Three years after the appearance of Covid-19, and as a new wave arrives, old information from March and April 2020 is being recycled. New: a graphic, which went viral at the beginning of October, is used to support these allegations of euthanasia orchestrated with Rivotril. But this graph is problematic for many reasons, as two researchers explain to us.
Rivotril, an anti-epileptic drug which can be used to relax and fall asleep, is wrongly blamed for having “mass-killed” elderly people in nursing homes. “Graphs show that the excess mortality in nursing homes during Covid corresponds exactly to the moment when we were injecting Rivotril into the elderly,” comments an Internet user, questioning Olivier Véran, then Minister of Health, in a post liked more than 1,200 times on X.
On March 28, 2020, a first decree had been adopted allowing until April 15, 2020 “the dispensation of Rivotril by community pharmacies” in order to care for Covid patients at home or in EHPAD “affected or likely to be affected by the SARS-CoV- virus 2” and presenting with dyspnea or respiratory distress. This involved providing an alternative to Midazolam, a benzodiazepine, a sleep-inducing substance, used in injectable form to relieve the suffering of patients at the end of life.
Three years ago, this decree was accused of “legalizing euthanasia in France”, which was not the case, as we explained then. Euthanasia remains prohibited in France – the latest law on this subject, adopted in 2016, only provides a “right to deep and continuous sedation” for people whose vital prognosis is at risk in the short term.
“This use [du Rivotril sous sa forme injectable] had to comply with the exceptional and transitional protocols established by the French society of support and palliative care”, told us the General Directorate of Health (DGS), which did not wish to comment on the graph, “to the extent that we do not have the method of constructing the latter.”
“It’s a complete madness”
This serious accusation has been taken up since the end of September, in particular by Didier Raoult, in an interview given to Idriss Aberkane, “the hyperdoctor”, who plagiarized one of his theses. In a viral extractshared more than 3,300 times, the former director of the IHU affirms that it was not possible to give hydroxychloroquine to the elderly, “but you could euthanize them with Rivotril”, he says , “a step” that he is not ready to “take”.
“It’s a complete madness,” replies Mathieu Molimard, professor in the medical pharmacology department at Bordeaux University Hospital and member of the board of directors of the French Society of Pharmacology and Therapeutics. Rivotril was given to dying patients to relieve their suffering. We do not give it to kill the elderly or to save on the prescription of hydroxychloroquine which would have saved them. » In April 2020, the French Society of Geriatrics and Gerontology (SFGG) protested against the “false” statement “euthanasia of the elderly” with the prescription of Rivotril, a position that she tells us she maintains.
“Used to make intubation more bearable”
From March 2020, “there has especially been an overconsumption of Midazolam in intensive care units, underlines Mathieu Molimard, because this is what is used to make intubation more bearable. The decision was made to use Rivotril, which is also a benzodiazepine, but which is less practical in intensive care. » There is therefore no overconsumption of Rivotril, but “compensation”, he insists, in replacement of Midazolam. “This measure was notably linked to the fact that midazolam-based drugs were not available in sufficient quantities, nor easily accessible in town,” the DGS confirms.
This compensation is verified using the Medic’AM database, which lists medications dispensed by town pharmacies and reimbursed by Health Insurance. The graph shows “a greater dip in the sale of Midazolam in the city between March and May 2020,” comments Mathieu Molimard. We went from 4,300 boxes of Midazolam reimbursed in March to 2,521 in April. At the same time, we went from 900 reimbursed boxes of Rivotril to 2,000. »
But, he recalls, “it is not these sales which caused the deaths, there is a Covid epidemic and the elderly have unfortunately died from it. » In 2020, indicated INSEE in a study of 2021, “the excess deaths compared to 2019 are largely due to the Covid-19 epidemic”. “During both waves, the increase in deaths is very strong” among those over 70, with + 31% in March-April and + 20% in September-December, continues the national statistics institute.
A graph that doesn’t hold up
Does the viral social media graphic hold up? No, say Mathieu Molimard and Jean-Marie Robine, research director at the National Institute of Health and Medical Research (Inserm). And this for many reasons. It was originally published in Covid-19: Open war against the peoplea book published in September, written under a pseudonym and which relays the conspiracy theory believing that Covid-19 is a tool intended to enslave populations.
“This graph has no value in scientific terms”, the data, presented as coming from the Santé Publique France and Medic’AM platform, have been “manipulated” and “truncated”, analyzes the professor in the pharmacology department medical. For example, the graph presents two entries: overconsumption of injectable Rivotril ampoules (although health insurance counts reimbursed boxes) and excess mortality data.
“Deaths do not equal blisters”
The entry on the left starts “from overconsumption and not from a number of boxes, so the curve is truncated”, notes Mathieu Molimard, it is “manipulation of data and, therefore, disinformation”, Raw data should be used and not relative data. The peak of more than 250 ampoules or boxes is also not consistent with Medic’AM data, since 1,039 boxes of Rivotril were reimbursed more in April 2020 compared to March. “Deaths do not normally equal blisters, as it is written on the left,” he notes.
The data available in Medic’AM on injectable Rivotril concerns sales in towns, this figure partly includes nursing homes, but also all town medicine. An element that Jean-Marie Robine also confirms: there is no information on “overconsumed” ampoules of injectable Rivotril in nursing homes in Social Security data. The provenance of this statistic “is a weak point”.
A reference curve for excess mortality
Another problem: the excess mortality curve cannot appear on its own like this either: “Each time we publish an excess mortality, there is a reference, which is exactly the same period in the same situation at least on a previous year, we always report it,” underlines the research director at Inserm. However, there is no reference curve in this graph.
According to the results of his work, which is based on data from CépiDc-Inserm and Cnam, more precise than those from Santé Publique France, Jean-Marie Robine was able to estimate excess mortality in nursing homes at 15,114 excess deaths. during the first wave. The peak of death certificates in nursing homes with mention of Covid-19 is 400 around April 10, which also does not correspond to the excess mortality curve in the graph and this mysterious more than 250.
“I don’t know where this figure of 250 comes from,” Mathieu Molimard also assures. This scale on the left does not correspond to the dead or the boxes. » He recalls that the scale of deaths in raw data is rather around 15,000 deaths each month in nursing homes, according to 2018-2019 figures from the Epi-phare investigation. “It’s not 250 deaths like 250 blisters, the scale is more like 15,000 deaths. » He sees this as a new “manipulation” of data.