Coronavirus. Open Letter to the Prime Minister: A Proposed Strategy in the War Against COVID-19

<p style="text-align: justify;">Honourable Pravind Kumar Jugnauth Prime Minister Republic of Mauritius</p>

<p style="text-align: justify;">Dear Sir,</p>

<p style="text-align: justify;">I wish to share out my views on actions which I feel need to be taken most urgently in the fight against COVID-19 in view of what I observe to be the situation locally and in the most advanced countries. I believe that it is important to add that my involvement at a strategic level in dealing with the H1N1 pandemic at a time when we had very limited experience in dealing with such situations has given me some insight and experience in pandemic preparedness. The situation is very dynamic and it is likely that as I am preparing this document many measures are already being planned.</p>

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		<figcaption>Les ministres Yogida Samynaden et Renganaden Padayachy, en compagnie du Premier ministre.</figcaption>
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<p style="text-align: justify;">I have chosen to communicate through this Open letter as during these difficult times a letter addressed to the Prime Minister&rsquo;s Office or the Ministry of Health and Wellness may not get the urgent attention it requires. At the same time I believe that it is a transparent way to define the magnitude of the problem whilst highlighting our difficulties and limitations. This would help to galvanize support which has already been forthcoming from the medical and health professionals at large, the Private Sector and all stakeholders.</p>

<p style="text-align: justify;">The main objectives of our Strategy has to be such that we EFFECTIVELY prevent /delay entry and halt local spread of the coronavirus (SARS-CoV-2 virus) whilst at the same time we develop a Primary Health Care/Hospital Preparedness Plan to deal with cases as and when they arise and in particular in the event that we get widespread sustained community infections. Most countries across the world are facing such a situation for the first time. Most countries are unprepared. Mistakes will be made. But we have to recognize our mistakes, be humble, accept positive criticism, learn from the mistakes, take corrective measures and move on.</p>

<p style="text-align: justify;">I would like to start off by making some observations and proposals about some of the basic but fundamental preventive measures:</p>

<p style="text-align: justify;">1. Washing of hands: Though there has been tremendous sensitisation on washing of hands at regular intervals, insufficient efforts have been made to provide adequate facilities for this simple measure to be implemented at public places, offices, sites of work, schools and even ministries. We are here talking about just soap and water. Urgent corrective measures are required. During the H1N1 pandemic the pharmacy department prepared sanitisers and distributed them to all health care and medical workers.<br />
	<br />
	2. Social Distancing: There is an urgent need for sensitisation for this measure to be implemented at Supermarkets and in public transports and in all other public places.</p>

<p style="text-align: justify;">3. During the confinement period some countries are allowing physical exercise under specific conditions. Basically individuals are allowed to go out unaccompanied for walks, walking of dogs and jogging. We have a population with a very high prevalence of pre-diabetes and diabetes. Persons with these conditions and with no space or facilities for indoor exercise may experience deterioration of their diabetes leading to com-plications such as heart attacks if they are unable to execise for long periods of time.</p>

<p style="text-align: justify;">4. We also need to facilitate planters to carry on with their activities under certain conditions whereby social distancing is maintained as this is beneficial both in terms of physical activity but it will also ensure that we get a continuous supply of fresh vegetables which is important for our health. We have to facilitate that this supply of vegetables is able to reach the population at places other than markets where social distancing may be maintained.</p>

<p style="text-align: justify;">The coronavirus has now entered our territory. We need to detect it wherever it is, as soon as possible, to prevent further spread. So the following measures are proposed:</p>

<p style="text-align: justify;">1. The message from WHO is crystal clear Test, Test, and Test every suspected case and isolate and treat and do contact tracing. We urgently need to considerably increase our capacity for testing. This can be done more easily with the participation of the Private Sector. Cepheid has just received emergency authorization from the Food and Drug Administration to use its testing machine called GeneXpert that can run tests for coronavirus in 45 minutes. I understand that we have the GeneXpert machine at our Central Laboratory. Staff can be rapidly trained to carry out these tests. We can rapidly increase our capacity for testing by engaging the Private Sector to also rapidly build its capacity for testing.</p>

