“Coronavirus climate”, quantified thresholds… In the context of the eighth wave, how to improve adherence to the use of a mask?

It was installed in early September and is winding down. The eighth wave of the Covid-19 epidemic is gaining momentum, with more infections and more hospitalizations. This Thursday, 65,537 new cases were registered, compared to 51,366 a week earlier. And the total number of hospitalized patients, at more than 16,000, is back to its mid-August level.

But if the numbers run, respect for barrier gestures is at the level of daisies. Wearing a mask on transport is strongly recommended but largely avoided. Why ? Is it just because of tiredness? Or is it the result of a lack of pedagogy of the health authorities? Before we get to an obligation, can we improve compliance with this recommendation to slow the spread of the virus? And how ?

A widely ignored recommendation

It is a quantified reality, “given that the use of a mask is no longer mandatory in closed public places”, the proportion of French people who wear a mask in public fell in September to the lowest level since the start of the health crisis. This is demonstrated by the new edition of the CoviPrev survey by Public Health France on the evolution of behavior during the epidemic, published at the end of the week.

The majority of French people say that they no longer use it or use it less often, especially in closed public places (76%, compared to 58% in May), at work (70%, compared to 57%) and in the public transport (61%, compared to 23%). Abandonment is also observed in the presence of the elderly or vulnerable people (58%, against 44%), according to the survey, carried out from September 12 to 19 with a representative sample of 2,000 adults. Even so, according to the survey, some French people would be willing to respect these barrier gestures this winter, if the epidemic was still accelerating. But “due to forgetfulness”, “tiredness” or a feeling of excessive coercion, they could not do it either.

Why this general “forgetting”? “For most people, the coronavirus is considered something benign, and after almost three years of the pandemic, there is also a way of trivializing the virus, we have gotten used to it, although it has caused more than 30,000 deaths since the beginning of the year, observes Antoine Flahault, an epidemiologist and director of the Geneva Institute for Global Health. In addition, the authorities have not based the mandatory use of the mask, nor its removal, on health indicators and specific scientific arguments, he continues. This has not been correlated with the incidence rate or with precise thresholds on the degree of viral circulation, at the risk of having great difficulty in reestablishing it later if necessary. And today we are paying the consequences: people do not see why the masks were removed or why they should be put back on, since this has never been clearly explained to them. »

A “Covid climate” to improve pedagogy and affiliation

So, how to improve the pedagogy and adherence of the general public to the mask? “By explaining the situation simply, clearly and directly, says Dr. Jérôme Marty, general practitioner and president of the French Union for Free Medicine (UFML). In practice, this could take the form of a “Covid weather forecast”, with each day a bulletin, with colors to illustrate the degree of viral circulation, such as the next day’s weather with temperatures and rain. Except there, when the Covid weather turns orange or red, it would mean you have to put your mask back on. »

A proposal acclaimed by Antoine Flahault. “The weather image is very revealing! We understand very well when rain is announced that you have to carry an umbrella. The Covid climate would allow risk to be managed in a more informed and wise way. » A pedagogy that must be complemented with precise indicators. “At some point, it would be time to model these types of measurements in numbers, a scientific basis,” insists Dr. Marty. “It is true that if there were rules that indicate that certain barrier measures are restored from certain thresholds, it would be clearer for the public”, adds Antoine Flahault.

Meanwhile, “we must hammer out the three situations in which we must take the reflex to wear the mask, adds the epidemiologist. When you have symptoms, you put it on, especially because it limits the transmission of all respiratory viruses, as we could not see in the winter of 2021-2021, where strict respect for barrier gestures with the use of a mandatory mask extinguished other epidemics. wintery . Then by public transport, all the time. And when the figures skyrocket, in closed places that receive the public and that are poorly ventilated: meeting rooms, shared offices, classrooms or even conference rooms, due to lack of investment to improve indoor air quality.” And “remember that we wear the mask to protect others, and that if everyone wears it, the others protect us”, emphasizes Dr. Marty.

“A political responsibility”

But while it is hoped to awaken the adhesion of the French, should the mask be made mandatory again? “We are thinking about that, not thinking about that, but calculating what would be the benefits of wearing a mandatory mask compared to wearing a recommended mask,” Professor Brigitte Autran, chair of the Committee for the Anticipation and Monitoring of Health Risks, explained on Thursday ( Covars), the body that succeeded the Scientific Council.

A possibility considered by the government. The Health Ministry “does not prohibit” such a measure, Minister François Braun said on Tuesday, but assured that he “trusts the French” so that they themselves take protective measures.

“Now we are in a situation in which the experts are giving the alert, pointing out that the simple recommendation is not being followed and that perhaps we should move to a more regulatory stage to finally manage to curb hospitalizations, deaths and Covid for a long time. time, observes Antoine Flahault. . But making the use of a mask mandatory is a political responsibility. And with the end last August of the state of health emergency within the framework of which this obligation had been established, the government no longer has a legal instrument to do so, the epidemiologist develops. Certainly, this measure should be presented to Parliament. »

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