Feedback: designing an effective screening
Press release from the French National Academy of Medicine
October 20, 2020
The acceleration of the Covid-19 epidemic, identified in France for several weeks, has not been controlled, hence the need for partial containment: many departments and large urban areas have been placed under a state of health emergency with curfew. This necessary decision was based on 3 recently defined indicators: (i) an incidence rate above 250 per 100,000, (ii) an incidence rate among people over 65 above 100 cases per 100,000 and (iii) an occupancy rate of intensive care beds by Covid-19 patients exceeding 30%. These late indicators, essential when the epidemiological situation compromises the capacity of intensive care units [1], should be supplemented by earlier warning systems allowing an early response to keep the epidemic under control. Despite a ” priority doctrine ” of RT-PCR tests introduced one month ago, the “test, trace, isolate” strategy fails to break all the chains of transmission: results are delivered too late, tracing capacities are insufficient and isolation is not systematically respected. The too late release of rapid diagnostic orientation tests (TRODs) has deprived the fight against the resurgence of an essential weapon [2]. The new strategy “test, alert, protect” promulgated on October 14, faces the same obstacles and is currently overwhelmed by the intensive circulation of SARS-CoV-2 throughout the country.
As the evolution of the Covid-19 pandemic suggests a series of rebunds punctuated by the intensity and continuity of the control measures implemented, it is necessary to draw lessons from the decontainment and to anticipate a targeted screening strategy to be implemented as soon as the health emergency measures are lifted. The priority objective of this strategy must be the early detection of SARS-CoV-2 transmission outbreaks, without waiting for the first symptomatic cases to appear, in order to rapidly circumscribe them.
The French National Academy of Medicine recalls the recommendations of June 28th which aimed to avoid the prospect of a re-containment [3] :
– to organize periodic screening, preferably weekly, in at risk communities (health facilities, EHPADs, companies, schools, universities, army, prisons, etc.) using antigenic TRODs or other rapid tests that could be approved [2] ;
– to promote a continuous wastewater monitoring program throughout the territory in order to locate early population groups where SARS-CoV-2 starts circulating again [5] ;
– to provide each Regional Public Health Autority with one or more regional mobile screening teams equipped with a portable laboratory and capable of responding within 24 hours to any detected outbreak;
– to involve local physicians more actively in diagnosing cases and screening contacts by using antigenic TRODs and indicating isolation measures;
– to obtain the support of a major part of the population to the “Tous Anti-Covid” (“All Anti-Covid”) application through an understandable and convincing communication campaign;
– to reinforce the human resources dedicated to tracing contact cases and verifying the isolation of contaminated persons.
[1] Press release of the French National Academy of Medicine “Don’t wait for a second wave”, September 28, 2020
[2] Press release of the French National Academy of Medicine and the National Academy of Pharmacy “Covid-19 tests: searching a Strategy”, October 9, 2020
[3] Press release of the French National Academy of Medicine “Let’s deconfine carefully for not having to to reconfine in a hurry”, June 28, 2020
[4] Press Release of the French National Academy of Medicine “Covid-19: screen more, screen better”, August 3, 2020
[5] Press Release of the French National Academy of Medicine “Covid-19: monitoring of SARS-Cov-2 traffic in wastewater, simple indicator for monitoring the Covid-19 pandemic”, July 7, 2020
