Policy responses for France - HSRM


Policy responses for France

1.5 Testing

The end of the lock-down on May 11 will be accompanied by the systematic testing of health professionals, older people and vulnerable individuals as well as, progressively, of all persons presenting symptoms of Covid-19 or those in contact with an infected case. In line with the necessity to resume healthcare following the end of the lock-down period, Covid-19 testing has also been made compulsory before undergoing any kind of surgery. The objective was to carry out at least 700,000 tests per week. To increase the testing capacity, all research and veterinarian labs, in addition to private laboratories, are now requested to support public laboratories.

At the end of the lock-down on May 11, between 150,000 and 250,000 tests were done every week. This number progressively increased, reaching 380,000 per week mid-July. On August 27, the Ministry of Health declared that laboratories need to reach 1 million tests per week to face the increase in the number of positive cases.

On June 30, the Ministry of Health announced that 32 towns of more than 10,000 inhabitants located in the Parisian region, but excluding Paris, will participate in an experimental campaign of massive Covid-19 testing. Selected towns are those with the highest rate of Covid-19 infections. 1.3 million individuals will receive a coupon to access free virological testing in public or private medical laboratories. The aim is to identify dormant clusters of asymptomatic cases. This experimentation could be extended to Paris or to other regions if proven conclusive in identifying additional clusters. In fact, it has already been carried out in additional territories facing a surge in Covid-19 infections. However, medical laboratories struggle to face the high demand for testing and very long waiting times have been reported (up to one to two weeks), with strong geographical variations, threatening the limitation of contaminations through early detection of positive cases (recommended within 24 hours of the first symptoms). Therefore, new professionals including lab technicians, nurses, assistant nurses, students in health career tracks (pharmacy, odontology and midwifery), firemen and first-aid workers are now allowed to carry out Covid-19 tests. Drive-through testing centres have also been set up in some territories to facilitate patient turn over (no need to disinfect premises after each patient, etc.). Since July 25, PCR tests are fully reimbursed by the social health insurance fund, even without a prescription, while their price, set at €73.59, is above to that of other European countries.
French nationals arriving in airports and ports from countries where the circulation of the Covid-19 is not under control will have to provide the results of a negative test carried out within 72 hours of their arrival or be tested on site before being able to enter the French territory. Individuals with positive test results are contacted by regional health agencies and asked to self-isolate at home or in dedicated places.

Since July 11 and until October 30, it is also possible for any adult to obtain a rapid serological test of Covid-19 in community pharmacies without a prescription. These tests are not intended for patients with current symptoms of a possible Covid-19 infection but for patients who think they might have been infected in the past. Such tests will be charged around €20 and so far are not reimbursed by the social health insurance fund. In case of positive results, patients will be addressed to medical laboratories to carry out further testing. 51 types of rapid serological tests have been authorized for distribution in community pharmacies by the Ministry of Health.

Following a high congestion on testing services in October, a new strategy was devised. It includes a priorisation of individuals tested (with dedicated plots in testing labs): people displaying symptoms of Covid-19, those with a medical prescription, contacts of a positive case and healthcare workers. This was combined with the implementation of ad hoc pop-up sites dedicated to Covid-19 testing (including 20 new sites in the particularly affected Parisian region), and distribution of new rapid antigenic tests. These tests can be carried out by physicians, pharmacists and nurses (who receive extra-funding for this purpose) and have been authorized by the French national authority (HAS) on September 25 for individual testing of symptomatic individuals. By November, their use was encouraged for collective testing in population groups with high exposure (e.g. university students and staff, abattoir staff…). Wide antigenic testing campaigns are also planned in nursing homes with weekly testing of staff. Since December 8, cases detected through antigenic tests are counted in the daily number of new positive cases (which was not the case previously).
At the end of January 2021, the national health authority (HAS) delivered a positive assessment of the efficacy of saliva Covid-19 tests in second intention for contact cases for whom a nasopharyngeal test is not possible or in first intention for targeted large-scale repeated screenings. This testing method is, in particular, expected to be deployed in schools and nursing homes after the winter break. However, medical laboratories expressed their concerns about the lack of capacity to analyse such large-scale testing results.

The testing strategy was reinforced following the onset of new variants of the Covid-19. Since early February 2021, each positive test (either a PCR or an antigenic test) must be followed within 36 hours by a specific multiplex PCR test which allows identifying the “British”, “South African” and “Brazilian” variants. A particular attention is then given to patients infected by these new strains of Covid-19 by contact tracing teams, which further insist on the necessity of stringent isolation. Regional health agencies are systematically informed about the presence of this variant on their territory. Indicators on variants involved in the positive cases tested is available on the Public Health Agency website.
Saliva tests, authorized by the HAS, have also been rolled out in schools since mid-February to allow for mass testing of pupils and staff to avoid clusters but were finally not sufficient in preventing schools from closing.

The policy on testing has been evolving in France in line with the evolution of the spread of the coronavirus. Patients with symptoms that are similar to those of Covid-19 are no longer systematically confirmed by testing.

Systematic testing was long limited to individuals with symptoms similar to those of Covid-19 who also have one of the following characteristics: signs of severity, health professionals or fragile and at-risk individuals, the first three individuals living in institutions for vulnerable populations, hospitalized patients, pregnant women and organ donors. For hospitalized patients, testing is carried out within hospitals, while others can be tested in the community upon medical prescription. Early April, the government has finally decided to launch large-scale testing in nursing homes and institutions for disabled individuals, both for residents and staff, using biomedical laboratories, the medical care reserve (see Section 2.2) and mobile testing buses.

The Ministry in charge of health has estimated the number of available tests per day at around 5,000 but expect to increase this capacity quickly. However, France has developed a dependency on international providers (in particular from China and the US) for the reactive of these tests, which limits national autonomy.

Mobile drive-through clinics have not been implemented at a large scale in France, but there are some similar local initiatives developed by biomedical laboratories.

On April 13, the president announced that the relaxation of the lock-down policy by May 11 would be accompanied by the systematic testing of health professionals, older people and vulnerable individuals as well as, progressively, of all persons presenting symptoms of the Covid-19 virus or in contact with an infected case.