Policy responses for France - HSRM


Policy responses for France

1.2 Physical distancing

On May 7, the Prime Minister confirmed the calendar for easing the lock-down, even though the exit plan was rejected on May 4 by the Senate (which only has a consultative role). The government insisted on the highly progressive and controlled nature of the process for lifting restrictions following local situations. On May 11, the regions were classified either as green or red, based on the number of hospitalisations for Covid-19 and the number of new cases. Four regions were graded as still at risk (‘red’): Grand Est, Ile-de-France, Hauts-de-France and Bourgogne-Franche-Comté. The Parisian area was still classified as a “tense sanitary situation” based on the suspected cases of Covid-19 (representing more than 10% of the visits to emergency departments) and bed occupancy rate (more than 80%). By June 2, the Parisian area remained under strong surveillance, along with Guyane and Mayotte, and some physical distancing measures were lifted more progressively there than in the rest of the French territory (on June 15 in the Parisian region).

Since May 11, French residents were allowed to circulate freely again, but only within 100km of their place of residence. Longer travels were only allowed for important business, family reasons or to move or visit new places to buy or rent. People not respecting this rule faced a fine of €135. Starting on June 2, these travel restrictions have been removed; now travel within France is allowed, although local authorities will be allowed to re-implement restrictive measures if the epidemiological situation gets worse.
Older people and fragile individuals have been advised to stay at home and avoid social contacts as much as possible. There is an emphasis on individual responsibility rather than on enforcing coercive measures due to concerns of stigma and discrimination towards high-risk persons. Some recommendations for people living with a disability in the post lock-down period were recently issued (https://handicap.gouv.fr/presse/communiques-de-presse/article/covid-19-les-grandes-lignes-du-plan-de-deconfinement-pour-les-personnes-en). Normal visits to nursing homes were allowed again from June 15 onwards.

Graveyards re-opened on May 11, but memorial services were limited to 20 persons. Religious services were allowed again since May 23 and weddings since June 2. Initially, parks only re-opened in the areas classified as "green" on May 11 and then on the whole territory on May 30. Beaches are also opened since June 1, local authorities will be allowed to require a compulsory use of masks in both parks and beaches if deemed necessary.

Gatherings of more than 10 individuals will remain prohibited as well as all large public gatherings of more than 5,000 individuals, including football matches, until at least October 30. All businesses were allowed to open after May 11 except hotels, restaurants and bars. Libraries and small museums progressively re-opened starting on May 11 as well as large museums, theatres and other entertainment venues from June 2 onwards, with a compulsory use of masks, except in the three specific areas where the epidemiological situation was considered not completely satisfactory (Parisian region, Guyane and Mayotte) but in the Parisian region, additional restrictions were lifted on June 15. Finally, cinemas have been re-opened on June 22, as well as casinos and summer camps, but nightclubs will remain closed until at least September (specific financial aids have therefore been announced for them in July). Starting on June 2, restaurants and bars are allowed to re-open with the limit of 10 guests per table and of 1 metre between each table. In the Parisian region, Guyane and Mayotte, only coffee places and restaurants with tables in an outdoor area were permitted to re-open, but since June 15, all restaurants and coffee places are allowed to open again. The re-opening of other businesses has been accompanied by strict guidelines on social distancing (e.g. the number of persons allowed in close spaces), together with a compulsory use of masks if it is impossible to guarantee social distancing within a shop. Large shopping centres may remain closed based on local authorities’ decision. On June 22, team sports (except for combat sports) were allowed again, and stadiums will re-open on July 11, but it won’t be possible to host more than 5,000 spectators.

Nursery and primary schools have re-opened on the whole French territory since May 11. However, this was applied on a voluntary basis and classes were limited to 15 children. Secondary schools were opened after May 18, in the less affected départements first and on the whole territory after June 2. High schools remained closed until the end of May. Starting on June 2, they will be allowed to host some pupils again in the less affected areas, but not in the Parisian area. Childcare services have started to re-open progressively since May 11, initially accepting children whose parents are in difficulty based on several criteria (e.g., the impossibility for parents to work from home, single-parent household, among others). Choices will be left to local authorities. This plan for education will be accompanied by a strict policy on masks, which will be compulsory for all teachers and also, in secondary schools, for all students. The higher education system will still be limited to online learning. The scientific committee advising the government had initially supported a re-opening all schools and universities by September only, but has stated that it understands the political, economic and social context in which the decision to re-open some schools has been taken. Finally, on June 22, all nursery, primary and middle schools re-opened with attendance being compulsory for all pupils and with strict physical distancing measures. New more flexible protocols were set up for September 1 (going to school became compulsory again): there are no more stringent social distancing measures in schools but masks are compulsory for teachers and children over 11 years old. While providing free masks to students had been called for by some, the government has not retained this option. In the case of school closures following the detection of positive cases, parents working in the private sector will be eligible for partial unemployment. Progressively, measures have continued to soften in schools with the detection of a single positive case no longer leading to the closure of the whole class (three positive cases are now necessary).

