Dr G. Zagury : “6 Minutes Covid” of 08/10/2020

🧭 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 6120 today
• Intensive care (7632) / Versus 1416 today
• Death (+ 605 at the Hospital) / Versus +80 today

The virus circulates diffusely

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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)

On the last day, decrease in the “pool” of occupied resuscitation beds (-10 beds or +/- 0.1%), and let’s hope that this decrease will become a trend over several days….

For some, the protection of fragile people, and preventive measures (3M 1T) will be sufficient: let’s be positive, many lives have already been saved, thanks to this type of measure.

We believe that there are still 4 key elements to optimize our dynamics compared to the current kinetics: 1 Digitization (tracking) 2 Effective isolation of C + patients 3 Regional structure for the care of all Covid + in the epidemiologically regions impacted (see our previous articles….) 4 Regular monitoring of the Seroprevalence study at local and national level, for more objective visibility than some current indicators (test positivity rate,…)

Let us not forget that in this pathology, a patient immobilizes an intensive care bed for about 1-3 weeks (very long / other usual pathologies!), And this as much as the usual activity of the intensive care services must be maintained.

💢💢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 65% – Paris 57%…).

⚠️ 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).

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)….

Watch out for the figures: carry over from the WE, and all that is “dependent test” (quantitative and qualitative) to validate a trend.

⚠️To go further:

6/ Kinetic deaths for major epidemic countries

One of the keys to navigating seroprevalence.

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Regular local, regional and national monitoring of this tool would make it possible to better direct public health measures.

Certain structures such as blood banks, will thus be able to shed light on viral kinetics.

Note that in the impacted European cities, this figure is around +/- 10%, at the beginning of the summer (example Geneva 10.8%).

Internationally, around 1/3 of the population is serologically positive in the following cities: New York, Mumbai (India), Johannesburg (South Africa).

———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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