Source: http://jdmichel.blog.tdg.ch/archive/202 ... 05096.html
" Game over ! for the Covid ": Professor Raoult and chloroquine
By Jean-Dominique Michel, health anthropologist, Wednesday March 18, 2020 10h42
Confining the entire population without detecting and without treating is worthy of dealing with the epidemics of past centuries. The only strategy that makes sense is to screen massively, then confine the positives and / or treat them, just like the risk cases since it is possible, as we see in China and Korea: massive screenings and prescription of chloroquine in treatment.
This was the resounding assertion made on February 26 last by the best infectious disease specialist in the world (according to the expertscape ranking), yet greeted with skepticism and even sarcasm by the scientific community. Three weeks later, reality is proving him right. Revealing in passing that we would have almost everything wrong in the face of the virus. Which is actually great news!
So here we are we are told in a "state of war". Novelty certainly for our generations who (except for the oldest) have known only times of peace. Europe is under a virtual curfew, with a massive restriction of individual freedoms and an economic and social disruption that promises to be dramatic. The speeches of the heads of state ignite to which better: we are "attacked", the enemy is "invisible", "devious", "formidable" but we will come to an end! This kind of vocabulary seems from another age. The reality is more prosaic: we are undergoing large-scale contamination by a virus which is a pure product of the encounter between human stupidity (crowding in cages of wild animals of various species in insanitary markets ...) and the inventiveness of the living. The beast therefore crossed the interspecies barrier and spread from there between humans. This is not a war, we can never defeat or eradicate this creature. We guard against its damage if, then we will have to learn to live with it. Which calls for another intelligence than that of sanitary martial slogans…
Introductory precaution
I have said it again and again: in these times of collective mobilization, we all have to scrupulously respect the measures that are imposed. Even if we doubt them or find them unsuitable, none of us can give ourselves the right to follow our own idea. This compliance - which I have never stopped advocating - inhabits me unconditionally.
On the other hand, this civil obedience must above all not lead to a ban on thinking or speaking.
We live in highly traumatic times, with considerable damage to the population. Giving meaning to what we live, informing ourselves, daring to ask questions is not only an inalienable right but also a vital necessity!
I've read quite a few ironic comments about the sudden number of virologists or amateur epidemiologists speaking on social media, which I can understand. But I think conversely that the more citizens are interested in what is happening to us, the more they will learn or even document themselves, the better it will help us to put into dialogue what we are experiencing, which is essential to the both for our individual mental health and our collective resilience.
It has sometimes been objected to me that I had a responsibility as a scientist, that the analyzes I could make (however relevant they might be) could be misinterpreted or cause people to do anything. I remind you therefore: we all have to follow without discussing the instructions of the authorities. And abstain strictly from any self-medication, in particular with regard to the substances which I will mention later. Used without strict medical supervision, they can indeed be dangerous. That said, let's go!
From where I speak…
I am a health anthropologist and public health expert. My job has consisted for over 30 years of studying healthcare practices and sanitary devices. I arrive at an age when we know (hopefully) that we are not the navel of the world and (with some exceptions) that we did not invent the wire for cutting butter. I have some references in my field, such as being (despite the embarrassing immodesty of this subject) one of the best current knowledge of the processes of salogenesis and recovery as well as the determinants of health. What brought me to be invited to teach in fifteen university programs and universities of health (Faculties of medicine of UNIGE and UNIL, EPFL, IHEID, Universities of Montreal, Friborg, Neuchâtel, etc.) I practiced my profession outside of academic circles, preferring to act within health policies as well as in the field. I have created various innovative socio-health systems, in particular in mental health, some of which still make reference today.
I apologize for this small display. This is the price to pay for taking advantage of (modest) competence as to what I will now advance.
Mundane or not mundane?
Since the beginning of the emergence of the coronavirus, I share my analysis that it is a banal epidemic. The term can shock when there are deaths, and a fortiori in the health crisis and the hallucinatory collective dramaturgy that we live. However, the data are there: the usual respiratory ailments that we experience each year cause 2 deaths worldwide every year.
With the Covid-19, we are in the fourth month of the epidemic, with 7 deaths, which is statistically insignificant.
I have said it before and I will say it again: the same political or journalistic treatment applied to any episode of seasonal flu would terrify us just as much as the current epidemic. As the staging (with live count of the victims) of any major health problem, be it cardiovascular disease, cancer or the effects of air pollution would make us shiver with dread as much and even infinitely more!
