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HEALTH

ANALYSIS: The nervous wait to see if France got its lockdown strategy right

So far, so good, writes John Lichfield, as France emerged cautiously and suspiciously from its eight weeks of lockdown.

ANALYSIS: The nervous wait to see if France got its lockdown strategy right
Police moving on crowds on the steps of Sacre-Coeur in Paris. Photo: AFP

It was a couple of days before life started to look something  like normal – perhaps too normal.

There were reports on Sunday of crowds on beaches or river-banks all over France. In my tiny village in Normandy, I saw three large groups of walkers pass my house – three more than on a pre-virus Sunday.

Who can blame them? Should we blame them? We will soon know.

Confusing and contradictory figures exist but it appears to take three to five days – and up to 14 days – for the first symptoms of Covid-19 appear.

READ ALSO What changes in France under phase 1 of lifting lockdown?

Health minister Olivier Véran has been forced to admit that the contact tracing app is not ready. Photo: AFP

Dr Jacques Basstoni, a GP in Calvados who is president of MG France, the largest union of family doctors, says : “We won’t know what impact the end of lockdown  has had before May 20th or 21st”.

In other words we may have some idea whether France is heading for a second wave of infections by Wednesday or Thursday. Other scientists and doctors say that a clear picture will not emerge until next week.

The key early indicators to look out for will be “confirmed cases” and “hospital admissions”, both of which have been radically reduced from their late March and early April peak.

The national health agency, Santé Publique France, says that only 2,950 new SARS-CoV-2 cases were reported by GPs in the seven days before the lockdown ended on Monday, May 11th. This compares with 94,810 cases at the peak – the seven days up to March 29th.

There have been 25 new family or workplace “clusters” of cases identified in the first week of déconfinement but these were all incubated during the eight weeks of widespread house arrest.

Overall, the number of new cases in recent days – despite a long overdue but incomplete increase in testing – has been well below the government’s target or ceiling of 1,000 to 3,000. From Saturday at 2pm to Sunday at 2pm, there were only 120 new cases reported in the whole of France.

Despite some glitches, the gradual easing of the lockdown has gone well (so far as we know until the infection figures appear post-Wednesday). The best measure of that success is the comparative absence of barracking and fault-finding by opposition politicians.

Emergency social-distancing measures on public transport in Paris and other big cities have been reasonably effective. The Metro is operating at 75 percent or normal. All those who want to wear masks appear to be able to find them. The country’ s economy, brutally cut  by one third from March 17th, is cranking slowly back into life.

There are some continuing failures. The health minister, Oliver Véran, boasted last Friday that testing was now running at “more than 50,000 a day”. The government had promised 100,000 a day.

The policy of “test, trace and isolate contacts” is supposed to be at the heart of the government’’s “deconfinement” strategy. By Dr Véran’s own admission it is still only operating at half-cock.

Some time early next week, the government will decide whether, and where, to go ahead with the second phase of the lockdown easing from June 2nd-3rd.

The distinction between “Red” France and “Green” France – the départements where the virus is active and those where it has retreated or never really appeared – will then become more real and painful.

READ ALSO What does it mean to live in a 'red zone' in France?

The map of red and green zone. Map: Santé Publique France

At present, the only differences are that green départements have open parks, middle-schools (collèges) and shopping centres. From early June, if all goes well, green départements will be allowed to open bars and restaurants.

Will the map change? Probably a little. Parts of Burgundy, Franche-Comté, and northern France, now in the red zone, may turn green.

I fear that it will be too early for the greater Paris area and for Alsace and other parts of the east, which have seen around three quarters of all French cases and deaths.

Much of the science remains uncertain. Only opposition politicians and the many loudmouths of social media are absolutely certain how Covid-19 works and how to defeat it.

Professor Didier Raoult in Marseille, the promoter of the hydroxychloroquine “cure”, is convinced that there will be no second wave. He has been wrong about several things since the epidemic began. He is undoubtedly a brilliant man. Maybe he is finally right about something.

