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Europe Versus Coronavirus – France: a Health and Trust Crisis

BLOG - 15 May 2020
Key Points
1

The first known coronavirus-related death in France occurred on February 14. In response to the first cases, a four-stage reaction plan, initially designed in 2011 to fight against a possible flu pandemic, was triggered by Olivier Véran, the French Minister of Solidarity and Health, on February 23, starting with stage 1 (slowing down the introduction of the virus). Five days later, stage 2 is triggered, following the identification of virus circulation clusters. A little more than a month after the first death, stage 3 of the coronavirus control plan is activated (active virus circulation) and lockdown is implemented from March 17 for an initial period of 2 weeks.

2

The government announces several measures to support the economy during the month of March, among these, enabling businesses to defer without justification, formalities or penalties, the payment of contributions and taxes due in March. State-backed loans are introduced, and at the beginning of May, €57 billion in 90% state-backed loans had been granted to 350,000 companies. A furlough system is implemented, as of early May, 11.7 million workers are concerned. All employees are asked to work from home when possible.

3

While the curves for the total number of additional cases and the number of people in intensive care are steadily decreasing, the President announced on April 13 that the lockdown would be partially and progressively lifted as of May 11. The end of the lockdown will be staggered throughout the country depending on the health situation in each département (red or green).

4

Among the most debated topics are the reopening of primary schools from May 11, mostly due to doubts regarding the ability to comply with health regulations, and the use of new technologies to combat the spread of the virus, leading to distrust among the population (at the beginning of May, only 46% of French people were prepared to download the StopCovid application and use it on their smartphone).

Timeline

  • January 24: First three cases of Covid-19 are reported in France.
  • February 14: An 80-year-old Chinese tourist dies at the Bichat hospital in Paris. He is the first person to die on French soil.
  • February 23: The four-stage reaction plan is triggered by French Minister of Solidarity and Health Olivier Véran, starting with stage 1 (slowing down the introduction of the virus).
  • February 25: A teacher in Crépy-en-Valois (Oise) dies from Covid-19. He is the first French national to die from the virus.
  • February 29: Stage 2 is triggered. Its objective is to slow the spread of the virus in the country. Gatherings of 5,000 people or more in confined spaces are banned. In the outbreak center in Oise, all gatherings are banned, movement is restricted and schools in affected towns are closed.
  • March 1: The first cases are recorded in Overseas France (Lesser Antilles, Saint-Barthélémy and Saint-Martin). 
  • March 6: 81 cases are reported in 24 hours in Mulhouse following an evangelical rally that brought together 2,500 people between February 17 and 21. This gathering will play a major role in the spread of the virus across the country.
  • March 11: Visits to nursing homes are forbidden.
  • March 12: Presidential address announcing the closing down of kindergartens, schools, high schools and universities. All companies will be able to defer the payment of contributions and taxes due in March without justification, formalities and penalties. A furlough system is considered. Employees are asked to work from home when possible.
  • March 14: The Prime Minister announces the transition to stage 3: all places receiving the public deemed non-essential are closed.
  • March 15: The first round of municipal elections is maintained, with an abstention rate of over 55%.
  • March 16: The President announces lockdown measures for a minimum of 15 days starting at noon the following day. The second round of municipal elections, initially scheduled for March 22, is postponed.
  • March 27: The Prime Minister extends the lockdown until April 15.
  • April 7: France reaches 10,000 Covid-19-related deaths.
  • April 13: The President announced that the lockdown will be partially and progressively lifted as of May 11 and gives the government 15 days to prepare a national "end of lockdown" plan.
  • April 14: More than 100,000 reported Covid-19 cases in the country.
  • April 28: The Prime Minister presents the "end of lockdown" plan to the National Assembly (staggered return to class for preschool and primary school students, no planned return to class for high schools and universities, bars, cafés and restaurants to stay closed, and all gatherings remain banned).
  • April 30: The Ministry of Solidarity and Health publishes an updated epidemiological report enabling the targeting of areas requiring stricter "end of lockdown" measures. The country is divided into red, orange and green zones.
  • May 5: The Senate adopts the bill extending the state of health emergency until July 10.
  • May 7: The Prime Minister announces the end of the lockdown for all French territories (except Mayotte), which are divided into "green" and "red" areas based on the three following indicators: the dynamics of the epidemic, intensive care occupancy rate and testing capacities.
  • May 7: The French National Institute of Statistics and Economic Studies (Insee) reports 453,800 net job losses in the first quarter.
  • May 11: First day of the "end of lockdown" period.

