Dr G. Zagury : “6 Minutes Covid” of 15/10/2020

🚀 6 ` Minutes Flash : Objective: Contain the tide  

We are in an epidemic phase, and we consider this to be a “new epidemic”, which cannot be compared to the previous one, because the ecosystem has completely evolved in terms of the physical environment and preventive measures ( following new knowledge). Taking into account the probable correlation with the season (see absence of “summer outbreak” in Europe), we call it: Covid 19 – Season 2, and reset the counters to zero.

GEOGRAPHICAL VISION: the virus circulates in a diffuse manner in high-density metropolises

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Source : Santé Publique France

THE SSF (French Health System) FACING COVID Season 2

💢SSF (“French Health System”) –NATIONAL: a rising tide

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• The 3 indisputable types of indicators (C + hospitalizations, C + resuscitation, C + deaths) are on the relatively linear increase.
• The teams of caregivers are quantitatively no more numerous than for phase 1, and qualitatively “morally tired”… consequently, do everything to spare them.

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

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• The government’s objective is that C + in intensive care only represent 10-15% of beds (versus 33% currently), within 1 month of “curfew” in the most epidemiologically exposed metropolises
• The corollary (via a dimensional equation) is to arrive at 4K new cases / day versus 20K new cases currently: a division by 5 of the connections.
• Also note the bet, that “flu” respiratory decompensation will be less following preventive measures (“3M” and massive flu vaccination).
• The objective of 75% vaccination coverage in “high-risk areas” (over 65s, caregivers, pregnant women, etc.), versus 50% last year, will probably be reached: 16 million doses have been ordered.

💢💢💢 REANIMATION BEDS – REGION-DEPARTMENTAL DISPARITIES: “Be sanitary, without being military” (social acceptability ++)

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⚠️ To go further

1/ Chronological Vision (Time)

2 & 3/ Regional Barometer & DOM TOM

4/ Intensive Care Barometer

Europe in epidemic phase with observed South North gradient

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• More deaths in Europe yesterday (1300) than in the USA (850), than in India (700), or in Brazil (680)
• All European countries impose new restrictions, with variable geometry according to the epidemiology and “cultural” acceptance: Holland, Spain, Czech Republic, Switzerland, Italy, UK,… ..

⚠️ To go further

5/ “Space-Time” Table

Time : A viral kinetics in 5 phases and a sixth which appears….

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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: 4 epicentres (more than 500 deaths / day)? – India… Europe and the two Americas

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• 1100 deaths yesterday in the EUropeen space including 20% in Spain, 10% in France, Poland, Ukraine and the United Kingdom,….

⚠️To go further:

6/ Kinetic deaths for major epidemic countries

To understand the situation in Israel, which went as far as the 3 week reconfinement, 5 points:

• Orthodox community: 12% of the population … but 55% of C + over 65
• Confinement had been established just before the 3 major religious festivals in series (Rochashana, Kippur, Sukkoth), sources of major family and religious gatherings.
• Very low sensitivity threshold for tests in Israel (PCR at 37 replication versus 34 in the USA and 30 in Germany) => more cases / hbt than elsewhere.

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• Extremely digitalized country, almost at the level of China …
• As a result, compared to other countries, we observe: many C (+) cases, but low lethalitis. In other words, rigorous application of “3M3T” measures (see: Deaths per million inhabitant in 223/500 for France).
• The government is still uncertain, on its decision to maintain confinement or not, because the results appear positive but still incomplete …. There is not only in France or social fractures (same debates as with us), but here also religious (exarcerbation of antagonism: secular / religious), exarcebent. What we know is that this deconfinement, unlike the previous one, will be very progressive and no cultural event before the 1st January.

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• To be continued …

———To come up——-

• Epidemiology: Italian study with% of asymptomatic cases according to age
• Geopathology (“Patho-Geopolitics”): barrier gestures depending on the country, vaccine update, trends in the USA & Brazil, the Israeli case (tomorrow), Covid illustrating the end of the illusion of supremacy in the Western World, …
• Strategy: A centralizing structure for C + in epidemiologically at risk regions (such as Val de Grace or other in IDF)

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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

« 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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