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

机译：法国Covid-19案例的未决部分威胁疫情控制

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摘要

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 levels~(1,2). 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 virological~(3)and participatory syndromic~(4)surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations~(2). 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 studies~(6,7). 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.
机译：随着欧洲的国家在第一波逐渐放宽限制后，测试追踪隔离策略在低水平下维持冠状病毒疾病（Covid-19）的发病率至关重要〜（1,2）。审查他们的缺点可以提供根据目前正在欧洲正在进行的第二波的要素。在这里，我们估计通过使用病毒学〜（3）和参与式综合征〜（4）监测数据锁定在锁定与区域住院的数学传输模型的参与式综合征〜（4）监测数据后估算法国的Covid-19症状案例的检测率。我们的研究结果表明，在2020年6月11日至6月28日锁定后的前7周内，监测系统在10万左右的90,000例症状感染，但在2020年6月28日至6月28日，虽然测试积极率没有超过5％的建议世界卫生组织（世卫组织）〜（5）。由于制度的加强以及流行病的减少，中位检测率随着时间的推移，中值从7％（95％置信区间，6-8％）增加到38％（35-44％）至38％（35-44％）至38％（35-44％）。活动。根据参与式监测数据，只有31％的人在研究期间咨询了一名医生。这表明，尽管血清学研究证实〜（6,7）确认，但大量的Covid-19症状案例不寻求医疗建议。令人鼓舞的意识和疑似Covid-19疑似病例的寻求医疗保健行为对于改善检测至关重要。然而，即使在锁定后达到的低流行活性，系统的能力仍然不足，并且预计随着Covid-19案例的发病率越来越快地恶化。需要更容易访问的基本更具侵略性，有针对性和有效的测试来充当控制Covid-19流行的工具。测试策略对使欧洲目前的限制性措施部分提升并避免第三波至关重要。

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  • 来源
    《Nature》 |2021年第7844期|134-139|共6页
  • 作者

    Giulia Pullano; Laura Di Domenico; Chiara E Sabbatini; Eugenio Valdano; Clément Turbelin; Marion Debin; Caroline Guerrisi; Charly Kengne-Kuetche; Cécile Souty; Thomas Hanslik; Thierry Blanchon; Pierre-Yves Boëlle; Julie Figoni; Sophie Vaux; Christine Campèse; Sibylle Bernard-Stoecklin; Vittoria Colizza;

  • 作者单位

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

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    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 Boulogne Billancourt France;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP;

    Santé publique France Direction des maladies infectieuses;

    Santé publique France Direction des maladies infectieuses;

    Santé publique France Direction des maladies infectieuses;

    Santé publique France Direction des maladies infectieuses;

    INSERM Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP|Tokyo Tech World Research Hub Initiative Institute of Innovative Research Tokyo Institute of Technology;

  • 收录信息 美国《科学引文索引》(SCI);美国《工程索引》(EI);美国《生物学医学文摘》(MEDLINE);美国《化学文摘》(CA);
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