Covid-19, flu, bronchiolitis… Will we have to put the mask back on to avoid a triple epidemic this winter?

Three epidemics for the price of one? After nearly three years of Covid-19 and a slew of variants and sub-variants coming out of the hat, the coronavirus still occupies the ground, at the heart of a long eighth wave that started at the start of the school year.

But if the Covid-19 remains in ambush, ready to contaminate and recontaminate the crowds, this winter could also be accompanied by a festival of other viral diseases with, in sight, a triple simultaneous epidemic of Covid-19, flu and bronchiolitis. To avoid it, will we all have to put the mask back on in closed public places?

Triple outbreaks abroad

When the winter virus season has not yet started, it is possible to count on the most probable scenarios by observing upstream how epidemics circulate – or not – among our neighbors, near and far. At the end of 2020, in full reconfinement, the Covid-19 circulates at full capacity, but the barrier gestures put the traditional winter epidemics – flu, bronchiolitis and gastro – on mute. An unprecedented scenario but observed a few months earlier, in the summer of 2020, at the other end of the globe, during the austral winter. “There should have been epidemics of influenza virus in the southern hemisphere, except that there were none, indicated then to 20 minutes Vincent Enouf, virologist and deputy director of the National Reference Center (CNR) for respiratory infection viruses at the Institut Pasteur. Ditto for other diseases such as respiratory syncytial virus (RSV), responsible for bronchiolitis in toddlers. There were none either” that summer.

But in 2022, the situation has changed, and several countries are facing a triple epidemic. First Australia which, still against the backdrop of the circulation of Covid-19, experienced a severe epidemic of seasonal flu, during which “we observed a high number of children hospitalized” for RSV, indicates to the Telegram Dr Conall Watson, epidemiologist at the UK Health Security Agency. This is now the case in the United States. The country, which still registers more than 270,000 new cases of coronavirus per week, is faced with the trio Covid-19, influenza, bronchiolitis. And sees its hospital services saturated by this phenomenon. “We are seeing the highest rate of flu-related hospitalizations in a decade,” said José Romero, from the National Center for Immunization and Respiratory Diseases, across the Atlantic.

And the health threat is getting closer. In the UK, for example, cases of bronchiolitis have risen sharply in the past two weeks, and “we are seeing the flu spread across all age groups,” added Dr Watson.

The beginnings of a triple epidemic in France

A scenario that is already looming in France. If the current wave of Covid -19 has shown signs of calm since the end of October, with a decline in contamination and hospitalizations, its circulation is “still very active”, recalls Public Health France, encouraging people at risk – the most 60 years in particular – to do their vaccination reminder.

“The incidence rate of cases of acute respiratory infection (ARI) seen in general medicine consultations was estimated at 225 cases per 100,000 inhabitants, observes the Sentinelles network in its latest respiratory virus surveillance bulletin. An increase in the rate compared to the previous week”, of the order of 10%.

For the time being, only “the detection of sporadic cases of influenza has been confirmed”, reassures Public Health France, but “the bronchiolitis epidemic has now spread to all metropolitan areas”. The health agency notes “very high emergency room visits and hospitalizations for bronchiolitis, at levels higher than those observed at the epidemic peaks of the three previous seasons, and already equivalent to those of the peak of the 2018-2019 season”.

Wearing a “recommended” mask

For the Academy of Medicine, between “the prospect of an early seasonal flu epidemic [qui] is becoming clearer in mainland France”, “bronchiolitis in children under 2 years of age has passed into an epidemic phase throughout the territory”, and the risk of “co-infection, exposing vulnerable people to the most severe forms and the services hospitals at risk of saturation”, there is an urgent need to resume good habits. “When we see the ease with which barrier gestures have been abandoned, the risk of co-circulation of these respiratory viruses is very serious”, added Dr Luc Duquesnel, general practitioner and president of the Les Généralistes-CSMF union. The health situation “justifies a rehabilitation of barrier measures, abandoned since the end of the state of health emergency on July 31, adds the Academy of Medicine. Although the health situation does not currently require a return to mandatory measures, it recommends wearing a mask “in closed public places.

In detail, it prescribes “the wearing of an FFP2 type mask in enclosed public spaces for the elderly or carriers of comorbidities, their entourage and health professionals who are in contact with vulnerable people. But also for pregnant women, even when they are up to date with their vaccinations. And she advises “wearing a surgical-type mask in hospitals, dispensaries, health centers and pharmacies, as well as in closed spaces open to the public, such as public transport”.

For the time being, this is a simple recommendation, since since the end of the state of health emergency on August 1, the government can no longer make the wearing of a mask compulsory again. Except to submit the measure to the vote of Parliament.