Is the pandemic behind us? If the Covid-19 still infects thousands of people daily in France, the government has decided that it is time to lift – almost completely – the foot on health measures. As of February 1, the end of derogatory work stoppages without a waiting day for people who test positive for Covid-19, according to a decree published on Saturday in Official newspaper.
Is this the right time to end these measures? What impact will their lifting have on the epidemic and its follow-up?
“A favorable epidemic context”
From this Wednesday, this decree therefore puts “an end” to “the issuance of derogatory work stoppages to insured persons who are unable to continue to work, including remotely”, provides for the decree. This device was to end “at the latest” at the end of the year. But with indicators back to green, the government has decided to bring forward the deadline. Since the beginning of the year, the health situation has improved markedly, with fewer than 16,000 patients currently hospitalized, compared to nearly 25,000 at the end of December 2021. And the number of contaminations has also fallen in one month, from more than 20,000 less than 5,000 per day on average, according to the site covid-tracker.
A downward trend confirmed by the latest figures from Public health France. “The incidence rate is decreasing (47 cases per 100,000 inhabitants, – 25%)”, as is the screening rate and the test positivity rate, notes the health agency. On the care side, it also notes “a drop in new hospitalizations of 40% and new admissions to critical care services (-43%)”. In this “favorable epidemic context”, this Wednesday, it is also over “systematic isolation” of positive cases and “carrying out a test” after two days for their contacts. In addition, the recording of positive test results in the SI-DEP computer file will now be “conditioned on the prior collection of the consent of the persons concerned”, until the end of this epidemic monitoring tool, scheduled for the end of June. Contact tracing, managed by Health Insurance, also ends definitively.
“The ultimate stage of living with”
After three years of pandemic and devices ad hoc to contain the virus, the government is thus choosing to reduce health expenditure linked to Covid-19 and to really live with the virus. “We are reducing the efforts made to limit the health burden of this preventable disease, to move towards a scheme similar to the management of influenza, analyzes Mircea Sofonea, lecturer in epidemiology and evolution of infectious diseases at the University of Montpellier . We accept that there is a virus that kills several thousand people a year, and which impacts the quality of life of several hundred thousand people in France affected by long Covid, a condition that we still do not know how to treat. With, in the bottom line, the question of knowing if we are doing enough to avoid the consequences of the pandemic ”.
As for the timetable, “the end of these measures makes sense in a logic where all the indicators are down, and the State could not finance such measures ad vitam aeternam, especially since there are a strong weariness of the population, comments the epidemiologist. It is important to loosen the level of restraint when the health threat is lower. On the other hand, we have no argument to think that SARS-CoV2 will disappear, but we accept this risk of indefinite duration and its impact on our healthcare system, our economy and our daily life ”. A decision that is all the more important “as once taken, it is difficult to go back. The authorities are choosing to treat Covid-19 like other respiratory viruses, when one would have hoped that they would learn from it to improve the long-term management of these diseases.
Better anticipation possible
However, this decree intervenes “without it being correlated to any quantified threshold, deplores Mircea Sofonea. The indicators are certainly down, but the political decision is not taken on the basis of objective criteria defined upstream. This makes it less readable and makes it more a matter of political communication than a clear public health policy. Is there a review clause? Does the government reserve the possibility of reinstating these measures in the event of an epidemic resumption? We will see in the fall with the return of respiratory viruses. But given the circulation and the emergence of sub-variants of Covid-19, better anticipation would have been possible: From what thresholds do we put these efforts back in place? When are we really going to act on the purification of indoor air, a fundamental issue? Or improve pedagogy on barrier gestures? »
Faced with these unknowns, and with a slippery anti-Covid vaccination reminder campaign, Public Health France insists on what to do to keep the virus at bay. “Adherence to barrier gestures, including wearing a mask (in the presence of vulnerable people, in the event of crowding in closed spaces such as public transport), remains necessary and must be accentuated to also preserve the healthcare system, prescribed the health agency. The monitoring of other measures remains essential: isolation in the event of a positive test or symptoms, hand washing and ventilation of closed places”. An isolation which, as we have seen, will no longer be compulsory.
More difficult epidemic monitoring
And with the end of contact tracing, derogatory work stoppages and the systematic declaration of positive cases in the SI-DEP database, “the screening rate will be in free fall, warns Mircea Sofonea. In practice, epidemiological monitoring will be very difficult to ensure, with data of lower quality since we will no longer have a representative sample. And that at the same time, there are no additional resources allocated to the development of modeling work. So there, we are a bit breaking the thermometer ”.
For its part, the government relies on everyone’s responsibility and recalls that despite the end of these measures, “it remains strongly recommended to people who have tested positive, as well as to people who have been exposed to a contagious person and who are likely to develop the disease, to respect hygiene gestures, to be tested and to avoid contact with fragile people.