通过使用病毒学和参与性综合征监测数据，并结合针对地区住院治疗的数学传播模型，研究人员估计了法国在封锁后COVID-19症状病例的检出率。研究结果表明，从2020年5月11日至2020年6月28日封锁后的前7周内，监测系统未检测到约90,000例症状性感染，相当于10例中的9例，尽管测试阳性率未超过WHO的建议（5％）。随着系统的加强以及流行病活动的减少，中位检测率随着时间的流逝从7％[6-8]％增加到38％[35-44]％，且区域差异很大。
根据参与性监测数据，在研究期间，只有31％的具有COVID-19样症状的人咨询了医生。这表明，尽管有建议，大量有症状的COVID-19病例仍未寻求医疗建议，正如血清学研究证实的那样。在可疑病例中增强警示和即日就诊对于提高发现率至关重要。但是，即使在封锁后达到低水平的病毒循环时，系统的容量仍然不足，并且据预测随着流行病活动的增加，该系统将迅速恶化。要成为抗击大流行的工具，就必须进行更积极的、针对且有效的测试，且便于大众检测。测试策略将再次具有至关重要的价值，从而解除欧洲目前的限制措施并避免第三波感染。
据介绍，随着第一波浪潮之后欧洲国家逐渐放宽锁定限制，检测-追踪-隔离策略对于将COVID-19维持在较低水平至关重要。鉴于欧洲目前正在发生的第二波感染，评估这些策略的缺点可以提供新的见解。
附：英文原文
Title: Underdetection of COVID-19 cases in France threatens epidemic control
Author: Giulia Pullano, Laura Di Domenico, Chiara E. Sabbatini, Eugenio Valdano, Clment Turbelin, Marion Debin, Caroline Guerrisi, Charly Kengne-Kuetche, Ccile Souty, Thomas Hanslik, Thierry Blanchon, Pierre-Yves Bolle, Julie Figoni, Sophie Vaux, Christine Campse, Sibylle Bernard-Stoecklin, Vittoria Colizza
Issue&Volume: 2020-12-21
Abstract: As countries in Europe gradually relaxed lockdown restrictions after the first wave, test-trace-isolate strategies became critical to maintain COVID-19 viral activity at low levels1,2. Reviewing their shortcomings can provide elements to consider in light of the second wave currently underway in Europe. Here we estimate the rate of detection of COVID-19 symptomatic cases in France after lockdown through the use of virological3 and participatory syndromic4 surveillance data coupled with mathematical transmission models calibrated to regional hospitalizations2. Our findings indicate that around 90,000 incident symptomatic infections, corresponding to 9 out 10 cases, were not ascertained by the surveillance system in the first 7 weeks following lockdown from May 11 to June 28 2020, although the test positivity rate did not exceed WHO recommendations (5%)5. The median detection rate increased from 7% [6-8]% to 38% [35-44]% over time, with large regional variations, owing to a strengthening of the system as well as a decrease of epidemic activity. According to participatory surveillance data, only 31% of individuals with COVID-19-like symptoms consulted a doctor in the study period. This suggests that large numbers of symptomatic COVID-19 cases did not seek medical advice despite recommendations, as confirmed by serological studies6,7. Encouraging awareness and same-day healthcare-seeking behavior in suspect cases is critical to improve detection. However, the capacity of the system remained insufficient even at the low levels of viral circulation achieved after lockdown, and was predicted to deteriorate rapidly with increasing epidemic activity. Substantially more aggressive, targeted, and efficient testing with easier access is required to act as a pandemic-fighting tool. Testing strategy will be once again of critical value to lift current restrictive measures in Europe and avoid a third wave.
DOI: 10.1038/s41586-020-03095-6
Source: https://www.nature.com/articles/s41586-020-03095-6
Nature：《自然》，创刊于1869年。隶属于施普林格·自然出版集团，最新IF：69.504
官方网址：http://www.nature.com/
投稿链接：http://www.nature.com/authors/submit_manuscript.html
本期文章：《自然》：Online/在线发表
