Deconfinement is looming but a “high plateau” worries

For ten days, Professor Djillali Annane, at the head of the intensive care unit of the Raymond Poincaré hospital in Garches, in the Hauts-de-Seine, has felt the pressure decrease. “We are slightly less solicited but we are still much more than normal, we still refuse patients every day,” he tempers immediately. For several weeks now, “its” 18 heavy intensive care beds and 10 critical care beds have been constantly occupied. And as soon as one of them is released, it is reassigned “within the hour”, specifies the practitioner. Under these conditions, it is impossible for him to rejoice in the deconfinement calendar set by the government. Too early, too fast, in his eyes. “The bet is extremely risky, the viral circulation remains intense”, he insists.

Since the beginning of April, the incidence rate has fallen sharply, and even more so in Ile-de-France. There are currently 336 cases per 100,000 inhabitants in the region, which is half as many as at the end of March. A significant drop but less rapid than during the first two confinements. Above all, the level of circulation of Covid-19 remains extremely high. On December 15, for example, during the second deconfinement, the incidence in Ile-de-France was 2.5 times lower (125). However, the terraces were never reopened and the curfew, a time set at 8 p.m., was quickly lowered to 6 p.m. As for the first confinement, if we tested little and therefore do not know precisely the incidence rate, the Obépine network, which monitors traces of viruses in wastewater, hardly detected any Covid-19.

Saturated intensive care units

“The horizon is clearing up but we are still in the third wave, still above the peak of the second”, recognizes bluntly the director of the Regional Health Agency (ARS) of Ile-de-France, Aurélien Rousseau. The intensive care units still show an occupancy rate of over 140%: 1,632 patients are currently staying there, where the region normally has 1,150 beds. In Professor Djillali Annane’s department, the majority of them are between 55 and 65 years old, often overweight, even if one of the beds is occupied by a 29-year-old man who does not present “especially comorbidities”. “Compared to the second wave, patients often stay longer because they are more severely affected. If it increases again, how do we do it? “, Worries the department head.

Aurélien Rousseau is well aware of this, after 15 months of health crisis and constant solicitation, the nursing staff is exhausted, even worn out. “The whole difficulty is to find a crest line between the hospital tension and the need to resume an activity because the braking measures weigh at all levels, psychological, educational, social …”, he admits. In his eyes, the situation this spring is nevertheless very different from that of last year. There are the tests first. After the first confinement, the ambition was to achieve 40,000 per week in Ile-de-France. Last week, 500,000 Ile-de-France residents were tested and 900,000 at the height of the third wave.

But the main development undoubtedly lies in the vaccination campaign. Certainly, with less than a quarter of the Ile-de-France population having received at least one dose of the precious serum, the region is a red lantern. “Ile-de-France is the youngest region in the country, but our vaccination campaign is linked to an age criterion,” corrects Aurélien Rousseau. If we compare the target populations, we are in the national average. “Above all, insists the director of the ARS, vaccination will accelerate in the coming weeks. 500,000 injections are planned for next week, 2 million in May. To meet growing needs, new centers are preparing to open, in addition to the 200 already in operation and the six vaccinodromes.

The hunt for variants

There are still unknowns and not the least. Will the resumption of school change the observed decline? According to the ARS, there are currently 293 closed classes *, far from the feared explosion. But the concern lies mainly in the variants, in particular “Brazilian” and “South African” against which the vaccines seem less effective. They now represent 10% of cases in Ile-de-France but have sharply increased in certain areas. In Val-de-Marne, the department with the highest incidence in France, the South African variant went from 5.5% to 14% in one month. As for the Indian variant, no official case has been identified in the region but around fifteen tests are being analyzed.

“It makes you wonder if we have learned the lessons of the second wave, insists Professor Djillali Annane. We know that by letting the virus circulate, the risk of the variants spreading is significant and that this could have an impact on our vaccine strategy, but we are going there anyway! “The director of the ARS, he assures that his teams are fighting” foot by foot “to contain these new strains. 90% of PCR tests are screened, isolation measures reinforced, massive screening operations are organized… No out-of-control cluster has yet been detected. Unlike the practitioner, Aurélien Rousseau is sure, “the battle of variants is not lost”. But if there is one thing they both agree on, it is the need not to let our guard down during this period of transition. “The resolution of the crisis cannot pass only through public policies. Everyone must be responsible and careful, ”insists the director of the ARS.

* 1,003 classes are closed in the region but more than 700 due to the absence of the teacher for whatever reason, specifies the ARS