Covid-19: “Test, trace, isolate”, a strategy undermined by Omicron



In two years of health crisis, Pierre-Olivier Variot had never seen this. “Last week, we tested almost all kindergarten and primary school students in the city. And we’re good to start over this week ”, breaths the president of the Union of dispensing pharmacists (USPO), stationed in Plombières-lès-Dijon (Côte-d’Or).

→ READ. Covid-19: Jean Castex announces a simplification of the health protocol at school

The health regulations at school may have been lightened at the end of the week, the pupils with contact cases are still required to carry out an antigen test on “D + 0” if they want to be able to return to class the next day. Results, “Some pharmacies see 40 students arrive at once, reports David Abenhaïm, head of the Pharmabest group. The teams are tired, stressed by these incessant changes in protocol. “

Never have the French been so tested

As for customers, they must be patient. Because to the long queues in front of pharmacies and laboratories are added the “bugs” of the Sidep platform, the national screening information system, extending the time taken to obtain their results. “From 5 p.m., it’s no longer worth trying, assures Pierre-Olivier Variot, the site is blocked. “

Overheating and for good reason: the French have never been so tested as at the start of the year. Between December 31, 2021 and January 6, 2022, 9.5 million PCR and antigen tests were performed, a quarter of which were in children – and not counting self-tests, which the French also use heavily.. “It was still playable during the holidays, but here, it becomes excessively complicated”, continues the president of the USPO, who says he is forced to make the “Sorting” between clients to avoid“Embolism”. “It earns me insults, but when there are too many people, I prefer sick people or contact cases. Non-vaccinated people who need to be tested to go to a restaurant go after ”, he assumes.

“Hundreds of screening centers” soon to be established

Announced Sunday by government spokesman Gabriel Attal, the upcoming opening of “Hundreds of screening centers” should facilitate access to tests. But, beyond the capacities, it is the very meaning of this massive screening that questions, while exhaustion threatens all health professionals, underlines Michèle Legeas, teacher at the School of Advanced Studies in Public Health (EHESP).

→ EXPLANATION. Covid-19: how the Omicron variant weakens the vaccine strategy

“We fell back a bit into logic: I get tested before going to see my friends or my grandmother, she laments. Not only does this weigh on the health system, but it is not a guarantee, because we can be negative one day and positive the next ”, insists this specialist in health risk management, for whom “The logic to test, trace, isolate” is reaching its limits.

She herself had contact at the time of the end of the year holidays, she did not get an appointment for a PCR until five days after her exposure to the virus. As for Medicare, it never joined. Nothing surprising according to Yannick Simonin. “For Medicare to effectively trace contact cases, there must not be more than 5,000 contaminations per day, recalls this virologist at the University of Montpellier. With 300,000 cases per day, this strategy is no longer tenable, unless thousands of staff are assigned to this operation. “

2,000 calls per day in Hauts-de-Seine

According to the Minister of Health Olivier Véran, “10% of the French population is in contact”. Unable to call as many people, Medicare set up, at the beginning of December, the sending of automatic SMS, reminding the isolation measures and referring to the instructions available on the Ameli.fr site. “This allows us to make the mass”, specifies Margot Godart, director of “Contact tracing” at the Hauts-de-Seine CPAM.

In this department where the incidence rate is close to 1,500 cases per 100,000 inhabitants, 110 telephone advisers, the majority of whom are on fixed-term contracts, work full time, seven days a week. “In one month, we went from 500 to 2,500 calls per day, indicates Margot Godart. Recruitments are still in progress, but it would take thousands of tracers to cope with the increase in the number of zero-daily patients. “

Therefore, the logic of prioritization has become essential. “Currently, agents mainly call people who do not have a known cell phone, potentially elderly people or people far from digital, but also people not or not fully vaccinated”, reports the manager of the platform Véronique Quintanna. As the outgoing calls are reduced, his “brigade” is more dedicated to incoming calls. Those of the insured worried or unable to recover their sick leave.“They need explanations but also to be reassured”, underlines Margot Godart. The others are independent and find information on official sites. “

Test so as not to be “blind”

Autonomous, maybe, but not necessarily “Responsible”, Michele Legeas fears. “The risk is that people who are not called say to themselves that they are calm and can continue their life as before”, she warns. Not so sure, according to doctor Thomas Hottier, for whom “Most people don’t need a phone call to know they need to self-isolate. As for those who have decided not to follow the rules, it is not a call from the Social Security that will change the situation ”, says this biologist, general manager of the Inovie laboratory group.

At a time when some doctors are calling for an easing of the tests, warns him of the risk of becoming “Blind” on the circulation of the virus. “No, massive screening is not a panacea, and yes, it costs money, but without the data from Sidep, there is no more visibility and no more anticipation possible”, warns the doctor, for whom “The current strategy must undoubtedly be adapted but above all not let go”.

“It is up to positive people to respect isolation”

This is also what Yannick Simonin defends, fearing that the Omicron variant may have unpleasant surprises in store for the hospital. “For the moment, it does not lead to more stays in intensive care. But the more the number of cases increases, the more the hospital risks overloading, especially since Delta is still circulating, underlines the virologist. To test yourself is to have the opportunity to be diagnosed and therefore to isolate yourself. As Medicare cannot keep pace, it is up to positive people to respect isolation measures and to warn those around them themselves. “

→ ANALYSIS. Covid-19: the Omicron variant would be less dangerous because it affects the lungs less

Individual responsibility is also what Medicare counts on. “A year ago, some people were crying on the phone when we told them that they were in contact, they were distraught, remembers Margot Godart. Today, the population knows what that means and has integrated the isolation measures. “

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The explosion of contaminations

France now records nearly 300,000 contaminations per day, after having passed the threshold of 100,000 daily Covid cases on December 29 and then that of 200,000 on January 6. The incidence rate is 2,668.8 cases per 100,000 inhabitants, the most affected being the 20-29 year olds (more than 3,600 cases per 100,000 inhabitants).

This progression is largely due to the contagiousness of Omicron. According to the founder of the CovidTracker.fr site, this variant could be the cause of 85.7% of positive cases in France. This percentage corresponds to the proportion of tests screened not having the L452R mutation, associated with Delta.

As of January 5, 20,688 people were hospitalized for Covid, including 3,695 in intensive care, or 7% more in one week. These patients currently occupy nearly three quarters of intensive care beds.

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