We now know that Covid-19 is benign in the absence of pre-existing pathology. The most recent data from Italy confirm that 99% of deceased people suffered from one to three chronic pathologies (hypertension, diabetes, cardiovascular disease, cancers, etc.) with an average age of victims of 79,5 years (median at 80,5) and very few losses below age 65.
There is another problem: the rates of complications and mortality that are brandished under our noses day after day mean nothing. In the absence of systematic screening of the population, we have no reliable data to which to refer the data we have (number of reported cases and deaths).
It is a classic in epidemiology: if you only screen for the dead, you will achieve a 100% mortality rate! If you test only the critical cases, you will have less but much more than in reality. If you screen a lot, you will have a lot of cases while if you screen a little, the number of cases will be small. The current cacophony just does not allow to have the slightest idea of the real progression of the virus and its spread.
The most credible estimates suggest that the number of people declared is very much lower (by a factor of the order of 1/5, / 10 or even according to estimates up to / 40) than the number of people actually infected, about half of whom will not even realize that she has contracted the virus.
For a formidable killer, he is sometimes rather nice…
We therefore have no idea at this stage of the real extent of the spread of the virus. The good news is that the real data (especially in terms of complications and mortality) can only be far less than what is commonly claimed. Real mortality, as announced in a previous article, should in fact be at most 0,3% and probably even less. Or less than a tenth of the first figures put forward by the WHO.
The latest statistics from China put the number of infected (and therefore immune) people at 800 for 000 deaths. Or indeed a mortality rate of 3/118 people infected.
End of the world or not ?!
Similarly, the projections that are made to imagine the number of possible deaths are nothing less than delusional. They are based on an artificial and maximum "forcing" of all the values and coefficients. They are made by people who work in offices, in front of computers and have no idea either of the realities on the ground, or of clinical infectious diseases, leading to absurd fictions. We could leave them the benefit of creativity and science fiction. Unfortunately, these literally psychotic projections do massive damage.
My experience in mental health makes me strictly avoid ready-made expressions such as "schizophrenia" or "psychosis", which are very often very often used abusively and in a derogatory manner for the persons concerned. Medically, psychosis is characterized by cognitive, perceptual and emotional distortions resulting in a loss of contact with reality. Here, the term is unfortunately fully indicated.
I appeal to my colleagues in the Faculty of Medicine and other university institutes to stop producing and peddling false and anxiety-provoking models. These experts protect themselves by recognizing as a precaution of language the outrageous character of their formalizations, the journalists scrupulously mention it (it is to their credit), one does not less diligently build a feeling of end of the world which not only does has absolutely no place to be, but moreover is itself deeply harmful!
We can certainly give credit to our leaders for considering the worst of the worst of the worst on the basis of these fantasies so as not to take the slightest risk of it happening. In the meantime, we are building a collective hallucination on the basis of figures that mean nothing. The reality, again, is that this epidemic is much less problematic and dangerous than what is claimed, the viewing of the first video referenced at the end of the article will give the reader (or the reader) the elements necessary to understand the good- founded on this assertion.
Yes, but all these dead and these engorged services ?!
Unfortunately, this is the real downside: if it weren't for these serious cases, the epidemic would be insignificant. It turns out that it causes rare but frightening complications. As Dr Philippe Cottet wrote to me, on the front line at the HUG: “It must be said, viral pneumonia is usually extremely rare in Switzerland. They have a crude and sometimes fulminant clinical picture, the warning signs of which are difficult to identify when faced with milder cases. It is a real clinical challenge, without counting the number of simultaneous cases ... ”
It is the existence of these serious cases (absurdly estimated at 15% of cases, probably in reality 10 times less) that justifies not simply relying on group immunity. We thus name this process by which each person who contracts the virus and does not die from it is immunized, the multiplication of the immunized leading to a collective effect of immune protection ...
In the absence - until recently - of treatment to protect or cure those at risk, the choice to let immunity build by letting the virus circulate appeared to be too dangerous. The risk for vulnerable people is such that it would be ethically untenable to take this direction, due to the seriousness of the possible consequences.
