We know that many journalists and decision-makers (“crisis cells”, ministries, …) read this analysis “served at breakfast”, and we are delighted. We simply ask you, when you use our ideas or illustrations, to have the elementary COURTESY to CITE us.
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Doctor Guillaume Zagury, based in Shanghai and specialist in international public health and “health innovations”, comments on a daily basis the evolution of the epidemic for more than 2 months, and gives us a preview of the elements of understanding on its “country analysis” and the foreseeable consequences (experiences of SARS in 2003 and Covid in China for 3 months).
A. Where is the health system in Ile de France, and more generally in France (CovidScore ©)?
1. Ile de France – Slowdown in resuscitation due to Covid-19
In Ile de France, we have observed since last Thursday (ie for 5 days), less tension for Covid-19 patients, with a slight deceleration in inflows.
This continuous decrease is explained by the results of the confinement in force for 20 days, faced with an incubation period of 14 days. The measures adopted on March 17th were to take effect around April 1st, which appears to be the case.
However, we must remain vigilant and not let our guard down.
2. The first wave is a priori passed in IDF, but a second is likely
The first wave that has been sweeping hospitals for several days is the Covid-19 patients. The second will be made up of people not affected by Covid-19 but affected by other pathologies: they have generally not received follow-up for 3 weeks and could decompensate.
The patients fled the doctor’s offices for fear of contamination or by alternative solutions such as tele-medicine.
However, the +/- 10% of the population with long-term illness (LTI), or around 7 million French people, must benefit from good follow-up, under pain of decompensation: coronaries (risk of infarction), management of cancers (1,000 new cases per day in normal times), type 1 or 2 diabetics (3-4% of the population), psychiatric patients (in particular psychotic), etc.
Over 3 weeks of insufficient follow-up because of the ongoing epidemic, many diagnostic and especially therapeutic delays can lead to decompensations and therefore hospitalizations in the intensive care unit, causing a second major influx of patients, without that -these are directly linked to Covid-19.
3. System must anticipate potential delays in diagnosis and treatment of non-Covid-19 patients
As we can see on the curve below, the load (7,000 beds) / capacity (9,000 beds currently) ratio should be monitored, both at the national level and at the regional level.
4. CovidScore © evaluation
We have raised certain ratings (including that of France) in our ranking, which now turns out to be the REFERENCE for assessing country strategies (health analysis equivalent to Moody’s agency in financial terms).
Several major media outlets have used the CovidScore © (which we’ve been showing you for over 2 weeks!) To challenge the authorities with the right questions … and get things done for the French population.
What makes our “fight” legitimate is to provide proof that different tools are also available to the authorities to optimize the management of this pandemic: our Asian DNA (most of the team is based in Asia, where the epidemic started earlier) is essential for seeing and improving preventive tools and practices.
Let us note an interesting case: Israel with 9,000 detected cases, (including 50% targeting Orthodox Jews, who however represent only 10% of the population) and 57 deaths. Israel represents around 10% of France (population of 7 million inhabitants), but announces for the time being 70 times fewer deaths per inhabitant, for an almost similar risk exposure (the epidemic reached the Middle East before to touch Europe). The measures taken on the spot are of the same type as those taken in Confucian Asia … which is reflected in the Israeli score when compared with European countries.
I received via Linkedin, a scoring request from a central European country, and our team will be delighted to show on objective and verifiable elements, the countries where health security is exemplary in the context of this epidemic (you can contact me – see mail below – and send us the “ad-hoc” quantitative elements to justify the measures).
The countries of Western Europe slightly raise their scores, following their change of policy on masks and tests (ex: in France, massive tests in Ehpad if less case, whereas it was not the case until ‘in recent days).
B. 6 reasons to be optimistic
1. France still follows Italy with 10 days lag
Italy now seems to be entering a phase of decline.
2. France raises CovidScore © to 14/30
This improvement is mainly due to a better preventive action, on masks and diagnostic tests (although the measures taken are still insufficient in our eyes).
The 180-degree turn on the masks is positive, as is the extension of testing capacity to all laboratories, although this has taken a long time to see the light of day. The new Ehpad strategy (test of the whole Ehpad in the slightest proven case) and the contribution of our academic-industrial arsenal are also to be highlighted.
Example for tests
3. If our health system has been damaged by lack of prevention, it has been “heroic” in the acute treatment phase
The caregivers, in very difficult social conditions (cf. recent strikes, …), put all their energy into the battle in a united way and without counting their time.
4. Some countries like Germany start announcing possible deconfinement dates
However, we must remain cautious, as long as we do not have the weapons of Germany: masks, tests, resuscitation beds (more than 20,000 beds in Germany, against less than 10,000 in France under current conditions)…
5. Let’s not forget that the pathology progresses favorably in 98% of cases
And that it affects only moderately (in proportion and severity) children and young adults.