Working from home was initially requested from all employees if possible, so many employers put in place teleworking options beyond June. For other workers, flexible shifts with out-of-office hours will be strongly supported. Individuals considered as "fragile" health-wise (at risk of a severe form of Covid-19 or with a chronic illness) will continue benefiting from partial unemployment coverage if they cannot work from home. Recognition of the Covid-19 infection as an occupational disease will be facilitated for individuals who contracted the infection while working. Masks will be compulsory in the workplace whenever physical distancing is not possible. General recommendations were published on May 3 by the Ministry of Employment; they include detailed rules such as the need to guarantee 4m2 per employee, to open windows at least three times a day during 15 minutes and to disinfect the workplace, in particular door knobs, daily. Guidelines for the different working sectors were made available by May 11. Around 60 guides providing a long list of specific rules for different sectors were released on the website of the Ministry. The employment branch of the national health insurance fund will finance up to 50% of small enterprises’ investment in protective equipment for their employees. On June 24, less stringent rules for the workplace were issued (working from home and guaranteeing 4 m2 by employee are in particular no longer the general rule). Public transports only re-opened up to 60% of their full-capacity on May 11 and will progressively get back to normal starting on June 2. Masks are compulsory in all transports for individuals aged over 11; anyone without a mask in public transport faces a fine of €135. It is advised that only one out of two seats should be used to maintain physical distancing (except in high speed trains), but it is not clear yet how this requirement will be meet in practice, especially in big cities. In the Parisian region, public transport during rush hours was limited until June 16 to people who had a written authorisation from their employers confirming that they needed to go to work. On August 18, following the increase in the number of workplace Covid-19 clusters, the Ministry of Labour announced that wearing face masks in shared offices and any other collective closed places would be made compulsory from September 1. Face masks will have to be provided by the employer. Teleworking is still strongly advised whenever possible.

Overall the transition period rely on three general principles: 1/ protecting (pursuing the respect of hand hygiene and respiratory etiquette, including a broader use of protective masks); 2/ more active testing (symptomatic individuals and all contacts of confirmed cases); 3/ isolating confirmed cases. In the onset of the second wave of the epidemic, these general principles have evolved towards testing, alerting and protecting.

On October 17, against the rapid increase in the number of new cases of Covid-19, a night curfew was set up from 9pm onwards for the Parisian region and eight other big cities (Lille, Grenoble, Lyon, Aix-Marseille, Montpellier, Rouen, Toulouse and Saint-Etienne), representing almost one third of the country. People not complying with the rule faced a €135 fine, which reached €1,500 in case of repeated offense. Police forces were deployed to enforce the new rule. Anyone outside during the curfew needed a certificate showing the necessity (notably, professional reasons and health emergencies). On October 24, the night curfew was extended to a larger part of the territory affecting 46 million French residents. It was accompanied by a nationwide ban on large-scale private events such as weddings.

All these measures appeared to be insufficient for containing the number of new cases. On October 28, the president announced a new national lock-down in mainland France which started on October 30 for at least one month (two weeks after its start, the government confirmed that these measures would be in place until at least early December). Overseas territories, except Martinique, were not included in this new measure. Similarly to the first lock-down, non-essential services and shops (cinemas, bars, restaurants…) have to close. But, this time, nursery, primary, middle and high schools remain open while universities have to fully switch to online teaching. Also, visits in nursing homes remain possible, albeit under strict sanitary protocols, considering the negative effects of isolating fragile older people that were observed during the first lock-down. Moreover, the government allowed for more flexibility in practicing professional activity this time and maintained all public services (post offices, public gardens, municipal services, etc.), food markets and some hotels for business trips. Working remotely from home is highly encouraged but employees who have a certificate from their employer are allowed to commute to their workplace. Otherwise, the conditions of the lock-down are similar to the first one: everyone needs a self-declared document justifying the reason why they are outside, which can include limited physical activity near the place of residence, medical reasons, shopping for basic food or providing care for a vulnerable person such as a disabled relative. People not complying with the rule are fined €135 with augmentation in case of repeated offenses.

