Precariousness: an increased risk of Covid-19
Press release of the French National Academy of Medicine and the National Academy of Pharmacy
21 June 2020
People in precarious situations have been particularly exposed to the Covid-19 epidemic because of their economic and social vulnerability. Their living conditions, in over-occupied or insalubrious housing, and the need to maintain a professional activity in their main employment sectors (security, cleaning, large-scale distribution, medico-social) did not allow them to fully protect themselves during the period of sanitary containment. Thus, in the department of Seine Saint-Denis, the poorest in France, with more than 27% of the inhabitants living below the poverty line, the rate of severe forms of Covid-19 requiring intensive care was among the highest.
Other people in precarious situations are highly exposed to Covid-19: residents of social and medico-social establishments (ESMS) with collective accommodation. In the Île-de-France region (IDF), an association for the fight against HIV/AIDS, in conjunction with the Regional Health Agency (ARS), offered in March more than 24 ESMSs to screen infected people and house them in isolation in order to stop the circulation of the virus in these establishments. As in the EHPADs, it appeared that infection levels were high (more than 20% among staff and more than 33% among residents). The vast majority are young people (under 60) whose state of health does not require an hospitalization and who are often asymptomatic. These initial results show that the circulation of SARS-CoV-2 is under-estimated in ESMS with collective accommodation and pleads for an extension of this screening and the support offer to all establishments that receive people living in precarious situations, usually without access to care. Such initiatives must be developed and facilitated throughout France in order to identify outbreaks of contamination as soon as possible and to break the chains of transmission within these structures.
The Academies of Medicine and Pharmacy recommend:
– to implement, under the aegis of the ARS, and throughout the country, a national screening program for Covid-19 among people in precarious situations;
– to facilitate access to free screening tests for the most vulnerable and people remote from health care circuits, whether symptomatic or not;
– to organize screening tests (RT-PCR and serology) in collaboration with city laboratories, hospital laboratories and health establishments able to mobilize biology “outside the walls” with the required safety conditions;
– to ensure the strict respect of medical confidentiality, whatever the screening circumstances and conditions;
– to allocate to ESMS or their partners in a position to carry out in situ screening actions, such as the CEGIDD1, the necessary funding to carry out these screening campaigns among their residents and employees.
 CEGIDD: Free Centre for Information, Screening and Diagnosis (CeGIDD) of human immunodeficiency virus infections, viral hepatitis and sexually transmitted infections