<p style="text-align: justify;">2. With our capacity for testing significantly increased, we need to urgently review our criteria for testing. Tests need also to be done on all cases of severe pneumonia, infective bronchitis and Adult Respiratory Distress Syndrome and other respiratory conditions, suspicious respiratory tract infections in the community. The decision for testing needs to rest with both the treating Specialist/Private Doctor and the Regional Public Health Superintendent. In case of disagreement, the final decision should rest with the Consultant in charge in Internal Medicine of the Region or the Consultant in charge of Chest Medicine. We need of course to continue testing in cases as per established criteria, for instance for contact tracing.</p>

<p style="text-align: justify;">3. We urgently need to significantly reinforce our capacity for contact tracing in order to ensure rapid and effective contact tracing and testing.</p>

<p style="text-align: justify;">4. Ideally we need to keep our borders closed throughout the pandemic. However this may not be possible for various reasons. It is anticipated that the pandemic may last for at least 6 months or even a year. There are two possible scenarios. We have either been able to control our local spread or not.</p>

<p style="text-align: justify;">If we are in a situation where-by we are having sustained com-munity spread, nothing that we do at our borders will alter much our local situation.</p>

<p style="text-align: justify;">5. If we have managed to control community spread or at best stopped it altogether, then when and if we&rsquo;re open our borders, we will need to quarantine all incoming travellers and test all travellers. We will have to quarantine travellers under strict conditions in designated hotels under the supervision of public health staff. It is proposed that International travellers be made to pay for the quarantine facilities and for testing. In order to win the war against COVID-19, we have to be always several steps ahead. We pray that we never reach the stage whereby we fail to prevent sustained community spread. But we have to start planning our primary care health service and our hospital response.</p>

<p style="text-align: justify;">In order to do so we have to consider different scenarios based on the evolution of COVID-19 in other countries. It is estimated that COVID-19 affects 30-70% of populations. The good news is that 80% of the population affected has a minor illness and gets better and 20% needs admission in hospitals. Some 5% of the affected population needs intensive care treatment. The mortality rate is around 1%. There are slight variations in figures available in the medical literature.</p>

<p style="text-align: justify;">We have an elderly population and a high prevalence of non-communicable diseases. Thus I estimate that in a worse case scenario 40% of our population may be affected. Sustained community transmission, if it happens, will happen over a 3-4 months period.</p>

<p style="text-align: justify;">The population of Mauritius is estimated at 1. 27 million people. So we may get around 500,000 people affected over a period of 3-4 months. Fortunately that 80% , that is 400,000 of these people will have a mild illness.</p>

<p style="text-align: justify;">If we assume that 50% of the people with mild illness will treat themselves in the private sector, we will still need to provide for some 200,000 people with mild illnesses in our primary health care centres and hospitals. It will mean some 50,000 additional attendances per month which means around 1,600 attendances daily.</p>

<p style="text-align: justify;">A decision will have to be urgently taken as to whether we will treat all our patients with no contraindications with Hydroxychloroquine. Research in Marseille, be it on a small number of patients, has shown that only 25% of patients treated with Hydroxychloroquine were carriers of the virus at 6 days compared to 90% of those not treated. I believe that treatment of all cases with no contraindications will diminish the transmission rate during sustained community transmission and possibly also the number of cases requiring admission or developing complications and deaths. During crisis situations like at present it may not be wise for us to wait for the evidence base to be well established before we take a decision. It appears that the United States and France will be using Hydroxychloroquine in most of their cases. It is likely that there will rapidly be a shortage of this medication on the World market.</p>

<p style="text-align: justify;">Now we come to the major challenge. This is dealing with the 100000 cases who will need admission over say a 4 month period. The bulk of these cases would most probably be attending our public services. Let us put this number in perspective we get about 200,000 admissions per year in our hospitals. This will mean some 25,000 additional ad-missions per month that is around an additional 600-1000 admissions daily in our hospitals.</p>

