France: COVID-19 National Strategy

Health System Overview
Health System Rankings
Health System Outcomes
Health System Coverage
Health System Costs for Consumers
Health System Expenditures
COVID-19 National Policy

Health System Financing
Health System Personnel
Health System Physical Resources and Utilization
Long-Term Care
Health Information and Communications Technologies
Medical Training
Pharmaceuticals

Political System
Economic System
Population Demographics
Health System History and Development
Health System Future Challenges

France COVID-19 Strategy: Resources

Government
Ministry of Health: Daily information on the situation; Information for health professionals; for social and health and social care professionals; Information for the general public
Economic measures for COVID-19, Ministry of Finance
National Public Health Institute (Santé Publique France)
General information relative to COVID-19
Data on COVID-19:
National Public Health Institute
French Government

Legislation dealing with the state of Health Emergency: and its specific decree for the health system
Daily mortality data by départment during the Covid-19 epidemic compiled by the National institute for statistical and economic studies (INSEE)
Recommendations of the scientific committee regarding the easing of the lock-down period

France COVID-19 Strategy: Third Phase Re-Opening Plans Cancelled

“A third phase, which was expected on January 7 with the re-opening of cinemas, theatres, museums sport clubs and ski resorts, was cancelled due to the “lack of improvement” of the epidemiological situation. On the contrary, a more stringent curfew starting at 6pm (instead of 8pm) was introduced first (on January 2) in 15 French départements, where the incidence rates were high, and then to the whole metropolitan France from January 16, 2021. Despite the recommendations of the scientific council urging a third lock-down in February, the government decided to keep the status quo maintaining the curfew at 6pm. As of mid-February, there is no date announced for re-opening of restaurants, cafés and sport clubs. At the end of January, large shopping centres (more than 20,000 m2) were closed, while universities were required to allow students to assist to face-to-face classes once a week considering the rising concerns about youth mental health. However, in practice, providing classes for a very small number of students appears to be very challenging for universities.”

Source: COVID-19 Health System Response Monitor. A project of the European Observatory on Health Systems and Policies, the European Commission, and the World Health Organization Regional Office for Europe. From the web at https://www.covid19healthsystem.org/mainpage.aspx, last accessed March 19, 2021.

France COVID-19 Strategy: Plans For Phased Reopening

“The first phase started with the opening of all shops and business, except for bars, restaurants, night and sport clubs, on November 28. This was accompanied with an extension of outside activity to three hours and within 20km of the place of residence (vs. previous regulation of one hour and within 1km). Outside after-schools activities started again and religious gatherings are allowed. Controls on movement however still apply with the continuous need to provide a self-declared document justifying the reason for being outside. The second phase is expected to start on December 15 if there are less than 5,000 new confirmed cases of Covid-19 per day (which might be adapted as this seems difficult to attain). In this case, the lock-down will end but a night curfew will be set up between 9pm and 7am on the whole French territory, except on Christmas and New Year’s Eve. After-school activities will also be allowed to re-open, as well as cinemas, theatres and museums, with strict sanitary protocols. The third phase is the re-opening of restaurants and sport clubs on January 20, 2021 if epidemiologic targets are met (in particular, still less than 5,000 new cases of Covid-19 per day). This phase includes starting of face-to face classes in high schools, which partly switched to online teaching. Universities are also expected to open 15 days later in the frame of a re-evaluation of the sanitary situation every fortnight. No date of re-opening of bars and night clubs has been announced yet.

“National guidelines for the festive season include recommendations to limit private gatherings to six persons at a time (not including children).”

