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Confinement, Deconfinement, Reconfinement: Back to Square One?

Three Questions to Nicolas Bauquet

 Confinement, Deconfinement, Reconfinement: Back to Square One?
 Nicolas Bauquet
Public Transformation expert

Research Director at Institut Montaigne, Nicolas Bauquet has been keeping a close eye on the French government’s management of the Covid-19 crisis. At a time when the French people and the public authorities fear a second wave, and even a new lockdown, Nicolas Bauquet evaluates how government action has evolved (or not) since the first measures. 

While the weeks following the deconfinement in France were marked by a sharp decline in the pandemic, debate rages about the danger of a second wave in certain regions of the country. Do we now have sufficient accurate data to understand and respond to a resurgence of the pandemic, and would we be able to build a more effective communication system? 

What has changed compared to the first period of the crisis is precisely the quality of the data we have to monitor the evolution of the virus. In May 2020, the Ministry of Health created SI-DEP, a secure platform which records the Covid-19 test results of all laboratories and hospitals. It is an extremely valuable tool which makes it possible to trace back the chains of contamination, and to follow the circulation of Covid-19 as closely as possible

New available data is also beginning to give a clearer picture of how the virus strikes differently according to one’s social context. However, we still lack an accurate assessment of how the virus affected the population during the first phase of the pandemic. To this end a large-scale epidemiological statistical study, coined EpiCOV, was launched. It aims to map the immunity status of the population, while analyzing its health, living conditions and social inequalities. This tool should provide valuable data that will be very useful to the modelling of the epidemic, but the first results are not available as of yet.

It is vital to share as much information as possible with the public, considering that the public has "the Right to Know".

What remains problematic is the interpretation of this data and the communication surrounding it. Who should we be listening to? Who can we trust? Communication done within regions, rather than at the national level, certainly needs to be improved. Better coordination of press conferences between regional administrations and the Regional Health Agency would allow for more clarity of communication. It is vital to share as much information as possible with the public, considering that, with certain exceptions, and in compliance with medical confidentiality, the public has "the Right to Know".

At the national level, it must be noted that messages continue to be spread in a scattered manner. All categories of leaders and representatives have been expressing themselves on national media, starting from President Macron on July 14, and the new Prime Minister Jean Castex, in his general policy speech on July 15, to the Minister of Health and the Director General of Health. On the medical side, the Scientific Council seems to have stepped back, but its president, Jean-François Delfraissy, continues to speak in the press and on television. As such, it is not clear whether his words have any institutional value or whether he is acting as a whistle-blower. 

This lack of clarity fuels uncertainty and concern and could prove very problematic in the event of a strong resurgence of the epidemic. A new crisis situation would probably be easier to manage if communication was clearly channeled through two main sources: a single political issuer, and an independent but clearly mandated scientific issuer. The latter would be the equivalent of a "Chief Medical Officer", who would have no administrative responsibility but would be the reference point for reliable information for the public, as well as political leaders. 

How prepared is the health system for the pandemic at this moment? 

Many essential measures have been implemented and the system is prepared to act, whether through the ability to test, to track the chains of contamination or to increase hospital capacity. However, there is still a great deal of uncertainty as to whether the system will be able to react quickly enough, or whether it will manage to increase its capacity or to identify the weaknesses in its response. This is the case, for example, with the issue of tests. Many warning signals are coming up about the saturation of certain test centres and the length of time it takes to obtain results, as has echoed Professor Delfraissy. As much as the coordination of the system is crucial, it is the transparency of the information on the performance of the health control instruments that will make it possible to inform, reassure and mobilize all the players in the fight against the pandemic. 

Another crucial point on which an informed and transparent debate is essential, is that of the control and monitoring systems implemented at airports. The pandemic is more global than ever and the question of border controls is essential. At this stage, neither the possible legal framework nor the measures actually put in place have been communicated clearly, and the public authorities do not seem to have a clear strategy. Between warning signals launched in the media and on social networks, and official communications intended to reassure, there is not yet a coherent mechanism for information and debate for both decision-makers and citizens. 

Is the decision to make masks obligatory in public places a turning point in the management of the pandemic? 

Yes, this decision appears to be a turning point. That is not so much due to the masks themselves, but more so due to how new actors have imposed themselves in the debate, from the medical world, to the civil society and social media. 

During the first months of the pandemic, regional practitioners developed a strong audience on social media. But the debates that developed there, identifying the essential issues often very early on, had little communication with the Ministry of Health or the Scientific Council, which mostly focused on the Parisian medical environment. Thus, without any institutional or academic legitimacy, several general practitioners, such as Dr. Yvon Le Flohic, in Ploufragan of northwestern France, have become reference figures. For several months, the "Stop Postillons" collective (essentially meaning "stop spit droplets") tried to mobilize citizens into wearing masks, notably with the hashtag #jamaissansmonmasque (#neverwithoutmymask). Another individual initiative was the translation of Christian Drosten's podcasts by Twitter user @Hergeloffeni, making the popular Berlin professor's analyses accessible.

It is very interesting to note the irruption of civil society in health debates, and its ability to influence certain public decisions by bypassing bureaucratic locks and corporatist silos.

In the first half of July, three factors combined to make these efforts more visible: the first signs of a return of the virus, the advance of scientific knowledge on aerosol transmission, and the indignation caused by the lack of respect for the barrier measures during the night of the municipal elections on June 28, and during the handover ceremonies between ministers following the government reshuffle on July 6. The idea of a petition calling for the mandatory wearing of masks in public places was floated by Dr. Le Flohic on Twitter on July 10, and the text was published two days later in the daily newspaper Libération. It very quickly managed to collect tens of thousands of signatures and to rally several institutional figures. Such were the President of the National Council of the Order of Physicians, Patrick Bouet, or Jean-Laurent Casanova, a member of the Scientific Council. On July 14, President Macron announced the obligatory wearing of masks in enclosed public spaces, which would go into effect on August 1. However, the public called for an immediate application of the rule, with a petition that exceeded 70,000 signatures. The measure was finally officially implemented on July 20.

It is very interesting to note the irruption of civil society in health debates, and its ability to influence certain public decisions by bypassing bureaucratic locks and corporatist silos. It is now up to politicians to find the ways and means to establish a dialogue with citizens, without appearing to simply give in to the injunctions of social media. Other debates today deserve to be held in dialogue with the civil society, be it on saliva tests, pooling techniques for mass testing, or methods of control at airports. This could be one of the responsibilities entrusted to a Chief Medical Officer who is clearly distinct from the political and administrative hierarchy. This person should know how to reach a wide range of audiences throughout the country and beyond, and to clearly and transparently communicate on the development of the pandemic and the preparedness of our healthcare system. 


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