It is in this complicated paradox between the very great safety of the virus and its extreme dangerousness in certain cases that we are found stuck. We then adopted measures absolutely contrary to good practice: to give up screening for possibly sick people and to confine the population as a whole to stop the spread of the virus. Measures, in fact, medieval and problematic since they only slow down the epidemic at the risk of potentially even worse rebound phenomena. And that they lock up everyone when only a small minority are concerned. Conversely, all public health recommendations are to screen as many cases as possible, and to confine only positive cases until they are no longer contagious.
The general confinement constitutes a pitiful last resort in the face of the epidemic when we lack everything that would make it possible to fight it effectively…
Why did we get there? Simply because we failed to immediately put the right answers in place. The lack of tests and screening measures in particular is emblematic of this sinking: while Korea, Hong-Kong and China made it the top priority, we were implausibly passive in organizing the provision of some technically simple thing.
The countries mentioned have taken advantage of artificial intelligence in particular to identify the possible transmission chains for each positive case (with smartphones, we can for example make an inventory of movements and therefore of contacts that infected people have had with other people within 48 hours of onset of symptoms).
Finally, we have significantly reduced the capacity of our hospitals over the past decade and find ourselves in shortage of intensive care beds and resuscitation equipment. Statistics show that the countries most affected are those that have massively reduced the capacity of intensive care services.
None of this has been thought of, even though the risk of a pandemic is obvious.
The truth is that we have been completely overwhelmed.
It is obviously easier to play on war metaphors than to recognize our tragic lack of preparation…
Game over ?!
The world's leading expert in communicable diseases is Didier Raoult. He is French, looks like a Gaul from Asterix or a ZZ top who would have put his guitar by the road. He heads the Institut Hospitalier Universitaire (IHU) Méditerranée-Infection in Marseille, with more than 800 employees. This institution has the most terrifying collection of bacteria and “killer” viruses in the world and is one of the best centers of competence in infectiology and microbiology in the world. Professor Raoult is also ranked among the top ten French researchers by the journal Nature, both for the number of his publications (more than two thousand) and for the number of citations by other researchers. Since the start of the millennium, he has followed the various viral epidemics that have struck people and established close scientific contacts with his best Chinese colleagues. Among his great deeds, he discovered treatments (notably with chloroquine…) which appear today in all textbooks of infectious diseases in the world.
On February 26, he published a resounding video on an online channel (including the word "tube") to affirm: "Coronavirus, end of game! "
The reason for his enthusiasm? The publication of a Chinese clinical trial on the prescription of chloroquine, showing the suppression of viral carriage in a few days in patients infected with SARS-CoV-2. Studies have already shown the effectiveness of this molecule against the virus in the laboratory (in vitro). The Chinese study confirmed this effectiveness in a group of affected patients (in vivo). Following this study, the prescription of chloroquine was incorporated into the recommendations for the treatment of coronavirus in China and Korea, the two countries which have succeeded in controlling the epidemic…
Chloroquine - with its pharmaceutical derivative hydroxychloroquine - is a molecule placed on the market in 1949, widely used as an antimalarial. All travelers from tropical countries will remember the tablets of nivaquine (one of its trade names) which were prescribed to them as a preventive against malaria. This remedy was then replaced by others for certain geographical areas, remaining in use for certain destinations.
So what?!
Why talk to you about this? Well because Professor Raoult and his teams are the best specialists in the world today in the use of chloroquine. He had in particular the brilliant idea of trying it against intracellular bacteria (which penetrate cells like viruses), in particular Ricksettia.
The Marseille IHU therefore has unparalleled clinical and pharmacological experience in the use of this molecule.
Chloroquine has also demonstrated potent therapeutic efficacy against most coronaviruses, including the dreaded memory loss SARS. Raoult therefore found in the Chinese clinical trial confirmation that chloroquine was also indicated against Covid-19.
However, he was welcomed like a hair on the soup, his colleagues denigrating his proposal straight away. Le Monde newspapers even went so far as to qualify his communication as "fake news", an accusation taken up on the website of the Ministry of Health for a few hours before being withdrawn.
In the aftermath, however, Professor Raoult obtained authorization to conduct a clinical trial on 24 patients in his department and was called upon to be part of the multidisciplinary committee of 11 experts formed in March by the French executive, in order to "clarify the decision. in the management of the health situation linked to the coronavirus ".
The results of the clinical trial were eagerly awaited, first by your servant. We know the caution required in the face of promising substances and the importance of not advancing anything before research confirms or not a hypothesis Science is neither divination nor magic, it is observation, test, then if necessary validation.
