EpiCOV: Population Immune Status Data to Guide Public Decision-Making

© Campaign Creators on Unsplash

Quantifying the proportion of French citizens who have developed SARS-CoV-2 antibodies and documenting the effects of the epidemic on their living conditions appear as key factors in preparing the most appropriate deconfinement and prevention strategies, in enabling the early detection of any resurgence of the epidemic and, over the longer term, in monitoring the efficacy of the measures taken.

Driven by Inserm and the Directorate for Research, Studies, Assessment and Statistics (DREES) of France’s Ministry of Solidarity and Health, in conjunction with their partners (National Institute of Statistics and Economic Studies [INSEE], Public Health Agency, National Center for Scientific Research [CNRS], National Institute for Demographic Studies [INED], Université Paris-Saclay), EpiCOV is a large-scale epidemiological study based on a major statistical survey. It is proposing global and scientifically reliable mapping of population immune status and dynamics across the French territory through the collection of biological samples paired with questionnaires.

The aims of EpiCOV are twofold: to provide precise mapping of the population’s immune status, health, living conditions and the social inequalities relating to these three parameters, and to monitor the dynamics of the epidemic over the short, medium, and long term. The exceptionally rapid deployment of a large-scale epidemic surveillance cohort that is statistically representative at local level will in particular provide data used in modelling the epidemic.

The project will be based on a major national survey of a representative sample selected at random by the National Institute of Statistics and Economic Studies (INSEE) of over 200,000 people aged 15 or over, resident throughout the territory (mainland France, Martinique, Guadeloupe and Reunion Island). They will be required to answer a 20 to 30-minute questionnaire (online or by telephone) with, in parallel, a consenting 100,000 of them mailing a small sample of their blood taken at home in order to determine whether they have come into contact with the virus. The responses will be treated in a confidential manner by the research teams, respecting current regulations (statistical confidentiality, French data protection authority [CNIL] regulations, and GDPR).

Results expected

With this project, it will be possible to elucidate the spatial, temporal, sociodemographic and familial aspects of the epidemic and of the confinement measures. It aims to describe the frequency of COVID-19 symptoms, supply data for models of population immunity evolution, provide estimations of the frequency of exposure to the virus, including the asymptomatic forms of transmission, and evaluate changes in the health, wellbeing and behaviors of people living in France. Intended to be both precise and representative of the entire French population, it includes geographically and sociodemographically defined subgroups. All French departments (including certain overseas departments and regions [DROM]) will be included in the survey.


The first wave of data collection will take place from April 30 to May 24, with a second wave to come in June. This operation may be repeated regularly to monitor the dynamic of the epidemic and the evolution of the country’s health and social conditions, across all territories, age groups and major social groups.

Initial findings based on responses to the questionnaires should be available on a national scale at the end of May.

The first results of the biological samples will be provided as early as possible from the end of May, depending on the availability of qualified serological tests currently under development and the capacity of the test platforms.

Local authority participation

The local authorities will be fully involved in this initiative and mobilized to communicate its importance to their citizens, given that the validity of the study depends on their good participation. The local authorities will have access to the results that concern them directly.

A local authorities-researchers liaison committee will be established in order to present the study, discuss the initial findings and their consequences, and disseminate information concerning additional studies initiated on the territories.

The StopCovid project-team and the ecosystem of contributors are working together to develop a mobile contact tracing app for France

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Inria, ANSSI, Capgemini, Dassault Systèmes, Inserm, Lunabee Studio, Orange, Santé Publique France and Withings create the StopCovid project team in order to structure and strengthen their contribution to the government project to set up a mobile contact tracing application (StopCovid). The purpose of this project is to provide the French health authorities with a complementary digital tool to help manage the sanitary emergency against Covid-19.

The French government has entrusted Inria with the operational management of the research and development project called “StopCovid”, which brings together the expertise of national players, both public and private, within the StopCovid project team. All these players are contributing to the work already under way to provide all French citizens with a tool to better protect them against Covid19.


