Policy responses for France - HSRM


Policy responses for France

1.3 Isolation and quarantine

Isolating confirmed cases was presented as a key point of the transition strategy to end the lock-down. People who are confirmed as Covid-19 cases will be asked to self-isolate at home. If this is not possible because of family situations, they will be hosted in requisitioned hotels for 14 days. All people who have been in contact with someone who is tested positive will be asked to self-isolate for 14 days. In the frame of the state of emergency prolonged until July 10, the government initially asked for a compulsory quarantine for all people arriving in France from countries outside Europe, even if they did not present any symptoms of Covid-19. If they presented symptoms and tested positive, they were to be isolated even more strictly, with no contacts within their place of quarantine. However, these measures were judged anti-constitutional and banned by the Constitutional Council on May 11, and they will only be applied on a voluntary basis.

Local GPs and the agents of health insurance funds will be asked to provide support for identifying potential contacts outside the household (including through telephone surveys).

Concurrently, the government was considering the possibility of launching a mobile application (StopCovid) to retrace physical contacts of individuals infected by the Covid-19 virus (in particular in public transports). Despite strong debates regarding the protection of private data and the tracing of citizens, the proposition was presented to the National Assembly on May 27, voted by deputies and released on June 2. Three weeks after its launch, 1.8 million individuals had downloaded the application, accounting for less than 3% of the French population (while 20% were estimated necessary for the app to be useful).  Technical malfunctions of the app were reported and supposed to be corrected in later versions. By October, there were 2.6 million downloads, 7,969 confirmed infections declared on the app, and only 472 persons alerted that they may have been in close contact with such cases (for a monthly cost of the app of around €100,000 and at a time when there were about 20,000 new positive cases a day). It is estimated that, in total, the StopCovid app had an annual cost of €6.5 million, including more than €2 million for communication only. A second version of the tracing app, which changed its name (“Tous anti-Covid”), was launched on October 22 given the lack of downloads in comparison to similar apps in other European countries. The new app provides additional information on the sanitary situation (circulation of the virus, nearest testing points…). It also provides direct access to certificates necessary to be able to circulate during the new lock-down, which may explain the rapid increase in the number of downloads in November (nearly 8.6 million by mid-November and 11 million by early December). The definition of contact cases through the app has also evolved: previously, a person who had spent more than 15 minutes within less than a meter of a confirmed positive case was considered as contact; the duration has now been reduced to 5 minutes. On September 11, the government announced that the quarantine duration for people suspected of being infected with Covid-19 was reduced from 14 to 7 days, to ensure that more people comply with the rule. Inspections were also announced but their modalities remain unknown.

To ensure a better isolation of positive cases and their contacts, the conditions of sick leave are simplified and extended, starting on January 10, 2021. Symptomatic individuals and their contacts will be able to obtain an immediate sick leave. They can apply for this on the website of the SHI fund, which will carry out a follow-up by phone and organise a nurse visit at home.

The management of quarantine in France has not been coherent. Initially, people coming from the first epicentre of the epidemic (Wuhan region) have been flown from China and put into quarantine for 14 days in the south of France in holiday facilities. But when the virus arrived in Italy, the policy was to tell people to self-quarantine themselves at home for 14 days if they came from Italy or if they had been in contact with people from Northern Italy, without any coercive measures.

With the emergence of confirmed infected cases on the French territory, isolation measures were extended to all people who had been in contact with such cases.

Suspected cases were initially isolated in hospital settings, but hospitals no longer have enough capacity to host all patients, and therefore patients are required to stay at home, except in cases of severe forms of the disease. Strict at-home isolation is now compulsory for all patients with a diagnosis of Covid-19 and their household members, and health professionals are told to advise their patients to lift isolation following strict clinical guidelines based on the time of apparition of the first symptoms and their disappearance.