This is a discussion paper launched in the Covid-19 La Marsa project. It’s a draft, any input and discussion is appreciated.
Author: Dr. Karim Ben Dhaou
Be warned of the effects of a potential deconfinement that would not be combined with the implementation of strict testing and isolation, at a time when the possibility of a second wave of contamination is becoming increasingly tenacious. It must be emphasized that this second wave would further paralyze the hospital system and probably saturate the country’s hospitals.
In addition to the mandatory tests to deconfinement, it is recommended to keep as much as possible the “barrier gestures”, which were advised from the first days of the health crisis.
Collective immunity is not affected, provided of course that the disease generates in all cases a strong protective immunity, which has not yet been formally demonstrated for this virus highly effective in neutralizing the cellular immune responses essential for its total eradication in infected patients.
Clearly, the actual number of infected subjects is certainly at this time much higher than the number of biologically confirmed cases corresponding almost exclusively to hospitalized patients. In a word, we are blind, for lack of epidemiological data, even approximate, to the real attack rate of the disease (the history of epidemics teaches us how important the ability to exhaustively identify patients, including healthy carriers, is for effective control of the spread of the pathogen).
The containment approach is marked by intensive individual hygiene measures including the use of masks in the general population, a wide, very wide use of diagnostic tests to identify and isolate patients and virus carriers, combined with investigations exploiting advances in artificial intelligence to detect contact subjects and put them in quarantine. Subjects at risk were confined, particularly the elderly (Korea has thus been able to control the epidemic, despite a very virulent outbreak in the southern part of the peninsula, which seriously threatened the entire country. Of course, these countries are not immune to rebounds, as they are unlikely to have achieved the prevalence of infections necessary to develop herd immunity as a result of this early success. Singapore, considered as one of the “good students”, after a semblance of initial control, has in recent days seen the number of cases, including deaths, skyrocket, and has decided to go for a total containment of its population again on April 7).
It is essential to explain these prospects to the citizens of Marsa now. They must be helped to understand that this exceptional situation will last. The end of the confinement will not be the end of the epidemic! The epidemic will always be present, less virulent, of course, than the wave that we are currently experiencing, but only waiting to bounce back.
Not only will deconfinement have to be progressive as already announced, but it will have to be accompanied by the maintenance of social distancing measures, adapted, improved… intelligent, on which we have solutions.
Our commune, its economy, its medical staff, its living forces will not be able to withstand one or more rebounds that would require a resumption of “accordion” containment measures. It is unimaginable, we must succeed in our deconfinement, and we have little time to prepare for it.
Due to lack of capacity, we have not been able to develop a proactive approach to expanded diagnosis, particularly in the most affected areas, such as La Marsa, at a key moment when the epidemic was accelerating.
Blind to the number, even approximate, of real cases, we were unable to carry out a large isolation of contagious subjects and a 14-day-quarantine of their direct contacts, or even an earlier confinement. This allowed the exponential transmission of a virus with an R0 higher than that of seasonal influenza to develop.
Getting out of confinement? the sooner the better, of course, the mental and social health of our population and the chances of reviving our economy depend on it. We can’t wait for drugs and vaccines. But let’s not confuse speed with haste. Two conditions must absolutely be met, and they are a matter of common sense, even more so than science:
Are we clearly out of the epidemic peak? No, we are not! Even if there are now some signals that we would like to see as positive, such as the stabilization of the number of new hospitalized patients and those requiring resuscitation, the situation remains uncertain.
Are we now gathering the elements to give the deconfinement strategy maximum chances of success? No! And there is still a lot to be done as time is running out.
The search for contacts of infected patients will naturally be associated with this approach. The famous “contact tracing” which is already the subject of an understandable societal debate, because it is immediately seen as a further step in the attack on our individual liberties, which have already been somewhat curtailed by anti-terrorist laws.
This debate must be tackled as soon as possible and the extraordinary support for the detection and the 14-day-quarantine of subjects in close and/or renewed contact with the subjects that have tested positive must be clearly set out. Artificial intelligence, “machine learning”, “big data”, all this can be combined with more traditional methods to ensure this epidemiological grid, which is essential to avoid the rebounds after deconfinement.
It is clear that this new paradigm, if it is chosen, must be accompanied by an inescapable legal and ethical framework, and must be organized and steered for its complex logistics and the integration of its multidisciplinary methodological dimensions by personalities of high moral and scientific value. It must also be accompanied by the citizens, and not imposed, and I insist not imposed, by means of a transparent pedagogy and the encouragement of their active participation.