Phone calls against social isolation during the Covid-19 lockdown

Context. During the Covid-19 lockdown, the southeastern France pension fund launched a phone call campaign to maintain social contacts with retirees living alone. A study was carried out among the pension fund's workers to explore their views on the campaign, and how retirees experienced lockdown. Methods. Qualitative study based on structured interviews with 19 workers between June 16 and July 2, 2020. Results. From the workers' point of view, retirees mainly suffered from a lack of physical and emotional contact with their families, and from a lack of physical activity affecting their quality of life and their autonomy. The workers reported a strong mobilization of friends and relatives (family, neighbors) and, in some areas, of local stakeholders. This campaign allowed the workers to feel useful, to rediscover humanity in their jobs, and to better understand the needs of older people. They regretted a lack of both technical and psychological preparation. Discussion. This study highlights several areas of improvement for this kind of campaign (target audience, training, collaboration between actors). © Caisse nationale d'assurance vieillesse. Tous droits réservés pour tous pays.

Attitude toward a Covid-19 vaccine in France: Different factors according to age (Covid-19 vaccine: The French population's attitude)

Like in many countries, the French health authorities are pinning their hopes on vaccination to stop the spread of the Covid-19 pandemic. However, this requires the public to get the vaccine. Based on six COCONEL surveys carried out during and after the lockdown among the general French adult population, which aimed to explore life conditions during this period and individual perceptions of the situation, this paper aims to investigate the acceptability of a putative vaccine against Covid-19 among the French population, and more specifically to compare attitudes among the elderly, who are more vulnerable to the disease, with those of younger people. Out of the 8,036 respondents, 27.5% declared that they would refuse the vaccine if it were available. Among the age groups of particular interest, 29.2% of people aged 18–64 said they would refuse the vaccine, compared to 12.4% of respondents aged 65 or over. For both groups, this refusal rate fluctuated depending on the date of the survey, gender, household composition, level of household income, and uptake of the last flu vaccine. In conclusion, more attention should be paid to elderly people, as they were more likely to report hostility toward vaccination in general. Finally, considering that several vaccines are now available, further studies should be done to study vaccine uptake in relation to the vaccine offered. © Caisse nationale d'assurance vieillesse. Tous droits réservés pour tous pays.

Impact of vaccine hesitancy on onset and severity of adverse events

Introduction: On July 12, 2021, the French president announced the implementation of a health passport requiring people to present proof of vaccination or a negative test to enjoy daily activities. This improved vaccination rates from 39% in June to 75% in October. However, many hesitant people felt coerced into being vaccinated. Worrisome expectations are a well-known determinant of nocebo effects and symptoms misattribution. We therefore draw on the French experience with the Covid-19 health passport to provide data on the relationship between being vaccinated while hesitant and the appearance of adverse events (AE). Material and methods: A cross-sectional online survey was conducted between September 22 and October 1, 2021 among a representative sample of the French adult population (n = 2015). We asked respondents whether they had been vaccinated and whether they had reluctances about the vaccine, and if they presented AE and if these AE had been "severe." Results: Among the vaccinated, 156 respondents (9.6%) reported many reluctances, 361 (22.3%) somewhat reluctances, 391 (24.2%) little reluctances and 659 (40.7%) no reluctance (40 did not know and 12 did not wish to answer). 589 (36.3%) participants reported at least one AE among whom 119 (20.2%) considered them severe. Proportions of reported AE and their severity depended highly on attitudes toward vaccination ranging from 66% of respondents with many reluctances (39% were considered severe) to 18% of respondents with no reluctance (5% were considered severe). Discussion/Conclusion: Our study suggests that vaccine hesitancy could be a major driver of patient reported vaccine related AE and their severity. Reporting these effects might be subject to recall bias and confounding due to differences in responders' characteristics and vaccines used. Covid-19 vaccination is likely to be a recurring endeavor, our data suggest that this is important to obtain high vaccine coverages and for the vaccinated's safety and the reliability of safety data.

