• With the introduction of the health pass, the number of tests broke all records this summer, and particularly on August 13, when nearly a million samples were taken in France, according to data from Public Health France.

  • The government announced in early August the end of free PCR and antigen tests known as "comfort" from mid-October.

  • However, since the start of the pandemic, screenings have enabled health authorities to monitor the circulation of the virus in France almost in real time.

Supported by Social Security since the start of the coronavirus epidemic, PCR and antigenic “comfort” tests will become payable from mid-October.

A change that risks reducing the number of screenings and skewing the figures for monitoring the health situation.

With the introduction of the health pass, the number of tests broke all records this summer, and particularly on August 13, when nearly a million samples were taken in France, according to data from Public Health France.

By paying, the tests may be fewer.

A number of cases that should not vary drastically

On August 4, the government announced that it would end in mid-October the free use of so-called “comfort” PCR and antigen tests, that is to say tests carried out by people who wish to obtain the test. health pass without being vaccinated or to remove the doubt of a possible contamination. Only symptomatic people or contact cases, provided with a prescription, will be able to perform a test free of charge. For Antoine Flahault, epidemiologist and director of the Institute of Global Health of Geneva, there is no doubt, "the number of tests will decrease enormously with the end of free treatment, the French having little habit of directly covering their health expenses" .

However, since the start of the pandemic, screenings have enabled health authorities to monitor the circulation of the virus in France almost in real time. “We will miss asymptomatic people, those who have doubts and who do not want to pay. We are going to fall behind in the identification of cases and in the breaking of the chains of transmission ", worries Michaël Rochoy, general practitioner, researcher in epidemiology and member of the collective On the side of science, which estimates that" the weeks which will follow the end of free access will be more complex for proper epidemiological monitoring ”.

But for Marie-Aline Bloch

,

researcher in management sciences at the School of Advanced Studies in Public Health (EHESP), the figures will not necessarily be biased: "We will trace the epidemic a little less, but monitoring will remain when even faithful.

We will have fewer people who will test themselves, but as symptomatic people and contact cases will be able to continue to do so for free, the number of cases will ultimately not be very different ”, tempers the specialist.

Several indicators needed

If the number of tests should drop, the positivity rate is likely to change. “Instead of having tests anytime, anyhow, the people tested will basically be those who have symptoms or are in contact. And de facto, the positivity rate will increase, it will be much higher, ”explains Michaël Rochoy, who believes that it will take a period of adaptation and“ probably a revision of the alert thresholds ”to have a real follow-up of virus circulation. The three specialists are clear: monitoring the epidemic is not based solely on the indicator of the number of tests carried out or on the positivity rate. Indeed, the number of positive tests is not the most representative indicator of the circulation of the virus, nor the one scrutinized by the health authorities.

“A single indicator is not enough to paint a picture of the health situation.

Side tests, we rely on the reproduction rate of the virus which is a very useful indicator for the management of the pandemic, ”explains Antoine Flahault, referring to the R0, that is to say the average number of people qu 'an infected person can infect.

"Then, we must observe the rates of hospitalizations, the figures in intensive care and deaths due to Covid-19, these are valuable indicators, especially if they are reported by age and vaccination status", continues the director from the Institute for Global Health in Geneva.

Increase vaccination coverage

Should the government review its screening strategy?

Not necessarily, for Antoine Flahault.

The epidemiologist pleads for "massively sequencing" in order to detect new variants and "to measure the rate of vaccination coverage in order to identify pockets of under-vaccination, which are areas at risk".

Because if the government has decided to make the so-called "comfort" tests free, "it is clearly to push the remaining population to be vaccinated", continues Antoine Flahault.

According to the latest data from the Ministry of Health, updated this Thursday, 73% of the French population over 18 has been fully vaccinated.

“When we see the minimal proportion of vaccinated people hospitalized compared to unvaccinated patients, we hope that this encourages people to be vaccinated,” adds Marie-Aline Bloch.

For specialists, this is also a decision taken for greater equity: "The cost of comfort tests for the unvaccinated could no longer be borne massively by the vaccinated [via their contributions to health insurance]. , like today, without causing any problems, ”suggests Antoine Flahault.

"It is normal that we regulate, that the free stops for people who decide not to be vaccinated and who carry out tests just to go to the restaurant or to the museum", adds Michaël Rochoy.

"France was an exception with free tests, but today, it is no longer the major measure to manage this epidemic", adds Marie-Aline Bloch.

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