Dr G. Zagury : “6 Minutes Covid” of 06/10/2020

🧭 60 ’’ Summary (“Last Round”)

💢 Less acute situation but at risk of evolution over time (slow but constant) and depending on region (IDF, North): “a marathon more than a sprint”.
💢💢 Diffusion throughout the territory: no East-West gradient (10-15% collective immunity, summer travel more South & West,)
💢💢💢 Disease in more than 98% cured (we are not in an Ebola configuration), and better therapeutic management: corticosteroids (see “city storm”), anticoagulant, CPAP rather than intubation, plasmapheresis …
💢💢💢💢 At the World level: the Americas did not have the resolution phase observed in the EU, and the Epicenter is now in India
💢💢💢💢💢 Note that New Zealand & Australia succeeded in containing the epidemic during the Southern winter (partial reconfinement of the state of Victoria), and aims to soon be “Covid Free” (like New Caledonia !)
💢💢💢💢💢💢 A vaccine likely by the end of the year

🚀 6 ` Minutes Flash   

Equation to dimensions: have in mind the “maximum figures” observed during the April peak:

• Hospitalizations C+ no ICU (32.131)  / Versus 5617 today
• Intensive care (7632) / Versus 1329 today
• Death (+ 605 at the Hospital) / Versus +32 today

Unlike phase 1 where an east-west gradient was observed, the virus circulates in more than 70% of the territory and in the overseas departments, and an epidemic phase is observed depending on the region (IDF, North, etc.)

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Source : Santé Publique France

To understand the situation in France, you have to know how to reason about the issue = intensive care beds, in terms of load / capacity.

On a national level : being sanitary without being military (social acceptability ++)

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Slow growth, made possible by the protection of vulnerable people, and by preventive measures: let’s be positive, very many lives have already been saved.

Epidemiological indicators are rising slowly but continuously (C +, Positivity rate, Hospitalizations, Resuscitation beds,): this phase 2 does not correspond to a tsunami, but to a wave which is brewing.

Consequently, we understand better, why the government is doing everything to “flatten the curve”, and thus avoid at all costs a situation of total or partial reconfinement (cf Israel, +/- Madrid, +/- Melbourne, +/- Quebec, +/- New York …)

To be coherent and to avoid “professional or geographical revolts”, it is necessary to think on the various tables (& not only epidemiological): compensation and responsibilities. The white coats are not against, but with the white counters to find the best “trade off”: epidemiological security / economic life, probably via more liberticidal measures, but in the interest of all our elders.

💢💢Knowing how to reason at the regional level:

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Epidemiological transparency must be shared (30% threshold and evolving trends over several days, etc.).

⚠️ To go further

1/ Chronological Vision (Time)

2 & 3/ Regional Barometer & DOM TOM

4/ Intensive Care Barometer

A North South gradient observed

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In terms of “homogeneous” comparisons, let’s not forget that we must reason at 4 levels: local (department) – regional – national – European

Note that the positivity thresholds of the tests are sometimes of variable geometry, depending on the country, and therefore we have chosen the% positivity indicator which cancels out this “measurement effect”.

Unlike phase 1, Italy seems for the moment “spared”: collective immunity (serologies are at 10-15% in the large cities of the North, for a figure normally required of 60% of cases), less of tourist flows… Conversely, 182 deaths in Spain yesterday.

⚠️ To go further

5/ “Space-Time” Table

Time : A 5 kinetic viral phase

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Have the few key figures in mind: 5k deaths / day and +/- 300k new officially declared C + / day (beware of everything that is “test dependent” in terms of measurement and interpretation).

Difficulty anticipating the kinetics of this pathology in the short to medium term …

Be careful of the week-end report !!

Space: India takes over from the Americas (improving trend to be confirmed)

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For the USA and Brazil, it seems that the situation is improving but very gradually (still nearly 1000 deaths yesterday)….

⚠️To go further:

6/ Kinetic deaths for major epidemic countries

Unlike Europe, the USA and Brazil, have not experienced epidemiological “rest”….

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———To come up——-

Seroprevalence studies depending on the location

Italian study with% of asymptomatic cases according to age

Geopathology (“Patho-Geopolitic”): barrier actions depending on the country, vaccine update, etc.

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« All success is collective and so thank you to our teams (Dr. Bachir Athmani, Carole Gabay, Richard Coffre,…), as well as to our patrons, and of course to the Paul Benetot Foundation/Matmut Group.

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“Live with” while protecting the most vulnerable with a “citizen” attitude

• 3M for the general population (70%)
• 4M for populations at risk and the most exposed (30%)
• 4M for places at risk of exposure (case by case and common sense: visiting a church alone is not at risk, conversely, risk if a crowded place and “proximity” rituals).

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See you tomorrow

Dr Guillaume Zagury
Specialist in International Public Health (DES)
HEC
Practitioner
Consultant in Medical Innovations (France, Israel, China)
In China for 20 years

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