On November 24, the president announced an easing of the second nationwide lock-down in several phases. The first phase started on November 28 with the opening of all shops and business, except for bars, restaurants, night and sport clubs. This was accompanied with an extension of outside activity to three hours and within 20km of the place of residence (vs. previous regulation of one hour and within 1km). Outside after-schools activities started again and religious gatherings are allowed. Controls on movement however still applied with the continuous need to provide a self-declared document justifying the reason for being outside. The second phase started on December 15. The lock-down ended but a night curfew was set up between 8pm and 6am on the whole French territory, except on Christmas night. This curfew will last until, at least, January 20, 2021. A third phase, which was expected on January 7 with the re-opening of cinemas, theatres, museums sport clubs and ski resorts, was cancelled due to the "lack of improvement" of the epidemiological situation. On the contrary, a more stringent curfew starting at 6pm (instead of 8pm) was introduced first (on January 2) in 15 French départements, where the incidence rates were high, and then to the whole metropolitan France from January 16, 2021. Despite the recommendations of the scientific council urging a third lock-down in February, the government decided to keep the status quo maintaining the curfew at 6pm. As of mid-February, there is no date announced for re-opening of restaurants, cafés and sport clubs. At the end of January, large shopping centres (more than 20,000 m2) were closed, while universities were required to allow students to assist to face-to-face classes once a week considering the rising concerns about youth mental health. However, in practice, providing classes for a very small number of students appears to be very challenging for universities.

National guidelines for the festive season included recommendations to limit private gatherings to six persons at a time (not including children), and a limitation of social contacts 5 days prior to family meetings with vulnerable individuals.

Following the emergence of the new more infectious variants of Covid-19, recommendations for social distancing (in particular, when it is not possible to wear face masks) were extended from one meter to two meters (this new distance is also the new threshold for identifying contacts of positive cases). By the end of February 2021 additional measures of physical distancing were introduced in some areas depending on their local epidemiological situation. Lockdowns during weekends were first set up in Nice and Dunkerque. On March 20 2021, new restrictions were implemented in 16 départements (including the Parisian region and accounting for nearly a third of the French population) considering the strain on ICU capacities. Travel restrictions were introduced beyond 10km of the place of residence and businesses considered as “non-essential” closed again. The list of “essential” services was, however, extended to include hairdressers, florists, book and music shops. Schools remained open but high schools partly switched to online teaching again. Concurrently, the national curfew was maintained, and extended from 6pm to 7pm to account for daylight saving. These new restriction measures were planned for a minimum of one month and on March 28, they were extended to three additional départements.

On March 31, 2021, these restrictions were extended to the whole French mainland territory. In addition, schools were closed for three weeks (including the Easter holidays, which usually last for two weeks).

The first global measure was limited to the interdiction of large public meetings of more than 5,000 persons first (on March 4), then of more than 1,000 persons (on March 8) and then of more than 100 persons (on March 13). Concurrently, on March 11, visits to all residential nursing homes were stopped to protect the older population.

Some policy measures were implemented earlier at the local level, where local clusters of infected cases were identified. These initial clusters were the Haute-Savoie, Oise, Morbihan, Haut-Rhin and Corse areas, where specific measures such as cancelling social events or the closure of schools were already introduced by early March.

At the national level, initial measures were followed by the closure of all schools and universities by a decree dating from March 13.

Two days later, all public places, except essential shops such as supermarkets, were also closed, but the first round of the municipal elections (March 15) was maintained. Despite these measures, between March 13 and March 15, the declared incidence of Covid-19 has doubled, and the total number of confirmed cases reached 6,400. As a consequence, the president announced a total lock-down (stay-at-home) policy from March 18 onwards and the second round of the municipal elections was postponed (it will take place on June 28). All employers were asked to put in place teleworking for their employees whenever possible. Only people who cannot work remotely and provide essential services (including health, medical research, production of essential goods…) are allowed to go to work. Others are only allowed to go out for getting food, medical reasons or for short recreation activities in the immediate vicinity of their place of residence. Those who do not respect these rules are now fined a minimum of €135 (up to €450 if they do not pay on time; €200 for the second fine within 15 days), and, after four fines, they risk €3 750 and 6 months of prison. The conditions of the confinement got stricter on March 23 with the closure of open food markets and an intensification of police controls for making people respect the stay-at-home policy. However, some restrictions apply less stringently for individuals living with autism spectrum disorders, who are allowed to go out without any limits on frequency or kilometres to better accommodate their specific needs.

Local authorities (prefects) took additional measures, notably to close down access to the public beaches in Southern France and on the Atlantic coast. All mountain activities, including hiking or skiing, are forbidden.

On March 27, the government announced that the lock-down policy would last at least until April 15. On April 13, the president extended the lock-down until May 11. He announced that visits to nursing homes and hospitals to patients in palliative care will be allowed, taking into account extreme distress of older people and families who were not allowed any visits. Consequently, visits to relatives in nursing homes are allowed again since April 20, albeit under stringent conditions and, in any case, without any direct physical contact, following a national protocol. Starting on June 5, restrictions will be eased and children under 18 will also be able to participate in visits.