Covid-19: are young people (really) less exposed to severe forms?

Will this fourth wave be that of youth? For several days, the French authorities have been alerting to the increase in the number of young people hospitalized in the services dedicated to Covid-19. This Tuesday, the Minister of Health, Olivier Véran, declared to have noticed “a rejuvenation of hospitalized patients and in intensive care”. Indeed, the training doctor said that patients admitted to critical care at this time in France were “five years younger than in previous waves”. Reputed to be more solid and endowed with more resistant immune defenses, young people have the reputation of not developing serious forms. But is the Delta variant – at the origin of a fourth wave – a game-changer?

As of July 30, there are 107 patients admitted to intensive care who are aged between 20 and 39 years according to data reported by Public Health France. And only nine patients in critical care under the age of 18. In total, there are 534 people classified among 20 and 39 years who are hospitalized because of Covid-19, this Friday (out of 7363). Admittedly, these figures are still low, but the trend is upward. It should be noted that these data fit into the following context: specialists note an increase in the number of hospitalizations in their department while the number of daily cases amounts to 25,000 on average in France. “The demand is greater and we observe people increasingly younger. The average age in my department is 44 years. Unheard of”, underlines to L’Express Benjamin Davido, infectious disease specialist at Raymond hospital Poincaré from Garches.

Covid-19: evolution of the resuscitation rate among young people (screenshot).

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So how do you explain this? “We did not see this type of patients in the previous waves, which suggests that the Delta variant is more symptomatic. This is something that should worry, because if it is more symptomatic, there may be more hospitalizations in categories of individuals who are less at risk of developing a serious form, ”answers the specialist. While it is still too early to draw conclusions regarding the impact of the Delta variant, vaccination has changed the profile of Covid-19 patients, since 80% of those over 75 are vaccinated. By way of comparison, only 46% of individuals aged 18 to 29 received a complete vaccination schedule. In total, France has protected 52% of its population.

“There is something new about this virus”

And the effects of vaccination are being felt in hospitals: for example, those over 80 accounted for 28% of intensive care patients during the peak in April. Today, they only occupy 4% of these beds. “By vaccination, the severe forms of elderly patients have deserted the hospital, notes the infectious disease specialist. Those who end up in the hospital are young people, we do not have the impression of having seen so many during the first wave. So there is something new about this virus. ” This reasoning is confirmed by the recent Drees study – published on Friday – which finds that nearly 85% of hospitalized patients are not currently vaccinated.

In fact, the virus fanned by the Delta variant circulates more actively in the youngest. Between July 21 and 27, the incidence rate – number of cases per 100,000 inhabitants – among 20-29 year olds was 631 (compared to 212 on average in the country). The logic is therefore as follows: if young people are less likely to go to intensive care, the fact that they are less vaccinated exposes them more to the virus – and therefore to the risk of developing serious forms. “Young people are less exposed to the risk of thrombosis, but it is not zero. With the increase in the number of young people affected, there is necessarily an increase in the number of serious forms”, explained epidemiologist Pascal Crépey, questioned by The Dispatch.

Benjamin Davido agrees: “We can no longer say that in 99.1% of cases nothing will happen for young people.” In its department at Garches hospital, nine beds are occupied by Covid-19 patients and “six or seven are under 40 years old”. The youngest hospitalized patient is even 22 years old. In those under 30, people with co-morbidities are often presented as more at risk. But they are not the only ones. “The young people I see have no comorbidities, they are fairly athletic people,” insists the infectious disease specialist. Based on this example, the specialist takes the opportunity to question the “bet” of the government which has bet on the strongest resistance of the youngest to contain the epidemic. “We didn’t think they would arrive at the hospital,” says the infectious disease specialist.

“Everyone is at risk”

If the number of people in critical care is not yet sufficient to assess the importance of the epidemic among young people, the health situation should become clearer in the coming days. One of the open questions: will the number of hospitalizations and deaths decorrelate from the infection curve like in the UK? While the peak of contamination in France is expected for mid-August, Benjamin Davido draws a dreaded scenario: to see hospitals full of young patients. “It would be an extremely difficult situation. When the average age is 45 years in a conventional intensive care unit, it is very particular to refuse patients on a daily basis”, fears the specialist.

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“The impression today is that the variant finds its place and that we will not be able to escape it (…) Everyone is at risk. Then, it is the hand of God that will decide who ends up in the hospital. ” And once out of the health facility, is the patient out of the woods? If young people have more stamina and stay in the hospital for a shorter period of time, it is difficult to know how quickly they will recover. Indeed, many symptomatic people retain traces of Covid-19 – even several months after their contamination. “We cannot predict what their sequelae will be in the long and medium term. Added to that these forms of long Covid … It becomes a public health problem”.

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