Gérald Kierzek is an emergency physician and health columnist, author in particular of
Coronavirus, how to protect yourself?
(Archipelago editions, March 2020).
FIGAROVOX.- Antigenic tests with rapid results (15 to 30 minutes) can now be deployed in pharmacies or airports: until now only doctors and nurses could perform them.
This relaxation is in line with what you advocate ...
Gérald KIERZEK.-
That's good news indeed, but we have to go further and faster.
So far our testing strategy is flawed, because it is not massive enough and the results of PCR tests are arriving too late.
They diagnose the sick when we need to detect the contaminators before they get sick!
These antigenic tests were not immediately available: it was necessary to verify their reliability, then to pass them under the caudine forks of the administration and the health authorities which considerably slowed down their availability.
These tests are also too often perceived as competing with PCR tests carried out by medical biology laboratories: the role of lobbies may have played.
What screening strategy should we deploy now?
There is an urgent need to carry out preventive mass screening, at least in the big cities to begin with (as Manchester, Liverpool, London… and as Slovakia has done on a country scale).
Because the areas affected by the virus are primarily urban areas, it is the population density which is the first factor in the spread of the epidemic.
A campaign must be organized as quickly as possible in the big French cities, to move from a diagnostic strategy to a screening strategy.
If we only test people who have symptoms, we cannot stop the spread of the virus because we are always one step behind.
We have to look for the "super contaminators", these few people (around 20% of those infected by the Covid) and who do not necessarily show symptoms but who infect a large number of their relatives and represent a total of 80% of the contaminations. .
I suggest organizing a large, rapid and preventive screening in all schools in France on the last day of class.
We can therefore test large cities by neighborhood, or test at the entrance of colleges, high schools, schools and faculties.
The benefit in terms of public health and control of the epidemic would be much more interesting rather than limiting the classes to 50% of the number of students: we do not know whether we are bringing in half of infected students or not!
We must no longer go blind: it is better that everyone can go to class, but only after a negative test.
The same reasoning can be done in companies or any place that brings together the public.
We must be able to detect and isolate immediately all infected individuals before they show symptoms.
And we will put a good chance on our side to tighten the mesh of the net.
Another advantage: it would give a more precise idea of the real circulation of the virus and the number of people infected.
In your opinion, are the infected people not sufficiently isolated?
Isolating yourself when you live in an apartment is more difficult.
But the problem is above all that we isolate infected people too late.
When people know they are infected, they take care and are responsible;
but they only learn it when they have already had time to infect other people.
All the studies have shown that we respect barrier gestures more when we know that we are positive or that a member of our entourage is.
The tracing carried out by Medicare staff, however meritorious it may be, is ineffective.
The search for contact cases around an infected person is difficult to do because it all takes place too late.
To break the chains of contamination, test results must be obtained before symptoms even appear.
With a large-scale screening strategy, deconfinement would therefore be possible?
It is even the sine qua non of deconfinement!
We cannot do otherwise to crush the epidemic, by flushing out all the asymptomatic positive patients who are in the wild.
We can either deconfin all the negative people, or then everyone at once but by squaring the population to isolate the positive people as quickly as possible;
in the end it is the same thing, but to be deconfined we have to be able to all be tested in a very short period of time.
Companies and schools are asking for such a strategy, because it would secure their activities.
We have seen several American faculties do so, and go from several dozen positive cases per day to only two or three.
So it works!
I suggest organizing a large, rapid and preventive screening in all schools in France on the last day of class.
So it is possible to "save" Christmas?
The other advantage is that it lets people know that family reunions are going to be secured very soon for the end of the year.
It is also interesting from a psychological point of view.
Rather than playing the Cassandra in wanting to prevent Christmas celebrations, why not secure them in advance and allow almost normal family reunions?
I suggest organizing a large, rapid and preventive screening in all schools in France on the last day of class: the negatives will have a peaceful vacation (with barrier gestures of course) and the positives will know and will be able to isolate themselves for seven days. .
The next step, to continue tracking the virus month after month, would surely be to deploy saliva self-tests for example, distributed in pharmacies in particular to regularly self-check and no longer allow the virus to progress.
With the experience gained, we should now be able to end the epidemic, and give hope to the French.
Our discourse and our strategy, both in the hospital (patients are now treated early before resuscitation) and in the tests, must change to move from ambient pessimism to positive and proactive mobilization.
