Covid-19: “There is no reason for 2023 to be very different from 2022”

Covid 19 There is no reason for 2023 to be very

This Wednesday, February 1, France is turning the page on the Covid a little more. In a very favorable epidemiological context (less than 5,000 infections recorded per day), many exceptional measures have been lifted. Isolation for positive cases and testing for their contacts lose their mandatory nature, even if they remain recommended. Contact tracing by Health Insurance stops, as does automatic sick leave without waiting days for “covid” people.

For Professor Antoine Flahault, epidemiologist and director of the Institute of Global Health at the University of Geneva (Switzerland), we are not yet finished with the Covid. While many variants likely to relaunch contamination are circulating all over the world, a new wave may even be emerging… This expert pleads for governments not to let their guard down, and to adopt measures to curb infections and avoid too many deaths.

L’Express: We have just passed the three-year milestone of the epidemic. Although the World Health Organization (WHO) maintains its maximum alert level for the moment, many feel that the pandemic is over. What do you think ?

Antoine Flahault: The emergency phase and the acute health crisis seem well behind us. The year 2022 will have been marked by five successive waves of Covid due to the Omicron sub-variant, but thanks to the very high vaccination coverage of the population, there has been no saturation of hospitals, nor a return to measures quarantine or confinement. However, we will not have succeeded in preventing the strong circulation of the virus, nor in preventing still very high mortality, with 40,000 deaths from Sars-CoV-2 last year. It is considerable. We can clearly see that in France, as in most countries, politicians are struggling to adapt to this crisis which has become chronic. In fact, we remain exposed to a risk of new waves and the possible emergence of a more virulent variant. Even if this catastrophic scenario does not materialize, our hospitals remain in tension, we have far too many avoidable deaths, and post-infectious forms continue to burden the health of the population. There is now a significant scientific literature pointing to the effects of infections and reinfections in terms of long Covid, or increased prevalence of diabetes and cardiovascular disease. We are therefore far from having finished with the Covid.

In this context, does the easing of measures announced in France from February 1 (end of contact tracing and compulsory isolation, etc.) seem legitimate to you?

Most European countries are freeing themselves more or less from the latest restrictions linked to Covid. This is not shocking, provided however that we are not satisfied with the current situation. If not, it means we collectively accept a new cause of death that supersedes all others. On the contrary, we should be concerned about all acute respiratory infections – Covid, influenza, RSV, tuberculosis – which represent a heavy health burden, and see how we could do better. This is quite possible, by improving air quality and making the mask compulsory in closed places during the few weeks surrounding the peaks of circulation of these viruses. Coupled with vaccination, we would then considerably reduce the damage that the Covid continues to do in our countries. But for that, it would still be necessary to have a precise health monitoring tool. In France, the thermometer is broken, and nothing replaces it. However, alternative surveillance systems exist: “sentinel networks” as for the flu, or tests on representative samples of the population as the British do, or even the analysis of wastewater as in the Netherlands or Switzerland. .

“It is always interesting to observe the behavior of the elites”

For the moment, there is hardly any question of all this…

Maybe we don’t want to know? But if this is the case, this brings us, all things considered, to the situation in 2020 where we tested very little in France, and where we followed the evolution of the epidemic through that of hospitalizations. This means that in the event of a new wave, the signal will be very late. We will not be able to anticipate and protect the population correctly.

For ventilation too, the measures are struggling to materialize…

It will take time, that’s for sure. In 1854, Dr. John Snow demonstrated that cholera was transmitted through water. Quite quickly, the wealthiest equipped their homes with filters and means to purify their drinking water. But it took fifty or sixty years for sanitation to become the rule. It is always interesting to observe the behavior of the elites: in Davos, the participants in the World Economic Forum protected themselves very well from the Covid. A negative PCR test was required to access the congress, the rooms were equipped with air purifiers, the ventilation was of good quality… Today, there is no longer any doubt that aerosols are the main mode of propagation of Covid. One day, no one will enter a bar or a restaurant without having guarantees on the quality of the air. But as with cholera and water quality, it will take a few more years for the idea to catch on.

Doesn’t the lack of information on the circulation of the virus risk harming adherence to vaccination in the future?

The normalization of Covid, which makes it almost a disease like the flu, could have the same consequences, namely low adherence to vaccination, including among the most vulnerable. At the same time, it had been said a lot that the population would not be vaccinated, and on the contrary, the demand was very strong. I have no doubt that if a new problematic variant emerged somewhere in the world, the French would very quickly return to the vaccine.

“A “soup” of over 700 Omicron variants”

Is a new wave already taking shape?

We see in almost all of Europe a rise in contamination, driven by the XBB.1.5 sub-variant. In France, we have probably reached the end of the decline. The number of cases is increasing, but the number of tests being reduced, it remains difficult to make predictions on this basis. Nevertheless, elements suggest that a new highly transmissible sub-variant escaping the vaccine, at least for the mild forms, could cause a new wave, in the logic of what we have seen with the other sub-variants of Omicron throughout 2022.

Should this succession of waves continue?

We didn’t have a lull last year, and without getting into any haphazard predictions, there’s no evidence to suggest that 2023 will be much different from 2022. There’s a “soup” of over 700 sub-variants of Omicron currently in circulation in the world, some of which are more transmissible and could select each in turn to come and cause new waves. We already know the XBB.1.5 which comes from New York, the CH.1.1, which is also progressing in Europe at the moment, the BA.2.75, and many others. Not to mention all those who will inevitably emerge in China in the months to come, due to the very active circulation of the virus in this country. By maintaining its maximum level of alert, the WHO hopes that States will become aware of the need to adapt over time to this virus which is here to stay.