Paris (AFP)

The last patient he lost died at the age of 85 in bed: respiratory failure. Dr Philippe Doll, general practitioner in Wittenheim, in the Haut-Rhin, suspects a case of covid-19 but, without test and out of hospital, this death will not enter the official death toll of coronavirus victims.

The doctor will put this word on the death certificate: "suspected covid". Without knowing if this will have an effect on the statistics.

For over a month, the Director General of Health Jérôme Salomon has been taking stock of mortality every evening. Officially, 13,832 people died of covid-19 in France: 8,943 in hospital and 4,889 in nursing homes and medico-social establishments. These are counted for around ten days.

But the toll could actually be much heavier, these figures not taking into account the victims who died at their home.

Each year, the majority of deaths (59%) occur in hospitals or clinics, 14% in retirement homes, according to INSEE. But more than a quarter also occur at home (26%). In March, out of a total of 57,440 deaths from all causes, around 13,000 people died at home. Or a hause of almost 10% compared to 2019.

INSEE does not specify the cause of death, and given the small number of tests performed in town medicine it is difficult to establish the exact number of deaths linked to the epidemic.

"My brother-in-law died yesterday. They said they had a cardiac arrest, we are willing to believe it, but hey," said a resident of Wittenheim, contacted by telephone by AFP. She knows the story well: a few weeks ago, this woman already lost her husband, from the coronavirus.

In this former mining town of 15,000 inhabitants, near Mulhouse, one of the major centers of the epidemic in France, 20 people died during the month of March alone. And since the start of the epidemic, almost a third of the 69 residents of the city's nursing home have died.

Tests were not performed on each of these deaths. "We have so many cases at the same time. When people are in respiratory distress, given what is happening, we also do not make an investigation: we know very well that it is the covid", says the mayor Antoine Homé.

- + 50% death -

For SOS Doctors, specializing in home consultations and especially present in urban areas, "the milestone of 50% increase in home deaths in France has passed": in two weeks, between March 22 and April 5, the federation of doctors recorded 253 deaths at home, 54% more than last year over the same period.

"One can reasonably think that a major part is linked to the epidemic of covid-19", estimates the president of SOS Doctors Pierre-Henry Juan.

"It would take an autopsy, but we don't do it, except when there is a medico-legal problem," he explains. "And as the cause of death at home is difficult to establish scientifically because we do not test the patient, we do not measure this excess mortality".

In March, the 1,300 doctors in the network performed more than 34,000 procedures in connection with covid-19, on observation of symptoms.

For general practitioners, the general number of cases of covid-19 is also largely underestimated. According to the MG France union, during the last two weeks of March, 56,154 cases of covid-19 were identified throughout the territory, on clinical diagnosis.

"Extrapolated to the total number of general practitioners working in France (55,000, editor's note), we can estimate the total number of cases around 1.5 million in the city," calculates Dr Jacques Battistoni, president of the union.

Or the equivalent of the number of official cases currently listed worldwide ...

- "Behind the doors" -

"In the departments strongly affected by the epidemic, we observe a number of deaths in clear progression compared to 2019", up to twice higher in March, explains to AFP Sylvie Le Minez, head of demographic and social studies from INSEE.

In Wittenheim, "the mortality increased by two and a half times compared to the other years", according to the mayor Antoine Homé. "For four weeks, we have been living a nightmare," he said.

"The epidemic is not theory, here we see it," he summarizes. Every morning, mortuary notices line 7 or 8 pages of the regional daily newspaper L'Alsace.

"In a few weeks, we will open doors and we may well discover that people who no longer responded have died at home," fears epidemiologist Emmanuel Baron, director of Epicenter, Doctors Without Borders research center.

According to the specialist, "forgotten deaths" are inherent in any epidemic.

"The fact of not confirming all the cases is classic in large-scale epidemics. In the event of an epidemic of cholera, measles or meningitis, we do not systematically do a diagnostic test because it would increase care and it would not change not the treatment, "he explains.

It will be necessary to wait for a complete scientific and demographic study, which will probably take many months, before having figures approaching reality, on the deaths attributable to the epidemic of covid-19.

After the deadly heat wave in 2003, it took several years to have a final number of deaths. In 2007, Inserm officially stopped the death toll from the heat wave at 19,490, four years after the health disaster.

© 2020 AFP