Again? A year ago, hospitals experienced a triple epidemic: Covid-19, bronchiolitis and the flu. At the time, Public Health France described the situation as “completely unprecedented”.
“We are indeed moving towards this type of scenario due to the weakness of preventive measures against the transmission of respiratory viruses. This leads us to have to face each year with epidemics of influenza and respiratory syncytial virus (RSV) which now added are the autumn-winter waves of Covid which remain powerful, mowing down in their path people at risk of serious forms”, underlines Antoine Flahault, director of the Institute of Global Health and professor at the Faculty of Medicine of Geneva.
During a triple epidemic, the clinical impact can be quite strong. “Already before the pandemic, it was not uncommon for the flu to lead to episodes of saturation of the health system and significant school and professional absenteeism at the time of the seasonal flu epidemic peaks,” continues Antoine Flahault. Especially since the flu and Covid-19 epidemics both affect the oldest and most vulnerable. RSV causes bronchiolitis in infants and young children, “but it also circulates in adults and this virus causes hospitalizations and deaths in the elderly as well,” specifies the epidemiologist.
The determining effectiveness of Beyfortus
However, several elements will be decisive regarding the intensity of this triple epidemic. Starting with the real effectiveness of preventive treatment for bronchiolitis. Indeed, the arrival of Beyfortus, used for several days in a vast infant immunization campaign, could cushion the shock. “We have succeeded in demonstrating the effectiveness of Beyfortus in clinical trials, now we will have to see in real life. It can be very different,” reports Djillali Annane, head of intensive care at Raymond hospital, to L’Express. -Poincaré de Garches.
Last season, the epidemic was on a scale unprecedented in more than a decade, sending tens of thousands of babies to hospital. Currently, visits to emergency rooms, hospitalizations, and consultations linked to this respiratory infection in infants are “at a low level” but “increasing”, according to the first weekly bulletin of the epidemic season, published Wednesday September 20 by Public Health France. Increases “comparable to those observed in the two years prior to the same period”, it is specified.
What about Covid-19? During the second week after the start of the school year in mainland France, care linked to suspected coronavirus was “on the rise among those under 75 in SOS Médecins associations and among 2-14 year olds in emergency rooms”, notes Public Health France. “Covid-19 has never left us. It has become routine, especially with fragile people. It is not excluded that with the new wave, if many people are affected, there will be serious forms among non-fragile people”, indicates Djilalli Annane.
The effectiveness of the determining vaccination
Since mid-summer, an epidemic resumption has been observed with two new sub-variants of Omicron: EG.5.1 – also nicknamed “Eris” – and BA.2.86 – “Pirola”. The first is more widespread on French territory, but does not present significant severity. The second was identified for the first time in France on August 31. In total, 171 cases of BA.2.86 were identified by sequencing* as of September 22 worldwide, including 11 in France. It is more mysterious and was classified “under surveillance” as of August 17 by the World Health Organization (WHO).
To alleviate the saturation of hospital establishments, the Minister of Health Aurélien Rousseau decided to bring forward the vaccination campaign by two weeks, to October 2. Vaccination for the most vulnerable was initially to be carried out at the same time as that of the flu, from October 17, but the minister followed the advice of the Committee for Monitoring and Anticipation of Health Risks (Covars) which recommends “access to the vaccine booster as soon as possible”.
“We survived last year”
At first glance, with 75% of the adult population having received a first booster dose, France is well equipped to face the virus. Except that the vast majority of them received this first reminder at least four months ago. Hence the importance of the future effectiveness of this new vaccination campaign. “A recent report from the European Center for Disease Prevention and Control (ECDC) predicts, through mathematical modeling, that 30% of hospitalizations for Covid could be avoidable thanks to the vaccination booster,” recalls Antoine Flahault.
Unlike bronchiolitis and Covid-19, the flu epidemic is less easy to predict. “This is our greatest uncertainty,” warns Djilalli Annane. Despite the triple epidemic that is looming, the specialist does not say he is worried: “We survived last year. We know that we are going to keep the engine running. We are permanently in the red, but we have to we treat patients.” In its intensive care unit, at Raymond-Poincaré hospital, 50% of beds are closed due to lack of staff.
Same serenity from Antoine Flahault: “It will, very probably, be a temporary phenomenon that our hospitals in Europe should manage to overcome without knowing the extraordinarily complicated conditions of the year 2020 or 2021.” This should not exempt certain French departments from activating white plans to better overcome possible difficult milestones during the fall or winter.
A public hospital running out of steam
Thus, beyond the triple epidemic, it is the health of the public hospital which is being singled out. According to health professionals, between 15 to 20% of hospital beds are closed due to “medical demographic issues in the hospital world”. On the emergency side, 163 services closed, at least occasionally, between July 1 and August 31, according to the survey by the SAMU-Ergences de France union. At the beginning of September 2023, its president, Marc Noizet, revealed on RMC : “It’s overwhelming. We are facing a vital emergency, there is a danger to the health of the French people.” As caregivers sound the alarm, they will once again have to demonstrate resilience this winter.
But there is a slight improvement. In June 2023, 4.98% of nursing positions were vacant in establishments dependent on the FHF, compared to 5.7% in April 2022. “We are in a positive dynamic where we are recruiting new caregivers, in the hope of reopening beds,” assures the head of intensive care, Djilalli Annane.
In order to avoid putting hospitals under pressure, Antoine Flahault advocates more ambitious policies with the aim of tackling more effectively the modes of aerosol transmission of respiratory viruses. The specialist puts several ideas on the table: effective and continuous health monitoring, analysis of wastewater, etc. Also note that Covid, flu or bronchiolitis viruses are transmitted in enclosed spaces. “Better ventilating these spaces would improve indoor air quality and make it possible to consider considerably reducing the impact of these diseases caused by respiratory viruses and bacteria,” believes the specialist. Starting with schools.