COVID-19

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Issu d’une collaboration internationale chapeautée par l’International Association of Forensic Mental Health Services (IAFMHS) sous la direction d’Anne Crocker et d’Ashley Lemieux (Direction de la recherche et de l’enseignement universitaire- UETMIS-SMJ), vous trouverez dans les pages de ce compendium, une compilation de politiques, pratiques, procédures, recommandations, études scientifiques et recensions des écrits en réponse à la pandémie de la COVID-19, à l’intersection de la santé mentale et de la justice. L’objectif de cet ouvrage est de documenter les transformations dans les milieux de la psychiatrie, de la psychiatrie légale et des services correctionnels à l’échelle internationale, ainsi que de soutenir la prise de décision dans un moment de crise sanitaire mondiale. Cette compilation est un document dynamique qui sera mis à jour régulièrement afin de répondre à une situation en constante évolution.

Transmission par voies respiratoires : par des gouttelettes

La transmission entre les humains se fait surtout par :

• des gouttelettes pendant un contact étroit et prolongé avec une personne infectée (comme des gouttelettes émises quand on parle ou on chante);
• par contact direct avec les gouttelettes des sécrétions respiratoires quand la personne infectée tousse ou éternue.

Ces grosses gouttelettes de mucus (plus grandes qu’environ 5 microns[1]) chargées de virus peuvent se répandre à une distance d’environ 2 mètre (6 pieds) de la personne infectée sont le principal mode de transmission.

Environ 25% de personnes qui transmettent le virus peuvent être sans symptômes. Ceci suggère que la toux et l’éternuement ne sont pas absolument nécessaires pour transmettre le virus.

[1] Un micron = un millième de millimètre

Transmission de particules fines, les aérosols : possible

Les personnes infectées peuvent émettre des particules de virus très fines, considérées des aérosols qui peuvent rester en suspension dans l’air pendant des heures et voyager avec des courants d’air à travers plusieurs mètres (des dizaines des pieds).

Certaines interventions médicales générant des aérosols (l’intubation trachéale, la ventilation avant l’intubation, la bronchoscopie, etc.) et le fait d’être présent lors de ces interventions augmentent donc le risque d’exposition au virus. Selon certaines études, les particules virales des aérosols pouvaient rester viables jusqu’à 3 heures.

 

Transmission par contacts physiques avec des surfaces infectées : possible

Dans cette situation, les particules virales émises par les voies respiratoires d’un individu infecté se posent sur une surface.

Ensuite, une autre personne touche cet objet, puis touche son nez, sa bouche ou ses yeux. Le virus s’infiltre ensuite dans le corps par les muqueuses, infectant la deuxième personne.

Selon le rapport publié par CDC (Center for Disease Control aux États-Unis), le 26 mars dernier sur le navire de croisière Diamond Princess sur lequel beaucoup de passagers et de membres d’équipage étaient atteints du coronavirus, une équipe d’enquête a trouvé des traces du matériel génétique (ARN) du SARS-CoV-2 sur les surfaces du navire de croisière, dans les cabines des personnes infectées jusqu’à 17 jours plus tard. Toutefois, aucune preuve n’indiquait que cet ARN viral était encore infectieux.

Jusqu’à présent, personne ne sait à quel point ce mode de transmission est courant, mais cela semble possible.

 

Ne se transmet pas par la nourriture et l’eau potable

Jusqu’à présent, rien ne prouve que le virus soit transmis par les aliments ou l’eau potable. Le virus ne vivra pas longtemps dans les aliments comme tels, et bien qu’il soit possible que les emballages alimentaires d’épicerie ou de plats à emporter puissent contenir de petites concentrations de particules virales, il est facile de réduire ce risque en se lavant les mains après avoir manipulé des produits d’épicerie et en nettoyant les emballages d’aliments et les aliments avec de l’eau et du savon.

Lorsqu’on est infecté par un virus, celui-ci pénètre et se multiplie dans les cellules de notre corps. La quantité totale de virus que la personne infectée porte en elle est appelée « charge virale ».

