'The only good strategy': How France is trying to stop a coronavirus resurgence in Paris' poorest suburbs
To avoid a second wave of coronavirus infections, France has chosen a different way of testing people in the country's hardest-hit suburbs around Paris in the hope it will help avoid a new spike. But is it working?
“Do you have any symptoms? Fever, headache or throat pain?”
The health worker, clad in a huge, plastic cloak, protective goggles, gloves and mask, looked up at Nassira, 39, who shook her head in response.
”And your daughter?”
“No,” Nassira said.
Nassira had come to the community centre in Pantin, a suburb on the north-eastern edge of Paris, to do her laundry.
That day the community centre, located in the département of Seine Saint-Denis, was offering PCR tests - the Q-tip test that can tell if a person is infected with the coronavirus - for everyone who wanted, free of charge and without appointment.
When she was asked if she wanted the test Nassira thought “why not?”.
Medical workers doing a brief pre-test interview with a visitor at the community centre in Pantin. Photo: The Local
“Don’t worry, it’ll be very quick,” said the female health worker, a 20-year-old studying to become a doctor.
Nassira shut her eyes as the woman stuck a long Q-tip up her nose, asking her to continue to breathe normally.
It was over in seconds. The health worker packed away the Q-tip in a sealed plastic bag, before she turned to Aya.
“I don’t want to do it!” Aya exclaimed, kicking her feet.
But she closed her eyes. When it was over, the health worker reminded Nassira to return in a few days to pick up the results.
If they turned out to be positive, the regional authorities would offer them a place to isolate themselves during the quarantine.
Nassira and her two children live in a foyer (social housing complex) in Aubervilliers, a neighbouring town to Pantin. They spent the lockdown inside, no a balcony or garden to breathe fresh air from. Aya is epileptic. The confinement period “was really tough,” Nassira said. pic.twitter.com/SrqIC5raru— Ingri Bergo (@ingribergo) June 20, 2020
The centre in Pantin was a communal multi-service building, well-known to the local community as a place to get a meal, a hot shower or just to chat and watch some TV.
The walls of the centre were covered with signs spelling out basic health advice, urging the reader to wash their hands frequently, to sneeze in their elbow, and to remember to keep a distance between themselves and others. Some signs were in Arabic, to reach the people in the area who do not speak good French.
Many of the visitors were clearly regulars, sipping their coffee outside in the garden or watching the news in the living room. Some looked like they had slept outside that night.
Asrem, 44, said he comes to the centre in Pantin regularly to have lunch, watch some news, chat with the people there and - recently - "to keep informed on the health situation." He decided to get tested on the spot, "because he was asked." Photo: The Local
As France began to ease its nationwide lockdown in mid-May, President Emmanuel Macron ordered local authorities to extensively test their populations to identify and cut transmission chains before they get out of control.
After heavy criticism for not testing enough in the early stages of the pandemic, France's testing capacity is now up to 100,000 PCR tests per day - on a par with Germany.
But Pantin and the rest of Seine Saint-Denis, France’s poorest département, faced a tough task to follow orders. The area is what in France is known as a “medical desert,” an area with a low number of doctors relative to its inhabitants.
To fill the gap, the greater Paris region’s health authority ARS Île-de-France decided to proactively seek out patients through the pop-up test centres.
Arsem, 44, was brave enough to both take the test and to let me sit in on it. “They asked me if I wanted to, so I said yes,” he said. pic.twitter.com/o2lCv0L8uH— Ingri Bergo (@ingribergo) June 20, 2020
The centre in Pantin was just one of three pop-up test centres set up by the regional health authority that day in the greater Paris region of Île-de-France. Usually, they would set up two or three centres at the time, in cooperation with local officials and community groups, who also helped to spread the word via social media and billboards.
Most of the centres were improvised instalments, white tents that would be taken down that same night.
“The goal is to give people who don’t necessarily have access to medical help - because they don’t have a GP, or because they live too far away, or they don’t have the time - the opportunity to get tested for the virus,” Luc Ginot, the Director of the Public Health Department at the Agence Régionale de Santé (ARS) Île-de-France told The Local.
'Close to the people'
The tests are free, but as all coronavirus PCR tests in France are fully covered by the public health care system, the most important element of the plan was not the cost, but the accessibility.
“We wanted to be as close as possible to the people,” Ginot told The Local.
Few in Seine Saint-Denis have a designated general doctor, and many were reluctant to spend time in waiting rooms, potentially exposing themselves to risk of coronavirus contagion.
Every time a test centre is set up, local people line up outside, Ginot said. “We really feel like we’re responding to an enormous need here,” he said.
