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

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Listed:
  • Giulia Pullano

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP
    Orange Labs, Sociology and Economics of Network and Services (SENSE))

  • Laura Di Domenico

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Chiara E. Sabbatini

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Eugenio Valdano

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Clément Turbelin

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Marion Debin

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Caroline Guerrisi

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Charly Kengne-Kuetche

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Cécile Souty

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Thomas Hanslik

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP
    UFR des Sciences de la Santé Simone-Veil, Université Versailles-Saint-Quentin-en-Yvelines
    AP-HP, Service de Médecine Interne, Hôpital Ambroise Paré)

  • Thierry Blanchon

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Pierre-Yves Boëlle

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP)

  • Julie Figoni

    (Santé publique France, Direction des maladies infectieuses)

  • Sophie Vaux

    (Santé publique France, Direction des maladies infectieuses)

  • Christine Campèse

    (Santé publique France, Direction des maladies infectieuses)

  • Sibylle Bernard-Stoecklin

    (Santé publique France, Direction des maladies infectieuses)

  • Vittoria Colizza

    (INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique, IPLESP
    Institute of Innovative Research, Tokyo Institute of Technology)

Abstract

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.

Suggested Citation

  • Giulia Pullano & Laura Di Domenico & Chiara E. Sabbatini & Eugenio Valdano & Clément Turbelin & Marion Debin & Caroline Guerrisi & Charly Kengne-Kuetche & Cécile Souty & Thomas Hanslik & Thierry Blanc, 2021. "Underdetection of cases of COVID-19 in France threatens epidemic control," Nature, Nature, vol. 590(7844), pages 134-139, February.
    • Handle: RePEc:nat:nature:v:590:y:2021:i:7844:d:10.1038_s41586-020-03095-6
    DOI: 10.1038/s41586-020-03095-6
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    Citations

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    Cited by:

    1. Benjamin Faucher & Chiara E. Sabbatini & Peter Czuppon & Moritz U. G. Kraemer & Philippe Lemey & Vittoria Colizza & François Blanquart & Pierre-Yves Boëlle & Chiara Poletto, 2024. "Drivers and impact of the early silent invasion of SARS-CoV-2 Alpha," Nature Communications, Nature, vol. 15(1), pages 1-13, December.
    2. Martin-Lapoirie, Dylan & McColl, Kathleen & Gallopel-Morvan, Karine & Arwidson, Pierre & Raude, Jocelyn, 2024. "Health protective behaviours during the COVID-19 pandemic: Risk adaptation or habituation?," Social Science & Medicine, Elsevier, vol. 342(C).
    3. Eugenio Valdano & Davide Colombi & Chiara Poletto & Vittoria Colizza, 2023. "Epidemic graph diagrams as analytics for epidemic control in the data-rich era," Nature Communications, Nature, vol. 14(1), pages 1-11, December.
    4. Mateusz Łuc & Marcin Pawłowski & Arkadiusz Jaworski & Karolina Fila-Witecka & Dorota Szcześniak & Hanna Augustyniak-Bartosik & Dorota Zielińska & Aleksandra Stefaniak & Anna Pokryszko-Dragan & Justyna, 2023. "Coping of Chronically-Ill Patients during the COVID-19 Pandemic: Comparison between Four Groups," IJERPH, MDPI, vol. 20(6), pages 1-14, March.
    5. Dina Albassam & Mariam Nouh & Anette Hosoi, 2023. "The Effectiveness of Mobility Restrictions on Controlling the Spread of COVID-19 in a Resistant Population," IJERPH, MDPI, vol. 20(7), pages 1-14, March.
    6. Costa, Guilherme S. & Cota, Wesley & Ferreira, Silvio C., 2022. "Data-driven approach in a compartmental epidemic model to assess undocumented infections," Chaos, Solitons & Fractals, Elsevier, vol. 163(C).
    7. Seungho Lee, 2022. "The COVID-19 pandemic, short-sale ban, and market efficiency: empirical evidence from the European equity markets," Journal of Asset Management, Palgrave Macmillan, vol. 23(2), pages 156-171, March.

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