- While the Prime Minister spoke for the first time Wednesday evening of deconfinement, which should be done gradually, the private medical analysis laboratories are organizing to be able to test in a more massive way.
- Because the government wants to build capacity on screening French people.
- But with shortages of masks, reagents, swab and rapid tests whose reliability has not yet been demonstrated, biologists are alerting to the challenges that remain.
They too are among the first-line caregivers without whom the fight against the coronavirus cannot turn into a victory. However, little communication has been made on private medical analysis laboratories. One of the major players in the massive screening strategy that the government seems to have recently wanted to develop.
Delayed decision?
For weeks, the government reserved the tests only for the most critical patients and caregivers, therefore in the hospital. "In an emergency, the government passed an authorization to reimburse the PCR test for city medical analysis laboratories on March 8," reveals Richard Fabre, member of the National Union of Biologists. And since last weekend, the Minister of Health began a clear coaster: it will be necessary to be able to test massively to get out of confinement. Hoping that 50,000 tests per day can be carried out at the end of April. But behind the figures, it is all the logistics that must be put in place for the hospitals, but also for the 3,700 city laboratories.
In any case, this is the message that these private biologists wish to deliver. “We are the victim of a doctrinal error by the Ministry of Health: they immediately said no to city biology, tackle Richard Fabre. Today, we realize that it was the opposite that had to be done: countries, like Germany, which have carried out mass screening did not need to confine. We suffer from hospital-centrism. "
Three tests
First of all, there are three types of tests. The best known, called PCR ("polymerase chain reaction"), consists of a nasopharyngeal sample. Clearly, "we put a swab deep in the nose, to extract RNA (ribonucleic acid, close to DNA), and amplify it by molecular biology, explains Alain Le Meur, medical biologist. During the day, we know whether or not we are carrying SARS-CoV2. "
The second, currently under development, is a serological test, carried out from a blood test. Goal ? Find out if you have developed antibodies to this coronavirus. "All the laboratories are working so that we can have it quickly, but for the moment, it is neither scientifically validated, nor in the nomenclature, nor invoiced, nor reimbursed", nuance Alain Le Meur. Who hopes that within two to three weeks, these tests, inexpensive and easy to perform, will be available. One can imagine, for example, that people who have already been in contact with the virus, and therefore who are immune, can leave their homes without fear. But beware, "the appearance of antibodies is delayed, studies have shown that they appear between 15 and 20 days after infection," he said.
Finally, we have heard a lot about "rapid tests" in recent days. Which are serological tests that could give a result in 20 to 30 minutes. France has placed an order for 5 million of these rapid tests, which look for the antigens of the SARS-CoV2 virus, as detailed in this article by Industry and Technology . But be careful, warn biologists, because the reliability of these rapid unit tests has not yet been demonstrated. Spain has also ordered 640,000 of these express tests from China… which have proven to be defective.
Shortages of masks, reagents and swabs
Several tools are therefore in the hands of power and analysis laboratories to allow that the deconfinement does not rhyme with a second wave of infections. Provided that this targeted or massive screening can be carried out. "Currently, 15,000 PCR tests are performed per day," explains Alain Le Meur, also president of the Association for the progress of medical biology, which represents three quarters of private laboratories. We can easily increase this capacity to reach 50,000 tests per day at the end of April. For serological tests, faster and with simpler technology, which we have mastered for thirty years, we would have a production capacity of more than 100,000 serological tests per day approximately. Perhaps the strategy will be to couple the tests: if you have a positive serology, we assume that you are no longer contagious. On the other hand, if your blood result is negative, we could add a PCR test to it. But today, we are awaiting the government's strategy. "
In the meantime, private laboratories have mobilized their teams, multiplied their suppliers, invested in machines, etc. Another strong point: "Our laboratories have seen their activity drop by 60%, so we can redirect our forces towards Covid-19 screening" , assures Richard Fabre, also president of the Regional union of the health professionals of the biologists of Occitanie. And on the economic side? A few months ago, a showdown took place between these labs and the National Health Insurance Fund concerning the envelope dedicated to these medical analyzes in the city. But “we have found a compromise that is satisfactory for both parties: a stabilized envelope and in the event of a crisis, such as the one we are experiencing, all the conditions have been provided to avoid an economic or legal brake. It would seem that we were a little more in anticipation than the General Directorate of Health in the management of this health crisis… ”, quips the biologist.
Precisely, if biologists claim to be in working order, they do not hide their concerns related to certain shortages. First of all, and this still concerns many caregivers, on protective equipment. “We had trouble getting FFP2 masks, but it is essential to protect yourself during the sampling and its analysis, regrets Alain Le Meur. It is a little better, but we still have to fight. "
Find our file
But above all, the shortages are expected to be glaring in terms of reagents and swabs, essential for carrying out PCR tests. “The reagents are produced in China, South Korea and the United States, and the swabs in Italy, specifies Richard Fabre. However, in this health war, all the countries order it. Donald Trump has thus chartered a military plane to grab swabs in Italy… We are afraid of being out of stock. "This is why the private analysis laboratories hope to be heard by the State:" It would be necessary to make air bridges to obtain supplies of reagents and swabs under guarantee of the State, as the government has done for FFP2, ”suggests Alain Le Meur.
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