La charge virale se mesure dans un volume d’un fluide humain tel le sang, la salive ou les postillons. Selon certaines études, plus la quantité du virus mesurée est élevée plus l’infection est sévère. La charge virale est considérée , donc par certains chercheurs, un indicateur utile pour évaluer la gravité de la maladie ainsi que son pronostic[1].

La charge virale varie d’un individu à l’autre et elle serait, entre autres, influencée par le stade de la maladie ainsi que par le volume de l’échantillon prélevé.

« La charge virale, c’est la mesure de l’intensité du feu qui brûle dans un individu, …»

(Traduction libre) selon Edward Parker de London School of Hygiene and Tropical Medicine. “The viral load is a measure of how bright the fire is burning in an individual, whereas the infectious dose is the spark that gets that fire going,” says Edward Parker at the London School of Hygiene and Tropical Medicine.[2]

Le nouveau virus SRAS-CoV-2 se multiplie à une vitesse fulgurante, dans certains cas allant jusqu’à 100 fois en 48 heures. C’est la raison pour laquelle, les personnes infectées par SRAS-CoV-2 atteignent une charge virale maximale beaucoup plus rapidement pouvant infecter plus vite d’autres personnes.

Vous pourriez propager le virus SRAS-CoV-2 sans vous rendre compte.

Ce nouveau virus agit comme « un ninja ». Il peut passer inaperçu auprès du système immunitaire, ce qui explique pourquoi des personnes à très haute charge virale ne développent pas de symptômes mais pourtant sont très contagieuses et propagent le virus sans au moins le savoir[3].

La probabilité de transmission du virus augmente avec la durée et la fréquence d’exposition d’un individu non infecté à une personne infectée.

Plus la quantité du virus qu’une personne infectée produit et peut potentiellement excréter est élevée, plus cette personne est contagieuse. Il s’agit de la « dose infectieuse », la quantité du virus nécessaire et suffisante pour provoquer une maladie.

La plupart des personnes infectées par le nouveau coronavirus sont bien plus contagieuses et beaucoup plus tôt que les personnes infectées par d’autres virus.

Il est, donc, très profitable de prendre toutes les précautions nécessaires pour éviter d’être infecter par ce coronavirus et de tomber malade de COVID-19.

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Source:
[1] https://lesobservateurs.ch/2020/03/30/coronavirus-la-question-de-la-charge-virale-une-information-essentielle-pour-se-proteger-et-comprendre-lepidemie/

[2] https://www.newscientist.com/article/2238819-does-a-high-viral-load-or-infectious-dose-make-covid-19-worse/#ixzz6KMvrBzZV

[3] https://www.futura-sciences.com/sante/actualites/coronavirus-coronavirus-sars-cov-2-replique-10-fois-plus-vite-sras-2003-80643/

Lorsqu’une infection ou maladie grave pouvant toucher plusieurs personnes survient dans une communauté, il devient important et urgent d’enquêter sur les facteurs qui ont facilité sa propagation.

L’enquête sur l’apparition d’une telle maladie vise à déterminer les mesures à prendre pour limiter (à court terme) et prévenir (à long terme) un problème de santé qui est généralement aigu.

Parmi les situations dans lesquelles une enquête épidémiologique pourrait être nécessaire on retrouve:

• Une épidémie : survient dans une communauté ou une région d’un nombre nettement plus élevé que prévu de cas d’une maladie, d’un comportement particulier lié à la santé ou d’autres événements liés à la santé (Last, 2001)[1]
• Une éclosion ou flambée : est une épidémie qui se limite à une augmentation localisée de l’incidence d’une maladie (ex. dans un village, dans un établissement fermé, un centre hospitalier, une agglomération, etc.) (Last, 2001).
• Une pandémie : est une épidémie qui s’étend au monde entier ou à une très vaste région géographique, franchissant les frontières internationales et touchant généralement un très grand nombre de personnes (Last 2001)

L’OMS déclare l’état de pandémie lorsque le nouveau virus cause un nombre extrêmement élevé de personnes malades ou de décès dans plusieurs zones géographiques étendues[1].

Exemples de pandémies de grippe documentées[1] :

• 1580 – première pandémie bien décrite d’une maladie apparentée à la grippe;
• 1918- 1920 type A (H1N1) – environ 20 à 40 millions de décès dans le monde;
• 1957 type A (H2N2) – grippe asiatique;
• 1968 type A (H3N2) – grippe de Hong Kong;
• 1977 type A (H1N1) – grippe russe.

