Long lagging behind in this area, France has crossed the symbolic bar of one million weekly RT-PCR tests in recent days for research of Sars-CoV-2, responsible for Covid-19. From August 24 to 30, 1,004,759 diagnoses were carried out in the territory in public and private laboratories, against 855,915 the previous week. That is an increase of 17% in just one week. With results delivered in less than twenty-four hours in 58% of cases, and less than thirty-six hours for 80% of cases, according to the government. On August 27, during a press point, the Minister of Health, Olivier Véran, recognized it however – while speaking about it in the past tense: “We have […] experienced difficulties in accessing tests. In certain areas of France, in particular, difficulties in making an appointment which could be explained by the summer period, by the taking of leave of certain laboratory personnel. “
For professionals in the sector, saturation is still relevant. “Things get stuck in many regions, sometimes with two to three days of waiting for an appointment, and three days for the results, reports Lionel Barrand, head of the union of young medical biologists (SJBM). We find ourselves almost in the situation of tension that we experienced in March. ”Her colleague Morgane Moulis, who works in Occitania, even mentions, in her region, delays in “Four to five days before obtaining the results, for non-priority audiences”.
In question, in a variable way according to the territories: the lack of personnel for the samples, but also of the shortages of material, such as swabs, reagents, and a whole set of small parts which, for the majority, depend on the foreigner . Gold, “International competition remains strong, as at the start of the crisis, recalls Morgane Moulis. And very often, the United States serves itself before everyone else, and we have to wait. “ Also missing, sometimes, the machines themselves (the “automatons”), whose delivery times are counted in months.
A situation of tension which follows an increasingly strong demand for tests, born of a radical change, in recent weeks, of the screening rules, as Olivier Véran again recalled, on August 27: “When [première] epidemic wave, we considered any patient suspected of coronavirus as a priori patient, with or without a biological diagnosis […]. Since then, things have changed. ” In particular because of “Scientific, French, international recommendations, [qui] told us to test more ”. The rule now: “Make the tests available to all those who need it and all those who want it”. In other words everyone … With, as a big change, “The lifting of the obligation of limitation”. No need for a prescription, therefore, since the middle of the summer, no obligation to show symptoms to be diagnosed. Add to this 100% coverage of costs by Social Security. “On paper, that’s very good, if it makes it possible to identify and break the chains of contamination, and to avoid new confinement, says Richard Fabre, president of the regional union of biologists in Occitania. Except that we didn’t think that people would rush to the labs like that. “ Not to mention also “Some people who are seen disembarking several times a week”, laments Morgane Moulis, who is in charge of a drive-test in the Toulouse region. In order to limit this influx of candidates, made up of nearly 80% asymptomatic, the government had established, on August 26, a doctrine of “prioritization”, placing first “People who are symptomatic or have been in contact with a patient”. A public for whom the examination had to be carried out within twenty-four hours, and the results delivered within the following twenty-four hours. “Except it doesn’t work like that, explains Morgane Moulis. Everyone who comes is obviously saying that they have symptoms to be a priority. We see it on discussion forums on the Internet, they give each other all the good advice to get ahead. “ Even if in principle, according to health insurance, “The patient, in the event of symptoms, must consult his attending physician as soon as possible”, who will then give him, “If the suspicion of infection is confirmed, a medical prescription for a screening test”. A request more than an obligation.
There is also strong pressure from travelers, for whom many airlines or states require a recent negative test. In France, for example, any person over 11 years old traveling from mainland to the French overseas departments and territories must present a test carried out in the seventy-two hours before take-off. Finally, another “hurried” public: patients having to undergo surgery. The French-speaking Society for Infectious Pathology (Spilf) indeed recommends that a test be carried out within twenty-four to forty-eight hours preceding the operation. Result: “Even with the doctrine of prioritization, which is difficult to apply, we do not get by, worries Lionel Barrand. We have to police between very aggressive people. We have a huge weight on our shoulders. ” Morgane Moulis, for her part, admits refusing people: “A person who has no symptoms, or who is not at risk of contact, has no reason to come for testing! Because of this influx of just anyone, we are falling behind for real patients and contact cases. ” Delay which then has repercussions on the work of tracing contact cases and neutralizing chains of contamination.
For Richard Fabre, “This situation is the result of the telescoping of two different philosophies: that of the test as a public health tool and that of the test as a medical diagnosis. Suddenly, the identification of patients is drowned in the tests of Mr. Everyone ”. Faced with this situation, the union of young medical biologists calls for a refocusing of the screening strategy. “We must put in number 1 people with prescriptions and with symptoms”, considers its president, Lionel Barrand. And for the asymptomatic, “We must test those at risk, but not all asymptomatic, otherwise it does not make sense.” Morgane Moulis, she calls for the return of the prescription obligation, “Which will also make it possible to restore the person to a course of care”. And for contact cases, “The presentation of an ARS document [agences régionales de santé, ndlr]». Application is also made of “Eliminate or limit as much as possible the massive screening campaigns, the massive sending of subscription warrants and the performance of systematic tests among all nursing home residents every month in the absence of symptoms or positive cases”. For air transport, the union proposes that the time limit for the test be reduced from seventy-two to ninety-six hours.
A service also open to health insurance investigators, in charge of identifying contact cases. “This makes it possible to prioritize test requests on real health emergencies, Covid patients or suspected Covid, explains the doctor Jean-Claude Azoulay, coordinator of the operation. 70% of Ile-de-France labs have integrated this secure test network and made strong commitments: they must have an on-call biologist who can be contacted at all times, commit to giving an appointment within twenty-four hours and the results of the tests within twenty-four hours. “ If the platform is slowly gaining momentum, with nearly 150 meetings obtained every day since the start of the school year and a request satisfaction rate close to 100%, it is however far from meeting daily demand in Ile-de-France. “We need to focus on providing information to doctors: not all are aware of the existence of this platform, and of the dedicated telephone number, recognizes Jean-Claude Azoulay. Many practitioners are still trying to reach the labs directly, as the instructions were given to them at the start of the epidemic, but the labs are so pressurized that they no longer respond. ” If success is confirmed, the experience could be rolled out in the Paca and Bourgogne-Franche-Comté regions.
Salvation, finally, could come from a technological innovation: the saliva test, currently being tested at AP-HP and in Guyana (Salicov-AP-HP and Covisal programs). “The saliva test represents a lot of advantages, supports doctor Solen Kernéis, from the infection prevention and control service at Bichat hospital, in Paris, and principal investigator of the Salicov-AP-HP study. It is much easier and faster to perform than a nasopharyngeal swab, and there is no need for special qualifications for the staff, nor for specific equipment. For example, we will avoid shortages of swabs. “ A way to streamline the circuit and massively increase the number of people collected. “If we are hyper optimistic, we can even imagine that people sample themselves, a bit like for a urinalysis”, says Solen Kernéis. In the meantime, the union of young biologists asks the government to launch a massive vaccination campaign against influenza and gastroenteritis, “In order to limit the number of cases” which would be added this winter to Covid patients. At the risk of attending, otherwise, the“Explosion of the entire screening and care system”.