The Ministry of Budget will be in charge of the distribution of masks for the general public after the end of the lock-down. The Ministry announced that deliveries at the local level will start on May 4. Meanwhile, the national production of masks will be increased to 15 million units per week by the end of April, while massive importations are occurring at the moment (around 20 million units). Local authorities are also encouraged to organize the provision and distribution of masks themselves for their citizens, and the government offered to pay for 50% of their costs. The national post office will open an online platform to order masks by April 30. Since April 24, businesses selling fabric and cloth were allowed to open again in order to enable people to sew their own masks. On April 26, a decree also authorized pharmacists to sell “non-sanitary” masks, while after May 11, they will receive a specific payment from the national health insurance fund to manage the stock of sanitary masks for assuring the provision for specific targeted groups (patients and ambulatory care professionals). The policy concerning masks indeed increasingly relies on reusable washable masks (5 million are expected to be produced each week). Overall, the Prime Minister announced that after May 11, 100 million surgical masks and 20 million washable masks will be available per week for the French population. The delivery of masks will include specific measures to target the most deprived populations, in particular through the involvement of community centers for social action. The prices of surgical masks are regulated by the government and will not exceed a fixed limit, but this is not the case for cloth masks.

To reinforce the respect of compulsory measures such as using masks in public transport or physical distancing in shops, additional workforce such as security officers of public transport companies or reservist police officers will be given the right to issue a fine to the French population. 

In order to answer concerns regarding a second wave of the epidemic, wearing face masks in closed public spaces (all shops and other closed places opened to the public) was made compulsory on July 20 at a national scale for all people aged over 11. This measure, which will be at the core of the on-going prevention policy, had been called for by many doctors for weeks. Some local authorities have additionally made compulsory the use of face covering in all outdoor public spaces (notably in Paris since August 28) or in those that are particularly crowded, such as open-air markets or shopping streets, as the French Ministry of Health has allowed prefects to take such decisions at the local level. People not complying with the rule will be fined €135 and up to €1,500 if they are found to repeat the offense within 15 days. While the government has limited the unit price of surgical face masks to €0.95 until January 2021, their regular use can impact the budget of French households. New distribution of free reusable masks to the most deprived populations through community centers for social action will therefore be organized following the new obligation for face covering in closed public spaces. 40 million masks will be distributed to 7 million individuals with low-income, including those receiving financial aid for supplementary private health insurance and migrants benefiting from a state medical aid. The government also advises all employers to start amassing a preventive reserve of masks for ten weeks for all their staff members.

While no vaccine against Covid-19 has been developed yet, a vaccine committee was already set-up to start devising a strategy for when such vaccine will be available. The committee works with the other scientific committees supporting the government decisions. Preliminary recommendations, made public on July 24, list individuals who should be vaccinated first. They include those with a professional exposition to Covid-19, in particular, health professionals, those at risk of a severe infection (elderly and individuals living with a chronic disorder) and deprived populations, representing nearly half of the French population. Recommendations also state that vaccination will not be made compulsory.

On August 27, the Ministry of Health announced that resuscitation bed capacity includes now 12,000 beds available in case of a massive second wave and the current stock of resuscitation drugs can treat 29,000 patients. He later announced that 4,000 additional beds could be opened by December if necessary.
During the second wave of the epidemic, collaborations between public and private hospitals became more common than during the first wave, with regional health agencies giving temporary derogations to private hospitals to provide intensive care for six months or more. Resuscitation capacities in the private sector, which usually amount to 1,000 beds, are currently of 2,000 beds and could reach 4,000 beds if necessary.

Following strains on resuscitation capacities in some territories in March 2021, medical trains have been set up again to move patients from hospitals under tension to less affected regions. However, such transfers are submitted to the consent of patients’ family and only a minority have accepted the transfer of their relative.

On March 31, 2021, the president announced that the number of resuscitation beds on the French territory had been increased to 7,000 and would be further increased to reach 10,000.