In Île-de-France as a whole the regional health authorities have so far organised 66 pop-up test operations and 16 in the département of Seine Saint-Denis.
Regional health authorities have told The Local that across the whole of the Île-de-France region they have carried out 10,134 tests at the pop-up centres since they began the programme on May 11th. The positivity rate of the tests was 0.72 percent.
In Seine Seine Saint-Denis alone 2,714 tests have been carried out, with only 22 positive results, a positivity rate of 0.81 percent.
Coronavirus health advice in Arabic inside the centre in Pantin. Photo: The Local
A coronavirus hot-spot
Seine Saint-Denis is seen as a key battleground against a second wave of infections. The area was hit particularly hard first time around and scientists have predicted that if there is a second wave it will likely emerge in Paris and its suburbs.
The epidemic swept mercilessly through its densely populated neighbourhoods, pushing the mortality rate up by 130 percent in March, more than anywhere else in the country.
In addition to being densely populated, Seine Saint-Denis is home to many of Paris’ key workers - cleaners, drivers, bin collectors, health workers and others - who did not have the option of working from home.
When the Paris public transport was running with nearly empty trains and buses, the metro line 13, which connects the urban areas in Seine Saint-Denis with the city centre, was packed with people who needed to get to work.
At the time, France was still lacking masks, and many of the workers were braving the contagion without protective equipment.
Another factor was that the country's lockdown, credited with stemming the spread of the epidemic, wasn't quite as effective in Seine Saint-Denis as it was elsewhere due to the characteristics of the area.
“The problem was not that the inhabitants did not want to confine themselves, it was just much harder for them do to it in practice,” he said.
This meant there was an even greater need for innovative testing strategies, not least because Seine Saint-Denis is home to a big proportion of the Paris region’s immigrant population, many of whom might shy away from public health initiatives where they need to answer questions and fill out forms.
A visitor watching the French President speaking inside the community centre in Pantin, before he got tested. Photo: The Local
'A hot-spot strategy'
The pop-up test centres have been backed by experts.
“When making public health decisions you want to consider all different levels and ask: what’s the best approach?,” said Claire Chaumont, a French instructor at Harvard T.H. Chan School of Public Health in the United States.
Chaumont said she believes the French strategy - setting up easily accessible, no-questions-asked test centres - was a good way to reach people who otherwise would fall through the cracks.
“This is not a blanket strategy but a hot-spot strategy,” Chaumont said. “From a public health perspective that makes a lot of sense.”
Celestin-Alexis Agbessi, an emergency doctor at the Parisian hospital Bichat, one of the Paris region’s reference hospitals for coronavirus patients, said the pop-up testing initiative was “the only good strategy," in an area that "because it had been let down by the state, needed positive discrimination."
Antoine Flahault, professor of public health and Director of the Institute of Global Health at the University of Geneva, has warned that countries in Europe need to prepare for a second wave and that extensive testing was the key to discover and eliminate new transmission chains.
“It's crucial to focus on deprived areas, because it’s very hard to impose lockdown there,” he said.
Seine Saint-Denis goes green
In mid-June the situation looked a lot better in Seine Saint-Denis than mid-April, when the coronavirus pandemic peaked in France.
Since Mid-April, Seine Saint-Denis’ coronavirus rates have dwindled alongside the rest of the country, in a national trend that can largely be explained by the positive, long term effects of the strict, nationwide lockdown as well as the change in testing strategy which has allowed authorities to quickly identify and isolate dozens of new clusters.
Over the two months the number of people hospitalised for the coronavirus in Seine Saint-Denis was more than halved, from over 1,600 in mid-April to 754 mid-June.
Intensive care rates also plunged, down from 251 critically ill patients in mid-April to 68 mid-June, according to the French public health agency Santé Public France.
On June 14th, President Macron announced that the entire Paris region, including Seine Saint-Denis, would turn green one week earlier than planned - meaning lockdown rules would be relaxed further.
The region had originally remained red in May before becoming an orange coronavirus zone as its level of contagion had remained too high to completely reopen cafés and bars alongside the rest of the country.
‘We will stay as long as it takes’
Île-de-France regional health chief Ginot however stressed that persuading people to visit the pop-up test centres was only one part of a larger, multilayered plan to prevent a resurgence of the virus.
The effectiveness of the centres in the battle against a second wave was not just about testing.
"It permits us to talk to people about coronavirus. It helps people understand that it's still a problem,” he said.
There was no set end-date to the project yet, and Ginot said they would stay for as long as they were needed.
“We will continue for as long as it takes. Either because there is a demand from the population, or because the health situation requires us to stay,” he said.