INTERVIEW. Coronavirus: “The second wave will look different”

The virus circulates in France but in a limited way. A reprieve which should allow us to be ready to face a second wave that is difficult to avoid in the fall. Very effective treatments are not for tomorrow, the key will be the organization and acceptance of constraints. For this, the fight must be refocused at the local level, believes Professor Pierre-Louis Druais, member of the Covid Scientific Council and general practitioner. He answers questions from West France.

Is a second wave in the fall-winter almost inevitable?

Most likely and the disease will undoubtedly present itself in a different way. Some believe that it risks taking Europe all at once. Against the second wave, we must organize. It will take a good logistical organization and this is not our basic culture. We do not win a war with offensive weapons, but with trains and engineers.

Isn’t the obligation to wear a mask outdoors exaggerated?

When you are in a very concentrated market, the risk is not the same as in a nightclub, but it does exist.

Should this be decided at the local level?

I believe we should let the mayors decide, in agreement with the prefects. The local level allows a better acceptance by the population. In my doctor’s office, whenever I offer therapy to a patient, I am in a negotiation between what is desirable and what is possible. It is this type of relationship that can be established. Especially since the mayors have just been elected, they have the confidence of the population.

How to test faster and better?

The reference diagnostic tests remain the nasopharyngeal PCR tests. Effective saliva tests would be very helpful, but they lack sensitivity at the moment. A research protocol has been launched in Guyana, where the virus is actively circulating.

Is it a question of comparing nasopharyngeal and oral tests?

Yes, but we also wonder about the best sampling technique. In a spit, deep in the throat, under the tongue? In the lab, we see a great variability in the specificity of the result (the specificity of a test measures its ability to detect only the virus sought). The advantage of these saliva tests is the possibility of having a response within a few hours and the better acceptability of the test.

Achieving group immunity by letting the virus spread will never be an option?

The Swedes wanted to take this route, it was not a success. In Florida, it was a disaster. The price to pay is too high.

“The population has not joined StopCovid”

The tracing of contact cases, as practiced, will be insufficient in the opinion of the Council …

It is currently relatively efficient because the intensity of the traffic is low. The declarative side of contact cases does not work so badly, but the procedure is slow and cumbersome. However, the CPAM must be credited with having launched something.

The tracking by the StopCovid application is a failure?

The population did not join. It works in Asia, where the awareness that everyone has a role to play for the collective is cultural. I hear people here telling me that they don’t want StopCovid because they fear it will collect their personal data. But often they have no problem being on Facebook or Twitter. The mask, physical distancing and barrier gestures remain our best weapons.

Achieving group immunity by letting the virus spread will never be an option?

The Swedes wanted to take this route, it was not a success. In Florida, it was a disaster. The price to pay is too high. In the best cases, in France, the seropositivity ”is less than 10%. 80% of the population would need to have developed neutralizing antibodies for group protection.

Won’t the constraints saturate the French?

We always have a problem with balancing coercion and education. I prefer education to coercion. It’s more complicated, it’s long. But in the long term, it is more efficient. Coercion may be necessary but cannot be the only answer.

“There is no miracle cure”

In order to better anticipate what will happen next, what is the most urgent scientific question to resolve?

The big problem is to have a precise idea of ​​the seropositivity rate in the population, on the part of the population a priori protected. This factor determines prevention strategies and targeting populations at risk. There is still a lack of data on how the disease is distributed by age group. What is certain is that currently the circulation of the virus is favored by the movements of the younger population. People identified at risk take precautions.

In terms of treatments, very little is working right now?

There is no miracle cure and this is not surprising, since we started by testing molecules designed for other diseases. Some experimental treatments (the corticosteroid dexamethrasone, the monoclonal antibody tocilizumab, to a lesser extent remdesivir) show beneficial effects in severe cases. But we do not have an effective early stage treatment that would reduce the negative course of the disease. And even less preventive treatment. In any case, mass is said for hydroxychloroquine and antibiotics, it does not work.

The controversy on this subject will leave traces?

From an alternative path, we moved to an unreasonable hope or even a belief. Fueling this belief is an unacceptable scandal on the part of researchers who claim to be caregivers. With speeches questioning the principles of the scientific method, even from doctors and professors.

Sometimes I felt like I was going back to the Middle Ages. It is not because something seems to be working, in some cases that it is the cause. Yes, it will leave traces. when you have entered the realm of belief, there is always something left.

We do not yet have the results of new treatments specifically targeting Covid-19?

Not yet. We do not even have analyzable intermediate data. But let’s remember how long it took to find the first treatment for HIV: seven years. If we find a treatment that is effective enough within two years, that will be an achievement.

“Nothing shows that we will have a safe vaccine quickly”

Is a short-term vaccine really possible?

I am quite amazed at the quality of the first objective data. We have several avenues exploited, for vaccines that protect or reduce mortality. For now, there is no evidence that we will have a safe vaccine quickly. When Russia says it has successfully tested a vaccine on its military, I don’t know if it’s fake news or politics.

Could he protect for a long time? People who have had Covid have not kept protective antibodies

It seems that the protection can sometimes disappear quite quickly. We don’t have all the answers. Faced with this virus, we have often reasoned from the example of other viruses, and this has failed us. The Covid-19 has already had many surprises in store for us. Professor Delfraissy says it’s a cow farm, I agree. Faced with this virus, we must remain humble, attentive, reasoned. And reinstall that word which is trust. We have used it in all Scientific Council opinions.

The Scientific Council has been extended until October. How do you operate now?

Until July, we had daily meetings, sometimes twice daily. We had four or five a week in July. At the beginning of August, some of us, including me, are taking a few vacation. But we keep a meeting once a week. And we discuss in the meantime on specific points, when there is an urgent need to agree. It works well, we know each other well now.

Epidemiologist Arnaud Fontanet, also on the Scientific Council, says that it would be good if new blood arrives at the start of the school year …

Absolutely. But we should not change the whole Council at once. There is a good dynamic in this group, although the load is heavy for all of us. It is a voluntary process. Someone like Arnaud also has teams of researchers to manage. For my part, I have my activity as a liberal doctor, which I had to reduce …

The Scientific Council will be extended after October?

It seems obvious.



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