Although a first case of the BA.2.86 variant has been detected in France, the analysis of wastewater shows a worsening of the epidemic and the latest figures indicate an increase in visits to emergency services due to suspicion of Covid-19 However, three years after the start of the pandemic, are we still monitoring the evolution of SARS-CoV-2?
“We only have a fragmented idea of the situation,” laments epidemiologist Dominique Costagliola, member of the Academy of Sciences and emeritus director of research at Inserm, for BFMTV.com.
Because since last July, the Sidep portal – population screening information system – launched in the spring of 2020 to follow the pandemic has been closed. A closure provided for by law that puts an end to the exceptional regimes created to fight the covid epidemic.
This system allowed exhaustive monitoring of all tests (PCR and antigens) carried out in hospitals, laboratories, pharmacies, but also in doctors’ and nursing offices. It gave the number of new daily cases, the positivity rate, the detection rate, the incidence and even the reproduction of the virus.
Although the new Néo-Sidep software allows the results of laboratory tests to be collected, this does not affect those performed in pharmacies or self-tests. And the data is not public. Regarding the situation in the hospital, the figures for hospitalizations of positive people, admissions to intensive care or new admissions to intensive care are no longer communicated.
“Wet finger”
So have we become blind when it comes to monitoring the epidemic? “Partly,” observes Dominique Costagliola, also deputy director of the Pierre-Louis Institute of Epidemiology and Public Health and vice dean of the Faculty of Medicine at Sorbonne University. “We do so little testing, even in the hospital, that it’s not representative.”
“On the number of cases, on the type of variant, we do not have reliable information. It is a wet finger.”
The only data available: the reasons for going to the emergency room, which are the subject of a weekly Public Health France bulletin, as well as the home visits by SOS doctors. For the former, after a last week of increase among children aged 2 to 14 years and a previous one in all age groups, visits to emergency services due to suspicion of Covid-19 remain stable among adults, indicates the latest Oscour newsletter.
Regarding medical interventions carried out by SOS doctors for suspected Covid-19, the increase also continues: +19% from September 18 to 24, notes the latest national newsletter, after a previous increase that was already 19%.
For what impact? According to the Sentinelles health surveillance network, the incidence rate of Covid-19 cases – which present respiratory signs observed in general medicine consultations – is estimated at 95 cases per 100,000 inhabitants.
“This rate increases compared to the previous week (which was then 81 cases per 100,000 inhabitants, editor’s note), or 49,248 new cases,” writes the latest bulletin. Data obtained from the observations of 558 general practitioners and pediatricians who participate in this network.
“We are in the fog”
While the Minister of Health, Aurélien Rousseau, indicated in an interview with La Montagne an incidence rate “around 41 new contaminations per day per 100,000 inhabitants”, epidemiologist Dominique Costagliola points out that these figures do not even correspond to those of the Public health. France.
“They don’t tell us the total number of tests performed, so I don’t see how we can estimate the incidence. Which makes me say that we can’t characterize the extent of the current situation.”
“We are rather in the fog,” Mircea Sofonea, researcher and professor of epidemiology and evolution of infectious diseases at the University of Montpellier, told BFMTV.com. “A fog that little by little settled.” Because, according to him, even before the disappearance of Sidep and Sivic (for hospital data), “the visibility of the epidemic was already lower due to the fall of controls.”
Although this epidemiologist confirms that the recovery is certified – “with a higher incidence than some previous waves” – he considers that the current data contains biases, that they are too fragmented and do not overlap.
“If the situation deteriorates, we won’t know which indicator to believe.”
“A risk of persistent symptoms”
To counteract this fog, it would have been necessary, according to Mircea Sofonea, to establish a reactive substitution monitoring system; as has been done in other countries, particularly with random population testing. But he regrets the lack of interest and investment by the French authorities in Covid monitoring and surveillance. He himself saw his requests for funding to continue his research denied.
“The problem with Covid is no longer the saturation of the intensive care units, although last winter the situation was very complicated in the pediatric departments.”
“It is the fact that we have a virus circulating, which can infect us several times in the same year, with a significant risk of persistent and disabling symptoms.”
In fact, repeated Covid infections may present a higher risk of developing heart and lung problems, brain conditions, kidney disease or diabetes.
Wastewater and sequencing
Another way: wastewater monitoring. This is precisely the mission of the Obépine network, the Epidemiological Observatory of wastewater, created during the Covid-19 health crisis, which has recently observed a resurgence of the epidemic. But only about thirty treatment plants of the approximately 21,000 in France are controlled. The national Sum’eau network, dedicated to microbiological surveillance of the virus, was to take over, but no data has yet been published.
“Monitoring wastewater is a good early indicator of the rebound or decline of the epidemic,” acknowledges Mircea Sofonea. “But this will only give us the concentration of SARS-CoV-2, not the number of cases or the size of the epidemic,” he warns.
One question remains: variant surveillance. For Dominique Costagliola, it is currently insufficient. “They tell us that the variants are being monitored. But in the latest update from Public Health France on variants, “There are less than 200 sequences (the sequencing of the virus allows us to know if it has mutated, editor’s note) that have been carried out.” Epidemiologist Mircea Sofonea agrees: “With less than 500 sequences, we should not expect to detect a new variant, you “You’re losing it.”
But instead of wondering about the danger of this or that new variant, Dominique Costagliola believes that it would be preferable to adopt lasting measures. From indoor air quality in schools, hospitals and nursing homes to an effective monitoring system so that the population is well informed and takes action.
“It is a public health problem that justifies the investment, but France acts as if it no longer exists.”
Initially scheduled to start on October 17, “in view of the epidemiological circumstances”, The Ministry of Health has decided to bring forward the new vaccination campaign to this Monday.
Source: BFM TV