France COVID-19 Strategy: Second National Lock-Down

“All these measures appeared to be insufficient for containing the number of new cases. On October 28, the president announced a new national lock-down in mainland France which started on October 30 for at least one month (two weeks after its start, the government confirmed that these measures would be in place until at least early December). Overseas territories, except Martinique, were not included in this new measure. Similarly to the first lock-down, non-essential services and shops (cinemas, bars, restaurants…) have to close. But, this time, nursery, primary, middle and high schools remain open while universities have to fully switch to online teaching. Also, visits in nursing homes remain possible, albeit under strict sanitary protocols, considering the negative effects of isolating fragile older people that were observed during the first lock-down. Moreover, the government allowed for more flexibility in practicing professional activity this time and maintained all public services (post offices, public gardens, municipal services, etc.), food markets and some hotels for business trips. Working remotely from home is highly encouraged but employees who have a certificate from their employer are allowed to commute to their workplace. Otherwise, the conditions of the lock-down are similar to the first one: everyone needs a self-declared document justifying the reason why they are outside, which can include limited physical activity near the place of residence, medical reasons, shopping for basic food or providing care for a vulnerable person such as a disabled relative. People not complying with the rule are fined €135 with augmentation in case of repeated offenses.”

France COVID-19 Strategy: Rules for Schools During Second National Lock-Down

“Starting in November 2020, all universities have to switch to virtual online classes. While nursery, primary, secondary and high schools remain open during the second national lock-down, stronger sanitary protocols apply, including the compulsory use of face masks for pupils aged over 6.”

France COVID-19 Strategy: Restrictions Reimposed In Response To Increasing Number Of Cases

“On October 17, against the rapid increase in the number of new cases of Covid-19, a night curfew was set up from 9pm onwards for the Parisian region and eight other big cities (Lille, Grenoble, Lyon, Aix-Marseille, Montpellier, Rouen, Toulouse and Saint-Etienne), representing almost one third of the country. People not complying with the rule faced a €135 fine, which reached €1,500 in case of repeated offense. Police forces were deployed to enforce the new rule. Anyone outside during the curfew needed a certificate showing the necessity (notably, professional reasons and health emergencies). On October 24, the night curfew was extended to a larger part of the territory affecting 46 million French residents. It was accompanied by a nationwide ban on large-scale private events such as weddings.

“All these measures appeared to be insufficient for containing the number of new cases. On October 28, the president announced a new national lock-down in mainland France which started on October 30 for at least one month (two weeks after its start, the government confirmed that these measures would be in place until at least early December). Overseas territories, except Martinique, were not included in this new measure. Similarly to the first lock-down, non-essential services and shops (cinemas, bars, restaurants…) have to close. But, this time, nursery, primary, middle and high schools remain open while universities have to fully switch to online teaching. Also, visits in nursing homes remain possible, albeit under strict sanitary protocols, considering the negative effects of isolating fragile older people that were observed during the first lock-down. Moreover, the government allowed for more flexibility in practicing professional activity this time and maintained all public services (post offices, public gardens, municipal services, etc.), food markets and some hotels for business trips. Working remotely from home is highly encouraged but employees who have a certificate from their employer are allowed to commute to their workplace. Otherwise, the conditions of the lock-down are similar to the first one: everyone needs a self-declared document justifying the reason why they are outside, which can include limited physical activity near the place of residence, medical reasons, shopping for basic food or providing care for a vulnerable person such as a disabled relative. People not complying with the rule are fined €135 with augmentation in case of repeated offenses.”

France COVID-19 Strategy: School Reopenings

“New more flexible protocols were set up for September 1 (going to school became compulsory again): there are no more stringent social distancing measures in schools but masks are compulsory for teachers and children over 11 years old. While providing free masks to students had been called for by some, the government has not retained this option. In the case of school closures following the detection of positive cases, parents working in the private sector will be eligible for partial unemployment. Progressively, measures have continued to soften in schools with the detection of a single positive case no longer leading to the closure of the whole class (three positive cases are now necessary).”

France COVID-19 Strategy: Face Coverings, Workplaces, and Public Transit

“Masks are compulsory in all transports for individuals aged over 11; anyone without a mask in public transport faces a fine of €135. It is advised that only one out of two seats should be used to maintain physical distancing (except in high speed trains), but it is not clear yet how this requirement will be meet in practice, especially in big cities. In the Parisian region, public transport during rush hours was limited until June 16 to people who had a written authorisation from their employers confirming that they needed to go to work. On August 18, following the increase in the number of workplace Covid-19 clusters, the Ministry of Labour announced that wearing face masks in shared offices and any other collective closed places would be made compulsory from September 1. Face masks will have to be provided by the employer. Teleworking is still strongly advised whenever possible. Overall the transition period rely on three general principles: 1/ protecting (pursuing the respect of hand hygiene and respiratory etiquette, including a broader use of protective masks); 2/ more active testing (symptomatic individuals and all contacts of confirmed cases); 3/ isolating confirmed cases.”

