The question of re-containment during the fifth wave of this fall / winter in France is closely linked to that of vaccination.

The fifth wave of the health crisis is now certain in France. In the capital, there are 250 cases per 100,000 inhabitants at the end of November 2021, which reaches the maximum alert threshold. This incidence rate – that is, the number of infections in a given population and period – is equivalent to that of the peak of the last wave. However, this fifth wave only seems to be starting.

Can the situation raise fears of confinement? What criteria should be taken into account to address this questioning?

The fifth wave is distinguished by the vaccination rate of the French population: more than 75% of eligible people are vaccinated at two doses. However, this comprehensive regimen helps reduce the risk of a covid infection turning into a serious illness (or long-term covid) requiring hospitalization or causing death. This is proven by studies based on “real life” data, that is, on the basis of vaccinations carried out in recent months. For example, a recent report from October 2021 estimates that it is 90% effective against severe forms (hospitalizations, death) in people over 50.

In fact, the fifth wave does not currently have the same structure as the previous ones. While the increase in the number of positive cases is dramatic, the number of deaths and hospitalizations is lower, not following the same trend. Clearly, this could be a wave of contamination more than a wave of hospitalizations and deaths.

Containment is an overall effective measure to curb the spread of the coronavirus. Studies have shown this effectiveness, but with some limitations. These limitations mean in particular that such a decision is quite fraught with consequences. However, after two years which have taken a heavy toll on society, it is clear that further confinement could have rather harsh psychological and economic consequences. The measure, if taken again, should therefore be really well justified.

But then what, precisely, justifies confinement? It’s not really the increase in the number of positive cases. In reality, confinement comes to avoid or very specifically stop hospital pressure. When the contaminations curve reaches a certain stage, then epidemiological models often show that in the days and weeks that follow, this will affect hospital admissions as well as deaths. This makes the care of patients more difficult, not to mention that the caregivers are overwhelmed.

Containment limits the number of contaminations to, precisely, stop or avoid this hospital pressure. This is what the Institut Pasteur recalls to explain the rationale for its projections: “In order to be able to continue welcoming these patients, hospitals may have to deprogram certain operations, close non-COVID-19 services and Reallocate staff in favor of COVID-19 care, with an impact that can be deleterious for COVID-19 and non-COVID-19 patients as well as for caregivers. These epidemic rebounds therefore generally lead to a strengthening of control measures, which should make it possible to reduce the pressure on the hospital system. “

However, since vaccination limits the number of severe versions of the disease, it statistically reduces the number of intensive care hospital admissions. This alleviates the risks of hospital pressure. In fact, the risks of containment being necessary in France are much lower than in all previous waves.

However, uncertainty arises as to the duration of immune protection: the effectiveness of vaccines seems to decrease over time, especially after 6 months, hence the current strategy of a booster dose for those most at risk of contacting serious forms. The booster vaccination rate could therefore have an impact on hospital pressure. In addition, the Institut Pasteur noted that “a flu epidemic concomitant with the COVID-19 epidemic could, however, increase the pressure on the health system”. The risk of the flu coming back in force justifies the continuation of barrier measures.

In Germany, the government has announced tightening restrictions on unvaccinated people specifically in areas where the number of hospitalizations exceeds the alert threshold. In Austria, confinement was decreed after a record in the number of contaminations (1,531 cases of Covid-19 per million inhabitants on November 21, 2021, the previous record was around 800), which raised fears of a hospital rebound Consequently. The decision to lockdown is therefore also very contextual at the national level.

The probability of re-containment is therefore relatively low in France. However, there are still some uncertain factors that could possibly push the authorities to consider this solution. On Thursday, November 25, the Minister of Health Olivier Véran planned to announce new measures to stem the 5th wave, but the method of containment is far from being on the program, if we are to believe the recent conclusions of the door -parole Gabriel Attal at the end of the last defense council.

As often, since the beginning of the epidemic, we would like to point out that the “uncertainty” factor is in itself real information to be taken into consideration. The models, projections and already established knowledge are not enough to foresee everything or to know everything, a fortiori in a context where the situation is changing a lot – sometimes quite quickly.

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