The results of his clinical study were released yesterday [Tuesday March 17, 2020], confirming the achievement of spectacular therapeutic effects. The methodology is robust, since the Marseille IHU was able to compare the negation of viral carriage in patients who followed the protocol with patients from Avignon and Nice who did not receive the treatment.
"Those who have not received Plaquenil [a drug based on hydroxychloroquine] are still 90% carriers of the virus after six days, while 25% are positive for those who received treatment" , explains Professor Raoult.
But it does not stop there: the IHU Méditerrannée-Infection has advised (like others) for a long time to give concomitantly an antibiotic in viral respiratory infections "because they are mainly complicated by pneumopathies. So all the people who had clinical signs that could progress to a bacterial complication of pneumonia, they were given Azithromycin. It has been shown to lower the risk in people with viral infections. The other reason is that Azithromycin has been shown in the laboratory to be effective against a large number of viruses, although it is an antibiotic. So even choosing an antibiotic, we preferred to take an antibiotic effective against viruses. And when we compare the percentage of positives with the hydroxychloroquine and Azithromycin combination, we have an absolutely spectacular decrease in the number of positives. "He adds.
Viral porting?
A study published in the journal Lancet on March 11 had meanwhile revealed a new but essential data: the time of viral carriage (duration between the beginning and the end of the infection - and therefore of possible contagiousness) turns out to be greater than what it was believed, with an average duration of 20 days.
With the hydroxychloroquine / azithromycin combination, this duration of viral sharing is reduced to 4-6 days.
The drastic reduction in viral delivery time not only gives hope of treating critical cases, but also of reducing the time it takes for an infected person to stop being contagious. And therefore presents enormous prospects for preventing the spread of the virus. This news is of course the best news we could have expected. The authorities and the scientists therefore welcomed it with joy will you think ...
Well nay! The reactions that have been heard first disputed stupidity with wickedness.
Certainly, neither the Chinese studies, nor the Marseille clinical trial has the value of evidence ("evidence") according to the criteria of scientific research. Replication of the results by other teams is required, not to mention a randomized double-blind study, the top of the pop research methodologies.
But the devil! we are in an emergency. Chloroquine is one of the best known and best controlled drugs (in particular by the Marseille IHU). We can therefore count on a very solid experience relating to the subject of his prescription. Taking refuge behind a procedural fundamentalism is ethically indefensible when we speak of a drug that we know by heart, which has already demonstrated its effectiveness on other coronaviruses, confirmed on it by two clinical trials, and then that lives are at stake day after day!
Raoult noted with irony that it was not impossible that the discovery of a new therapeutic utility for a drug that had long been in the public domain would be disappointing for all those hoping for a Nobel Prize thanks to the shocking discovery of a new molecule or vaccine… without forgetting the prospect of tens of billions of dollars in revenue to be taken, where chloroquine literally costs nothing.
Celebration of caregivers!
For the past few days, the confined population has been speaking every day to pay tribute to caregivers and support them in the trying circumstances they are going through. It is a beautiful expression of solidarity, obviously deserved by remarkable professionals of selflessness and commitment, at the front of this heavy suffering and this new danger.
In the circles of the luminaries, things are unfortunately less brilliant.
Medical research and authority are also often made up of pettiness, manipulation, dishonesty or abuse of all kinds, as well as pitiful but violent battles of ego.
On BFM TV, Dr. Alain Durcadonnet immediately broke sugar on Raoult's back, recalling that a scientific conclusion was published in scientific journals and not by video… This, then, that in his communication, Prof. Raoult (the researcher French (who, it should be recalled, has published the most in scientific journals in its field) obviously had just specified that the article describing his clinical trial had been sent for publication to a peer-reviewed journal. This anecdote showing the level, like the following.
On March 1, well after the publication of the first Chinese clinical trial, the director general of Assistance Publique - Hôpitaux de Paris, Prof. Martin Hirsch, said to the microphone of Europe 1: "Chloroquine works very well in a test tube. , but never worked in a living being ", which was already perfectly false!
