the difficulties of the tracing brigades

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the difficulties of the tracing brigades


<span class = "image" data-attrib = "AFP" data-caption = "Specialists fear that these health insurance teams are not effective enough. The most precarious could slip through the cracks.

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© AFP
Specialists fear that these health insurance teams are not effective enough. The most precarious could slip through the cracks.


Since the deconfinement, tracing brigades have been in place within the primary health insurance funds (CPAM). Their mission: to break the chains of contamination. To do this, general practitioners and health establishments refer positive patients to them. Covid-19, then instructs the brigades to quickly identify all the people with whom they have been in contact. If these cases are complex or numerous, the regional health agencies take over. Over the past two weeks, around 5,500 people have been screened across the country and 14,000 contact cases identified.

This rather promising assessment does not calm the concern of some health specialists who fear “flaws in the system”, according to one of them. The first fear concerns the front door of the device. A patient can only integrate him if he presents a positive PCR test to Covid-19 or a scanner with suggestive signs. However, some tests have insufficient sensitivity, leading to errors in 20 to 30% of those infected.

“In case of persistent symptoms, we recommend a second test a few days later,” says Aurélie Combas-Richard, director of the CPAM of Seine-Saint-Denis. Insufficient, according to the practitioners contacted, for whom clinical diagnoses should also be based in order to be sure not to miss anyone.

No quick fix

But the main criticism lies in the very method of identifying “contact cases” by telephone. In other countries, such as Austria where this has been a success, the system is certainly also organized around door-to-door sales but also with home visits. In France, there was a time when it was a question of erecting physical tracing as a rule rather than as an exception limited to complex situations only. On April 15, the president of the scientific council had also mentioned the figure of 30,000 people to be mobilized for this purpose. They are ultimately only 6,500 to perform these missions, and only remotely.

And many epidemiologists believe that this single tracing by telephone risks missing those whom they call in their jargon the “hard-to-reach populations”. In good French, the fragile public, difficult to reach because excluded from the healthcare system, precarious or marginalized. The issue is essential: statistically, they are among the most affected by the Covid-19.

Covisan, the device of the AP-HP, opted for physical tracing, using pairs that crisscross the region. Active in Île-de-France since mid-April, they now cohabit with the CPAM brigades. However, if Covisan works well in places, the rate of refusal of home visits remains very high in Seine-Saint-Denis, the poorest department in France, hard hit by the virus. “There is no quick fix, you have to adapt,” says Professor Olivier Bouchaud, head of the infectiology service at the Avicenne hospital in Bobigny, involved in Covisan. People are sometimes in such social disarray that they are suspicious of anyone who comes to their home. “

The fear of “denouncing” your knowledge

According to him, the term brigade does not help anything. More and more, its teams must fight to distinguish themselves from a device whose martial name worries. And even within a CPAM where we ensure that calls are sufficient to detect contact cases, we admit to avoiding this government name which is confusing.

“This gives the impression of a health police, desperate Jérôme André, director of HF Prévention, which deals with HIV testing with marginalized audiences. So people do not want to ‘denounce’ their knowledge.” Such situations would multiply. Like this resident of a Covid-19 positive working-class neighborhood who approached HF Prévention, which redirected him to the CPAM circuit: “They told him to give the name of his relationships. was afraid and replied that he did not know them when they were his neighbors, sighs Jérôme André. The educational work is not done. ” In Rue de Ségur, discussions are underway to integrate these structures used to emergency health actions. “We are waiting, he gets impatient. We are still wasting time.”

This Friday, a first street screening operation for the most vulnerable was tested in Clichy-sous-Bois (Seine-Saint-Denis) with the ARS, the municipality and the AP-HP. Such a model could be multiplied to make tracing operations more efficient. “The government has not become aware of these specificities, deplores Professor Bouchaud. From the start of the epidemic, it could have set up these devices. And that was lacking.”

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