L’acquisition d’une infection ou d’une maladie, dans notre cas la COVID-19, résulte de l’interaction de l’agent infectieux (le virus SRAS-Cov-2), l’hôte (l’humain) et l’environnement, tout ce qui est à l’extérieur de l’humain (la triade épidémiologique) [1].

L’enquête épidémiologique vise à identifier d’autres cas et à documenter des éléments de la triade épidémiologique afin d’être capable d’interrompre la propagation et stopper le plus rapidement possible la transmission interhumaine de la maladie.

Une des premières étapes d’une enquête est d’élaborer les définitions de cas (cas confirmé, cas probable) et de les revoir tout au long de l’enquête. La définition de cas pour la COVID-19 au Québec est celle publiée sur le site web du MSSS (professionnels de la santé).

La définition de cas est un outil pour classer les personnes touchées en catégories et déterminera la prise en charge ultérieure spécifique à chaque catégorie.

L’outil communément utilisé en enquête afin de recueillir les renseignements nécessaires auprès de la personne infectée (le cas) est le questionnaire d’enquête.

Dans un questionnaire d’enquête épidémiologique on retrouve d’habitude: des données d’identification de cas et de ses contacts, des données cliniques (date d’apparition des premières symptômes, signes, données de laboratoire, service de santé consulté, etc.), des informations sur l’exposition (la source) et les facteurs de risque, d’autres questions exploratoires et ouvertes[1].

Lors d’une enquête épidémiologique, le professionnel joue un rôle de « détectif » à la recherche d’indices, des renseignements utiles pour déterminer la prise en charge ultérieure et les mesures de « lutte » à mettre en place contre l’agent infectieux.

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Source
[1] Tiré de PHAC-ASPC- Enquête sur une éclosion-Lessard-Apr10

Le premier problème lié au port du masque au-delà de six heures par jour est la dermite d’irritation, qui peut s’étendre aux joues et sous le cou et se manifester par des rougeurs, une sécheresse, une sensibilité cutanée et, parfois, des démangeaisons, notamment au niveau de l’arête nasale. La tige métallique qui permet de bien fixer le masque appuie sur une zone du nez qui n’a pas l’habitude d’être autant sollicitée. Tout comme pour les personnes qui portent des lunettes la première fois, il faut un certain temps d’adaptation pour ne plus sentir le frottement.

L’autre problème rencontré fréquemment est la « dermite de confinement« . La peau est confinée sous le masque, occluse, et peut développer ou aggraver une folliculite ou une dermite séborrhéique.

L’allergie aux masques est très rare. Les symptômes d’une éventuelle allergie sont l’aggravation de la dermatose malgré l’application d’une crème, une zone irritée de plus en plus étendue, voire l’apparition de squames, d’érosions. Dans ce cas, contactez votre médecin qui vous proposera un traitement adapté.

Voici les conseils afin de prévenir et soulager les problèmes cutanés liés au port du masque.

Soins quotidiens :

1. Nettoyez votre peau le matin et le soir avec un nettoyant doux et sans parfum;
2. Démaquillez votre visage de façon quotidien, s’il y a lieu;
3. Après le nettoyage de la peau, appliquez une crème hydratante légère matin et soir, pour lutter contre la sécheresse et les irritations;
4. Évitez les produits comédogènes comme les fonds de teint et des crèmes grasses.

Soins lors du port de masque :

1. Après avoir retiré votre masque, lavez votre visage avec un nettoyant doux et sans parfum qui n’assèche pas la peau pour éliminer la transpiration;
2. Assurez-vous d’utiliser de l’eau tiède et non chaude. L’eau chaude peut être plus abrasive pour la peau et compromettre davantage la barrière cutanée;
3. Appliquer une eau en spray régulièrement pour apaiser les irritations.

 

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Sources :

https://www.health.com/condition/infectious-diseases/coronavirus/face-mask-skin-irritation

https://www.santemagazine.fr/sante/sante-au-travail/comment-eviter-les-problemes-de-peau-lies-au-port-du-masque-433409

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