In the returns of the national press, the emphasis is placed heavily on the risk of overdose with chloroquine, effectively toxic beyond 2 gr / day in the absence of somatic comorbidity. The Chinese favored doses of 2x 500 mg / day during their test. Raoult and his team, finding this dosage excessive, preferring to opt for 600mg / day. The objection is therefore appallingly vacuous - it should be recalled that no clinical team knows this molecule better than that of Méditerranée-Infection. It would be like saying about Dafalgan: "Wow, beware, it can be toxic if misused, so it's not a good idea to consider treating headaches with this drug!" "
We invoked (yes, if, read the press!) The risks associated with prolonged use, where the proposed treatment lasts an average of 6 days. The IHU also has the experience of exceptional long-term prescriptions (up to two years!) For the treatment of certain intracellular bacteria. No matter how well you know it is good to be charitable with your neighbor, sometimes stupidity combined with dishonesty makes it difficult ...
Others insisted (and still insist) that definitive conclusions cannot be drawn from clinical trials. Which is absolutely right in absolute terms, but does not apply well to the present case, given the perfect knowledge of this molecule! An absurd situation summed up as follows by Raoult: “There is a health emergency and we know how to cure the disease with a medicine that we know perfectly well. You have to know where the priorities are. "
Faced with the reality of the epidemic, Professor Raoult recommends to stop panicking and to detect patients without waiting for their case to get worse to better treat them.
The problem goes further…
The loneliness of extreme skill ?! Raoult explains how Emmanuel Macron came to get him after his first public announcement on February 26 and the strange experience that has been since his in the circle of experts who advise the martial president. To the question asked by a journalist from Marianne: “Are you heard? », He replies:« I say what I think about it, but it is not translated into action. They are called scientific advice, but they are political. I'm like an alien there. "
It is his certainty, obviously uncomfortable for the authorities: with the measures currently taken against the epidemic, we are walking on our heads. Our countries have given up (unlike the Chinese and the Koreans) systematic screening in favor of confinement which Professor Raoult emphasizes that it has never been an effective response against epidemics. It is an ancestral reflex of confinement (as in the days of cholera and the Hussar on the roof of Giono). To confine people who are not carriers of the virus to their homes is infectiologically absurd - the only effect of such a measure is to destroy the economy and social life. A bit like bombing a city to keep away mosquitoes carrying malaria…
The only way that makes sense according to him is to confine the carriers of the virus only, and to treat them if necessary either to avoid terrible complications like those which we see, or to reduce the time during which they are contagious.
In Switzerland as in France (and everywhere in the West), the decision taken is to confine people to their homes, sick or not. When they are sick, we wait until they get better then (because of the duration of viral carriage), we let them stand out while they are in fact still contagious! People at risk sometimes develop complications, in particular acute respiratory distress which leads them to emergencies. They then clog up the intensive care services, and, for some patients, die there while Raoult claims, we could have treated them before!
Confining the entire population without detecting and without treating is worthy of dealing with the epidemics of past centuries.
The only strategy that makes sense is to massively screen, then confine the positives and / or treat them, just like the risk cases since it is possible, as we see in China and Korea, which have integrated the association of massive screenings with the prescription of chloroquine in their treatment guidelines.
Neither Hong Kong nor Korea, two territories that experienced the lowest mortality rates from Covid-19, imposed confinement on healthy people. They just organized themselves differently.
The decline of the West
It is unfortunately glaring and revealed here in all its rawness ... We have a quality medicine, but a medieval public health. Technological and scientific leadership has gone to the Far East for a long time now, and our intellectual navel-gazing often makes us cling to the lanterns of the past rather than to the science of today.
Systematic testing would be easy to establish, as long as it is a health priority and organized, which the Koreans have done in record time. In Europe, we have been completely overwhelmed, as if we were living in another time. The authorities now understand that this is a top priority - following in this direction the insistent WHO recommendations.
Producing the tests presents no difficulty:
"It is trivial PCR [polymerase chain reaction] that everyone can do, the question is the organization, not the technique, it is not the diagnostic capacity, we have it, Raoult comments. It is a strategic choice which is not that of most technological countries, in particular the Koreans who are part, with the Chinese, of those who have mastered the epidemic by screening and treatment. We are capable in this country like anywhere else of doing thousands of tests and testing everyone. "
Certainly, more disciplined or even authoritarian political regimes have an advantage of social compliance, but the question is not there. The problem is us. France sinks into endless polemics before anyone has even opened their mouth, while their Jupiterian president flies away in ancient perorations on the "state of war" while contemplating herself in a mirror ... In our country, the Federal Council reacted without agitation or malice, but giving as always the impression that it woke up unpleasantly from its nap.
In short, for our country which prides itself on its quality of innovation and biotech, it's still a bit of a celebration in the village…
The change is now ?!
