New isolation rules against Covid-19: "It's realism that takes precedence", says Professor Bruno Mégarbane

Positive caregivers will be able to continue to work under certain conditions, "a transitional plaster to allow us to pass the acute course" with this explosion of contaminations in France, affirms Professor Bruno Mégarbane, head of the intensive care unit at Lariboisière hospital in Paris.

Invited by franceinfo, he reacts to the “good strategy” announced by the government by relaxing the rules of isolation for positive people and contact cases. Bruno Mégarbane estimates "that today we have in the territory a million people carrying the Omicron variant and therefore, in fact, almost 10% of the population who could be in contact". "In practice, it is realism that prevails". On the other hand, he says he is more "reserved" about the return of the mask outdoors from the age of 6.

franceinfo: Positive caregivers will be able to continue working under certain conditions. Which ones?

Bruno Mégarbane: The conditions are extremely drastic to authorize contaminated, and therefore positive, nursing staff to be able to work. It must first, of course, be asymptomatic. In addition, the agreement of the department head and management is required. There must be a real need, that is to say that all the other possibilities have been explored and that, finally, there is a lack of personnel and that the absence of this carer leads to the closure of the beds, and obviously he has to take care of patients who are not at particular risk of taking care of them himself. So, in practice, the positive carer will only be able to work in a positive Covid sector. The risk is extremely measured. At the hospital, we work with strict respect for barrier measures and caregivers put on FFP2 masks, especially when caring for Covid patients. In fact, contamination is reduced, if not zero. Of course, there is always a risk, but it is a minimal risk strategy between having a positive but asymptomatic caregiver work and closing beds. I think it's even better to be able to take care of patients who need it.

Will this make it possible to solve staffing problems within the public hospital?

It is one solution among others to be able to pass this difficult course, of the possible influx of Covid patients linked to the Omicron wave. Obviously, this does not at all solve the basic problem, which is a deprived public hospital, a flight of nursing staff who are no longer motivated, who no longer find satisfaction in working in the public hospital. It is a transitional plaster to allow the acute course to be passed. Afterwards, we are of course expecting a reform of the structure of the public hospital, we hope as soon as possible, in any case very clearly, the future President of the Republic will have to take it up immediately after his election.

The Minister of Health also announced the isolation of vaccinated positive people, which will be of the same duration, regardless of the variant, seven days, or even five, if the test is negative. It was ten days before for the Omicron variant. Is this measurement consistent?

Yes, it is consistent in the sense that the symptoms appear more quickly with Omicron because by being vaccinated, therefore immunized, your immune system reacts very quickly when the virus is present. And then the viral load peaks earlier and the reduction in viral load is faster, so the symptoms are shorter in time. And the elimination of the virus is faster, therefore perfectly authorizing a reduction in the duration of isolation of positive people. In addition, when you go to five days, you must have a negative PCR or antigen test to be able to leave isolation. Otherwise, you will do seven days systematically. So, obviously, in the two or three days that follow, you will have to be extremely careful. In the United States, for example, the duration of isolation was shortened to five days, but it is recommended to wear an FFP2 mask.

Second scenario, contact cases in the event of zero or incomplete vaccination will now be isolated for seven days, but vaccinated contact cases will be able to work with a PCR test then free self-tests. Do you think this presents an additional risk of contamination?

We are in a risk reduction strategy, given the extremely large number of infected people and therefore of people in isolation for contact. It has been estimated that we have today in the territory one million people carrying the Omicron variant and therefore, in fact, almost 10% of the population who could be in contact. Obviously, if we put all these people in solitary confinement, we can stop big companies, industry, hospitals. So I think it's a good strategy.

But is it an economic concern more than a health one?

Yes quite. If you don't have a metro to go to the hospital to treat patients, how do you do it? If you don't have caregivers in the hospital because they are in isolation, what do you do? If you don't have ministers or an administration to manage the country, what do you want to do? In practice, realism takes precedence. And it is true that the fact of carrying out a repeated test, that is to say this iterative testing strategy that moreover we are asking for in the schools, in my opinion, will make it possible to minimize as much as possible the possibility of dissemination of the virus, although obviously it is very clearly inferior to systematic isolation.

The mask from the age of 6, will this really be a plus to limit contamination?

There, I am more reserved. The advantages-disadvantages balance may lean more in favor of the disadvantage, especially in open space. We have all said that contamination takes place in a closed, poorly ventilated environment and therefore requiring a mask for a child, in the open space, in the street, seems to me of extremely little interest. I believe it is better, on the contrary, to let them breathe in the open air. Now, we understand that in this difficult period, it is necessary to give signals to the population of the potential seriousness of the situation.

Olivier Véran says that "this fifth wave may be the last". What makes it possible to say this today?

The virus in its natural history wants to find a balance with its host, which is man. This one gains in immunity because of the various natural infections and vaccination, especially with booster doses. And so, the virus will try to adapt, that is to say give humans the fewest possible signs, the least possible morbidity, but at the same time be able to replicate and spread without any concern. In fact, future variants will be able to take on these characteristics, that is to say have a very high transmissibility like Omicron and, conversely, a lower virulence. However, this cannot be said definitively. We are not immune to a new mutation which may not have appeared yet and which causes a new variant to appear and which again leads to a cycle of pathologies. Today in hospitals, we are still in the Delta wave, but it is clearly beginning to level off. For example, in the service, for 48 hours, I have had no incoming for serious Covid infection showing that the Delta wave is starting to level off, or even already to regress. The whole question is now whether there will be people entering intensive care at the hospital from Omicron contaminations. It takes another fortnight to be sure that this Omicron is really benign.