<p style="text-align: justify;">We managed to deal with a similar number of cases during the H1N1 pandemic but for the COVID-19 pandemic we may have to deal with very significantly more admissions. Here are the measures proposed :</p>

<p style="text-align: justify;">1. We need to urgently start to educate the population about the different stages of our strategy and about basic initial management of the COVID-19. We also need to review our advice to the general public about the use of facemasks in the light of new evidence. Facemasks need to be therefore made generally available to the public at affordable prices.</p>

<p style="text-align: justify;">2. As of now we need to plan out COVID-19 clinics within our primary care network. As far as possible patients should as from now be sensitised to eventually attend COVID-19 clinics in primary care centres of their region rather than attending the Accident and Emergency Department. The reasons should be clearly spelt out to them.</p>

<p style="text-align: justify;">3. In the event that CO-VID-19 clinics are set up in hospitals they should be well away from the Accident and Emergency Department and from other crowded activity areas.</p>

<p style="text-align: justify;">4. We will need to plan the timing of reconfiguration of services offered in hospitals and we will need to plan when to stop elective procedures and treatment during the sustained community spread period.</p>

<p style="text-align: justify;">5. As of now clear proto-cols should be worked out for the management of mild and moderate cases of COVID-19 and these protocols should be circulated widely including to the health and medical personnel of the private sector.</p>

<p style="text-align: justify;">6. We need also to work out the protocol for the management of severe cases needing admission and needing intensive care treatment.</p>

<p style="text-align: justify;">7. We need to establish communication with the experts in China to learn from their experience. It would seem that they may advise us based on their experience we need to develop our protocols. All the health and medical personnel need to be urgently trained and provided with information for the management of these cases.</p>

<p style="text-align: justify;">8. We need to re evaluate our stock in terms of medical and oxygen supplies, protective gear, medication, medical equipment in order to deal with such large number of patients. We may here need to seek the help of India and China for providing us with certain items of medical supplies in particular ventilators and Hydroxychloroquine if we do not have enough in stock. We have to ascertain that Hydroxychloroquine is readily available in all public and private pharmacies in sufficient amounts. The price of Hydroxychloroquine in private pharmacies has to be very reasonable.</p>

<p style="text-align: justify;">9. We need to plan out the logistics for transport, catering and laundry for dealing with these numbers of admitted patients.</p>

<p style="text-align: justify;">10. We need to consider the urgent creation of banks of recently retired medical and health staff who may be called in at critical times when up to 50% of staff may be absent due to contamination, illness, exhaustion or attending to loved ones who have fallen ill. These retired staff will need to be provided with top up training.</p>

<p style="text-align: justify;">11. We urgently need to develop protocols to deal with dead bodies. We have unfortunately already had two deaths. We need not reinvent the wheel. The protocol of the Ministry of Health of India is available online. We just need to amend it in line with our local context. We also need to plan the logistics for dealing with the increased number of deaths which may arise.</p>

<p style="text-align: justify;">12. We need to establish a clear line of communication with our staff working at grassroots level and their trade unions so that we respond to their queries and fears rapidly and effectively.</p>

<p style="text-align: justify;">13. The population at large and all medical and health personnel need to be kept aware of all measures being planned and also of our difficulties and limitations. We have to transparently prepare our population for difficulties we may face in the future. In that way we will achieve the buy in and full participation of the population.</p>

<p style="text-align: justify;">14. Most importantly we will need to plan for enhanced security at all our institutions.</p>

