Sunday, 16 January, 2022

Covid: how Medicare wants to review the tracing of infected patients


The authorities are studying how to develop “contact tracing”, possibly by looking for previous contaminating events. In three weeks, Medicare reimbursed 250,000 antigenic tests to the liberal health professions.

The Caisse Primaire d'Assurance Maladie (CPAM) of Bas-Rhin, in charge of

The book “contact tracing” looks back on the job. Operational since the first deconfinement, in mid-May, the device for identifying and alerting people in contact with patients infected with Covid has not proved its worth, the second wave of the epidemic being as strong or even stronger than the first.

The public authorities are thus working on improving the triptych “test, alert, protect” with a view to the second deconfinement. This was explained by Thomas Fatome, the director of the National Health Insurance Fund (CNAM), pilot administration of “contact tracing”, this Wednesday, to the Association of Social Information Journalists (Ajis) .

“The device will evolve”, he confirmed. While its teams are in the process of providing feedback, the CNAM is already studying new avenues with the Ministry of Health. “To adapt to a future deconfinement”. This is of course the integration of the results of the antigenic tests in the surveys, centralized since Monday in the Si-Dep screening file. But it is also a question of deepening these investigations by practicing, as in Japan, “retro-tracing”.

The track of retro-tracing

The whole point is “Go back to the origin of the contamination” patient zero, “To identify a time or places at the origin of significant chains of contamination”, explained Thomas Fatome, instead of being satisfied with identifying and alerting the “contact cases”, that is to say the people that this zero patient could himself have contaminated. Tracing back makes sense with this virus which can spread at full speed from an at-risk household, as we saw with the evangelical gathering in Mulhouse in February. This would make it possible to flush out infectious foci, in addition to the work done by the regional health agencies (ARS) in nursing homes, workers’ homes, schools, etc.

Read also:

DOSSIER> Reconfinement: what you need to know

The CNAM, the ARS or the epidemiological investigators from Public Health France could carry out the retro-tracing if this track is confirmed. “We will continue with classic tracing anyway, these are complementary approaches”, explained Thomas Fatome.

Contact tracing is already mobilizing many people at Medicare. Since mid-May, explained Thomas Fatome, 5 million people have been called, i.e. “Just under one in ten French people”, with more than 100,000 calls per day in October and conversations lasting 20 to 30 minutes. The primary health insurance funds (CPAM) are taking more than 140,000 calls per day at the moment, twice as many as normal.

Room for improvement

Without going as far as retro-tracing, Medicare is looking for room for improvement in the current system. She is proud to have called 90 to 95% of contact cases in October: “If we call 2 or 3 times, can we maximize to reach 100%? “ asks Thomas Fatome. “Positive people tell us that they have no contact. How to change this? “ he adds.

Indeed, epidemiologists were surprised to note that in France as in neighboring countries, there are often only three contacts per zero patient, perhaps due to withholding of information. As a result, only one in five new positive cases has been previously identified as a “contact case”.

Other track, “Better support in the test”, by recalling contact cases seven days later to verify that they were tested, and to tell people at risk of being infected “How to better isolate yourself”.

Read also:

Hospitals remain under pressure despite the decline in the epidemic

In any case, health players are waiting for something new on the strategy aimed at breaking the chains of contamination. “We must be able to learn from it” before reopening the country, “Even if this assessment shows points of weakness”, indicated Frédéric Valletoux, the president of the Hospital Federation of France, Tuesday, punctuating his remarks with this quasi-slogan: “A poorly prepared deconfinement is the third wave guaranteed”.

Antigenic tests are on the rise

On Tuesday, 250,000 antigenic tests had been reimbursed by Medicare to health professionals in town, which Thomas Fatome described on Wednesday as “Relatively rapid ramp-up” since launch three weeks ago. The expense amounted to 14 million euros, or an average cost of 56 euros, lower than the 74 euros for RT-PCR tests. As the government has opened up access to these rapid tests widely, Thomas Fatome expects “A very significant remedy”, of the order of 1.5 to 2 million tests per week.

