Covid-19: Fearing a second wave, the French government is relying on a local strategy

During his speech on September 11, the French prime minister made a worrying assessment of the evolution of the Covid-19 health crisis. Castex noted there had been a "clear worsening" of the spread of the virus in France and that it has "not lowered in intensity" and "will still be with us for some months".

But, Castex stopped short of imposing any new national measures, saying France's aim is to "avoid a general lockdown" and succeed in living with the virus through social distancing, mask-wearing and ramped-up testing.

With 42 departments in the red zone indicating very high levels of infection, the government is banking instead on the autonomy of regional authorities to deal with a second wave of Covid-19, a strategy quite different from the one on March 17 when the government imposed a national lockdown.

For Castex, it is now up to "local health authorities and elected representatives to trigger additional risk reduction measures, notably on the wearing of masks, gatherings in public spaces, major events or the opening hours for certain shops".

Jan-Cédric Hansen, a doctor and member of the French Society for Disaster Medicine, believes this approach is necessary and can help bridge "a disconnect between [national] measures and the reality on the ground".

France 24: Can we talk about this change in the government's approach towards more localised management?

Jan-Cédric Hansen: Until now, the state's management of the crisis has been very top-down and there is now a willingness to tackle problems locally. It is clear that the government's priority is to continue to move the country forward and protect its citizens, but accepting that there is a greater risk for the weakest. Of course, the economic aspect is paramount, but it cannot be the only barometer of political decision-making, otherwise we run the risk of greater disaster, as we have seen in the United States.

At the same time, there has been a growing awareness of the harmful effects of lockdown. Even if it is the most effective method of fighting the virus, it has a heavy impact on the lives of citizens, whether in terms of social ties or even health. In nursing homes, some people have died from the consequences of lockdown. This is a serious issue that must be taken into account.

Are regions better able to assess and manage this health crisis?

Two very distinct aspects of this need to be differentiated. The health strategy must be national, decided by the government and passed on to local authorities throughout the country. On the other hand, its implementation must be done in consultation with local professionals in the field.

Until now, the approach has been very homogenous, regional health agencies followed the instructions and there was sometimes little room for discussion.

I witnessed this situation when the health authority asked a nursing home to test all residents in one day and then isolate the positive cases. There were two hundred residents who needed to have the importance of the procedure explained to them and their relatives and the implications it could have on their future. Some of them would have to be moved, though the bedroom in a nursing home is much more of a living space, unlike in a hospital room.

In the end, despite pressure from the health authority, the process took a week. This is a good example of the disconnection between official orders and the reality on the ground. The desire to give more decision-making power to the regions is a step in the right direction, even if in my opinion the scale is still too large. The department representative must be able to make strong, localised decisions based on the epidemiological analysis of the circulation of the virus.

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More than 700 clusters are currently being investigated in the French territory according to the health authorities. The government has not announced any localised lockdowns, but does not rule out this possibility. Do you think they will be necessary?

As I said earlier, I believe that lockdown is the best treatment against the spread of the virus. But it still has to be used wisely, because if you have 10% of the population infected and you confine 100% of the people, you are imposing an unnecessary measure on 90% of the population.

Localised lockdown makes it possible to isolate very targeted areas where the virus circulates a lot, to identify carriers quickly and to apply the necessary measures. We have access to very precise population flow studies in France. Rather than testing everyone, we need to identify the most exposed people, i.e. those who move around the most, and test them as a priority.

For a long time, the government did not want to consider the option of local lockdown, there was a big delay in this, but I think it will become the norm. This method is essential, but it must be understood that it represents very complicated and diverse logistical challenges.

If we identify a cluster at a factory for example, should we prevent the employees from returning home? Politicians will have to judge between respect for individual freedom and the need to contain the pandemic. The question of maintaining basic services will also arise, because if a drinking water treatment plant is identified as a source of contagion, it will not be possible to close it down.

All of these issues cannot be addressed by national guidelines and must be addressed through consultation on a case-by-case basis.

This article has been translated from the original in French.