Underdetection of cases of COVID-19 in France threatens epidemic control

Autor: Thierry Blanchon, Marion Debin, Pierre-Yves Boëlle, Sophie Vaux, Giulia Pullano, Julie Figoni, Vittoria Colizza, Caroline Guerrisi, Thomas Hanslik, Eugenio Valdano, Laura Di Domenico, Christine Campèse, Charly Kengne-Kuetche, Sibylle Bernard-Stoecklin, Cécile Souty, Clément Turbelin, Chiara E. Sabbatini
Přispěvatelé: Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Santé publique France - French National Public Health Agency [Saint-Maurice, France], ANR-19-CE46-0008,DataRedux,Réduction de données massives pour la simulation numérique prédictive(2019), European Project: 101003589, H2020-SC1-PHE-CORONAVIRUS-2020,RECOVER(2020)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Nature
Nature, Nature Publishing Group, 2021, 590 (7844), pp.134-139. ⟨10.1038/s41586-020-03095-6⟩
ISSN: 0028-0836
1476-4679
1476-4687
DOI: 10.1038/s41586-020-03095-6⟩
Popis: As countries in Europe gradually relaxed lockdown restrictions after the first wave, test–trace–isolate strategies became critical to maintain the incidence of coronavirus disease 2019 (COVID-19) at low levels1,2. Reviewing their shortcomings can provide elements to consider in light of the second wave that is currently underway in Europe. Here we estimate the rate of detection of symptomatic cases of COVID-19 in France after lockdown through the use of virological3 and participatory syndromic4 surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations2. Our findings indicate that around 90,000 symptomatic infections, corresponding to 9 out 10 cases, were not ascertained by the surveillance system in the first 7 weeks after lockdown from 11 May to 28 June 2020, although the test positivity rate did not exceed the 5% recommendation of the World Health Organization (WHO)5. The median detection rate increased from 7% (95% confidence interval, 6–8%) to 38% (35–44%) over time, with large regional variations, owing to a strengthening of the system as well as a decrease in epidemic activity. According to participatory surveillance data, only 31% of individuals with COVID-19-like symptoms consulted a doctor in the study period. This suggests that large numbers of symptomatic cases of COVID-19 did not seek medical advice despite recommendations, as confirmed by serological studies6,7. Encouraging awareness and same-day healthcare-seeking behaviour of suspected cases of COVID-19 is critical to improve detection. However, the capacity of the system remained insufficient even at the low epidemic activity achieved after lockdown, and was predicted to deteriorate rapidly with increasing incidence of COVID-19 cases. Substantially more aggressive, targeted and efficient testing with easier access is required to act as a tool to control the COVID-19 pandemic. The testing strategy will be critical to enable partial lifting of the current restrictive measures in Europe and to avoid a third wave. Analyses of virological and surveillance data in France show that a substantial proportion of symptomatic cases of COVID-19 have remained undetected and that easily accessible and efficient testing is required to control the pandemic.
Databáze: OpenAIRE
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