As the pandemic accelerates in France, Prime Minister Jean Castex wants to pursue a regionalized approach. “Most of the measures should not be decided by Paris,” he said on Friday, leaving it to the prefects, in the 42 departments classified as red, to introduce further measures. A completely different strategy, therefore, like the one adopted before prison, and deciphered by Jan-Cédric Hansen, physician, member of the French Society of Disaster Medicine.
During his speech on 11 September, the Prime Minister drew a worrying observation of the development of the health crisis with an “obvious deterioration” of the situation due to an increasing number of infections and hospital stays. However, Jean Castex did not introduce new national measures.
With 42 departments in the red zone, the government instead relies on the autonomy of the regional authorities to handle the second wave of Covid-19, a completely different strategy than the one that in March 2020 led to generalized containment.
For 1your Minister, it is now up to “health authorities and local elected officials to initiate further risk reduction measures, in particular with regard to masking, gatherings in public spaces, major events or opening hours for certain shops”.
Jan-Cédric Hansen, MD, member of the French Society of Disaster Medicine, believes this approach is necessary and can help bridge “a link between actions [nationales, NDLR]and the reality on the ground. “Explanations.
France 24:Can we talk about a change in the government’s attitude to more localized administration?
Jan-Cédric Hansen:So far, the state’s crisis management has been very vertical and today we feel a desire to address the problems locally. We can see that the government’s priority is to continue to move the country forward by protecting its citizens, but by accepting that there is a risk for the weakest. There is, of course, the economic aspect which is essential, but which cannot be the only barometer of political decision-making, under penalty of disaster, as we have noted in the United States.
Finally, in parallel, there has been an awareness of the harmful effects of inclusion which, although the most effective method of combating the virus, has a major impact on the lives of citizens, regardless of social ties. or even the fitness track. In nursing homes, some of the consequences of confinement die, it is a serious subject that must be taken into account.
Can regions better assess and manage the health crisis?
We must distinguish between two very distinct aspects. The health strategy must be national, it is decided by the government and transferred to local authorities across the country. However, the application must be made in consultation with professionals in the field. Until now, the approach was very homogeneous, the regional health services left the instructions and there was sometimes little room for discussion. I witnessed this situation where ARS asked an Ehpad to test all residents in one day and then isolate the positive cases. There were two hundred inhabitants for whom it was necessary to explain the significance of the process, as well as to their relatives and the consequences for the future; some would need to be moved, but the room is a place for life in a nursing home, unlike the hospital room. In the end, despite the pressure from ARS, the process took a week, it is a good example of the disconnection that exists between the measures and the reality on the ground. The desire to give more decision-making power to the regions is going in the right direction, even if the scale in my opinion is still too large, the head of department must be able to make strong, highly localized decisions, according to the epidemiological analysis of viral circulation.
More than 700 “clusters” are currently under investigation in the territory, according to health authorities. The government has not announced localized locks, but does not rule out this possibility. Do you think they will be necessary?
As I said before, I believe that containment is the best treatment for the spread of the epidemic. But you still have to use it wisely, because if you have 10% of the population infected and you limit 100% of the people, you are introducing 90% of the population an unnecessary measure.
Localized containment makes it possible to isolate highly targeted areas where the virus circulates a lot, to quickly identify carriers and to take action. We have access to very accurate population flow studies in France. Instead of testing everyone, we need to identify the most vulnerable people, that is, those who move the most and test them as a priority.
For a long time, the government did not want to consider the option of local containment, there was a big delay at this level, but I think it will be necessary. This method is essential, but it should be understood that it represents very complicated and different logistical challenges. For example, if we identify a company as a cluster, should we prevent employees from returning home? Politicians must distinguish between respect for individual freedoms and the need to limit the epidemic. The question of maintaining basic services will also arise, because if a drinking water treatment plant is identified as a source of infection, it is not possible to close it. All of these questions cannot answer national guidelines and must be understood through case – by – case consultation.