Analysis

In mid-February, as France is about to experience the beginning of the epidemic, it is also in the midst of a minor political crisis: following Benjamin Griveaux’s withdrawal from the Paris mayoral race, he is replaced by Agnès Buzyn, then Minister of Health. Olivier Véran, an MP and neurologist, finds himself propelled to a strategic position, while the situation in Italy foreshadows the epidemic that is about to hit France. A Council of ministers is exceptionally held on Saturday, February 29 to prepare scenarios to deal with the looming health crisis. On March 11, an ad-hoc scientific council is created, which reports to the Minister of Health and aims "to enlighten the public decision in the management of the health situation related to the coronavirus". It is chaired by Professor Jean-François Delfraissy and includes ten other experts.

On March 11, an ad-hoc scientific council is created, which reports to the Minister of Health and aims "to enlighten the public decision in the management of the health situation related to the coronavirus".

Following the controversial decision to maintain the first round of the municipal elections on Sunday, March 15, the presidential address on Monday, March 16 marks the beginning of an official national lockdown on Tuesday 17. While this lockdown is less strict than the one enforced in Italy or Spain due to exemptions granted by the French government, it nevertheless represents a more coercive response to the virus than that of the United Kingdom, for example, which chose the risky herd immunity strategy.

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.

Furthermore, France is one of the few European countries to carry out a very low number of PCR tests each week. At the end of March, after having developed its first test in mid-January, Germany conducted between 300,000 and 500,000 tests weekly, while France conducted between 35,000 and 85,000 (benign and asymptomatic forms are not tested). According to OECD figures from April 28, France was carrying out 9.1 tests per 1,000 people, less than half as many as Germany (25.1) and Spain (22.3), and three times less than Italy. 

France was carrying out 9.1 tests per 1,000 people, less than half as many as Germany (25.1) and Spain (22.3), and three times less than Italy.

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.

In total, the state's emergency plan is estimated at more than €110 billion (5% of GDP), with an additional €315 billion in state-backed loans.

In total, the state's emergency plan is estimated at more than €110 billion (5% of GDP), with an additional €315 billion in state-backed loans. In a survey commissioned by Les Echos, Institut Montaigne and Radio Classique, Elabe shows that these measures to help businesses and protect assets are very widely approved by the French people: 92% are in favor of deferring the payment of social security contributions and taxes, and 90% are in favor of generalizing the furlough system.

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 French solution is thereby similar to the one used in the United Kingdom, with its benefits and flaws. In the French case, the government wished to favor the understanding of the spread of the virus by epidemiologists, as well as the security of identifiers and associated data, which are stored in a single place and therefore deemed easier to protect than when they are stored in telephones throughout the country.

An improving health situation before the end of lockdown was initiated

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 [...] 34% on May 7).

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. 

59% of French people were against a gradual reopening of schools and 7 out of 10 parents did not intend to send at least one of their children to school on May 11,

Starting on May 11, between 80 and 85% of schools will reopen, with no more than 15 pupils per class in elementary schools and 10 pupils per class in kindergarten. Strict health measures will be imposed, and parents are given the right to withdraw. These guarantees have not been enough to dispel doubts among the population: 59% of French people were against a gradual reopening of schools and 7 out of 10 parents did not intend to send at least one of their children to school on May 11, according to a poll carried out by Odoxa on May 6. As of the week of May 18, high schools in green areas will welcome their pupils again.

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

 

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