Dr G. Zagury : “6 Minutes Covid” of 07/10/2020

🧭 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 5972 today
• Intensive care (7632) / Versus 1415 today
• Death (+ 605 at the Hospital) / Versus +66 today

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Source : Santé Publique France

To understand the situation in France, we have to go back to the fundamentals = resuscitation beds, (with tension in the fall-winter already in pre Covid).

On a national level : a tide (linear) and not a tsunami (exponential)

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Slow growth (+/- 1% day), made possible by the protection of vulnerable people, and by preventive measures: let’s be positive, very many lives have already been saved.

Let us not forget that in this pathology, a patient mobilizes an intensive care bed for about 3 weeks (very long / other usual pathologies!) And this explains why we can be very quickly saturated (like many European countries from South).

💢💢Disparities at regional and departmental level: sanitary without being military (social acceptability ++)

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Epidemiological transparency must be shared (30% threshold and evolving trends over several days, etc.), to get the population to adhere.

At the departmental level, in terms of load / capacity, some resuscitations are already saturated (Guadeloupe 145%), and some could be in turbulence (Martinique 79% – Seine Saint Denis 65% – Bouche du Rhone 64% – Paris 54%. ..).

⚠️ 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”.

The situation in Spain is improving following localized drastic measures, but progressive diffusion in the United Kingdom, in Italy,…. And Germany preventively establishes a “target curfew in the evening” in Berlin and Frankfurt (closing of bars….)

⚠️ 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 !! and all that is “dependent test” (quantitative and qualitative) to validate a trend.

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

So what? … To adapt more than to close

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“To govern is to foresee” (2/2)
=> Anticipate next month (hoping of course that the trend will be reversed!)….
=> Try not to suffer

“Take a head start” on the disease (think not now but in mid November!), And anticipate with dedicated C + Hospitals (& with a reserve of beds in intensive care)
-For us, we must leave the Hospitals with their “flow” of usual patients, and create in certain regions, this type of structure.

The example of Wuhan (+/- equivalent of the IDF in terms of population, etc.) is significant: in addition to confinement, the epidemiological dynamic changed on the day (mid February) when the patients were grouped together in the 2 hospitals of 1000 beds (roughly = Georges Pompidou or La Pitie, built from nothing in 3 weeks!), totally dedicated to the care of C (+).

In France, we are already lucky to have this type of infrastructure, which should be adapted at the regional level (Val de Grace type or other in IDF) according to the epidemiological risks.

Of course, this poses problems, in terms of resources (see “wartime”):

Human above all => medical teams to be mobilized see military doctors, reservists, pensions,… see paramedics….
Equipment => C + patients, ICU, Isolation, Biology, Imaging, …
Statutory or administrative: military type management (see logistics ++) would be a source of efficiency.
Economical
In our opinion, the initial cost is substantial, but this will be nothing compared to a possible reconfinement of an area like Paris or the IDF (too high sanitary pressure = do not give a patient a chance for the 6 th world power!)

Better an effort of consequent anticipation, hoping not to have to use it,… than to let “rise the tide” especially in season autumn-winter, and to adjust with “measures late of a train” (see mask, test, tracking, isolation,….).

———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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