The impact of the COVID-19 epidemic on primary care in South-eastern France: implementation of a real-time monitoring system based on regional health insurance system data.

BACKGROUND: The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020. METHODS: Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020. RESULTS: Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old). CONCLUSION: The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.

[The impact of the COVID-19 pandemic on first-line primary care in southeastern France: Feedback on the implementation of a real-time monitoring system based on regional health insurance data]. / L'impact de l'épidémie de COVID-19 sur les soins de premier recours en région Provence-Alpes-Côte d'Azur : retour d'expérience sur la mise en place d'un dispositif de surveillance en temps réel à partir des données régionales de l'Assurance maladie.

BACKGROUND: Starting in spring 2020, the COVID-19 pandemic markedly impacted the French healthcare system. Lockdown and risks of exposure to the coronavirus induced patients to modify their ways of use. The objective of this article was to share feedback on the implementation of a real-time monitoring system concerning (a) the activity of private practitioners in southeastern France, and (b) the evolution of reimbursements for drugs prescribed to persons with diabetes, for treatment of mental health disorders, and for performance of some vaccines. METHODS: Data regarding 2019 and 2020 were extracted from regional health insurance databases. They were used to elaborate several indicators relative to the general health insurance scheme, which were calculated and updated each week, starting with week 2. RESULTS: We observed a drop in private physician activity during the lockdown (-23% for general practitioners; -46% for specialist doctors), followed by a return to a semblance of normalcy. Concomitantly, a boom in teleconsultations occurred: at the height of the crisis they represented 30% of medical acts. The initial stage of the lockdown was characterized by peak provisioning for drugs, whereas vaccination strongly declined (-39% regarding measles, mumps and rubella vaccine among children aged less than 5 years; -54% regarding human papillomavirus vaccine among girls aged 10 to 14 years). CONCLUSION: The COVID-19 pandemic could lead to health effects other than those directly attributable to the coronavirus itself. Renouncing care may result in healthcare delays highly deleterious for people and society. Public authorities are preoccupied with these questions; they have set up action plans aimed at encouraging patients to seek treatment without delay. That said, the COVID-19 pandemic crisis has also created opportunities, such as the expansion of telemedicine. Although partial, these indicators can provide useful information enabling public decision makers to be reactive and to implement specific actions to meet the health needs of the population.

Between an ethics of care and scientific uncertainty: Dilemmas of general practitioners in Marseille

While COVID-19 continues to progress worldwide, the French situation is particularly affected by a lack of masks, tests and, as everywhere else, by the lack of clinically validated therapeutic options. The French government has made the choice of confinement and remote monitoring of patients, with recourse to the healthcare system only when signs of worsening appear (hospitalisation). But in Marseille, a hospital research centre (IHU, led by Pr. Raoult) decided to apply the doctrine of ‘test and treat’ using hydroxychloroquine. This chapter explores the effects of this decision on local doctors’ practices relative to COVID-19. We will show the dilemmas faced by doctors: how they navigate the controversy over hydroxychloroquine as well as negotiate with their patients’ demand for testing and treatment with hydroxychloroquine. This chapter constitutes a first attempt at bringing together the results of a wider research project involving analysis several surveys and interviews conducted among GPs in Marseille and 1200 GPs in France, an analysis of the coverage of the hydroxychloroquine debate in the French national press and surveys conducted among representative samples of the French population. It will also draw on one of the authors’ experience of being a general practitioner in Marseille. © 2021 selection and editorial matter, Deborah Lupton and Karen Willis.

What could explain the late emergence of COVID-19 in Africa?

At the end of November 2019, a novel coronavirus responsible for respiratory tract infections emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in southern Europe and America in spring 2020. Many studies predicted an epidemic in Africa similar to that currently seen in Europe and the USA. However, reported data do not confirm these predictions. Several hypotheses that could explain the later emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic in African countries are being discussed, including the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs.