French surveillance system
In France, according to the COVID-19 surveillance protocol, physicians suspecting a COVID-19 case have to contact immediately either the emergency hotline (SAMU-Centre 15), if the patient is seeking medical attention from a general practitioner, or a referring infectious diseases specialist at hospital level. Together, they evaluate whether the patient matches the case definition criteria for a possible case (see below). If they do, the case has to be reported immediately through a 24/7 available phone line to the Regional Health Agency (Agence régionale de santé, ARS), which informs without delay the hospital infection control teams involved in the management of the patient, the French Public Health Agency (Santé publique France, SpFrance) and the Ministry of Health.
A standardised investigation form collecting socio-demographical information, clinical details and history of exposure (history of travel to or residence in Wuhan, China or contact with a confirmed case) is completed for each possible case at regional level, in collaboration between the clinicians, the ARS and SpFrance. Data are entered into the secure web-based application Voozanoo (Epiconcept, Paris).
Possible cases have to be hospitalised, isolated and cared for in one of the 38 French referral hospitals designated by the Ministry of Health, according to the guidelines for the management of patients with Middle East respiratory syndrome (MERS) [3].
For each possible case, respiratory samples from the upper respiratory tract (nasopharyngeal swabs or aspirates) and when possible from the lower respiratory tract (bronchoalveolar lavage fluid, when indicated, or induced sputum) are collected and sent to one of the laboratories accredited to perform SARS-CoV-2-specific real-time RT-PCR. Until 27 January, only the National Reference Centre for respiratory viruses (Institut Pasteur, Paris) was able to test for the presence of the SARS-CoV-2.