Le 24 janvier 2020, le terme Covid-19 n'existait même pas. C'est à cette date, il y a deux ans, que les trois premiers patients porteurs de la maladie ont été identifiés en France. Depuis, le monde a beaucoup appris sur le Sars-CoV-2, sa létalité, comment il se propage, les façons de s'en protéger. Surtout, le virus n'a pas cessé de surprendre et d'évoluer. Confrontés à deux variants aux profils très différents, Omicron et Delta, soumis à des règles changeantes et débattues, armés de vaccins dont l'efficacité comporte des inconnues, les Français ont de quoi être un peu perdus.
And the specialists?For the past two years, we have also been suspended from the declarations of doctors, virologists, infectiologists, epidemiologists, in the hope of filling our questions.But they too are sometimes looking for answers.Franceinfo wanted to know what were the questions they kept in mind, sometimes since the start of the pandemic, and which seemed important to them to know what tomorrow will be done.Ten experts have agreed to answer us, evoking very concrete, sometimes more philosophical questions, on the virus, vaccines or even their impact on society.
1 Communication variants carrying as many mutations emerge?
Mylène Ogliastro is virologist, vice-president of the French Virology Society and director of an INRAE department.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""At the start of the pandemic, there was a fairly low level of mutations, about two per month, without it changing the properties of the virus a lot.This is how the flu or cold is evolved from one year to the next.Then the Alpha variant exploded, and we quickly saw that we were no longer at all in the same register.And today we have variants of the virus that have emerged independently, which we cannot trace the common ancestor.
We assume the type of context conducive to their emergence: immunocompromised people or who have contracted long covid forms, who do not manage to control infection and in whom there is a huge diversity of mutations in the virus.These transferred viruses will contaminate other people, and those who best escape the immune system will emerge.But all this remains a hypothesis.The mechanisms of evolution are common to all living things, but there are keys that we have not yet.Which raises questions for the rest of the pandemic.Because today, when I hear that Micron may be the last varying, I prefer to remain more cautious.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2 possible mutations in the virus limited or endless?
Marie-Paule Kieny is virologist, specialist in vaccines and public health.Research Director at INSERM, former deputy director general of the World Health Organization (WHO), she is part of the guidance council of the vaccination strategy against the COVVI-19.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""We see that the Sars-Cov-2 virus is evolving and that variants appear which are more or less neutralized by antibodies induced by a previous infection or by vaccination.We do not yet know if the repertoire of these mutations will remain limited, in order to preserve a functional structure of the SPIKE protein, or if the universe of possible mutations is almost unlimited (as for HIV).In the first case, we should quickly arrive at population immunity that will control a virus that has become endemic.In the second, we could continue to have more or less important epidemic waves.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
>> Quand et comment la pandémie prendra-t-elle fin ? Voici les hypothèses des scientifiques
3 do we see durably coexist virulent variants and more mild variants?
Samuel Alizon is a specialist in the modeling of infectious diseases and their evolution, research director at CNRS and the Institute of Research for Development.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""How evolves the virulence of Sars-Cov-2 in humans? Globally, the lethality of infections decreased thanks to vaccination.Until then, we have seen more contagious and more virulent variants emerge, alpha or delta.Omicron seems less virulent than Delta while being a little more contagious.Are we witnessing a divergence within the Sars-Cov-2, with these virulent variants on one side which exploit the low respiratory tract-what we see for the moment-and, on the other hand, less virulent variants exploiting the high respiratory tract, of which Omicron would be a precursor still very virulent?And are we going to observe a coexistence? """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Can this virus have the same level of contagiosity as avian flu, and cause diseases as serious as sras?
