The Covid-19 monitoring and surveillance system has been considerably simplified. To the point of no longer being able to assess the evolution of the pandemic?
While a first case of the BA.2.86 variant has been detected in France, the analysis of wastewater shows an upsurge in the epidemic and the latest figures indicate an increase in visits to emergency departments for suspected Covid-19, how, three years after the start of the pandemic, do we continue to monitor the evolution of SARS-CoV-2?
“We only have a fragmented idea of the situation,” regrets epidemiologist Dominique Costagliola, member of the Academy of Sciences and emeritus research director at Inserm, for BFMTV.com.
Because since last July, the Sidep portal – for population screening information system – launched in spring 2020 to monitor the pandemic has been closed. A closure provided for by law putting an end to the exceptional regimes created to fight the covid epidemic.
This system allowed exhaustive monitoring of all tests – PCR and antigens – carried out in hospitals, laboratories, pharmacies but also nurses’ and doctors’ offices. It gave the number of new daily cases, the positivity rate, screening rate, incidence and even reproduction of the virus.
Although new software, Néo-Sidep, makes it possible to collect the results of laboratory tests, this does not concern those carried out in pharmacies or self-tests. And the data is not public. Regarding the situation at the hospital, the numbers of hospitalizations of positive people, entries into intensive care or new admissions to intensive care are no longer communicated.
“With a wet finger”
So, have we become blind to monitoring the epidemic? “Partly,” observes Dominique Costagliola, also deputy director of the Pierre-Louis Institute of Epidemiology and Public Health, vice-dean of the Sorbonne University faculty of medicine. “We do so few tests, including in hospital, that it is not representative.”
“On the number of cases, on the type of variant, we have no reliable information. It’s a wet finger.”
The only data available: the reasons for going to the emergency room which are the subject of a weekly bulletin from Public Health France as well as home visits from SOS doctors. For the former, after a last week of increase among 2-14 year olds and a previous one in all age groups, visits to emergency departments for suspected Covid-19 are stable among adults, indicates the latest Oscour bulletin.
As for medical procedures by SOS doctors for suspected Covid-19, the increase also continues: +19% from September 18 to 24, notes the latest national information bulletin, after a previous increase which was already 19%.
For what impact? According to the Sentinelles health monitoring network, the incidence rate of cases of Covid-19 – presenting respiratory signs seen in general medicine consultation – is estimated at 95 cases per 100,000 inhabitants.
“This rate is increasing compared to the previous week (which was then 81 cases per 100,000 inhabitantsEditor’s note), or 49,248 new cases”, writes the latest bulletin. Data obtained from the observations of 558 general practitioners and pediatricians who participate in this network.
“We are in the fog”
While the Minister of Health, Aurélien Rousseau, indicated in an interview with La Montagne an incidence rate “around 41 new contaminations per day per 100,000 inhabitants”, epidemiologist Dominique Costagliola points out the fact that these figures do not correspond to those of Public Health France.
“We are not told the total number of tests carried out, so I do not see how we can estimate the incidence. Which makes me say that we cannot characterize the extent of the current situation.”
“We are rather in the fog”, nuance for BFMTV.com Mircea Sofonea, researcher and lecturer in epidemiology and evolution of infectious diseases at the University of Montpellier. “A fog that gradually settled in.” Because according to him, even before the disappearance of Sidep and Sivic (for hospital data), “visibility on the epidemic was already less due to the drop in screening”.
If this epidemiologist confirms that the recovery is attested – “with a higher incidence than certain previous waves” – he believes that the current data contains biases, that they are too fragmented and do not overlap.
“If the situation deteriorates, we won’t know which indicator to believe.”
“A risk of persistent symptoms”
To counter this fog, it would have been necessary, according to Mircea Sofonea, to set up a reactive substitution monitoring system; as has been done in other countries, notably with random screening of the population. But he deplores the lack of interest and investment from the French authorities in monitoring and surveillance of Covid. He himself saw his requests for funding refused in order to continue his research.
“The problem with Covid is no longer the saturation of intensive care units, although last winter the situation was very complicated in pediatric departments.”
“It’s the fact that we have a virus circulating, which can infect us several times in the same year, with a significant risk of persistent and disabling symptoms.”
Repeated Covid infections can in fact present an increased risk of developing heart and lung problems, brain conditions, kidney disease or diabetes.
Wastewater and Sequencing
Another avenue: wastewater monitoring. This is precisely the mission of the Obépine network – the Epidemiological Observatory in Wastewater – created during the Covid-19 health crisis which recently observed an upsurge in the epidemic. But only around thirty treatment plants out of the approximately 21,000 wastewater treatment plants in France are monitored. The Sum’eau national network, dedicated to microbiological surveillance of the virus, was to take over but no data has yet been published.
“Wastewater monitoring is a good early indicator of rebound or decline of the epidemic,” recognizes Mircea Sofonea. “But this will only give us the concentration of SARS-CoV-2, not the number of cases or the size of the epidemic,” he warns.
One question remains: surveillance of variants. For Dominique Costagliola, it is currently insufficient. “We are told that the variants are being monitored. But in the latest update from Public Health France on variants, it is less than 200 sequences (the sequencing of the virus allows us to know if it has mutated, Editor’s note) which have been carried out.” Epidemiologist Mircea Sofonea agrees: “With less than 500 sequences, we should not expect to detect a new variant, you are missing out.”
But rather than wondering about the dangerousness of this or that new variant, Dominique Costagliola believes that it would be preferable to adopt lasting measures. From indoor air quality in schools, hospitals and nursing homes to an effective monitoring system so that the population is well informed and takes action.
“It is a public health problem which justifies investment but France acts as if it no longer exists.”
Initially scheduled to start on October 17, “in view of the epidemiological circumstances”, the Ministry of Health has decided to bring forward the new vaccination campaign to this Monday.
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