6. On the treatment front
Therapeutic solutions via multicenter trials conducted for 3 months should ultimately give results: chloroquine, serotherapy, antivirals, …
C. Geopathology: France D20 and the world – Still in the epidemic phase
Analysis with the contribution of Dr Bachir Athmani and Stéphane, companions from the start
All the information (even over-information without hindsight) is already present in the media, so I give you my point of view in the form of 6 points and 6 synthetic diagrams.
1. A global pandemic affecting all continents
4 billion people are currently confined to the planet. In time and space, the epidemic broke out in early January in Hubei and then spread to surrounding countries, then to the Middle East and now to the West (European wave since early March, and now wave north-american).
Global kinetics: new cases with an increase in delayed mortality within 10 days (deaths generally occur in the second or third week after the onset of symptoms)
Geographic vision (source: John Hopkins University)
Prevalence: 80% of active cases detected are in the West, 10% in the Middle East and 10% in the rest of the world.
2. The virus is in the West and has crossed the Atlantic
82% of existing cases (at least those that are measured!) Are detected in the West, compared to 10% in the Middle East.
Prevalence by continent: the center of gravity shifts to America.
By country: incidence and prevalence
3. But these figures are only of relative value
Because they depend on testing strategies and means: what is, for example, the real situation in Africa, where the lack of tests is glaring?
Africa (47 countries): there is obviously an underestimation of the real number of cases
– Egypt (1,173 cases / 78 deaths)
– Ethiopia (44/2)
– Algeria (1320/152)
– Senegal (226/2)
– Ghana (214/5)
– Morocco (1113/71)
– Tunisia (574/22)
– Burkina Faso (345/17)
– Togo (52/3)
– Ivory Coast (261/3)
– Guinea (121)
– Mali (47/5)
– Mauritania (6/1)
– Gabon (24/1)
– Kenya (158/6)
– Rwanda (104)
– Uganda (52)
– Sudan (12/2)
– Cameroon (658/9)
– Namibia (16)
– Democratic Republic of the Congo (148/16)
– Congo (45/5)
– South Africa (1 665/11)
– Central African Republic (8)
– Equatorial Guinea (16)
– Benin (22)
– Liberia (13/3)
– Somalia (7)
– Djibouti (59)
– Nigeria (232/5)
– Gambia (4/1)
– Zambia (39/1)
– Niger (184/10)
– Chad (9)
– Angola (14/2)
– Zimbabwe (9/1)
– Mozambique (10)
– Eritrea (29)
– Madagascar (72)
– Libya (18/1)
– Botswana (6/1)
– Tanzania (22/1)
– Burundi (3)
– Sierra Leone (6)
– Malawi (5)
4. United States and United Kingdom
Having skipped prevention when they had a week longer than France to prepare, their health systems will undergo a “tsunami” of resuscitation support (note that British Prime Minister Boris Johnson has been hospitalized in intensive care).
5. Ethical issues raised
The head of the management of the Covid-19 epidemic in Congo suggests to try as soon as possible any vaccine candidate in his country, who can finance all prevention and screening …
To be continued, but personally I would not approve such a route unless we are absolutely sure of the safety of the vaccine tested
6.Prime Minister of Singapore at the time of SARS 2003: “We will die of economic death before dying of biological death”
1 month of confinement is equivalent to a decrease estimated at 4% of GDP by the experts (see% of workers actually in production).
The level of the 1929 crisis (loss of 16% of GDP) is equivalent to 4 months of confinement (we are currently one month away).
Let’s find intelligent solutions to get out of containment with the least economic impact and while maintaining health security …
Our Covidminute team will soon be proactive on this subject: to be continued!
7. France: figures by region
D. In the coming days…
– Therapeutic vision (with Anne)
– Post-containment vision (with the essential Dr Bachir Athmani)Virus Preventions 4 W’s:
Wear a mask, Wash your hands, Watch out for sick people, Wait for new updates from covidminute.com !
Protect yourselves, and above all protect the most vulnerable!
Dr. Guillaume ZAGURY,
Specialist in Public Health and Health Innovations
Consultant at “Health Innovations”
HEC
In China for 20 years“All success is collective”, thanks to:
– the whole “Back Up” team (Mathieu Bousquet, Carole Gabay, Flavien, Marie, Laetitia, Anne-Sophie, …), without whom this project would not have been possible.
– all the “Medical” team (Dr Bachir Athmani, Dr Ibrahim Souare, Dr Taieb, Dr Viateur …) who allow this project to exist,
– all historical financial sponsors (Jerome, Benjamin Denis & B Square, Benoit Rossignol, Arnault Bricout) who work for “Citizen Actions”
If you feel like a patron or of partners to finance IT development, don’t hesitate to contact me (guillaume@covidminute.com).
Also, even if part of the team is based in Shanghai, do not hesitate to come and join us, because there is no shortage of work :-)If you want to find more analyses and infographics, follow our account at:Know the latest updates
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