<p style="text-align: justify;">15. The major challenge will be finding the beds for admissions. We may be getting 25,000 ad-missions monthly over a period of 3-4 months that is 600-1,000 ad-missions per day. We have around 3,700 beds presently in our institutions and there are 4,415 beds in the public and private sectors. We have to assume that we may only be able to use 3,000 of these beds exclusively for COVID-19. We will therefore need to start urgently to work out how we will manage to cater for such demands. We will need to look into the possibility of setting up negative pressure wards. We may now begin to understand as to why several hospitals were built urgently in Wuhan. I suggest that we discuss with the Chinese experts regarding our bed capacity requirements and we may even discuss with them about the setting up of required facilities rapidly.</p>

<p style="text-align: justify;">16. The other major challenge will be meeting with the demand for intensive care treatment. It is estimated that 5% of COVID-19 patients re-quire intensive care treatment. So around 25,000 patients may need intensive care over a 3-4 months period. I can only say that we have to urgently very very significantly increase our capacity for intensive care treatment. We will need to look into the possibility of setting up intensive care units with negative pressure facility. Here again I suggest that we tap into the Chinese expertise to advise us on our intensive care treatment capacity requirements and we may also seek their help for building up such capacity rapidly.</p>

<p style="text-align: justify;">I wish to re-iterate that at this moment of an absolute public health emergency with its dire socio-economic implications I feel it is my duty to share my views. I very much hope that we may control and halt the com-munity spread which has just begun and that we may never reach the point of sustained community spread. I also hope that if ever we have sustained community spread it happens to a much smaller scale.</p>

<p style="text-align: justify;">I take this opportunity to wish you and your team plenty of courage during these difficult and challenging times.</p>

<p style="text-align: justify;">by Dr. K. Pauvaday, GOSKM. B. Ch. B ( Leeds ) F. R. C. P ( London )Formerly Director General Health Services Ministry of Health and Wellness. Formerly Senior Clinical Honorary Lecturer ( Imperial College, London)</p>

<p style="text-align: justify;"><strong>Copy to: Dr the Hon Kailesh Kumar Singh Jagutpal Minister of Health and Wellness.</strong></p>

Curfew #day 1: The Art of War

<p style="text-align: justify;">Sun Zi said :&ldquo;War is a matter of vital importance to the state. It is a matter of life and death to its people and the road either to its survival or its ruin.&rdquo;</p>

<p style="text-align: justify;">When I woke up this morning, my eyes first caught the rays of sunshine gently flattering my cheeks, then my ears got sense of this unusual quietness. It took a few seconds for my brain to recall that yes, we are at war, a war where the enemy strikes silently and you don&rsquo;t even know where the blow will come from. This enemy is indeed the Covid-19, with over 12 000 deaths worldwide ( figures recorded Saturday by the Johns Hopkins University in the United States) and already two deaths in Mauritius. Now is the time for our &ldquo;invincible warriors&rdquo; to understand the seriousness of the situation and do home-made roti and dholl puri rather than queuing up on the streets.</p>

<p style="text-align: justify;">Sun Zi believed that there were factors determining or predicting what troops will be victorious at the end of the day. Here comes chapter one; the importance of laying plans. The first factor determinant of the outcome of a war is the moral influence; that is, &ldquo;that thing which causes the people to be in complete ac-cord with their sovereign so that they will follow him without the slightest disloyalty.&rdquo; Countries like China, Singapore and now India amongst others won over this first factor through tough consequential measures in case of breach of the confinement orders. Others like France, the UK and Mauritius amongst others failed in winning over this first step. If we already know the results in terms of death toll for the European countries mostly Italy, the worst hit European country, we might soon get to know the consequence of civil irresponsibility in our small island nation too with around 700 cases forecasted in a period of five days shall we not respect the curfew. Videos of people grouped without the recommended safety distance respected to buy some &ldquo;baja&rdquo; is shocking.</p>

<p style="text-align: justify;">The second factor is the weather. It seems that &ldquo;communities living in warmer places appear to have a comparative advantage to slow the transmission of coronavirus infections, according to an early analysis by scientists at the Massachusetts Institute of Technology&rdquo;, reports the New York Times. However, warm temperatures will not halt the disease from spreading. This being said, it is likely that factor two is advantageous for us.</p>