Denis Malvy is infectiousologist, head of the infectious and tropical disease department at the Bordeaux University Hospital, and member of the Scientific Council.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""This question is the one I asked myself on January 24, 2020 by receiving one of the very first patients affected by what will later be called the COVVI-19.And this is the question that I had asked a few months earlier in a scientific article, where I mentioned the preparation for the next pandemic.I wrote that the worst scenario would be that of a contagious virus like that of avian flu, transmitted by airways and not simply by contact, and with pathogenicity [the ability to cause serious forms] of SARS-COV-1, which caused the sras.I asked myself this question as a white blouse, from the patient's bed.Because, followed in this question, was that of the care to be deployed.
When I formulate the question today, I do not do it in the same way and I can answer it much faster, at least by posing several hypotheses: for omicron, the level of contagion is very important, and the lower pathogenicity thatthat of Delta, with a vaccine that still makes a lot of services.But with each new variant that points to its nose, we ask ourselves this question.If I stopped putting it to myself, I would be an impostor, because I am neither a soothsayer nor prophet.And I rush to keep the same question intact in the face of patients in the next epidemic.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
5 Well, does not have a test to identify who has a very high risk of serious form?
Djillali Annane is a resuscitatory doctor and directs the resuscitation service of the Raymond-Poincaré de Garches hospital (Hauts-de-Seine).
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""The early identification of people who will make a severe form of the COVVI-19 is the field where we must make progress.We know risk factors: obesity, hypertension ... but still not the genetic signature which would make it possible to say, after contamination, that a given person really has a very high risk of developing a severe form.Not genetic in the sense of hereditary factors, but in the molecular sense: this can be linked to the environment, hygiene of life, to treatments that we take.Knowledge would strengthen vaccination monitoring, personalize and improve care, administer certain treatments that are only given when the disease has worsened.
We have data on hundreds of thousands of people who have made severe forms, samples.But it would take a collective effort to pool them and identify these genetic signatures.Then draw a quick diagnostic test which would tell you, as soon as contamination or even before, 'attention, you risk making a very serious or even deadly form'.It's not science fiction, we have the tools.What is missing are the means and political will.I participate in a working group from the World Health Organization (WHO) and this is not being set up because of rivalries, nationalist selfishness, regulatory barriers ... """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
What is the duration and extent of the protection provided by post-vaccination immunity?
Arnaud Fontanet est médecin épidémiologiste, chercheur à l'Institut Pasteur où il dirige l'unité de recherche d'épidémiologie des maladies émergentes, et titulaire de la chaire """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""Santé publique"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" du Collège de France.He is a member of the Scientific Council.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""This is an important question, because it will depend on the hoped -for transition to a seasonal epidemic of colds and angina, with few serious pulmonary forms, and therefore without overflow of hospital capacities.It is now acquired that circulating antibodies do not protect against infection when their concentration drops in the blood from a distance from vaccination.A fortiori in the face of variants with mutations on the protein targeted by vaccines.But what about T lymphocytes, whose targets are more extensive and less dependent on the mutations of the virus [it is therefore more difficult for a variant of them]?And the local production of antibodies in the lungs, which can act delayed, and whose role could be decisive in the protection against the serious forms of the disease?The responses we have on the duration and extent of these other forms of protection are partial, for a fundamental question.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
7 The technological jump driven by the pandemic will it allow us to further improve vaccines?
Anne-Claude Crémieux is an infectious scientist at the Saint-Louis hospital in Paris, and professor in infectious diseases at the University of Paris.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""The importance of the crisis prompted governments to invest massively and to fluidify the journey of provision of vaccines.It made us make an undeniable and impressive technological leap.As we have seen, research already existed, but it was stored in the boxes.Flu vaccine technology, for example, has hardly changed since 1945.
