Will Macron pass the test on coronavirus testing in Monday night address?
After initial delays, France has finally accepted the World Health Organization’s directive to conduct mass testing to fight the coronavirus pandemic. But with equipment shortages and questions over the reliability of some tests, it’s proving to be hard to implement. With all eyes now set on Emmanuel Macron’s Monday night speech on the crisis, French people are wondering if their president will address this critical issue.
"Test all residents and staff when the first case is confirmed,” said French Health Minister Olivier Véran on April 6 while announcing the launch of a "vast screening operation" for Covid-19 infections in France’s old age homes, which have been particularly hit by the pandemic.
While the vast operation was intended for the elderly living in institutions and staff caring for this vulnerable section of the population, the French government is now working to extend testing and screenings to the wider population.
As governments evaluate future lockdown exit strategies, debating time frames and models for relaxing restriction measures, testing has turned into a key factor in gradual reopening scenarios. Public health experts agree that a “test and trace” regime, like the one implemented this week in Wuhan, the Chinese province that was the source of the coronavirus, is critical.
Macron’s administration has faced criticism for its mixed messaging on testing and the use of face masks since the coronavirus began spreading in France.
Although the French president has enjoyed a popularity bump for his handling of the crisis, his administration has been accused of underplaying the usefulness of coronavirus tests as well as face masks because they knew France did not possess enough of either.
They are issues Macron is likely to tackle in his speech Monday, April 13, his third televised address from the Élysée presidential palace since the crisis began.
Announcing the speech last week, the presidential office said Macron had spent the past few days speaking to “a large number of public and private actors – French, European and international – on what is at stake concerning Covid-19” and was preparing “the decisions that will be announced on Monday".
On March 16, the day Macron announced a strict, nationwide lockdown, the World Health Organization (WHO) issued a clear policy directive to fight the disease. "We have a simple message for all countries: test, test, test,” the WHO said in a Twitter post.
"We have a simple message for all countries:— World Health Organization (WHO) (@WHO) March 16, 2020
Test every suspected #COVID19 case.
If they test positive, isolate them & find out who they have been in close contact with up to 2 days before they developed symptoms & test those people too"-@DrTedros #coronavirus
Testing or containment priorities
But countries have followed different policies, determined by differing levels of capacity and preparedness, on coronavirus testing. South Korea, Taiwan and Germany made testing a priority since the very beginning of the crisis, with massive screening measures to identify and isolate sick people and contain the contagion. Given the low mortality rate in these countries, this has proven to be an effective measure compared to the models adopted in France, Italy and Spain, which have implemented containment measures as a priority.
In his March 16 press briefing, WHO head Tedros Adhanom Ghebreyesus was explicit in admonishing countries too focused on social distancing while sidelining testing measures. “You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected," he said.
A few days later, on March 21, Health Minister Véran announced that France would increase its screening capacity, which until then had been reserved for priority individuals, including healthcare workers, the elderly and people with serious pre-existing medical conditions.
‘I gave up. I can’t tell if it was the coronavirus’
There are broadly two categories of tests for coronavirus infections, according to the US Centers for Disease Control and Prevention (CDC) website:
- molecular tests, clinically known as real-time reverse-transcription polymerase chain reaction (rRT-PCR), or sometimes shortened to PCR (polymerase chain reaction) tests, and
- blood or serology tests.
In France, PCR tests are now available to anyone with a doctor’s prescription. For these tests, the specimen is collected using a nasopharyngeal swab and is brought to a specialised laboratory for analysis. This must be done within a short time frame -- hence the term “real-term” – because these tests will not reveal the presence of the virus if the patient no longer has any symptoms.
While the tests are considered clinically effective by health authorities, on the ground, logistics such as availability of kits and personnel can pose challenges. "I started coughing when I was confined with my pregnant wife and my son. My doctor prescribed a test," explained Marc, a resident of the Parisian suburb of Yvelines.
But Marc’s area, or commune, did not have a specialised facility and the test could only be done in a neighbouring commune. “But my appointment was postponed because the analysis laboratory where the samples were to be sent was overloaded with requests. After a week, my cough was gone. I gave up. I can't tell if it was the coronavirus," he said.
His experience underscored the capacity challenges still confronting health officials in France. "We have the necessary staff, but we lack testing equipment, protection and tools to carry out analyses -- not to mention the fact that only a hundred or so laboratories are authorised to analyse these samples,” explained Dr Claude Cohen, president of the National Union of Medical Biologists, in an interview with FRANCE 24.
“In Germany, they have been more reactive in purchasing the equipment and they have the capacity to produce some kinds of tests. In France, we have a big problem of dependency [on imports] and the international market for this type of equipment is extremely tight," he added.
In late March, lawyers representing a group of 92 health care workers asked the French government to publish details on Covid-19 testing authorisation contracts. Weeks later, on April 2, French Prime Minister Édouard Philippe announced a "considerable" increase in tests from 20,000 to 30,000 a day in an interview with French TV station, TF1.
Do blood tests pass the test?
While PCR tests to detect the presence of the virus have a high level of reliability, the same cannot be said for serological tests to measure immunity to the disease.
Studies are currently underway to evaluate the effectiveness of this method, which involves identifying antibodies indicating that a patient has been infected, in order to assess his or her level of immunity. Health departments and companies across the world are also set to unroll new tests to gauge the spread of the virus.
In France, blood tests are already being conducted by some laboratories. They are authorised on the condition that they have the "CE" label, which shows they have met EU norms. But "none of these tests have been validated by scientific authorities," stressed Cohen. “Labelling is absolutely not an indicator of reliability and no country performs these tests routinely in the population. The government's silence on the subject is incomprehensible."
Speaking to FRANCE 24, Jean Mariani, professor emeritus at the Sorbonne University, also warned against an unchecked enthusiasm over the tests. "We can't afford mass screening without reliable tests. It's an essential element to be acquired as quickly as possible," he noted.
The possibility of estimating the level of immunity of the population is a key factor in stemming the pandemic and the method is raising many hopes. In France, as elsewhere, the race for tests has already begun. On April 9, the Grand Est region in eastern France, which has been heavily hit by the coronavirus, set up a multi-million euros purchase plan. “These serological tests should be available as of the beginning of next week,” said Alexandre Mora, chief of staff of the Grand Est region, "when we are certain of their efficiency."
(This article has been translated from the original in French.)
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