<p style="text-align: justify;">Factor 3; terrain. It here refers to the distances, small or big places. Mauritius being a small island where everybody at some point seem to know everybody, avoiding transmission of the disease if the self-quarantine is not well respected looks hard to achieve. The fourth factor is the commander. Here we refer to the general&rsquo;s ability of wisdom, strictness and courage amongst others. With this reinforced curfew and complete or so closure of the borders but with delay in taking preventive measures before the virus reached our shores and failure in making people abide to rules, time will tell if Mauritius won over this fourth factor.</p>

<p style="text-align: justify;">The last factor is the doctrine; that is, the principles guiding the organisation of the forces and having the right persons at the right place. Is the minister of Health at his right place managing the situation to the best of his capability? Or will his looks of being engulfed in this situation win over him? Those people who are or were in quarantine in awful sanitary conditions might have an idea.</p>

<p style="text-align: justify;">All these factors being considered, can we forecast victory or defeat? Maybe it&rsquo;s high time for us to realize the importance of respecting the measures of this curfew and keep our families safe.</p>

<p style="text-align: justify;"><strong>Laetitia Melidor</strong></p>

Covid-19 : les gestes de prévention à domicile et dans les services essentiels

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<p style="text-align: justify;">Avec le couvre-feu imposé, les déplacements des Mauriciens sont restreints aux services essentiels. À la maison comme dans les supermarchés, il faut avoir les bons réflexes. Les voici.</p>

<h3 style="text-align: justify;">À la maison</h3>

<h3 style="text-align: justify;">Les contacts entre proches</h3>

<p style="text-align: justify;">Si vous vivez en couple, en collocation ou en famille, le premier geste barrière à la pandémie est la réduction des contacts physiques répétés. Si l&rsquo;un est malade, il faut respecter en moyenne la distance d&rsquo;un mètre, un mètre cinquante entre vous et le malade.</p>

<h3 style="text-align: justify;">Le toucher</h3>

<p style="text-align: justify;">Évitez de vous toucher les yeux, le nez, la bouche et le visage car ce sont des portes d&rsquo;entrée pour le COVID-19, précise un médecin. Si vous devez vous moucher ou éternuer, utilisez plutôt des mouchoirs jetables à usage unique et débarrassez-vous en dans une poubelle fermée. En l&rsquo;absence de mouchoirs en papier, utilisez votre coude plié en cas de toux ou d&rsquo;éternuements.</p>

<h3 style="text-align: justify;">Le lavage des mains</h3>

<p style="text-align: justify;">À domicile, lavez-vous régulièrement les mains avec de l&rsquo;eau et du savon ou du gel hydro-alcoolique pour éliminer les microbes. <em>&laquo;Une fois le lavage terminé, il ne faut pas fermer le robinet avec les mains. Il est préférable d&rsquo;utiliser une serviette en papier. Faites de même avec la poignée de porte juste après le lavage des mains&raquo;, </em>explique le Dr. Denis Li Kam Wa, gastro-entérologue.</p>

<h3 style="text-align: justify;">L&rsquo;entretien du foyer</h3>

<p style="text-align: justify;">Comme vous êtes confinés, il est impératif d&rsquo;entretenir et de nettoyer votre lieu de vie. Assurez-vous que la maison soit bien aérée. Par exemple, ouvrez les fenêtres le matin, le soir et également pendant les cycles de nettoyage.</p>

<h3 style="text-align: justify;">La désinfection des surfaces</h3>

<p style="text-align: justify;">Désinfectez les objets trop souvent manipulés comme les téléphones, les ordinateurs, les tables de votre bureau, entre autres. Des lingettes désinfectantes peuvent être utilisées ou une dilution de javel et d&rsquo;eau pour les surfaces et sols.</p>

<h3 style="text-align: justify;">Dans les supermarchés</h3>

<p style="text-align: justify;"><strong>La manipulation des caddies et des aliments</strong></p>

