Why is “a disorganization of society” feared in January?

In what state will France go through the month of January? We are not even talking here about the classic risks of hospital saturation or the bed capacity of intensive care units in the face of the coronavirus. The crisis, due to the Omicron variant, would affect far beyond the health sector. The Scientific Council was indeed worried, Thursday, « of a possible disorganization of a certain number of essential services » in January, because of « absenteeism » and « work stoppages » due to « very large number contamination at Omicron ”.

The cases climb very quickly, because of the extreme virulence of this variant, even more contagious than Delta. France has on average more than 60,000 cases per day this week, an absolute record. The Minister of Health Olivier Véran expects to see the threshold of 100,000 cases per day crossed by the end of the year, while epidemiologist Arnaud Fontanet estimates that there will be « several hundred thousand cases » per day in January.

Lack of staff everywhere, solution nowhere

Faced with these apocalyptic forecasts, France risks being confronted with a big concern: 100,000 cases per day, it is potentially 700,000 workers on the floor each week. Of course, not all cases are symptomatic and do not lead to total incapacity to work, but not all employees can work from home. This face-to-face work does not only concern caregivers but also teachers, truck drivers, police, soldiers, cashiers, etc., lists epidemiologist Mahmoud Zureik interviewed by 20 Minutes.

So much for the “disorganization of society”. But another huge problem is added, that of contact cases. For the moment, the health protocol is clear: positive or not, vaccinated or not, a contact case of the Omicron variant must be isolated for seven days, and ten additional days if he shares the same focus as the positive case. On average, each positive case results in ten contact cases,
according to epidemiologist Antoine Flahault. With 100,000 daily cases, that gives a million French people who isolate themselves for a minimum of one week each day. In just a few days, the country would be at a standstill, almost involuntarily confined.

Towards protocol adjustments

For this reason, the contact case protocol is unlikely to remain as such. Thursday, Olivier Véran thus indicated that « the rules will probably evolve » to « avoid any phenomenon of paralysis in the country. « With regard to caregivers and other essential professions, some could be required to continue working even if they have been confirmed as contact cases, said the minister.

Would this be sufficient or should the isolation of contact cases be lifted for all triples vaccinated, more and more numerous in France? [plus de 19 millions de personnes ont fait leur dose de rappel] ? The answer is far from straightforward. “The dilemma is that the more we relax the protocol, the less we isolate ourselves, the more contamination there is. It is therefore removing a problem and replacing it with another, ”deplores Mahmoud Zureik.

Insolvent dilemma

Maxime Gignon, head of the Prevention, Risks, Medical Information and Epidemiology Unit at the Amiens-Picardie University Hospital, raises the real question that arises: « How far are we ready to go by focusing on non-contamination? » « . « This puts the notion of risk acceptance at the center of decisions, » says our expert. The hospital practitioner also notes that it is currently difficult to know what is the percentage of risk of being contaminated when there is contact but that we have respected the barrier gestures and received a triple dose. Studies are underway and should make it possible to find out more quickly. « The preliminary results of British field studies show that a vaccination with two doses protects against contamination at only 20-30%, and at 70-75% with the booster dose in addition, » says Mahmoud Zureik.

A protection that could be considered sufficient to lift the case contact protocol for triple vaccinated? Here again, even if the British results are confirmed, a mystery will remain: how long does the protection triggered by the third dose last? A few weeks, a few months, more? Difficult to decide, and return to the initial dilemma: « Do we relax the rules with the risk of having more contamination or do we maintain the rules by taking the risk that the country will no longer turn? » », Summarizes Mahmoud Zureik.

No contact case, problem anyway

Assuming that France lifts the isolation of contact cases, logically leading to an increase in cases already exploding, not certain that the country can run at full speed. « Whatever we decide, we are heading towards very tense weeks in several essential sectors, » laments Maxime Gignon.

According to Mahmoud Zureik, it is not impossible, for lack of staff, that caregivers « positive for the coronavirus but asymptomatic must continue to exercise by strictly respecting barrier gestures and wearing FFP2 masks ». A decision taken this Christmas by
the AP-HP of Paris-Saclay which suggests that positive, asymptomatic and voluntary caregivers continue to work to make up for the staff shortage. We are only at the end of December and, in January, the executive could therefore be pushed to make a choice in the face of the exponential increase in cases. Or this, from this December 27, when the Elysee has just announced that Emmanuel Macron was going to hold a new Health Defense Council that day.

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