Source: ACTU Toulouse Author: Hugues-Olivier Dumez

Philippe Douste-Blazy is the author of a book against the State facing the crisis. In an interview for Actu Toulouse, he reaffirms in passing his support for Didier Raoult.

His word counts in the public debate. The former mayor of Toulouse , between 2001 and 2004,  Philippe Douste-Blazy , was several times Minister of Health (1993-1995 and 2004-2005).

Professor of medicine, he has just published a book “French disease …” where he shoots red balls on the government. A book prefaced by the specialist in infectious diseases, Didier Raoult , the now famous and controversial director of the IHU Méditerranée – of which Philippe Douste-Blazy is an administrator – who advocates the use of hydroxychloroquine in the treatment against the new coronavirus. 

At the origin of an anti-pandemic plan when he was minister, Philippe Douste-Blazy severely criticizes the current management of the health crisis. 

Interview.

“Our country was not ready”

News: To govern is to plan. To read you, our politicians have not been up to the challenges. Was a pandemic like that of Covid-19 predictable?

Philippe Douste-Blazy: In 2004, I proposed to President Chirac a plan against a possible viral pandemic. For millennia, we have known regular epidemics. The last dated back to 1919, with the Spanish flu and more than 50 million deaths. It was obvious, statistically, that a new pandemic was coming. Based on a political idea, which was mine, the French administration was able to establish, in a concrete way, what a plan to fight a viral pandemic could be. Everything was planned. If the virus arrived at such and such a border, that border would be closed. Textile factories were requisitioned to make masks, they were stored. The French administration – which was the first in the world to know what.

Can we speak of fault on the part of the State?

PD – B .: Basically, there are two medicines. The first is curative and individual medicine: there is a patient, there is a doctor. It is a relationship of trust, on the part of the patient. It is a report of conscience, on the part of the doctor. This medicine, whether at the level of liberal doctors or hospital doctors, is of very good quality in France, it must be admitted. Then there is a second medicine, which is preventive, community, collective medicine. This is called public health. This medicine is not sufficiently developed in a country like ours. It is the medicine of epidemiological surveys, population prevention, screening … This is what we have paid dearly. Unlike surgery or anatomy, we don’t we do not sufficiently teach our medical students the issues of prevention, screening and epidemiology. The State, that is to say you like me, are at fault because we do not have this culture, unlike the countries of Northern Europe. We should have, for tomorrow, a true culture of public health.

“This is the first pandemic we are experiencing after the advent of the jet plane”

Should we fear other more contagious epidemics in the future? And what do you recommend?

PD – B .: There was 1919, with significant mortality. We had an influenza epidemic in 1969 which killed 30,000 to 40,000 people in France. At the time, there was no social media. Twenty years from now, ten years from now, perhaps tomorrow, another even more contagious epidemic could spread with a death rate that would strike us down. We therefore have neither the time to breathe nor the luxury of believing ourselves to be sheltered for a long time. However, we are already completely devoid of this small epidemic. Remember that the mortality is 1%. Imagine Ebola with 50% lethality. We must have a national reflection, but also a global one. Nothing is planned at the WHO level. Mankind must organize a highly developed plan. A reflection must be carried out as quickly as possible. VS’ is the first pandemic we experience after the advent of the jet plane. Before, we could quarantine sailors …

You denounce the lack of preparation of the public authorities, in particular the lack of masks during the first wave and the problem of tests. Could the confinement of March, particularly restrictive from the point of view of freedoms, be avoided?

PD – B .: It is obvious that this absence of public health culture, which I mentioned, is the cause of an absence of a strategy for detecting the disease. When faced with an infectious disease, you have three questions to ask yourself. Do we know the germ? The answer is yes, since the Chinese gave us the genetic map of the virus. Is it possible to test? The answer is yes. Is this germ dangerous? We didn’t know how to answer the third question at the beginning, but we did know how to answer the first two. It was decided in this country not to carry out systematic and massive tests, outside of Marseille. Therefore, people stayed at home and infected their loved ones. In addition, it was not possible to treat the patients early enough, so we waited until they were out of breath to take care of it. Unfortunately, at the stage of shortness of breath this means that the disease is already in an advanced stage of lung inflammation. So it was people a few hours away from resuscitation. Finally, it is in the early stages that we must look at the oxygen saturation. It is a disease which, in 66% of cases, results in chest radiological disorders, while people are often asymptomatic. However, when the oxygen saturation drops to 95%, oxygen therapy must be given, otherwise they become short of breath and can go into intensive care. So yes, this lack of massive screenings and testing has been a mistake. If you compare to Germany, a country which has screened massively, there were four times fewer deaths. Knowing that the confinement was much lighter in Germany. At home, people who tested positive were quickly isolated without infecting relatives. Germany did not do hard containment, as it screened massively from the start.

“Otherwise, we will have a third wave”

A re-containment seemed, again this summer, avoidable. How did we get there today? Are we going from confinement to confinement, while waiting for a possible vaccine?

PD – B .: The cornerstone of any epidemic is the isolation of the sick. It is also necessary to know early enough that they are positive. If you wait four days for a test, and then another three days for the result, as was the case between June and early September, then the tests are useless. You have no result. The person got out of the woods, but it infected a lot of people around him. Today we are paying for the lack of a rapid test in July and August. We had 5,000 cases of contamination per day at the beginning of September. And we now have between 50,000 and 100,000. You should know that from 10,000 daily cases, the epidemic becomes uncontrollable. The President of the Republic was therefore right to confine. Now it would be time to be ready so that upon leaving confinement, the French can be systematically tested. And with quick results. At the Assistance publique des Hôpitaux de Marseille, there are PCR results in 20 minutes. There is no reason not to do it elsewhere. When we have tens of millions of tests available to the French, then we can eradicate the disease. Otherwise, we will have a third wave in March and a re-containment. You have to take things head on two or three months in advance and not two or three weeks late. there are PCR results in 20 minutes. There is no reason not to do it elsewhere. When we have tens of millions of tests available to the French, then we can eradicate the disease. Otherwise, we will have a third wave in March and a re-containment. You have to take things head on two or three months in advance and not two or three weeks late. there are PCR results in 20 minutes. There is no reason not to do it elsewhere. When we have tens of millions of tests available to the French, then we can eradicate the disease. Otherwise, we will have a third wave in March and a re-containment. You have to take things head on two or three months in advance and not two or three weeks late.

“The National Medicines Agency must look at these figures”

Didier Raoult, director of the IHU Méditerranée Infection, lodged an appeal with the Council of State to challenge the decision of the Medicines Agency not to widely authorize the prescription of hydroxychloroquine against the coronavirus. Do you continue to support his fight?

PD – B .: There is not a single person in the world who questions the exceptional scientific level – in infectiology, virology, bacteriology, medicine – of Didier Raoult. We know very well today that this disease acts in phases. There is a first phase, purely viral, that we cannot know on condition of systematically screening. Hydroxychloroquine helps reduce the viral load for early cases. Indeed, hydroxychloroquine is useless in the late phases. We know it. There is a dialogue of the deaf here. The strategy must be to screen massively and early, to lower the viral load and look at the oxygen saturation. A study has just come out, a few days ago, which shows that half of the EHPAD, in Marseille, who were treated with hydroxychloroquine and azithromycin, had a 13% mortality. The other half of EHPADs, with the same average age, the same number of men and women and with the same risk factors, did not have the treatment and their mortality is 27%. This study, which covers more than 200 people, was published and is not questioned by anyone. The National Medicines Agency must look at these figures as soon as possible …



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