Europe Versus Coronavirus – France: a Health and Trust Crisis

A relatively less exponential virus spread than elsewhere in Europe

In spite of a late lockdown in France (16 days after reaching the 100-case mark) compared to Spain (12 days) or Italy (14 days), France's contamination curve followed a less exponential trajectory than its neighbors. On February 23, one month after the first cases of Covid-19 were recorded in France, the Minister of Solidarity and Health, Olivier Véran, launched the country’s reaction plan. The first of its four stages aimed to slow down the introduction of the virus. Stage 2 was triggered on February 28, with the aim now being to curb the spread of the virus throughout the country. It involved, among other things, banning gatherings of 5,000 people or more in confined spaces. The centers of epidemic outbreaks (Haut-Rhin, Oise, and Morbihan départements) closed their schools. Stage 3 is launched on March 17 as the lockdown begins for the entire country.

While the country’s health spending is among the highest in the OECD countries (11% of GDP, compared to 9% on average within the OECD), the situation nevertheless became critical in the hospitals in the most affected areas due to the rapid spread of the virus and:

• A lack of intensive care beds. According to Olivier Véran, France usually has 5,000 intensive care beds. In mid-March, he announced "an objective of 14,000 to 14,500" beds, while an additional field hospital was set up at the end of March in Mulhouse. Achieving this objective is not  only required for nursing staff to handle a substantial workload increase, but also for the provision of extra equipment, in particular ventilators. The government ordered 10,000 ventilators from Air Liquide Group.
• A shortage of masks and protective equipment. The government's communication with regard to this topic has been criticized: after stating that unaffected people were not required to wear masks, the government backtracked and now encourages every citizen to wear one, with masks playing a key role in the success of the post-lockdown strategy, which started on May 11.

On April 28, as the lockdown was being loosened, the Prime Minister told the National Assembly that the objective was "to carry out at least 700,000 PCR tests per week" from May 11 onwards.

The element of surprise and a notable economic response

As was the case for many of its European neighbors, French industries, organizational and hospital capacities were taken by surprise by the virus’ arrival, and had to react quickly, with no visibility of the situation’s evolution. The lack of agility in crisis situations of centralized organizations (less flexible than regionally-managed health systems) such as the Regional Health Agencies (ARS) was very quickly pointed out by hospital directors, particularly regarding their response time to requests from health establishments in their areas.

The government's economic responses – less dependent on external factors than its health responses – were very swift. Announced during the presidential address on March 12, the generalization of furloughs (allowing employees to receive 70% of their gross salary and 100% of minimum wage) and the deferment of social security contributions and taxes, as well as state-backed loans (backed between 70% and 90% by the state, with no repayment required in the first year) are part of the government's package of countercyclical economic measures. While these measures received massive public financial support, they are still a far stretch from the amounts included in the rescue plan voted by the Bundestag and the German federal government on March 26.

The measures decided in France concern both supply and demand. Their aim is to "freeze" the economy and preserve, as much as possible, business production capacities, jobs and household incomes. The first budget amending act was adopted on March 20.

Affected by the sudden simultaneity of supply and demand shocks, French GDP shrank by 5.8% in the first quarter of 2020, a greater decline than after the 2008 financial crisis, which had caused a 1.6% drop in the first quarter of 2009. Although Insee has not published a forecast for the entirety of the year, in its budget amending act the government anticipates an 8% decrease in GDP, a public deficit of 7.6% and a public debt of 115% of GDP. For its part, in its growth forecasts of May 6, the European Commission announces a recession of 7.7% for the euro zone as a whole, with 9.5% for Spain, 9.4% for Italy, 8.2% for France, and 6.5% for Germany.

Public opinion quickly turned critical and challenging of the French government and the use of technology

As the end of lockdown is fast approaching in numerous countries, the French government remains judged much more severely than its European counterparts.At the beginning of May, only 24% of French people stated being "satisfied" with French President Emmanuel Macron. German Prime Minister Angela Merkel reached a 50% satisfaction rate, while British Prime Minister Boris Johnson had a 48% approval rate, despite the recent worsening of the situation in the latter’s country. In France, there has been a movement of mistrust towards institutions, reflected in the level of trust in the government (which dropped from 55% on March 23 to 35% on April 23, before rising to 39% on May 4 and falling again to 34% on May 7). This relative disappointment should be tempered by the French health system’s excellent reputation in the eyes of the public. Economic measures are generally better accepted than more general measures, the acceptance rate of which eroded as the lockdown continued.

The use of technology to limit the Covid-19 epidemic is among the most hotly debated topics. In contrast to the more physical issues of masks and testing, the government tackled the possibility of using tracing and tracking instruments at a relatively early stage. Tracing is part of the numerous preventive measures used by Asian countries to manage disease outbreaks. For example, Singapore quickly implemented a coronavirus tracing system with the TraceTogether application. The French StopCovid application is scheduled for release on June 2. The development of the application triggered, both in France and elsewhere in Europe, a bitter debate on data privacy. The solution chosen by France is a so-called "centralized" system, i.e. anonymized data (each user is given a random identifier) are stored on a single server, and not on users' phones, as is the case with "decentralized" solutions, such as the one adopted by Germany or the ones developed by Apple and Google.

The total number of patients admitted into intensive care units has been decreasing since April 1, with more patients leaving hospitals than entering them since April 9. While the situation is still sensitive in certain areas that were particularly affected by the epidemic, in his speech on April 13, the French President took note of this overall shift by announcing that the lockdown would be partially and progressively lifted as of Monday, May 11.

All in all, France will have registered more than 25,000 Covid-19-related deaths so far (May 11). The lockdown implemented on March 16 prevented this number from increasing. As reported by the École des hautes études en santé publique (EHESP) on April 22, more than 60,000 deaths were avoided as a result of this lockdown. According to their calculations, had no lockdown been enforced, approximately 600,000 additional people would have been hospitalized between March 19 and April 19, and intensive care units would have had to accommodate more than 140,000 additional patients, far exceeding the total capacity of intensive care units by approximately 90,000 beds. A more conservative Imperial College study reported 5,000 deaths avoided over one month.

However, this lockdown also had a strong economic and social impact. In addition to the economic impact estimated by Insee (see above), which is expected to last for many months, the issue of widening educational inequalities was highlighted on April 21 by Minister of National Education Jean-Michel Blanquer in his bid for a gradual reopening of schools from May 11, despite the Scientific Council’s reluctance, as expressed in a note published the previous day. 

Conclusion

The French lockdown lasted from March 17 to May 11, at which point the country started to gradually ease out of the lockdown rather than abruptly attempting to return to a pre-lockdown state. It helped limit the spread of the epidemic, which remained concentrated in a few virus clusters. This lockdown also had a very marked impact on the French economy, which entered a recession in the first quarter of 2020. The progressive improvement in the overall health situation encouraged the government to restart the economy, which will nevertheless not reach its cruising speed for several months.

Due to the political context in which it was devised and implemented, the lockdown was complicated to understand for the French people, who remain very critical of the government, with three main contentious topics: contradictory positions on masks, digital tracking measures and the reopening of schools. The evolution of the situation in the coming weeks will determine whether the "second wave" feared by many epidemiologists will indeed take place. If so, the government reserves the possibility of implementing a second lockdown to slow down the spread of the virus once again.

Copyright: VALERY HACHE / AFP