 

The Covid-19 epidemic arrived in France on an already difficult hospital context. Many hospital workers, including emergency specialists and nurses, were on strike last November/December demanding additional resources for public hospitals. 

Also, very quickly in the early days of the epidemic, there were issues regarding sufficient availability of protective masks, solutions for hand hygiene, and diagnostic tests. It turns out that, since the H1N1 epidemic crisis in 2009 where the government (and the WHO) had been accused of over reacting with regard to the acquisition of masks and vaccines, there has been a slight change in the doctrine or attitude of scientific and public authorities towards the continued preparation for the risk of a pandemic linked to an emerging virus with respiratory tropism. Consequently, there was a change in the state policy towards its stocks, in particular, regarding masks. Since 2011, the policy of consecutive governments was to reduce the national reserve of masks, and to pass the responsibility of stocking to individual facilities and healthcare centers, or physicians. In particular, it seems that there was a lack of higher quality masks (FFP2) which are necessary for healthcare professionals at high risk, that is, those dealing with infected people. There were several primary care doctors who have been infected and died in the past week (week 12). On April 9, in response to the issues previously encountered, a national online platform dedicated to help managing the stock of masks available in pharmacies has been opened. On April 13, the president minimized the issue of the shortage of protective gears in France, reporting that it had been experienced by all countries around the world, while maybe not to a similar extent. He also announced that the easing of the lock-down policy by May 11 would be accompanied by a general distribution of masks for all in coordination with local authorities. The priority distribution of masks to health professionals will be extended from now and until May 11, to ambulance drivers, pharmaceutical assistants, radiology technicians and domestic helps. But for the moment, many health professionals such as physiotherapists, dentists or orthodontists cannot work since they do not have the protection material. It is not clear yet when/if they will be served.

The government announced that an "air bridge" was set up for the transportation and long-term supply of medical equipment, especially of masks. France awaits full delivery of 1 billion masks over the next 14 weeks at the rate of 2 deliveries per week, some of them coming from China. In addition, the private sector has placed an order for 5 million masks, delivered by March 30.

Concerning hand hygiene, ambulatory and hospital pharmacies are allowed to prepare hydro- alcoholic solutions intended for human hygiene by a new decree (2020/107/F). The government also set by this decree fixed priced for disinfectant care products. Therefore, by week 12 there were no more problems concerning these solutions. On April 17, the value-added tax on hydro-alcoholic solutions and protective masks was reduced from 20% to 5.5% to increase their financial accessibility for all.

There were about 5,000 "resuscitation" beds in France before the epidemic. These are beds in dedicated units intended to take care of patients suffering from deficiencies of major vital functions (e.g. respiratory, cardiovascular, renal, hepatic…), where strict standards in terms of staff and equipment are applied: 24h presence of a specialist, nurses with prior specific training, as well as particular monitoring devices, respirators and intravenous perfusion systems. But this capacity can be increased significantly by using resources in intensive care and other operative units which also have monitors, respirators and qualified personnel (nurses) to carry out similar functions for patients affected by the failure of a specific vital function.

The resuscitation bed capacity has been increased from 5,000 to 8,000 beds by March 24. Hospitals and private clinics have been given authorization to increase their intensive care capacity across the country. On April 19, the Minister of Health however declared that there were persistent strains on resuscitation drugs with potential risks of shortage. Specific dispositions to facilitate the delivery in nursing homes of drugs used to treat pain in end-of-life care were also taken to limit shortages in these specific settings.
There was a mobilization to help the most affected regions. A medical train (called health TGV) is set up to move patients from hospitals under tension to less affected regions. In the eastern border areas, some patients are also transferred to hospitals in Luxembourg, Switzerland, Germany and Austria. The medical aircraft of the Army and the Military Field Hospital have also been supporting hospitals in need. All in all, 644 cases were transferred by April 19.