In Week 11, all indicators—which were already at very high levels—continued to rise, notably with an increase of 30,000 new cases per day, representing a 17% rise. This acceleration is affecting all regions (except Corsica and Provence-Alpes-Côte d’Azur). In five departments of the Île-de-France region, the incidence rate has reached or even exceeded the level observed during the second wave of the epidemic. The deterioration of all indicators is already placing very heavy strain on the hospital system in several regions. Incidence rates, hospitalization rates, and intensive care admissions—which had declined significantly among people aged 75 and older, reflecting the impact of vaccination coverage in this age group—have been rising slightly over the past two weeks. In this context, as the French public appears to be growing weary of social distancing measures, adherence to individual prevention measures, compliance with collective containment measures, and the acceleration of vaccination efforts are major challenges.

Continued deterioration of surveillance indicators

The number of new cases nationwide increased by 17% in Week 11 (March 15–21, 2021). There were 209,839 new confirmed cases, or nearly 30,000 cases on average each day. The incidence rate (313 per 100,000 inhabitants), positivity rate (7.9%), and testing rate (3,940 per 100,000 inhabitants) were all higher than in the previous week.

The sharp increase in incidence observed since Week 10 across all age groups continues. Although less pronounced, this increase also affects those aged 75 and older (171 per 100,000 inhabitants vs. 160 in Week 10, a 7% increase), among whom a decrease had been observed since Week 4. In Week 11, the sharpest increase was observed among those aged 0–14 (+31%), against a backdrop of a significant rise in the testing rate (+41%) and a decrease in the positivity rate (-0.5 percentage points), partly due to the intensification of testing campaigns organized in schools.

During Week 11, two weeks after the start of the school year in the last school district to return from vacation, the number of cases with a school-related history rose sharply, suggesting either increased transmission linked to schools and/or improved case identification due to testing efforts in these settings. This increase in the number of cases among 0-18-year-olds, representing 18% of cases identified in Week 11, is particularly concerning due to the risk of secondary transmission within families.

The hospital system is under even greater strain, nearing the peak of the second wave in some regions

The number of hospitalized COVID-19 patients in France is very high and rising in Week 11, with 26,818 people hospitalized as of March 23. In Week 11, the weekly hospitalization rate and the rate of admissions to intensive care units increased by 11% and 7%, respectively, compared to Week 10. This trend implies a 9% increase in the number of people currently hospitalized in intensive care units, with 4,655 patients hospitalized (vs. 4,260 on March 16).

The regions most affected in Week 11 were still Île-de-France, Hauts-de-France, and Provence-Alpes-Côte d’Azur. These regions had the highest rates of hospitalizations and intensive care admissions.

In Île-de-France, these rates were the highest in mainland France and were rising compared to the previous week, at 25.2 per 100,000 (+13%) and 6.4 (+9%), respectively. During the second wave of the epidemic, the peak rates of hospitalizations and ICU admissions in this region were 31 per 100,000 inhabitants and 5.2 per 100,000 inhabitants, respectively.

In Hauts-de-France, the hospitalization rate was 24.6 per 100,000 inhabitants (+17%) and the rate of admissions to critical care units was 5.4 (+12%).

In Provence-Alpes-Côte d’Azur, the hospitalization rate was again on the rise (24.7 per 100,000 inhabitants, +6%) in S11, and the rate of admissions to critical care units, although decreasing, remained high (4.8, or -6%).

Trends in the Spread of Variants

According to indicators on the results of screening tests for variants of interest collected via the SI-DEP tool, the following was observed nationally in Week 11:

• an increase in the proportion of suspected 20I/501Y.V1 (UK) variants: 76.3% versus 71.9% in week 10

• a stable proportion of suspected 20H/501Y.V2 (ZA) or 20J/501Y.V3 (BR) variants: 4.7% versus 5.0% in week 10

These variants were detected in all metropolitan regions. The proportion of suspected 20I/501Y.V1 (UK) variants was greater than 50% (among screened positive tests) in 94 metropolitan departments (compared to 91 departments in week 10) and greater than 70% in 67 of them. Nine departments had a proportion of suspected cases of the 20H/501Y.V2 (ZA) or 20J/501Y.V3 (BR) variant cases exceeding 10% (among screened positive tests), with a proportion of 36% in Moselle, which remains particularly high despite having declined over the past several weeks (36.4% vs. 54.4% in S08) in this department.

A cluster of infections caused by a variant of clade 20C (“variant 20C/H655Y”) was detected in a hospital in Côtes d’Armor, with cases occurring between January and March 2021. According to the information available to date, all confirmed cases of the 20C/H655Y variant have a direct or indirect epidemiological link to a municipality in the Côtes d’Armor, and the spread of the 20C/H655Y variant therefore appears to be currently limited to this geographic area.

Prevention: Vaccination continues, and intentions to get vaccinated remain

The results of the CoviPrev survey (wave 22, March 15–17, 2021) show that while preventive measures are widely used by the population, the systematic adoption of contact reduction is declining, likely reflecting public fatigue with control measures. At the same time, the intention to get vaccinated among those who have not yet done so has remained steady, even though the temporary suspension of the AstraZeneca vaccine during the survey might have raised concerns about increased mistrust. The differences in uptake across population groups already observed in previous waves persist, as do the reasons for not getting vaccinated. Vaccination appears to be accompanied by a relaxation of preventive measures, even though it is essential to maintain them.

As of March 23, 2021, vaccination figures were as follows:

• 6,616,899 people who had received at least one dose of the COVID-19 vaccine and 2,506,023 people who had received two doses, representing 9.9% and 3.7% of the population in France, respectively.

• 91.2% of residents in nursing homes (Ehpad) or long-term care facilities (USLD) have received a first dose of the vaccine, and 71.1% have received two doses. Additionally, 51.5% of healthcare professionals working in nursing homes or long-term care facilities have received at least one dose of the vaccine.

Given the high level of viral circulation and the significant strain on the healthcare system, the strict enforcement of all individual and collective measures is more essential than ever. It remains crucial that anyone exhibiting symptoms suggestive of COVID-19 immediately self-isolate and get tested as soon as possible.