Covid France: Why cases are up but hospitalisations stable

Despite the significant rise in positive Covid-19 tests and reported cases in France over recent weeks, the number of hospitalisations are not rising at the same rate. A French epidemiologist explains why.

17 August 2020
People outside wearing masks. Covid in France: Why cases rising but hospitalisations notMask-wearing is becoming mandatory in more places in France as cases rise, with more younger people now reporting positive tests
By Connexion journalist

The rise in cases in France has been widely reported, with masks becoming mandatory in public places in thousands of towns and cities. Countries including the UK and Belgium have advised against all but essential travel to and from France and imposed a quarantine on arrivals from France.

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In its latest update (from Sunday August 16), Santé Publique France (SPF) reported 3,015 new cases over the previous 24 hours, slightly fewer cases than in the 24 before that (3,310 on Saturday August 15). Previously, the 3,000-case mark threshold had not been breached since May

Yet the number of patients in intensive care has remained stable, at 376, and only one death in hospital was reported in the previous 24 hours.

Younger people

Epidemiologist Dr. Pascal Crépey, from public health university l’Ecole des Hautes Etudes en Santé Publique de Rennes, explained the phenomenon to news service FranceInfo.

He said: “The response is simple. The people who are most exposed [to infection] at the moment are the young. Since the start of the epidemic, we know that young people are less subject to severe forms of Covid-19, and are therefore not hospitalised at the same levels.”

Health minister Oliver Véran appeared to corroborate this statement in an interview with TV channel France 2, on August 12. He said: “The public being diagnosed today is younger, more from the 20-40 age group, less fragile. Older people are continuing to protect themselves.”

Looking at the figures from SPF also confirms this explanation.

In its most recent update, it said that for the week of August 3-9, the number of cases per 100,000 people (also known as the level of incidence) was three times higher among 15-44 year olds, at 28.9 per 100,000 people; compared to 9.6 cases per 100,000 among people aged 75 and over.

This number is on the rise among all age groups, but especially so among people aged 25-29 (up 55%) and 30-34 (up 52%) compared to the national average (up 42%).

This is not simply due to a rise in testing (up 41%). This shows that the number of cases is indeed rising more among younger people.

Hospitalisation rise ‘not negligible’

Although the number of hospitalisations has not kept pace with the increase in positive cases, the number is still on the rise and “not negligible”, Dr Crépey said.

The number of hospital admissions due to Covid-19 linked causes only increased from 778 to 782 from August 3-9; but there was a sharp rise a few weeks earlier (July 13-19), from 604 to 782.

Even among young people, while just 8% of hospital admissions were of people aged 40 or under in May and June, this has now risen to 18% since July.

The number of intensive care admissions has also risen over the past month or so, from 73 from June 29-July 5, to 122 between August 3-9.

And while the level of incidence is rising especially fast among young people, it is still rising among all age groups (up 43% among people aged 75 and over from August 3-9).

Dr Crépey said that because of this, it was still extremely important to take precautions, even among young people - and that young people were not immune to the spread.

He said: “We cannot hermetically seal one age group off from the population. We have many reasons to believe that people who know they are at risk take more precautions than others. You rarely see older people going out to party in night clubs and bars.”

And while Dr Crépey said that many older people have also been staying away from the workplace, which is also a high-risk zone, they could still be at risk from family members who are not being quite so careful.

He said: “[Older people] are still at risk from contamination between families. This will take longer, but if there is a rebound of the epidemic and it is not controlled, whatever the age of people affected, the virus will once again begin to spread.”

Caution advised

Indeed, last week (August 12), Prime Minister Jean Castex described the situation as “worrying”, said it was developing in the “wrong direction”, and called for more “vigilance, discipline”, and mask-wearing.

Read more: PM calls for discipline as Covid worsens in France

Overall, though, the public in France appears to be more worried about the health risks of Covid-19 than the economic issues caused by the crisis.

A nationally-representative poll of 1,003 people by Ifop (online from August 13-14) for newspaper Le Journal du Dimanche showed that 53% were worried about the health risks, versus 29% worried about economic concerns.

In addition to warnings from Dr Crépey, another epidemiologist, Dr Antoine Flahault, from the University of Geneva in Switzerland, tweeted about the “paradox” of young people with the virus apparently not infecting older people as much as one might expect.

He said: “No epidemiologist understands it very well”, but warned of the importance of “limiting the spread among young people and its spread to seniors”, or the situation could “become a tragedy that no-one wants to live through again”.

He especially warned of the risk of transmission at multi-generational, family events, such as family parties, weddings, cruise ship holidays, and funerals. He said that people should continue to self-isolate where necessary, and recommended that localised lockdowns be brought in in areas “not under control”.

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