France COVID-19 Strategy: Transition: Borders and Tourism

“Borders with EU countries re-opened on June 15. The second largest French airport (Orly airport) will re-open on June 26. From July 1, it will be possible to travel to non-EU countries where the epidemic is under control. A first list of around 50 countries where air travels with France will be allowed will be issued in the coming days in coordination with other European countries based on objective epidemiological data such as the number of new cases of Covid-19 per 100,000 inhabitants. This list will be updated every fortnight, but is not expected to include countries from North or South America so far due to the epidemiological situation there.

“Measures which eased the conditions to receive a short-time or partial unemployment allowance (automatic upon request by firms) are extended until the beginning of June.

“For businesses within the tourism industry, as well as for bars and restaurants, partial unemployment coverage measures will be extended until at least September 2020, while for those working in show business (‘intermittents du spectacle’), their rights to financial aid will be extended up to August 2021.”

France’s COVID-19 Strategy: Transition: Physical Distancing, Business and Facility Reopening

“Isolating confirmed cases was presented as a key point of the transition strategy to end the lock-down. People who are confirmed as Covid-19 cases will be asked to self-isolate at home. If this is not possible because of family situations, they will be hosted in requisitioned hotels for 14 days. All people who have been in contact with someone who is tested positive will be asked to self-isolate for 14 days. In the frame of the state of emergency prolonged until July 10, the government initially asked for a compulsory quarantine for all people arriving in France from countries outside of Europe, even if they did not present any symptoms of Covid-19. If they presented symptoms and tested positive, they were to be isolated even more strictly, with no contacts within their place of quarantine. However, these measures were judged anti-constitutional and banned by the Constitutional Council on May 11.

“Local GPs and the agents of health insurance funds will be asked to provide support for identifying potential contacts outside the household (including through telephone surveys).

“Concurrently, the government is considering the possibility of launching a mobile application (StopCovid) to retrace physical contacts of individuals infected by the Covid-19 virus (in particular in public transports). However, the development of this app, which will be provided through a European consortium, is not finalized yet. In addition, it already triggered strong debates regarding the protection of private data and the tracing of citizens. The Prime Minister promised that there will be a specific debate in the Parliament on this issue before any decision will be made. The app is not part of the first measures of contact tracing for easing the lock-down. However, it has been announced that it will be released by June 2.”

France COVID-19 National Strategy: Transition: Physical Distancing, Business and Facility Reopening

“Since May 11, French residents were allowed to circulate freely again, but only within 100km of their place of residence. Longer travels were only allowed for important business, family reasons or to move or visit new places to buy or rent. People not respecting this rule faced a fine of €135. Starting on June 2, these travel restrictions have been removed; now travel within France is allowed, although local authorities will be allowed to re-implement restrictive measures if the epidemiological situation gets worse.
Older people and fragile individuals have been advised to stay at home and avoid social contacts as much as possible. There is an emphasis on individual responsibility rather than on enforcing coercive measures due to concerns of stigma and discrimination towards high-risk persons. Some recommendations for people living with a disability in the post lock-down period were recently issued (https://handicap.gouv.fr/presse/communiques-de-presse/article/covid-19-les-grandes-lignes-du-plan-de-deconfinement-pour-les-personnes-en). Normal visits to nursing homes were allowed again from June 15 onwards.

“Graveyards re-opened on May 11, but memorial services were limited to 20 persons. Religious services were allowed again since May 23 and weddings since June 2. Initially, parks only re-opened in the areas classified as “green” on May 11 and then on the whole territory on May 30. Beaches are also opened since June 1, local authorities will be allowed to require a compulsory use of masks in both parks and beaches if deemed necessary.”

