“I am very embarrassed that a vaccination booster is required as an obligation, both in form and in substance”

FIGAROVOX / MAINTENANCE – Emmanuel Macron announced that the health pass for over 65s will be conditioned on a third dose of vaccine. Gérald Kierzek, emergency doctor and health columnist, expresses his perplexity.

Gérald Kierzek is an emergency physician and health columnist, medical director of Doctissimo, and author in particular of Coronavirus, how to protect yourself? (Éditions de l’Archipel, March 2020).


FIGAROVOX. – Emmanuel Macron announced that the health pass for over 65s will be conditioned on a third dose of vaccine. Then, at the beginning of December for 50-64 year olds. Do you agree with this decision?

Gérald KIERZEK. – Targeting those over 65 is a good thing since they are the most at risk of severe forms. But above all, we must go and find the unvaccinated in this category, which is about 10% of our fellow citizens, rather than imposing a booster of which we do not know the real need.

Since the start of the epidemic, more than 90% of patients hospitalized in intensive care were over 65 years old so it seems legitimate to protect them as a priority, as well as the age group slightly below 50-64 years and people obese. Very early on, it was shown that more than 47% of infected patients entering intensive care are in a situation of obesity and the severe form (namely a BMI greater than 35) with a significant increase in the risk of being placed under invasive mechanical breathing ( intubation), regardless of age, high blood pressure and diabetes. The priority must therefore be to vaccinate them with a first complete regimen.

I am very embarrassed that a vaccination booster is required as an obligation, both in form and in substance. In terms of form, deactivating the health pass for people over 65 who do not have a vaccination booster is violent and is like an obligation. Consent is a fundamental patient right. This prolongs de facto the health pass which was to be initially stopped on November 15 and proportionate to the epidemic situation according to the initial decision of the Constitutional Council whereas this pass does not in any way limit the contaminations and has already fulfilled its role, push for mass vaccination this summer.

I am very embarrassed that a vaccination booster is required as an obligation, both in form and in substance.

Gérald Kierzek

Given the vaccine success, it would therefore be legitimate to no longer use it and I can only regret that the President, probably under pressure from the alarmist and hygienist current of the Scientific Council, is prolonging it.

Subsequently, the need for a vaccination booster can be discussed. Indeed, it is based on serology studies showing that those over 65 see their antibody level drop. But immunity is much more complex than just measuring antibodies! When the antibodies drop, cellular immunity is there to also ensure the immune defenses and we are medically incapable, in daily routine, of knowing the duration of vaccine protection. Natural immunity is also a strong immunity, stronger than that granted by the vaccine as shown by many studies, in particular because it allows the development of mucosal immunity (IgA antibody) at the ENT level alone capable of stopping the viral circulation. The vaccine does not prevent contamination because it does not confer this mucosal immunity; it protects against severe forms.

It would therefore surely be desirable to let the virus circulate in the less fragile (no risk of serious forms and strong natural immunity) as well as in the vaccinated without a booster. We could even say that the rebound of contaminations makes it possible to consider stopping the viral circulation and putting an end to the epidemic! But for that, you have to get out of “panic mode” in front of the positive test curves!

It is imperative not to sink into a politically and medically dangerous hygienist madness. Here again, we must not give in to the panic of the numbers.

Gérald Kierzek

While the number of infected is increasing again, should we strengthen the barrier gestures as the president said?

Basic barrier gestures yes, restrictive measures no! Let me explain. Barrier gestures such as regular hand washing or hydro-alcoholic solutions when hand washing is impossible is reasonable to fight against all viruses (Sars-Cov-2, influenza, gastroenteritis and others). Likewise, ventilation of premises, private and public, is fundamental. On the other hand, wearing a mask for children or even outdoors does not make sense. Long-term, sustainable barrier measures are needed to live with this virus and limit other viruses. We cannot socially, psychologically and even immunity live in a bell.

The psychological consequences of wearing a mask in children are real and terrible, including in the long term, while its effectiveness as a barrier gesture more than hypothetical. Too much hygiene kills hygiene on the immune level. We are currently seeing this with the resurgence of bronchiolitis in children born during confinement measures. Their immune system has not been confronted with the classic viruses linked to life in society (nurseries, etc.) and is weakened.

It is imperative not to sink into a politically and medically dangerous hygienist madness. Here again, we must not give in to the panic of the numbers.

Contamination will increase inexorably but do not constitute a wave in the sense of hospital saturation. In 2020, we witnessed waves of resuscitation saturation in two regions mainly (Grand-Est and Ile de France); Strictly speaking, we can no longer speak of a third, fourth or fifth “wave” since it is now a wave of positive tests without hospital repercussions.

The current hospital crisis, and I was going to say even that of 2020 supposedly linked to COVID, is structural and linked to the lack of beds and now of staff. COVID patients represented only 2% of all hospitalized patients during the year 2020 according to the report of the Technical Agency for Information on Hospitalization, which collects and analyzes all hospital data! Far from the collective fantasy of a hospital full of COVID patients with people who cannot be taken care of and “sorted” to enter the hospital.

And yet the hospital almost did not hold and I would even say no longer holds in view of the leaks of personnel and the lack of territorial remeshing with local hospitals. Every day in France, the Sanitary Reserve of Public Health France, dedicated to exceptional health situations, now calls on volunteers (doctors, caregivers, laboratory technicians, radio manipulators) to ensure the activity of bloodless and passing hospitals. rob Peter to pay Paul.

I can only salute the President’s “Let’s not be afraid, believe in ourselves”, who does not give in to dishonest alarmism.

Gérald Kierzek

Is the arrival of drug treatments good news?

Yes, although miracle drugs should not be expected. The molecules in the running are molnupiravir from the MSD Merck laboratory for which the British Medicines Agency (MHRA) has just given the first regulatory authorization for the treatment of mild to moderate forms of Covid-19 in adults. Phase III results show that this oral antiviral, originally designed for influenza, reduced the risk of hospitalization or death by approximately 50% compared to placebo, for mild to moderate forms of Covid-19. The other molecule is Pfizer’s Paxlovid, developed against SARS, which appears to be effective in preventing severe forms of Covid-19 in people at high risk by blocking an enzyme that the coronavirus needs to reproduce. Fluvoxamine, an antidepressant, also shows promise and could be used.

In all cases, these drugs are drugs in addition to the vaccination strategy and the classic and early management of patients at risk in particular. The fundamental difference between March 2020 and November 2021, in addition to vaccination, is that we now know how to identify and treat patients at risk: rapid CT scan to see the pulmonary damage or not, monitoring and / or outpatient or hospital treatment (oxygen, cortisone , anticoagulants, antibiotics, etc.). This support avoids resuscitation. It is also necessary to have the human and logistical resources to do it for everyone and everywhere.

I can only greet the “Don’t be afraid, believe in ourselves»Of the President of the Republic, who does not give in to dishonest alarmism. I would now like the probable future candidate for re-election, and the other candidates, to finally understand that COVID is only an indicator and the symptom of a deep crisis in the health system that must be urgently reformed under pain never to get out of this crisis.

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