Emmanuel Macron spoke on April 13 in a long-awaited speech by the French. At the start of this fifth week of confinement, the President announced an extension of the confinement. “The strictest containment must still continue until Monday May 11“, “This is the condition for further slowing the spread of the virus, succeeding in finding places available in intensive care and allowing our caregivers to rebuild their strength”.
From this date, schools will gradually open and it will be possible to return to work. “Masks will be available and screenings will be organized” (for symptomatic people, the elderly and frail with chronic pathologies). “The situation will be assessed every week”, added the President.
When and how to get out of confinement completely?
When can we hope to get out of confinement completely? “I have no answer to that”, “a small minority of French people have contracted Covid-19”, “we are far from collective immunity”, underlined Emmanuel Macron.
Beyond this question, the challenge is to know what strategy will be chosen to get out of it. The objective being to avoid a dreaded “second wave“. Because if people go out, while carrying the virus, they will be able to spread the virus again. In this context, Inserm published on April 12 a model measuring the impact, in Ile de France, of the confinement implemented since March 17 and tested different strategies to get out. This study “does not constitute an attempt at prediction but presents an assessment of the effects of different scenarios, taking into account the type of more or less restrictive measures and the moment when they would be applied,explains to the world Vittoria Colizza, who coordinated this work with Pierre-Yves Boëlle (Pierre Louis Institute for Epidemiology and Public Health, Inserm and Medicine Sorbonne University). We have tested theoretical hypotheses in this period when collective immunity is insufficient. “
Lifting of confinement: gently, not before mid-May or in June, according to Inserm
According to these scientists, the containment should only be lifted at best in May, or even at the end of May or in June. In addition, they warn of the risks of a sudden lifting of confinement, which could lead to a risk of a second epidemic wave and would lead to saturation of resuscitation services in hospitals. This strategy of deconfinement “by stages” had also been announced by Edouard Philippe during a speech on March 25.
Two conditions: screening and social distancing
If this period (at least 1 month) is necessary, it is because it will allow preparation for the release from confinement. And for good reason, underlines Inserm: progressive deconfinement can only take place on two conditions. The first is that it is possible to massively test people with the virus and their contacts in order to isolate them. You have to know how many people have antibodies or not in a given region. But it remains to validate their effectiveness and to be able to mass produce them.
-Virological tests (nasal or salivary) identify whether you are a carrier or not.
-Serological (blood) tests based on looking for antibodies to find out if a person has developed antibodies against the virus.
The second condition according to Inserm is that a social distancing in order to avoid any new cluster: in schools that would remain closed and in Ephad in order to isolate the frail elderly.
Collective immunity must progress
If social distancing measures are necessary in the coming months, explains Inserm, it is because of the weak immunity of the population. The institute, which has studied the Ile de France region, estimates that on April 5, between 1% and 6% people have been infected with the virus. At the national level, the Scientific Council considers that this rate is less than 15%.
Remember that collective immunity is considered to be achieved when 60% of the population is provided with antibodies. At that time the epidemic is stopped. To achieve collective immunity, we rely on vaccines. But it will take time. Until then, only systematic serological tests would allow deconfining without risk. Those who are immune could go out safely, while others should remain cautious and continue to apply protective measures.
Digital tracing, virus mapping … What tools to get out of confinement?
To know the collective immunity, it will be necessary to know where the virus circulates. However, in France we do not currently have a mapping of immunity by region. France is working on the development of a StopCovid smartphone application, which can be used “on a voluntary basis” to identify people who have been in contact with a person infected with the coronavirus. Objective: to track recent contacts of a recently infected person. The application could help limit the spread of the virus. “The idea would be to warn people who have been in contact with a patient who tested positive in order to be able to be tested themselves, and if necessary to be taken care of very early, or to confine themselves”, explained recently Cédric O, the Secretary of State in charge of Digital of the French Republic.
The effectiveness of containment and its limits
Containment – as well as social distancing measures and barrier gestures – have been effective in limiting the increase in the number of severe patients in intensive care and the spread over the territory. However, as Professor Salomon underlined during the last press briefing on the epidemic situation, “We must remain vigilant because the hospital services still take care of a large number of patients”.
However, while this confinement is useful and necessary, it has its limits. From an economic point of view of course, but also from a health point of view: “it accentuates inequalities and risks having medium-term consequences on people’s health”, recalled in its last report (end of March) the Scientific Council. People who present the most medical risks must be able to maintain their care, as well as people in precarious situations.
