Adherence and sustainability of interventions informing optimal control against COVID-19 pandemic

After one year of stop-and-go COVID-19 mitigation, some European countries still experience sustained viral circulation due to the B.1.1.7 variant. As the prospect of phasing out this stage through vaccination draws closer, it is critical to balance the efficacy of long-lasting interventions and their impact on the quality of life. Focusing on the current situation in France, we show that moderate interventions require a much longer time to achieve the same result as high intensity lockdowns, with the additional risk of deteriorating control as adherence wanes. Integrating intensity and duration of social distancing in a data-driven "distress" index, we show that shorter strict lockdowns are largely more performant than longer moderate lockdowns, for similar intermediate distress and infringement on individual freedom. Our study shows that favoring milder interventions over more stringent short approaches on the basis of perceived acceptability could be detrimental in the long term, especially with waning adherence.

High seroprevalence of anti-SARS-CoV-2 antibodies after the first wave of the COVID-19 pandemic in a vulnerable population in Perpignan, France

BackgroundIn March 2020, many cases of COVID-19 were reported in three socially deprived neighbourhoods of the city of Perpignan, in the south of France, where large sedentary gypsy communities live. A study to measure seroprevalence was conducted in July 2020 to assess the level of contamination in these neighbourhoods after the first wave of the pandemic, and to identify factors associated with seropositivity. MethodsSCoPe is a cross-sectional survey conducted in selected persons aged six years old and over living in three neighbourhoods in Perpignan. Households were selected by systematic sampling and participants by random sampling. Collected blood samples were tested for SARS-CoV-2 IgG and IgM antibodies using the EIecsys(R) immunoassay to target the coronaviruss spike protein. Antibody seroprevalence was estimated from weighted data and associated factors were investigated using multivariate logistic regression. ResultsThe seroprevalence of anti-SARS-CoV-2 antibodies was 35.4% (95% CI: 30.2-41.0). Over a fifth of seropositive individuals (21.7% ([14.1-31.8]) did not report any COVID-19 symptom. People aged 15-64 years old were at greater risk of seropositivity than those aged 65 years or over. Obesity prevalence was 40.7% (35.8-45.8) and obese people were more likely to be seropositive (aOR=2.0 [1.1-3.8]). The risk of being seropositive was higher in households with clinical COVID-19 cases (One case: aOR=2.5 [1.3-5.0]). In the neighbourhood with the highest measured seroprevalence, people living in a dwelling with 1-2 rooms had a higher risk of being seropositive than those living in a 4-room house (aOR=2.8 [1.2-6.3]). Working during the lockdown was associated with a lower risk of seropositivity (aOR=0.2 [0.03-1.0]). ConclusionTransmission prevalence of the SARS-COV-2 virus in this vulnerable population was very high during the COVID-19 pandemics first wave. Our results highlight the need to strengthen and adapt preventive measures by taking into account all social determinants of health, especially housing conditions.

Prevalence of SARS-CoV-2 antibodies in France: results from nationwide serological surveillance

BackgroundAssessment of cumulative incidence of SARS-CoV-2 infections is critical for monitoring the course and the extent of the epidemic. As asymptomatic or mild cases were typically not captured by surveillance data in France, we implemented nationwide serological surveillance. We present estimates for prevalence of anti-SARS-CoV-2 antibodies in the French population and the proportion of infected individuals who developed potentially protective neutralizing antibodies throughout the first epidemic wave. MethodsWe performed serial cross-sectional sampling of residual sera over three periods: prior to (9-15 March), during (6-12 April) and following (11-17 May) a nationwide lockdown. Each sample was tested for anti-SARS-CoV-2 IgG antibodies targeting the Nucleoprotein and Spike using two Luciferase-Linked ImmunoSorbent Assays, and for neutralising antibodies using a pseudo-neutralisation assay. We fitted a general linear mixed model of seropositivity in a Bayesian framework to derive prevalence estimates stratified by age, sex and region. FindingsIn total, sera from 11 021 individuals were analysed. Nationwide seroprevalence of SARS-CoV-2 antibodies was estimated at 0.41% [0.05-0.88] mid-March, 4.14% [3.31-4.99] mid-April and 4.93% [4.02-5.89] mid-May. Approximately 70% of seropositive individuals had detectable neutralising antibodies. Seroprevalence was higher in regions where circulation occurred earlier and was more intense. Seroprevalence was lowest in children under 10 years of age (2.72% [1.10-4.87]). InterpretationSeroprevalence estimates confirm that the nationwide lockdown substantially curbed transmission and that the vast majority of the French population remains susceptible to SARS-CoV-2. Low seroprevalence in school age children suggests limited susceptibility and/or transmissibility in this age group. Our results show a clear picture of the progression of the first epidemic wave and provide a framework to inform the ongoing public health response as viral transmission is picking up again in France and globally. FundingSante publique France.