<p style="text-align: justify;">Pour tout déplacement dans les grandes surfaces, le gastro-entérologue recommande l&rsquo;usage d&rsquo;un gel hydro-alcoolique après la manipulation d&rsquo;un caddie<em>. &laquo;Si une personne infectée en fait usage, les particules du virus peuvent se loger sur les poignées et être transmises au prochain client&raquo;</em>, indique-t-il. Le nettoyage de ces dispositifs doit également être assuré par la direction du supermarché, suggère-t-il. Quant au choix des denrées alimentaires, il faut éviter les manipulations, notamment pour le pain, les laitues, les fruits et légumes. <em>&laquo;La prévention, ce n&rsquo;est pas juste l&rsquo;arrêt des poignées de main, les embrassades, entre autres. Peu importe où on passe, il faut essayer de limiter le toucher à son minimum&raquo;</em>, précise le médecin.</p>

<h3 style="text-align: justify;">Le port des gants</h3>

<p style="text-align: justify;">Qu&rsquo;en est-il du port des gants? Selon le spécialiste, ils ne constituent pas le meilleur mode de protection car ils se salissent vite.</p>

<h3 style="text-align: justify;">Les paiements</h3>

<p style="text-align: justify;">Pour le médecin, les transactions en espèces peuvent être vectrices de microbes si l&rsquo;acheteur ou le commerçant est infecté. Aussi, la carte bancaire est donc privilégiée. Au cas contraire, utilisez le gel hydro-alcoolique juste après avoir touché aux pièces de monnaie ou billets.</p>

<h3 style="text-align: justify;">Les transports en commun</h3>

<p style="text-align: justify;">Selon le Dr. Denis Li Kam Wa, il vaut mieux limiter le recours aux autobus et d&rsquo;autres transports en commun car les poignées peuvent contenir des microbes. Les passagers s&rsquo;exposent ainsi aux risques de contamination.</p>

Espace jeunes

<p style="text-align: justify;"><strong>#stayathome</strong></p>

<p style="text-align: justify;">L&rsquo;heure est grave, les jeunes. Ceci n&rsquo;est pas une blague. L&rsquo;ennemi invisible appelé Co-vid-19 sévit dans l&rsquo;île et a déjà fait deux morts. Comme vous le savez déjà, nous sommes en confinement national, afin de freiner la propagation du virus. En tant que jeune, vous avez le devoir de respecter cette règle pour protéger votre entourage et vous-même. Comme les réseaux sociaux font partie de votre quotidien, voici quelques idées pour ne pas vous ennuyer mais aussi pour sensibiliser d&rsquo;autres personnes à rester chez elles.</p>

<p style="text-align: justify;"><strong>(1) #stayathome :</strong> Depuis que le Covid-19 sévit à travers le monde, plusieurs personnalités se servent de ce hashtag pour sensibiliser leurs followers. Vous pouvez en faire autant. Utilisez-le sous vos photos et vos publications en ligne car plus il deviendra viral, plus les gens comprendront le message.</p>

<p style="text-align: justify;"><strong>(2) Créer un album de confinement :</strong> Afin de vous occuper, et en même temps, sensibiliser le maximum de personnes, vous pouvez créer un nouvel album photo intitulé : Confinement ou Lockdown. Dans cet album, vous pouvez partager sur les réseaux sociaux tout ce que vous faites tous les jours, avec votre communauté. Vous pouvez mettre la photo d&rsquo;une recette facile à faire, d&rsquo;un livre que vous lisez, d&rsquo;une liste de films à regarder, entre autres. Vous pouvez même faire des vidéos comme des pas de danse, poster des vidéos de chansons. À vous de voir. Mais bien entendu, restez respectable. L&rsquo;idée est de distraire les autres et de les inciter à faire de même.</p>