Fortunately, we can hope that the wind changes quickly and well. The French Ministry of Health has just mandated the Lille University Hospital for a trial aimed at replicating the results obtained in Marseille. Let us recall that convincing tests have already been carried out in China and Korea - but in France we generally hold that what comes from abroad is unworthy of French genius. Some hospital departments and their chief physicians are able to see that they were wrong, for example, the case of Pr Alexandre Bleibtreu of the Pitié-Salpêtrière Hospital, who recently tweeted with humor:
balbus
Interest in chloroquine is now global with teams working around the world. If the very likely efficacy of the drug is confirmed today, it will be a major game-changer.
Once people at risk of complications are treated promptly, the innumerable benign infections due to SARS-CoV-2, which many of us will experience, will provide the mass immunity that will swallow this “pandemic” to the rank of a dirty mishap.
Mass screening is now finally a health priority. The time to organize the laboratory analysis capacity, we will all be gradually entitled to it. The Sanofi laboratory has also just proposed to the French government to produce one million doses of chloroquine free of charge.
What if the molecule did not keep its promises? This is of course a possible hypothesis, even if it is at this stage unlikely. Other drugs are currently under review, including known antivirals (such as Favipiravir) tested in China also with first encouraging clinical results. According to new news this morning:
"China has completed clinical research on favipiravir, an antiviral drug with good clinical efficacy against the novel coronavirus (COVID-19).
Favipiravir, an influenza drug approved for clinical use in Japan in 2014, did not cause any obvious adverse reactions in the clinical trial, said Zhang Xinmin, director of the National Center for Biotechnology Development in China reporting to the Ministry of Science and Technology at a press conference.
Favipiravir has been recommended to medical treatment teams and should be included as soon as possible in the diagnosis and treatment plan for COVID-19, he said. "
What is striking about chloroquine is the religiosity of the debate that this option provokes - a classic however in science. Raoult is described as a kind of guru (despite his remarkable scientific service) and we describe the "belief" in this drug as being the expectation of a "miracle cure" which would mislead people by holding up "hopes" impossible ”.
Fortunately, there remains an approach which is called science and which aims precisely to move from the register of opinions (everyone sees the world in their own way) to knowledge (what we have experienced, verified and validated independently of personal opinions) .
If the results obtained in Marseilles and China are denied, then the collective nightmare in which we are involved will continue, with very heavy consequences on our society, our lives, our physical and mental health. If, on the other hand, they are confirmed, we will have taken a giant step to get out of this heavy swelling, and it will then indeed be “Endgame! for the Covid ". We will have learned a lot in passing.
Tribute to the authorities
It is not my habit to be complacent with the authorities. Too often I have seen the ravages of flattery and shamelessness (like gratuitous criticism or a trial of intent) to fall into the trap. Here we hear a lot of criticism that seems unfair to me. Yes, our health system is not really one, we have an illness industry - which is not the same. Yes, our sanitary responses are incredibly dusty and even outdated. Yes, the Federal Council has lead shoes - this also sometimes has its advantages.
But I want to say my feeling that the reaction of the federal and cantonal authorities was proportionate to what we knew and did not know. It is easy to say that the borders should have been closed a month ago in a world where the threat was still hardly visible and where we would have been the only ones to do so.
Closing everything inevitably leads to economic and social disaster. In the absence of the means to apply the best strategy (screening - confinement - treatment), resorting to a "lock-down" is an archaic and ineffective measure, but the only one that could be taken.
In Geneva in particular, the Council of State (with Messrs. Mauro Poggia and Antonio Hodgers on the front line) was solid, human, reassuring, and clear, acting with calm and an undeniable sense of proportionality.
Finally, one last piece of information, which I hope will encourage us all to be cautious: the latest infectious data would tend to confirm that children are only very few carriers and / or contaminators of SARS-CoV-2. If this hypothesis is confirmed, the closure of the schools would in fact not be necessary. The data I am relaying here fell this week. At the time when the closure was decided, they were ignored - as I specified in my previous blog - it was therefore a precautionary measure, in this case unnecessary. We must also see if they are soon corroborated, contradicted or contrasted by other data.
So let's be patient and diligent. Once this collective hallucination has passed, it will be time to make a rigorous "post-mortem" of health decisions and to seek to understand what happened so that this incredible societal waste is generated ...
Jean Dominique Michel