Read also:

DOSSIER Covid: the figures for the epidemic and the health response in France

The authorities are studying how to develop “contact tracing”, possibly by looking for previous contaminating events. In three weeks, Medicare reimbursed 250,000 antigenic tests to the liberal health professions.

The Caisse Primaire d'Assurance Maladie (CPAM) of Bas-Rhin, in charge of

The book “contact tracing” looks back on the job. Operational since the first deconfinement, in mid-May, the device for identifying and alerting people in contact with patients infected with Covid has not proved its worth, the second wave of the epidemic being as strong or even stronger than the first.

The public authorities are thus working on improving the triptych “test, alert, protect” with a view to the second deconfinement. This was explained by Thomas Fatome, the director of the National Health Insurance Fund (CNAM), pilot administration of “contact tracing”, this Wednesday, to the Association of Social Information Journalists (Ajis) .

“The device will evolve”, he confirmed. While its teams are in the process of providing feedback, the CNAM is already studying new avenues with the Ministry of Health. “To adapt to a future deconfinement”. This is of course the integration of the results of the antigenic tests in the surveys, centralized since Monday in the Si-Dep screening file. But it is also a question of deepening these investigations by practicing, as in Japan, “retro-tracing”.

The track of retro-tracing

The whole point is “Go back to the origin of the contamination” patient zero, “To identify a time or places at the origin of significant chains of contamination”, explained Thomas Fatome, instead of being satisfied with identifying and alerting the “contact cases”, that is to say the people that this zero patient could himself have contaminated. Tracing back makes sense with this virus which can spread at full speed from an at-risk household, as we saw with the evangelical gathering in Mulhouse in February. This would make it possible to flush out infectious foci, in addition to the work done by the regional health agencies (ARS) in nursing homes, workers’ homes, schools, etc.

Read also:

DOSSIER> Reconfinement: what you need to know

The CNAM, the ARS or the epidemiological investigators from Public Health France could carry out the retro-tracing if this track is confirmed. “We will continue with classic tracing anyway, these are complementary approaches”, explained Thomas Fatome.

Contact tracing is already mobilizing many people at Medicare. Since mid-May, explained Thomas Fatome, 5 million people have been called, i.e. “Just under one in ten French people”, with more than 100,000 calls per day in October and conversations lasting 20 to 30 minutes. The primary health insurance funds (CPAM) are taking more than 140,000 calls per day at the moment, twice as many as normal.

Room for improvement

Without going as far as retro-tracing, Medicare is looking for room for improvement in the current system. She is proud to have called 90 to 95% of contact cases in October: “If we call 2 or 3 times, can we maximize to reach 100%? “ asks Thomas Fatome. “Positive people tell us that they have no contact. How to change this? “ he adds.

Indeed, epidemiologists were surprised to note that in France as in neighboring countries, there are often only three contacts per zero patient, perhaps due to withholding of information. As a result, only one in five new positive cases has been previously identified as a “contact case”.

Other track, “Better support in the test”, by recalling contact cases seven days later to verify that they were tested, and to tell people at risk of being infected “How to better isolate yourself”.

Read also:

Hospitals remain under pressure despite the decline in the epidemic

In any case, health players are waiting for something new on the strategy aimed at breaking the chains of contamination. “We must be able to learn from it” before reopening the country, “Even if this assessment shows points of weakness”, indicated Frédéric Valletoux, the president of the Hospital Federation of France, Tuesday, punctuating his remarks with this quasi-slogan: “A poorly prepared deconfinement is the third wave guaranteed”.

Antigenic tests are on the rise

On Tuesday, 250,000 antigenic tests had been reimbursed by Medicare to health professionals in town, which Thomas Fatome described on Wednesday as “Relatively rapid ramp-up” since launch three weeks ago. The expense amounted to 14 million euros, or an average cost of 56 euros, lower than the 74 euros for RT-PCR tests. As the government has opened up access to these rapid tests widely, Thomas Fatome expects “A very significant remedy”, of the order of 1.5 to 2 million tests per week.

Read also:

DOSSIER Covid: the figures for the epidemic and the health response in France