<p style="text-align: justify;"><strong>(3) Ne partagez pas de Fake news : </strong>En ce temps de crise, vous verrez sur la toile plusieurs nouvelles, qui ne sont pas nécessairement vraies. Ne vous fiez pas aux rumeurs et ne les partagez surtout pas. Partagez uniquement des nouvelles que vous obtenez sur des sites d&rsquo;informations locales. Celles-là sont plus fiables. Car rappelez-vous que les Fake news font plus de mal que de bien. Soyez responsable et utilisez vos réseaux sociaux à bon escient.</p>

Dans vos paniers

<p style="text-align: justify;"><strong>Le thym, une fine herbe vous vient en aide</strong></p>

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<p style="text-align: justify;">À l&rsquo;heure où le coronavirus se fait de plus en plus menaçant, il est plus que nécessaire de renforcer votre système immunitaire. Pour ce faire, optez pour le thym. Cette petite plante, que nous utilisons habituellement pour aromatiser nos plats, est connue aussi pour ses propriétés stimulantes du système immunitaire. Ainsi, le thym contient du linalol, qui aide à lutter contre les problèmes pulmonaires et du thymol, qui est antiseptique, antibactérien et antifongique. En sus d&rsquo;agrémenter vos plats, vous pouvez le prendre sous forme d&rsquo;infusion. Associé au miel, faites une infusion de thym. Consommée chaude, cette infusion est une boisson idéale à prendre le soir avant de vous mettre au lit.</p>

Les troubles d’apprentissage

<p style="text-align: justify;">Parfois, un enfant ordinaire peut avoir des troubles d&rsquo;apprentissage. Cela se traduit par une grande difficulté à rester attentif, à lire, à écrire ou encore à calculer. Ils sont permanents et peuvent poser des difficultés même à l&rsquo;âge adulte.</p>

<p style="text-align: justify;">Il y a aussi des cas d&rsquo;autisme léger. L&rsquo;autisme est un trouble de développement qui peut varier de sévère à léger, on appelle cela le spectre autistique. Si les cas sévères sont détectés assez facilement et demandent un traitement spécialisé, ceux considérés légers sont plus difficiles à identifier car ils sont rarement visibles. Un enfant qui souffre d&rsquo;autisme léger peut avoir des difficultés à comprendre et à capter et donc à apprendre.</p>

<p style="text-align: justify;">Parmi les troubles d&rsquo;apprentissage, il y a aussi ce qu&rsquo;on appelle les<em> &laquo;dys&raquo;.</em> Ce sont des troubles spécifiques à la lecture, l&rsquo;écriture, les calculs, entre autres. Les trois <em>&laquo;dys&raquo;</em> principaux sont la dyslexie, la dysgraphie et la dyscalculie. Les <em>&laquo;dys&raquo;</em> touchent en moyenne un enfant sur 10. Et les garçons sont trois fois plus affectés que les filles.</p>

<p style="text-align: justify;"><strong>LA DYSLEXIE&nbsp;: </strong>Les lettres bougent, ils dansent sur le papier, jouent à saute-mouton. C&rsquo;est un peu ce que voit un enfant qui souffre de dyslexie lorsqu&rsquo;on lui demande de faire de la lecture. Alors t&rsquo;imagines la difficulté pour suivre les leçons.</p>

<p style="text-align: justify;"><strong>LA DYSGRAPHIE :</strong> Cette fois-ci, ce sont surtout les doigts qui ne veulent pas faire ce qu&rsquo;on leur demande. Ceux qui souffrent de dysgraphie ont beaucoup de mal à écrire correctement, à former les lettres et mettent souvent un b à la place d&rsquo;un d.</p>

<p style="text-align: justify;"><strong>LA DYSCALCULIE :</strong> Ah les mathématiques ! Ce sont le cauchemar de beaucoup d&rsquo;enfants. Mais pour un enfant qui souffre de dyscalculie, c&rsquo;est encore pire. Car les chiffres et les nombres, il n&rsquo;arrive vraiment pas à les comprendre, les utiliser ou même parfois les reconnaître.</p>