicine and research, etc.
In addition, in wartime, we act quickly by requisitioning the means available and by practicing a medicine of first necessity with what we have on hand instead of multiplying impediments and paralysis!
In a humor post, did you extol the "virtues of the coronavirus" which has lifted the veil on our poor lifestyle?
This spike followed a declaration by the Swiss minister in charge of health who had just declared that he "had to tell the truth, even if it meant being unpopular" . As the field of health is full of unsaid, half-truths and conflicts of interest, I ironically said that I was delighted to hear it also recall that 60 to 80% of the diseases from which the population would be avoidable and are the product of lax legislation. Leaving it exposed to five major risk factors: toxic food, air pollution, chemical pollutants, physical inactivity and stress.
60 to 80% of the diseases from which the population suffers are preventable and are the product of the laxity of our legislation.Large industries (such as the food, petrochemical, fossil fuels or transportation) are granted "permits to prosper" by causing major damage to people's health.
790,000 people die each year from air pollution in Europe, far more than the victims of the Covid. I never knew that I imposed a lock-down or interrupted air and road traffic to avoid these deaths. This time, for a new but much less serious virus as a health problem than chronic killer diseases, we showed that doing something was possible!
Do you think that the coronavirus could suffocate by itself, by "group immunity"?
The forecasts are always perilous. The emergence of group immunity to Sars-CoV-2 does not seem to come as expected. On the other hand, the known phenomenon of attenuation, by which a virus having invaded a new species adapts to its host by reducing its virulence, seems to be at the rendezvous: the proportion of severe cases is today much lower than in spring. It also appears that part of the population is already immunized against Sars-CoV-2 due to the antibodies produced after exposure to other coronaviruses (such as those from the common cold). Our hope is that the new coronavirus will fade, or become commonplace by becoming a recurring winter respiratory virus, but without causing the damage we have known this spring.