COVID-19

Covid-19: a month after the end of free trials, what effects on the monitoring of the epidemic?

Since October 15, adults not vaccinated against Covid-19 must pay for their so-called “comfort” exams, that is, the purpose of which is, for unvaccinated people, to obtain a temporary proof of the health pass. For these some six million citizens, each test now costs between 22 and 45 euros (and ten euros for supervised self-tests, again authorized for the health pass), if it is not justified by medical prescription. Or follow-up of contact cases

Read also Covid-19: what exceptions to the end of free PCR and antigen tests?

Beyond the question of the budget, which can be significant for the most precarious, the scientific council was concerned, in its opinion of October 5, about a “certain form of difficulty in interpreting epidemiological data” due to the decrease in the number of number of projections made. “The tests were already a bad indicator. It will just get even worse from now on, ”epidemiologist Catherine Hill judged in Marianne on October 23. One month later, what were the effects of ending routine screening coverage?

1. Decrease in the number of tests

Predictable consequence: after a spike on the last day of “free”, the number of daily tests has fallen by around 35% since October 15 (on average over the last seven days, all ages, regions and test types combined).

However, this decrease is more measured than the representatives of the profession had anticipated, for several reasons:

  • After the strong increase in the number of tests during the summer, after the entry into force of the health pass, a decrease in screening had already begun as of the third week of August, a corollary of the decline in the epidemic and the strong increase in vaccination . coverage in mainland France;
  • the number of tests remains “at a high level, comparable to that registered a year ago,” as the Directorate for Research, Studies, Evaluation and Statistics (Drees) pointed out on 4 November;
  • the recent period has been interrupted by school holidays (October 23 to November 8) which reduced screening among children, as well as by two public holidays (November 1 and 11).

The number of tests continues to decline as of August.

RT-PCR and antigen test data, by collection date, ranging from Wednesday May 19 for . The curves represent an average of seven days.

2. Reducing the use of screening tests in asymptomatic and unvaccinated adults

The government appears to have achieved its goal of limiting “personal fitness” testing in asymptomatic unvaccinated adults. At least that is what the most recent data, published by Drees, indicates when crossing the file that lists the tests, Sidep, and the information system that tracks all the injections of vaccines against Covid-19, Vacsi.

The detection rate (only by RT-PCR tests) has been relatively stable for symptomatic unvaccinated people over 20 years of age. But, if we include the asymptomatic, it has been significantly reduced.

This decrease is probably underestimated, since RT-PCR tests account for less than half of the tests performed each week, and their cost is higher. However, Drees does not offer this same data set, including antigenic tests.

Routine elimination of tests has affected the unvaccinated more

Daily detection rate (RT-PCR tests only on collection date), average of seven days, from for , for the population aged 20 and over, corresponding to 100,000 inhabitants.

Vaccinated

… of which symptomatic

Not vaccinated

… of which symptomatic

3. An increase in the incidence rate “moderately underestimated”

But has this drop in screening tests among the asymptomatic, also measured by Public Health France (SPF), allowed new cases of Covid-19 to go unnoticed? At a constant level of viral circulation, the number of newly diagnosed patients is, in fact, by definition higher in a territory where more tests are carried out: screening makes it possible to identify more cases, even in small numbers.

Therefore, with the end of the free “comfort” tests, we could expect a mechanical drop in the incidence rate (number of positive cases per 100,000 inhabitants). However, asymptomatic and unvaccinated people undergoing the health pass test rarely carried SARS-CoV-2. The rate of positivity among this public “being low (less than 1%), the impact was minimal in the incidence rate”, explains Public Health France to the World.

But in parallel with the systematic elimination of tests, the circulation of the virus has increased. Thus, from October 18 to 24, 2021, the incidence rate increased by 14% compared to the previous week … while screening decreased (-21%). The increase was maintained in early November. It seems corroborated by other indicators. Thus, from November 1 to 7, visits to the emergency room and the actions of SOS Doctors for suspicion of Covid-19 increased respectively by 7% and 22% compared to the previous week, correcting the effect of the holiday. As for new hospitalizations, these increase or stabilize depending on the region. These data are subsequent to those associated with the tests, with the incubation period of five to seven days, that of a possible worsening of the disease from seven to ten days.

This long-term analysis of the different indicators makes it possible to overcome the limitations of each of them, particularly those related to virological tests. In addition, their analysis requires a lot of precautions, especially during the transition phases between various detection policies (the one related to delisting, in the opinion of SPF, is now over).

Read also Incidence rate, number of people vaccinated: definitions and limits of the main Covid-19 indicators

4. No rebound of the first injections

By limiting free trials, the government sought to “continue to encourage people to get vaccinated” against Covid-19, as justified by Prime Minister Jean Castex in late September. But if now more than 75% of the French population is vaccinated, the elimination of the tests was not accompanied by a resumption of the first vaccine injections.

These only concern almost 20,000 people per day, far from the peak of 370,000 daily bites observed in early August, after Emmanuel Macron’s speech announcing the establishment of the health pass and already beginning the future elimination of the “comfort tests” for the unvaccinated.

No increase in injections since mid-October

Daily number of first injections, from for . Figures are seven-day moving averages.

Find below the screening test reimbursement conditions:

no yes Are you fully vaccinated? Are you a minor? You do not have to pay for your exam. Have you tested positive for Covid-19 in the last 6 months? (Certificate of recovery, positive antigen test to be confirmed) Do you have a prescription? Have you been identified as a contact case? (By Health Insurance, in TousAntiCovid or by the regional health agency, or by National Education) Do you have any contraindications for vaccination? Do you carry out a quarantine exit test, or is it imposed on your trip between the metropolis and abroad / New Caledonia? The tests carried out are at your own expense *. Its price varies according to several parameters, in particular the type of test. The reference price for RT-PCR tests in medical biology laboratories is € 43.89. * The tests will be free in Guyana and Martinique until the end of the state of emergency (until 06/12 in Guadeloupe). In Mayotte, trials are still free.

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