French COVID-19 Strategy: Transition: Physical Distancing, Business and Facility Reopening

“Gatherings of more than 10 individuals will remain prohibited as well as all large public gatherings of more than 5,000 individuals, including football matches, until at least August 31. All businesses were allowed to open after May 11 except hotels, restaurants and bars. Libraries and small museums progressively re-opened starting on May 11 as well as large museums, theatres and other entertainment venues from June 2 onwards, with a compulsory use of masks, except in the three specific areas where the epidemiological situation was considered not completely satisfactory (Parisian region, Guyane and Mayotte) but in the Parisian region, additional restrictions were lifted on June 15. So far, cinemas remain closed to the public. Starting on June 2, restaurants and bars are allowed to re-open with the limit of 10 guests per table and of 1 metre between each table. In the Parisian region, Guyane and Mayotte, only coffee places and restaurants with tables in an outdoor area were permitted to re-open, but since June 15, all restaurants and coffee places are allowed to open again. The re-opening of other businesses has been accompanied by strict guidelines on social distancing (e.g. the number of persons allowed in close spaces), together with a compulsory use of masks if it is impossible to guarantee social distancing within a shop. Large shopping centres may remain closed based on local authorities’ decision. Sport venues will be allowed to open again after June 2, except in the most affected areas. Clubs and stadiums will remain closed.

“Nursery and primary schools have re-opened on the whole French territory since May 11. However, this was applied on a voluntary basis and classes were limited to 15 children. Secondary schools were opened after May 18, in the less affected départements first and on the whole territory after June 2. High schools remained closed until the end of May. Starting on June 2, they will be allowed to host some pupils again in the less affected areas, but not in the Parisian area. Childcare services have started to re-open progressively since May 11, initially accepting children whose parents are in difficulty based on several criteria (e.g., the impossibility for parents to work from home, single-parent household, among others). Choices will be left to local authorities. This plan for education will be accompanied by a strict policy on masks, which will be compulsory for all teachers and also, in secondary schools, for all students. The higher education system will still be limited to online learning. The scientific committee advising the government had initially supported a re-opening all schools and universities by September only, but has stated that it understands the political, economic and social context in which the decision to re-open some schools has been taken. Finally, on June 22, all nursery, primary and middle schools will re-open and attendance will be compulsory for all pupils, in the same conditions as before the epidemic.

“Working from home is still requested from all employees if possible. For other workers, flexible shifts with out-of-office hours will be strongly supported. Individuals considered as “fragile” health-wise (at risk of a severe form of Covid-19 or with a chronic illness) will continue benefiting from partial unemployment coverage if they cannot work from home. Masks will be compulsory in the workplace whenever physical distancing is not possible. General recommendations were published on May 3 by the Ministry of Employment; they include detailed rules such as the need to guarantee 4m2 per employee, to open windows at least three times a day during 15 minutes and to disinfect the workplace, in particular door knobs, daily. Guidelines for the different working sectors were made available by May 11. Around 60 guides providing a long list of specific rules for different sectors were released on the website of the Ministry. The employment branch of the national health insurance fund will finance up to 50% of small enterprises’ investment in protective equipment for their employees.

“Public transports only re-opened up to 60% of their full-capacity on May 11 and will progressively get back to normal starting on June 2. Masks are compulsory in all transports for individuals aged over 11; anyone without a mask in public transport faces a fine of €135. It is advised that only one out of two seats should be used to maintain physical distancing (except in high speed trains), but it is not clear yet how this requirement will be meet in practice, especially in big cities. In the Parisian region, public transport during rush hours is limited to people who have a written authorisation from their employers confirming that they need to go to work.”

France COVID-19 National Strategy: Physical Distancing, Facility and Business Closing:

“The first global measure was limited to the interdiction of large public meetings of more than 5,000 persons first (on March 4), then of more than 1,000 persons (on March 8) and then of more than 100 persons (on March 13). Concurrently, on March 11, visits to all residential nursing homes were stopped to protect the older population.

“Some policy measures were implemented earlier at the local level, where local clusters of infected cases were identified. These initial clusters were the Haute-Savoie, Oise, Morbihan, Haut-Rhin and Corse areas, where specific measures such as cancelling social events or the closure of schools were already introduced by early March.”