Professor Didier Raoult – will be be proved right on epidemic curves if not on hydroxychloroquine? Photo: AFP

Raoult says that all epidemics of this kind burn themselves out, whatever we do, or don’t do, to control them.

It is striking, when you look at the French statistics that Covid-19 deaths peaked in the last couple of days of March and the first five days of April. This is roughly two to three weeks from when the lockdown began – suggesting that the eight weeks of house arrest did serve its purpose.

As Professor Raoult points out, however, exactly the same pattern of peak and fall can be traced in other epidemics, like the great flu epidemic which killed 31,000 people in France in the winter of 1969-70. (The present French death toll from Covid 19 is just over 28,000, not including “home deaths”.)

The chart shows daily death tolls from January 1st 2010 to April 20th 29020, with the addition of high daily death tolls from past years, including the 2003 heatwave (in yellow) and the 1969 flu epidemic (in blue). Map: INSEE

There was no social distancing or lockdown in France in 1969-1970. In fact, the epidemic was scarcely mentioned in the press at the time. It still went  away with the spring and early summer.

We will know in the next few days whether a) Professor Raoult is right  b) whether the government has judged its déconfinement well.

If the number of Covid-19 cases, and serious cases, begins to soar again, we will know they were both wrong.

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HEALTH

Where in France are there concerns about pesticides in drinking water

An investigation has revealed that tap water supplied to some 12 million people in France was sometimes contaminated with high levels of pesticides last year.

Where in France are there concerns about pesticides in drinking water

Data from regional health agencies, and collated by Le Monde, found that supplies to about 20 percent of the population, up from 5.9 percent the year previously, failed to consistently meet regional quality standards. 

The study highlighted regional differences in tap water quality. Hauts-de-France water was the most likely to be affected, with 65 percent of the population there drinking water contaminated by unacceptable pesticide levels. In Brittany, that level fell to 43 percent; 25.5 percent in the Grand-Est, and 25 percent in the Pays de la Loire.

Occitanie, in southwest France, meanwhile, showed the lowest level of non-compliance with standards, with just 5.1 percent of the region’s population affected by high pesticide levels in their tap water. However, figures show that 71 percent of people in one département in the region, Gers, were supplied with water containing high levels of pesticides.

Regional discrepancies in testing, including what chemicals are tested for, mean that results and standards are not uniform across France. Tap water in Haute-Corse is tested for 24 pesticide molecules; in Hauts-de-Seine, that figure rises to 477. 

One reason for regional testing standards are differences in local agricultural requirements.

Part of the increase in the year-on-year number of households supplied with affected water may also be explained by the fact that tests in many regions now seek to trace more molecules, Le Monde noted.

Water quality standards in France are strict – with a limit for pesticide residues set at 0.1 microgramme per litre, so the “high” levels found in tap water supplies may not represent a danger to health.

The question of the level of health risk to humans, therefore, remains unclear. The Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail (Anses) has not defined a maximum safety level for 23 pesticides or their metabolites. Le Monde cites two metabolites of chloridazone, a herbicide used until 2020 on beet fields, for which only provisional safety levels in tap water have been set. 

Many of these molecules and their long-term effects remain unknown – and “the long-term health effects of exposure to low doses of pesticides are difficult to assess,” admits the Ministry of Health.

Michel Laforcade, former director general of the ARS Nouvelle-Aquitaine told Le Monde that health authorities have “failed” on this subject. 

“One day, we will have to give an account,” he said. “It may not be on the same scale as the contaminated blood affair, but it could become the next public health scandal.”

In December 2020, the Direction générale de la santé (DGS) recommended “restricting uses of water” as soon as the 0.1 micrograms per litre quality threshold is exceeded, in cases of residues for which there is no formal maximum health value.

But this principle is not always applied, according to France 2’s Complètement d’enquête programme.

In December 2021, the DGS asked the Haut conseil de la santé publique (HCSP) “for support on the management of health risks associated with the presence of pesticides and pesticide metabolites in water intended for human consumption.”

The HCSP, in response, said that “an active and urgent policy must be implemented to reduce the contamination of resources by pesticides”.

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