Week after week finds France in a sort of COVID limbo, as the number of coronavirus cases remains relatively steady. While the extremely slow decrease may frustrate citizens coping with an uncompromising 6 pm curfew, public health experts are also celebrating the fact that an expected rise in cases has not materialized despite the rise of the so-called “English variant”, which now makes up roughly half of new positive tests in Paris.

The precarious stability has given French policymakers hope that there’s a narrow path to avoid a fresh lockdown: while most of France’s neighbours have shuttered their shops and schools, French businesses are managing to take advantage of an extended annual sales period and French schoolchildren are still benefitting from in-person learning. The latter is a particularly important public policy victory given concerns that distance learning is exacerbating inequalities. Maintaining it until widespread vaccination is achieved will require meticulous monitoring of the full epidemic picture, including keeping a close eye on localised outbreaks and variant strains.

Winter spent at an elevated plateau

French government officials have been candid both about the challenges which the upcoming months could pose, as well as their hopes to avoid tightening the screw yet again in a country already living under a strict curfew. “We are making no bets about the future, but we can see that we have already made up time, and we hope to avoid [another lockdown],” Health Minister Olivier Véran recently told reporters. “Management measures that we have put in place, our strategy of testing, alerting, protecting… have slowed the spread of the virus in general across our country.”

The 7-day incidence of coronavirus cases in France is now sitting at 190 per 100,000 inhabitants, though some areas, such as the offshore region of Mayotte and parts of the Côte d’Azur, are in far worse shape. For now, public health experts agree that the virus is under control, but warn that the spread of more contagious variants could see an exponential rise in new cases such as that which pushed France into a second lockdown last fall.

As one public health expert explained, the variant strains are a “sword of Damocles” hanging over the country and threatening to dislodge it from its fragile epidemiological plateau. Despite the strict travel conditions which France imposed on travel from the UK in December, the coronavirus variant first identified in Kent now makes up the bulk of recent cases in the French port city of Dunkirk—and is steadily displacing the dominant strain in other parts of the country as well. According to France’s largest network of private labs, Biogroup, the English variant showed up in half of its western Paris tests in the first week of February—while the more vaccine-resistant South African variant is spiking along the German border.

Wastewater: the key to more precise and pre-emptive tracking?

As this first year coping with the coronavirus pandemic has illustrated, keeping an extremely close eye on the situation will be essential to long-term control of case numbers. Fortunately, new and technologically advanced tools are already being rolled out which could offer authorities a clearer picture of the viral spread.

A coalition between Swiss security expert SICPA, the Marseille Firefighters’ Battalion and French health data firm OpenHealth is rolling out a scheme to track the spread of COVID variants, in real time, using data from surface water and wastewater. SICPA has a history of providing solutions for a range of valuable material: currency, identity documents, and now wastewater, which has proven a surprisingly important commodity amidst the coronavirus pandemic.

The virus is known to drop its outer protein layer in the GI tract, while its RNA material is “shed” in faeces and flushed down the drain. Since this genetic material is released into wastewater even before an infected person might experience typical symptoms, sewage may be the ideal source material for authorities keen to accurately gauge caseload in time to implement preventative measures. Indeed, examining wastewater has been shown to provide an accurate picture of the epidemic situation some seven days before a change in the caseload begins showing in polymerase chain reaction (PCR), or nose swab, tests. As such, careful analysis of sewage could become the new non-invasive gold standard for forecasting the short-term, local risk of the coronavirus epidemic.

The new system which SICPA is rolling out in collaboration with OpenHealth and the Marseille firefighters uses blockchain technology to ensure the security of data and the integrity of processing activities; with this new tool, French authorities are able to make traceable and auditable decisions based on data they can rely on.

Perhaps most importantly, however, real-time wastewater testing allows policymakers to implement highly targeted measures at a localized level. Flare-ups of the coronavirus have typically taken place very locally, and widespread disparities between regions has emphasized the need for more targeted responses. The Italian region of Lombardy, for example, endured double the number of deaths in March and April 2020 than in previous years, while most eastern regions registered limited excess mortality— or none at all. National lockdown strategies are, at their core, a blunt instrument better suited to the early days of the pandemic.

This latest monitoring system, which could be rapidly deployed anywhere in France or beyond, could offer European policymakers a new tool to predict local curves of the coronavirus and track variant strains. This would be welcome news indeed for European governments, who are trying to balance public health imperatives with cratering economies, citizens’ increasing intolerance for restrictions on their liberty, and other priorities such as ensuring students don’t fall behind.

The slow pace of vaccination in the bloc, combined with the increasing prevalence of more contagious variants, means that inoculation programmes alone are unlikely to prevent a second summer under siege from the disease. Targeted monitoring of the virus and its known variants, however, could allow some restrictions to be eased while giving authorities the visibility they need to keep a lid on the pandemic.

 

Photo by the International Monetary Fund on Flickr. Creative Commons License 2.0.