Dr G. Zagury : “6 Minutes Covid” of 09/10/2020

Live from Shanghai since January 28 th.

🧭 60 ’’ Summary («Take Home Message »)

💢 At the national level, current trend observed (cf.% C + intensive care beds) following preventive measures: rather linear advance (“tide”), than exponential (“tsunami”)
💢💢 At the local level: some departments are in potential turbulence (Guadeloupe, Martinique, Seine Saint Denis, Bouche du Rhône, Paris, etc.)
💢💢💢 At European level: viral spread leading to upstream measures, in many States (Italy, Germany, UK, etc.)
💢💢💢💢 At the World level: the epicenter is now in India and the Americas
(USA, Brazil) present a priori a positive trend, which will need to be confirmed these days.
💢💢💢💢💢 While waiting for a very possible vaccine (validation in the coming months and marketing in early 2021): “Living with and without re-containment”, being sanitary without being military (social acceptability ++)
💢💢💢💢💢💢3 elements in parallel to anticipate:

1 Protection of fragile land  ✅

2 Health structures by anticipating tight flows (to be prepared!): “The strength of the chain is at its weakest link” => intensive care beds are our “weak link” in the countries of the South of the Europe (1-3 weeks of Intensive Care on average).

3 Compliance with the 2 main types of measurement: individual (barrier gestures: “3M” ✅) and collective (“3T”: Test ✅ but: Digital tracking and Triage-isolation need to be improved)

💢💢💢💢💢💢💢 Above all, maintain a winning morale, essential to the “Mental Health” of the Country (more than 98% survival…).

🚀 6 ` Minutes Flash : Objective: Contain the tide  

🇫🇷 France : dashboard

  • Deaths => = 76 ((cumulates 32.5 k)
  • Reanimation C (+) => + 114 (current total 1427)
  • C (+) non-ICU hospitalizations => + 711 (current total 7,603)
  • Positivity Test => + 9.8%
  • Nb Cluster = + 87

Dimensional equation at national level: keep in mind the “maximum figures” observed during the April peak (= 100% C + Health System, which can no longer be the case):

  • C + non-ICU hospitalizations at peak (32,131) / versus 7,603 (1/4) today
  • C + max resuscitation at peak (7632) / versus 1416 (18%) today
  • Death C + (+ 605 at the Hospital) / versus + 80 today

🇫🇷 France : local gestion

The virus circulates diffusely

Source : Santé Publique France

To understand the situation in France, we have to go back to the fundamentals = resuscitation beds, (with epidemiological tensions in the fall-winter already in pre-Covid, exacerbated by the economic challenges of fee-for-service / T2A pricing).

💢SSF (“French Health System”) -at national level: a tide (linear) and not a tsunami (exponential)

  • The 3 indisputable types of indicators (C + hospitalizations, C + resuscitation, C + deaths) are on the linear rise (see figure). The positive rate of tests (less questionable than simple C + tests) has increased from 4.5% to 9.8% in one month (doubling).

💢💢REANIMATION BEDS – at national level: the KEY to understanding

  • Regarding the key issue = resuscitation beds, let’s 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 all the more that the usual activity of the Resuscitation Services must be maintained. The following figure helps to understand the problem that we are currently facing:
  • For some, the protection of vulnerable people, and the current preventive measures (“3M 1T”) will be sufficient: let’s be positive, very many lives have already been saved, thanks to this type of measures.
  • 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 epidemiologically impacted regions (see our previous articles with our suggestion to open a dedicated C + structure in IDF type Val de Grace or other….): With my colleague surgeon Dr Athmani, we persist in this suggestion (“Whoever wants to find a way, whoever does not want to find an excuse”)… to be continued… .and no doubt, we will probably still be “ taken back “… !
4 Regular monitoring of the Seroprevalence study at local (blood bank type, etc.) and national level, for more objective visibility than certain current indicators (test positive rate, etc.)

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

At the departmental level, in terms of load / capacity, some resuscitations are already saturated (Guadeloupe 135%), and some could be in turbulence (Martinique 89% – Seine Saint Denis 65% – Bouche du Rhone 64% – Paris 57% …).

  • Note, already in Paris, postponement of 20% of non-urgent surgical activity (cataracts, hernias, etc.)

⚠️ To go further

1/ Chronological Vision (Time)

2 & 3/ Regional Barometer & DOM TOM

4/ Intensive Care Barometer

🇪🇺 Europe : “Barometer per country”

A North South gradient observed

In terms of “homogeneous” comparisons, let’s not forget that we must reason at 4 levels: local (department) – regional – national – …but also 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 and Stuttgart (closing of bars….)

⚠️ To go further

5/ “Space-Time” Table

World : “World pandemy”

Time : A 5 kinetic viral phase

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

For the USA and Brazil : still on a plateau (unlike Europe, which has experienced a peak, but with a return to “normalcy” for 3 months), we can see a slight downward trend … To be continued …

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

———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.

« 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.

“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).

See you tomorrow

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

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