France COVID-19 National Strategy: School and Business Closings

“At the national level, initial measures were followed by the closure of all schools and universities by a decree dating from March 13. Two days later, all public places, except essential shops such as supermarkets, were also closed, but the first round of the municipal elections (March 15) was maintained. Despite these measures, between March 13 and March 15, the declared incidence of Covid-19 has doubled, and the total number of confirmed cases reached 6,400. As a consequence, the president announced a total lock-down (stay-at-home) policy from March 18 onwards and the second round of the municipal elections was postponed. All employers were asked to put in place teleworking for their employees whenever possible. Only people who cannot work remotely and provide essential services (including health, medical research, production of essential goods…) are allowed to go to work. Others are only allowed to go out for getting food, medical reasons or for short recreation activities in the immediate vicinity of their place of residence. Those who do not respect these rules are now fined a minimum of €135 (up to €450 if they do not pay on time; €200 for the second fine within 15 days), and, after four fines, they risk €3 750 and 6 months of prison. The conditions of the confinement got stricter on March 23 with the closure of open food markets and an intensification of police controls for making people respect the stay-at-home policy. However, some restrictions apply less stringently for individuals living with autism spectrum disorders, who are allowed to go out without any limits on frequency or kilometres to better accommodate their specific needs.

“Local authorities (prefects) took additional measures, notably to close down access to the public beaches in Southern France and on the Atlantic coast. All mountain activities, including hiking or skiing, are forbidden.”

“As of April 20, there is still very little information on the conditions of the end of the lock-down period. In any case, the Prime Minister announced April 19 three general principles for the period after the end of the lock-down period: pursuing the respect of respiratory etiquette and hand hygiene, testing symptomatic individuals and isolating confirmed cases. The president also declared that, after May 11, infected confirmed cases will have the possibility to be hosted in hotels to protect their relatives, that the re-opening of schools might not happen for all schools and all students simultaneously, and that the use of masks is likely to be compulsory in public transports.”

Testing:

“Systematic testing was long limited to individuals with symptoms similar to those of Covid-19 who also have one of the following characteristics: signs of severity, health professionals or fragile and at-risk individuals, the first three individuals living in institutions for vulnerable populations, hospitalized patients, pregnant women and organ donors. For hospitalized patients, testing is carried out within hospitals, while others can be tested in the community upon medical prescription. Early April, the government has finally decided to launch large-scale testing in nursing homes and institutions for disabled individuals, both for residents and staff, using biomedical laboratories, the medical care reserve (see Section 2.2) and mobile testing buses.

“The Ministry in charge of health has estimated the number of available tests per day at around 5,000 but expect to increase this capacity quickly. However, France has developed a dependency on international providers (in particular from China and the US) for the reactive of these tests, which limits national autonomy.

“Mobile drive-through clinics have not been implemented at a large scale in France, but there are some similar local initiatives developed by biomedical laboratories.

“On April 13, the president announced that the relaxation of the lock-down policy by May 11 would be accompanied by the systematic testing of health professionals, older people and vulnerable individuals as well as, progressively, of all persons presenting symptoms of the Covid-19 virus or in contact with an infected case.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated March 19, 2021 by Doug McVay, Editor.

Cookie	Duration	Description
_GRECAPTCHA	5 months 27 days	This cookie is set by Google. In addition to certain standard Google cookies, reCAPTCHA sets a necessary cookie (_GRECAPTCHA) when executed for the purpose of providing its risk analysis.
cookielawinfo-checkbox-advertisement	1 year	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Advertisement".
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

Cookie	Duration	Description
_ga	2 years	This cookie is installed by Google Analytics. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. The cookies store information anonymously and assign a randomly generated number to identify unique visitors.
_gat_UA-71314304-2	1 minute	This is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites.
_gcl_au	3 months	This cookie is used by Google Analytics to understand user interaction with the website.
_gid	1 day	This cookie is installed by Google Analytics. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form.

Cookie	Duration	Description
IDE	1 year 24 days	Used by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. This is used to present users with ads that are relevant to them according to the user profile.
test_cookie	15 minutes	This cookie is set by doubleclick.net. The purpose of the cookie is to determine if the user's browser supports cookies.