Covid-19: “I am very embarrassed that a booster vaccine is becoming an obligation, both in form and in substance”

Gérald Kierzek is an emergency doctor and health columnist, medical director of Doctissimo, and author in particular of Coronavirus, how to protect yourself? (Editions de l'Archipel, March 2020).

FIGAROVOX. - Emmanuel Macron announced that the health pass for people over 65 will be conditioned on a third dose of vaccine. Then, at the beginning of December for 50-64 year olds. Do you approve of this decision?

Gerald KIERZEK. - Targeting the over 65s is a good thing since they are the most at risk of serious forms. But above all, we must seek out the non-vaccinated in this category, ie still around 10% of our fellow citizens, rather than imposing a recall, the real need for which we do not know.

Since the start of the epidemic, more than 90% of patients hospitalized in intensive care were over 65 years old, so it seems legitimate to protect them as a priority, as well as the age group slightly below 50-64 years old and people obese. Very early on, it was shown that more than 47% of infected patients entering intensive care are in a situation of obesity and the severe form (namely a BMI greater than 35) with a significant increase in the risk of being placed on invasive mechanical respiration ( intubation), regardless of age, arterial hypertension and diabetes. The priority must therefore be to vaccinate them with a first complete scheme.

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I am very embarrassed that a booster shot is an obligation, both in form and in substance. In terms of form, deactivating the health pass for people over 65 who do not have a booster shot is violent and akin to an obligation. Consent is a fundamental patient right. This de facto extends the health pass which was initially to be stopped on November 15 and proportionate to the epidemic situation according to the initial decision of the Constitutional Council, while this pass in no way limits contamination and has already fulfilled its role, pushing to mass vaccination this summer.

Given the vaccine success, it would therefore be legitimate to no longer have recourse to it and I can only regret that the President, probably under pressure from the alarmist and hygienist current of the Scientific Council, is extending it.

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On the merits then, the need for a booster shot can be discussed. Indeed, it is based on serology studies showing that people over 65 see their antibody levels drop. But immunity is much more complex than a simple measurement of antibodies! When the antibodies drop, cellular immunity is there to also ensure the immune defenses and we are medically unable, in daily routine, to know the duration of vaccine protection. Natural immunity is also a strong immunity, stronger than that granted by the vaccine as shown by many studies, in particular because it makes it possible to develop mucosal immunity (IgA antibodies) at the ENT level alone capable of stopping the viral circulation. The vaccine does not prevent contamination because it does not confer this mucosal immunity; it protects against severe forms.

It would therefore surely be desirable to let the virus circulate in the less fragile (no risk of serious forms and solid natural immunity) as well as in vaccinated people without giving a reminder. One could even say that the rebound in contamination makes it possible to envisage stopping viral circulation and ending the epidemic! But for that, you have to get out of “panic mode” in front of the positive test curves!

As the number of infected increases again, should barrier gestures be strengthened as the president said?

Basic barrier gestures yes, restrictive measures no! Let me explain. Barrier gestures such as regular hand washing or hydroalcoholic solutions when hand washing is impossible is reasonable to fight against all viruses (Sars-Cov-2, flu, gastroenteritis and others). Likewise, the ventilation of premises, private and public, is fundamental. On the other hand, wearing a mask in children or even outdoors does not make sense. Long-term barrier measures are needed to live with this virus and limit other viruses. We cannot socially, psychologically and even immunely live under glass.

The psychological consequences of wearing a mask in children are real and terrible, including in the long term, while its effectiveness as a barrier gesture is more than hypothetical. Too much hygiene kills hygiene on the immune level. We are currently seeing this with the resurgence of bronchiolitis in children born during containment measures. Their immune system has not been confronted with the classic viruses linked to life in society (nurseries, etc.) and is weakened.

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It is imperative not to sink into a hygienist madness that is politically and medically dangerous. Here again, we must not give in to the panic of the figures.

The contaminations will increase inexorably but do not constitute a wave in the sense of hospital saturation. In 2020, we witnessed waves of intensive care saturation in two main regions (Grand Est and Ile de France); stricto sensu, we can no longer speak of a third, fourth or fifth “wave” since it is now a wave of positive tests without hospital repercussions.

The current hospital crisis, and I was going to say even that of 2020 supposedly linked to COVID, is structural and linked to the lack of beds and now staff. COVID patients represented only 2% of all hospitalized patients during the year 2020 according to the report of the Technical Agency for Hospitalization Information which collects and analyzes all hospital data! Far from the collective fantasy of a hospital full of COVID patients with people who cannot be taken care of and "sorted" to enter the hospital.

And yet the hospital almost didn't hold up and I would even say no longer holds up given the leaks of personnel and the lack of territorial remeshing with nearby hospitals. Every day in France, the Réserve Sanitaire de Santé Publique France, dedicated to exceptional health situations, now calls on volunteers (doctors, caregivers, laboratory technicians, radio manipulators) to ensure the activity of bloodless hospitals and in passing rob Peter to pay Paul.

Is the arrival of drug treatments good news?

Yes, even if you shouldn't expect miracle drugs. The molecules in the running are molnupiravir from the MSD Merck laboratory for which the British Medicines Agency (MHRA) has just given the first regulatory authorization for the treatment of mild to moderate forms of Covid-19 in adults. Phase III results show that this oral antiviral, initially designed for influenza, reduced the risk of hospitalization or death by around 50% compared to placebo, for mild to moderate forms of Covid-19. The other molecule is Paxlovid from the Pfizer laboratory, developed against SARS, which seems effective in preventing severe forms of Covid-19 in people at high risk by blocking an enzyme which the coronavirus needs to reproduce. Fluvoxamine, an antidepressant, also shows promise and could be used.

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In all cases, these drugs are drugs in addition to the vaccination strategy and the classic and early management of patients at risk in particular. The fundamental difference between March 2020 and November 2021, in addition to vaccination, is that we now know how to identify and treat patients at risk: rapid scan to see lung damage or not, monitoring and/or outpatient or hospital treatment (oxygen, cortisone , anticoagulants, antibiotics, etc.). This treatment avoids resuscitation. It is still necessary to have the human and logistical resources to do it for everyone and everywhere.

I can only salute the “Let's not be afraid, believe in us” of the President of the Republic, who does not give in to dishonest alarmism. I would now like the probable future candidate for his re-election, and the other candidates, to finally understand that COVID is only an indicator and the symptom of a deep crisis in the health system which must be urgently reformed under never come out of this crisis.

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