"The French healthcare system is capable of fairly extraordinary plasticity"

Romain Pirracchio has been head of the anesthesia-resuscitation department at Zuckerberg General Hospital in San Francisco since September 2018. He previously exercised the same functions in Paris, at the Georges-Pompidou hospital. He is also a professor in the Faculty of Medicine at the University of California at San Francisco (UCSF), where research on the Covid-19 began.

In mid-March, New York and San Francisco had the same number of Covid-19 cases. At 1er April the death toll since the start of the epidemic is 1,941 in New York and 67 in San Francisco Bay. Why such a difference ? Did the Californian metropolis succeed in "flattening the curve"?

Flatten, I don't know, but the curve is relatively less steep than it is in other places, including Los Angeles or New York. In San Francisco, we clearly have an increase in the number of cases, but much slower. Undeniably, the movement limitation and social distancing decrees (taken by the town hall on March 16) played an important role.

In New York, the population density is much greater and, above all, the public transportation network is much more developed. There are many more direct contacts between people. In the San Francisco Bay area, people use the private car more. There was also great support from the population. Most employers quickly set up work at home arrangements. Overnight, we saw the difference in the streets. It is true that in Silicon Valley, working from home is much easier to organize.

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Have the screening problems that appeared at the start of the epidemic in the United States been resolved?

This is still a limiting factor. Our testing capacities remain lower than those of other countries, to Germany, France probably. At first, the process was centralized at the CDC (American Center for Disease Control and Prevention). The tests had to be sent to Atlanta, to be approved, when the criteria were very restrictive, and to be performed there. Imagine the time to get the results. A fortnight ago, it was possible to locate the tests in public laboratories in cities and states.

Now the hospitals themselves can administer their tests, but it was started quite late. Meanwhile, “bio-startups” have appeared which often develop very simplified techniques, consisting in detecting a small part of the virus. We see a lot of this temptation to take these very quick tests, but they are much less specific. We have to find a balance.


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