French testing system missed 9 of 10 COVID-19 cases after first lock-down

On December 21, Nature published a peer-reviewed accelerated article titled, “Under-detection of cases of COVID-19 in France threatens epidemic control.” In the paper, epidemiologists and data scientists led by Giulia Pullano use mathematical modelling to chart the estimated spread of the virus in France over seven weeks—from the end of lock-down measures, on May 11, to June 28. They compare this estimated spread of the virus to the recorded cases to measure the effectiveness of France’s test and trace system in this period.

During this period, Santé publique France (the public health system) recorded a few hundred cases a day. However, the authors estimate that France’s testing system missed around 90,000 symptomatic COVID-19 infections. This amounts to 86 percent of symptomatic cases. As many cases are asymptomatic, however, the true rate of detection in this period was likely well under 10 percent.

A nurse holds a phone while a COVID-19 patient speaks with his family from the intensive care unit at the Joseph Imbert Hospital Center in Arles, southern France, Wednesday, Oct. 28, 2020. (AP Photo/Daniel Cole)

This massive under-detection of the virus, due to a lack of testing, removed the real possibility of stamping out the virus in France after the first wave and of preventing the devastating second wave currently engulfing the country and claiming hundreds of lives every day. Since the end of the first lock-down on May 11, 36,621 people have died from the virus—taking the total number of COVID-19 deaths in France to nearly 63,000.

In a comment published by Nature alongside the paper, Columbia University virologist Jeffrey Shaman stated: “The findings suggest that the overall testing and control system in place was inadequate to contain the virus successfully in this country of around 65 million people.” He added that “many countries, as a result of leadership failures, cultural or institutional barriers, or simple fatigue, have failed in their efforts to achieve or maintain control of the virus.”

The paper found that in this seven-week period, only 31 percent of those with COVID-19-like symptoms consulted a doctor. For the majority of the French population, during this period it was necessary to contact a doctor for a prescription before receiving a test. Shaman concluded that this byzantine process “might have disadvantaged communities that have more limited access to health care, and reduced testing rates.”

This suggests that having only 1 percent of tests turn out positive by itself does not guarantee that the pandemic is controlled. Throughout the seven-week period, the proportion of positive tests never exceeded 1 percent. That the virus kept spreading anyway shows that a massive increase in testing—along with a shutdown of non-essential production, services and educational facilities—is critical to control and eradicate the virus. Even with the production of a vaccine, such measures are needed to save hundreds of thousands of lives in the coming year.

The paper’s findings constitute an indictment of the French government’s criminal policy of malign neglect in response to the pandemic—i.e., to protect profits while the virus spreads throughout the population. The premature end of initial lock-down measures, the reopening of schools and workplaces, and an underfunded and underdeveloped testing system, made a deadly resurgence of the virus inevitable.

President Macron announced a lock-down only on March 16, after a wave of wildcat strikes and sick-outs spread across Europe. Directed by the profit demands of big business, the French government prematurely ended the lock-down on May 11 and forced workers back onto the job. This reckless policy was criticized by scientists at the time.

Numerous media groundlessly speculated, however, that “herd immunity” might have been reached in France. The Pasteur Institute refuted these claims, issuing an estimate that only 4.4 percent of the population had been infected and warning: “our results show that, without a vaccine, herd immunity alone will not be enough to avoid a second wave at the end of the lock-down. Efficient control measures must thus be upheld after May 11.”

To falsely reassure workers that the virus was no longer a threat, the government announced a rapid expansion of testing and tracing. The success of test-and-trace campaigns combined with strict lock-downs in countries with sharp initial outbreaks, like China and South Korea, showed such measures effectively control the virus.

Macron said, “Starting on May 11 we will have a new system to make this step [the end of lock-down] a success.” Then-Prime Minister Édouard Philippe described his government’s strategy as “Protect, test, isolate.” This system was detecting less than 10 percent of new cases, however.

The obstacles the government placed to workers’ access to testing suggest that Macron and his ministers were aware testing capacity was limited. From May 11, most Frenchmen had to obtain a prescription from their doctor before receiving a test. The government claimed this was necessary to prevent abuse of the system; in reality, this deliberately imposed a barrier that cut the number of tests conducted.

It was not until August 23 that the target of 700,000 weekly tests was reached. By then, the virus was out of control and the second wave well under way. On September 11, Prime Minister Jean Castex announced that medical staff were now being prioritized as testing capacity was stretched to its limit. On September 16, staff at 20 testing clinics in the south of France went on strike over poor pay and exhausting working conditions.

By September 17, France’s positive test percentage exceeded 5 percent: according to WHO guidelines, based on the 1 percent positive test rule, the virus was out of control. In September, Macron reportedly rebuked Health Minister Olivier Véran for the 12-day delay to obtain test results. At that time, many people claimed that they were not receiving test results at all.

By October 12, the positive test rate exceeded 10 percent: tens of thousands of positive tests were being returned daily. This preceded a sharp rise in hospital admissions, which was followed by the hundreds of daily deaths ever since. With new cases and deaths at this scale, contact tracing was impossible.

In late September, amid the ongoing resurgence of COVID-19, the government passed its 2021 budget. In this only €9.8 billion went for emergency health spending, while a further €42 billion and a tax cut were handed to the banks and corporations.

The partial lock-down measures adopted in November, which left both schools and factories open, did not stem the spread of the virus. Their further relaxation over the Christmas and New Year period is setting the scene for a further surge of deaths in the new year.

The Nature paper shows that the Macron government’s policy undercut the gains of the first lock-down. In May, a sufficient expansion of testing on a Europe-wide basis could have eradicated the virus in France and across Europe. Instead, billions of euros were given to the banks and corporations, schools and workplaces were reopened, and insufficient testing and tracing failed to contain the virus.

Like its counterparts across Europe and in the United States, the Macron government placed profit before lives at every step of its response to the pandemic. The winter surge in COVID-19 deaths is only getting underway, but this policy of malign neglect has already led to hundreds of thousands of preventable deaths.

Against the anti-scientific response of the ruling class, there must be an international struggle of the working class armed with a program that uses the best available scientific research in response to the pandemic, unobstructed by the profit concerns of the capitalist elite.