France holds its breath on the eve of Covid-19 lockdown lifting

When French President Emmanuel Macron announced in mid-April that the country would begin lifting its Covid-19 lockdown measures on May 11, he was effectively giving his government a deadline. In order for even a partial reopening not to provoke a disastrous second wave of the epidemic, the country’s public health capacities would need to be dramatically expanded – and fast.

“Starting on May 11 we will have a new system to make this step a success,” Macron said on April 13 before a record TV audience. He promised that every French resident would get access to a “mask for the general public” (if not a FFP2 or surgical mask), that anyone presenting Covid-19 symptoms would be able to get tested, and that 10,000 new, domestically produced ventilators would be supplied to hospitals to dramatically ramp up intensive care capacity.

Prime Minister Édouard Philippe has summed up the government’s strategy succinctly: “Protect, test, isolate”.

On the eve of the partial lockdown lifting, however, many are worried that the French government has not done enough to prepare the country for a safe reopening.

700,000 tests per week?

A key premise of the government’s plans for this new phase is widespread testing. French authorities have faced severe criticism for falling short on testing in the early stages of the epidemic, even as the World Health Organization urged countries to “test, test, test”.

On Thursday, at a press conference confirming the government’s May 11 plans, Health Minister Olivier Véran said France is now “ready to test massively”, pointing to a map that showed testing capacity at 100 percent nationwide.

A spokesperson from the French health ministry told FRANCE 24 that the country has of late been carrying out between 200,000 and 270,000 Covid-19 tests per week, and that the country is pursuing a “mobilisation of all laboratories and testing sites to arrive at a capacity of 700,000 tests” per week, a number first evoked by government officials in late April.

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The spokesperson confirmed that the government believes it can roughly triple its current capacity to meet the 700,000 goal as early as this coming week, with veterinarians, police and drive-through stations supplementing the efforts of private and public laboratories and hospitals. Some health experts, though, are sceptical.

“On the issue of tests, everyone is lying,” Dr. Philippe Froguel of the Lille university hospital center told France 3. He called the government’s goal “impossible”.

Moreover, epidemiologists worry that even 100,000 tests per day is far too few.

“Ideally, you would need vastly more, because you need to track the virus,” said Catherine Hill, former head of biostatistics and epidemiology at the Gustave Roussy cancer institute. “Ideally, you would need to test everyone.”

To arrive at its 700,000 figure, the government worked backwards from a predicted 1,000 to 3,000 new Covid-19 infections per day. For every positive test, it estimated that 25 of the person’s contacts would need to be tested. This would amount to a maximum of 525,000 tests per week, which the government rounded up to 700,000.

Such an approach is insufficient to prevent the spread of the virus, Hill told FRANCE 24.

“If we only find people with symptoms and it takes one or two days to find them, and then we look for their contacts and it takes another day or two to find them, most contaminations will already have taken place,” she said. Hill noted that those infected with Covid-19 can be contagious five days before and after they show symptoms – not to mention that some never show symptoms at all.

“I’m rather worried, actually,” she said.

Hill noted that the countries that have had the most success in containing the virus (including South Korea, New Zealand and Australia) have conducted widespread testing even among those who show no symptoms.

“The right indicator, actually, is: for every 100 tests, how many are positive? Because that shows how wide a net you’ve cast.”

In Taiwan, where testing began early and reached wide, less than 1 percent tests turned up positive and only six people have died, out of a population of nearly 24 million. In France, where testing has essentially been limited to those showing significant symptoms, a far larger share has been positive and more than 26,000 have died.

The figures from Santé Publique France do show the percentage of positive tests declining steadily since late March, as the overall number of tests has ramped up and the number of infections declined during lockdown. The latest figures available from the agency show the total number of positive laboratory tests at roughly 5 percent. It’s unclear, though, whether this trend will hold once the lockdown is lifted.

Masks required on public transport, ‘preferable’ elsewhere

Meanwhile, the government’s recent communications around wearing a mask “have not been very clear”, said Hill. On this subject, too, Macron’s government has already faced harsh criticism. Health officials initially advised the public that wearing a mask was not necessary if you were healthy, and that masks should be reserved for those who needed them the most: health care and other essential workers.

Several investigations, including by the news site Médiapart, have since shown that the government’s position was driven primarily by a shortage of masks, and that officials were scrambling to make up the shortage even as they gave the public conflicting information.