But today, we are starting to see the weaknesses of vaccines against the COVVI-19, especially the reduction in protection over time, that we did not expect that.To this must be added variants like omicron that reduce their effectiveness.The opening of society, too, is more important than when the vaccines have been tested.Will the unpublished pressure and financial means that will continue to be allocated to allow us to continue the vaccination revolution?We would like to find the high protection against the infections that we had initially admired with the mRNA vaccines, and extend the duration of this protection.The margin for improving vaccines determines all other questions about the way this epidemic will evolve.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
8 What are children at the heart of so many debates on the pandemic?
Christèle Gras Le Guen is a pediatrician, president of the French Pediatric Society and Cheffe of the Pediatric Service of the Nantes CHU of Nantes.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""This is a question that I share with many pediatric colleagues: why was the child placed in the midst of so many discussions and controversies during a pandemic who affects his health so little?knew from the start, and it is confirmed today, that this virus affects children less, makes them less sick, that they are probably less contagious even if we have seen an evolution ... It could have made the child beOut of words in this pandemic.
On the contrary, while it is complicated to convince adults to vaccinate themselves against their will, it was easy to impose on children measures which we know that they will not be able to refuse them, such as wearing the mask.These are also the first to stigmatize and present as a potential danger.We have seen bright epidemiologists take unscientific postures and extraordinary virulence to ask to close schools and lock up children at home, while we, pediatricians, are well placed to see that they are very little sick, not or little contagious, and mostly contaminated with their close adults who are not vaccinated.Wouldn't that reflect the place given to the child in society?It is both the subject of a lot of concern and many preconceived ideas, and often treated as an adjustment variable.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
9 Well, do not have learned the lessons of forty years of combating AIDS?
Gilles Pialoux is a infectious scientist and head of the infectious disease service at Tenon Hospital in Paris, vice-president of the French Society for the fight against AIDS and Professor at Sorbonne University.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""There are basic lessons that we have not drawn.For example, the fact that screening is also a prevention tool, because a person who knows he is contaminated does not have the same behavior as the one who ignores it.Or that the opening of expertise and decision -making structures for non -biomedical sciences (ethics, epistemology, etc.) was one of the major advances in the fight against AIDS.Like the effectiveness of combined prevention, while the discourse of politics has constantly been to substitute one tool for the other: the vaccine with barrier gestures, detection pass ... and what about the need for governancesupranational policy, of a fair redistribution of vaccines and the opening of patents as for AIDS?Without this, the emergence of exhaust variants even more effective than Delta or Omicron will constantly impose on the cards of vaccination at the international level. Pourquoi répéter les mêmes erreurs que celles ayant eu cours après la découverte d'une trithérapie contre le sida, au nom d'un """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""nationalisme sanitaire"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" désuet et mortifère ? Enfin, pourquoi ne pas avoir attribué une place, une parole, aux associations de malades à risques, aux familles endeuillées, aux patients devenus experts et plus globalement à la démocratie sanitaire, l'un des acquis de la lutte contre le VIH ?""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
10 What will be the consequences of this pandemic on the hospital and society?
Jean-Michel Constantin is a revival doctor, head of the anesthesia-resuscitation service of the Pitié-Salpêtrière hospital in Paris, and secretary general of the French Society of Anesthesia and Resuscitation.
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""The question that haunts me the most is how long this pandemic will last, and what will be the impact on a societal level.Every time we think we arrive at the end, she leaves.How will the hospital get out of it?He holds, but I have the impression that it is a baroud of honor and that behind, everything will collapse.Surgeons are prevented from operating, some file the camp in the private sector and patients follow them, nurses wonder if it's worth continuing.We have not finished doing the accounts, from the balance sheet of deprogramming in particular.We are still in it, and I find that we do not really realize the washing machine in which we are taken.On the one hand, two years, it is nothing in a life, but on the other, I find it difficult to have professional memories before the pandemic.Many colleagues have no space to try to think about what happened, take a step back.We will have to call on people to help our teams, discuss and build the continuation together.
My question goes beyond the medical field.After having lived under constraint, in such a cleavage society (even if I think that 90% of people are on the same side), how are we going to live after?Are we going to flee the big cities, as the sociologist Jean Viard thinks?What confidence will we have towards politicians?There will be a real societal work to be carried out, and that seems to me to be an issue of the presidential election that we are talking about.""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