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Starting on Monday, masks will be mandatory on public transport nationwide, subject to a €135 fine. Interior Minister Christophe Castaner said that the government will be supplying 10 million masks to local transport operators to distribute to passengers who don’t already have a mask of their own, including 4.4 million for the Paris region.

In other public places, wearing a mask is “preferable” but not required, Prime Minister Philippe has said. A few cities, like Nice, have taken matters into their own hands and will require masks locally, and the mayors of the country’s largest cities have expressed interest in following suit.

As the cost of masks has surged, the government has fixed prices to a maximum of 95 cents per surgical mask, while declining to set limits on the price of cloth and other reusable masks. In early January, surgical masks (which are intended to be disposable) were available online for just 8 cents.

Some opposition members argue that the government should concentrate on distributing masks for free rather than penalising those who don’t have them.  

“If there is an obligation for citizens [to wear a mask], there must be an obligation for the state to make this product available,” member of parliament Danièle Obono, of the left-wing La France Insoumise (France Unbowed) party, told the National Assembly on Friday. She argued that putting the financial burden on individuals to procure a mask could deepen inequalities and put those unable to procure masks at risk of abusive policing.

“You are going to create a situation, in public transport notably, where there will be tensions,” said Obono.

Heavy-handed enforcement of lockdown measures fuelled dramatic clashes between police and residents in Paris’s working-class banlieues (suburbs) in late April.

New ventilators ‘clearly not suitable’ for intensive care

What if the planned precautions aren’t enough, and the lifting of lockdown brings a second wave of the epidemic?

In March and April, French hospitals rushed to boost capacity by cancelling “non-urgent” medical procedures and enlisting personnel from the least-affected regions to back up those in the regions hardest hit. This, along with the purchase of ventilators, allowed France to increase its number of intensive care beds from 5,065 beds to nearly 14,000 at the peak of the crisis, the health ministry said.

Since then, capacity has gradually been scaled back again. Just over 2,800 Covid-19 patients are in intensive care as of May 9.

With tests, masks and everyday precautions like handwashing, the government’s priority is to keep that number low so that intensive care capacity can return closer to normal while less urgent procedures resume.

“At the same time, thanks to the massive acquisition of respirators, the government’s goal is to be able to increase [intensive care capacity] again very quickly in the event of a second wave, up to 10,000 or even 14,000 beds,” a health ministry spokesperson said.

This plan, too, has faced obstacles.

In late March, France’s sole domestic producer of ventilators, Air Liquide, teamed up with three other heavyweights of industry to begin rapid production of 10,000 new ventilators. But there was a hitch. Air Liquide said it would be impossible to produce the government’s requested amount (5,000) of its top-tier, T60-model ventilators within the proposed 50-day timeline. Instead, the company agreed to make 1,500 of the T60 model and 8,500 of a less complex Osiris model.

Hospital guidelines published by the Health Ministry on April 3 and revealed by the investigative unit of Radio France, however, specified that the Osiris-model ventilators were insufficient for intensive care use.

“This is clearly not… a ventilator suitable for the treatment of complicated acute respiratory distress,” said Philippe Meyer, an intensive care doctor at Necker hospital in Paris.

In a statement, the government said that the use of the Osiris ventilators for intensive care had been approved by four different groups of relevant medical experts, “in case of unavailability of more powerful ventilators and as a last resort”, adding that additional ventilators were on the way in order to bring capacity of top-tier ventilators to 15,000 nationwide.

Critics have also highlighted the French state’s longer-term disinvestment in public hospitals, which fuelled a nearly year-long strike movement by health care personnel beginning in March 2019.

Fears of a second wave

The string of controversies helps explain why much of the French public is anxious about the lifting of lockdown measures. In one poll conducted this week, 58 percent of respondents said they did not trust the government to manage the transition successfully.

Between the isolation of lockdown and the fears of a second wave, many feel caught between Scylla and Charybdis.

“I'm afraid to go back to Paris,” said Eugénie, 28, a health consultant. She has spent the lockdown in the countryside but has to return to Paris after May 11 to complete her move. “I'll feel less safe. I find it hard to imagine the social distancing in public transport,” she told FRANCE 24.

Carole, 42, a nanny in the Paris region, told AFP that she has spent the last eight weeks secluded at home, eaten by fear. She has been without fresh groceries for two weeks.

“It was pasta and noodles. The most important thing was that there was milk for my daughter,” she said.

Still, she plans to continue isolating herself after May 11.

“I'm even more afraid, because there will be a lot more people on the streets,” she explained, saying she plans to consult a psychologist to help her deal with the fear.