Sharing the guidelines set by the Government, the project is based on five foundations:

  • The use of the StopCovid app as part of the global strategy for managing the health crisis and epidemiological monitoring. StopCovid project is an additional brick that provides public health actors with a decision-making support for the deconfinement phase.
  • Strict compliance with the data protection and privacy framework at national and European level, as defined in particular by French law and the RGPD, as well as the toolbox recently defined by the European Commission on proximity monitoring applications.
  • Transparency, which notably involves the dissemination, under an open source license, of the specific work carried out within the framework of the project. This is in order to provide all the guarantees in terms of controls by society: transparency of algorithms, open code, interoperability, auditability, security and reversibility of the solutions. Thus, this solution could offer basic building blocks that can be used by all countries that wish to use them.
  • Respect for the principles of digital sovereignty of the public health system: control of health choices by French and European society, protection and structuring of health data assets to guide the response to the epidemic and accelerate medical research.
  • The temporary nature of the project, whose lifespan will correspond, if deployed, to the duration of the management of the Covid-19 epidemic.


The project is conducted under the supervision of the State and gives rise to regular interactions with independent control authorities, notably the CNIL (Commission Nationale de l’Informatique et des Libertés – French Data Protection Authority). It also involves DINUM (inter-ministerial directorate for digital).

The project, in its prototype construction phase, involves public and private organisations acting on a pro bono basis, as part of the StopCovid project team.

At European level, the project is also being carried out in close cooperation with national teams developing comparable applications in Germany, Great Britain, Italy, Spain and Norway, based on comparable approaches and ensuring interoperability.


Within the project, coordinated by Inria, the members of the StopCovid project team are involved in their field of expertise:

Inria: coordination and transmission protocol, privacy-by-design;

ANSSI: cybersecurity;

Capgemini: back-end architecture and development;

Dassault Systèmes: SecNumCloud qualified sovereign data infrastructure;

Inserm: health models;

Lunabee Studio: development of mobile applications;

Orange: application distribution and interoperability;

Santé Publique France: integration and coordination of the application in the global strategy of contact tracing;

Withings: connected objects.


Alongside them, the entire ecosystem of research, innovation and companies is mobilized through the “ecosystem of StopCovid contributors“. Open, it brings together organizations or individuals who have shown their willingness to participate in the project, either through spontaneous contributions or in response to requests, whether through participation in technical expert groups, think tanks, provision of open source code, sharing of feedback on comparable solutions, or participation in field experiments.

“Inserm is participating in the development of this digital tool which will be a complement to the other elements necessary for a successful end of lock down (in particular the respect of hand hygiene and physical distancing): the digital tool will identify possible cases of Sars-cov infection, in order to be able to isolate them as quickly as possible, and help reduce the spread of the virus. It is therefore necessary to be able to go back to the chain of contacts of an infected person and identify any other people. This identification, in compliance with privacy and regulations, is all the more important as some contagious people ignore being infected. “

Dr Gilles Bloch, Inserm CEO

Malaria: Vaccine clinical trial for Pregnant Women yields promising results

©Benoît Gamain. Gestational malaria is associated with low birth weight for the baby and an over-risk of neonatal mortality.

Malaria infection during pregnancy represents a major public health problem in the regions endemic for the disease, substantially increasing the risks to mothers and their unborn children. For newborns, malaria is linked to low birth weight and an excess risk of mortality. To protect this population, a team of researchers from Inserm and Université de Paris led by CNRS Research Director Benoît Gamain is developing a vaccine at the French National Institute of Blood Transfusion (INTS). Called PRIMVAC, the vaccine has undergone a clinical trial to study its safety and collect preliminary data on its ability to induce an immune response. The results of this clinical trial sponsored by Inserm[1] have been published in the prestigious journal Lancet Infectious Diseases.

According to the World Health Organization, malaria is responsible for over 400,000 deaths each year. Despite the progress made in fighting the disease in recent decades, some populations remain particularly vulnerable. One such population is pregnant women.

In the areas of the world where malaria is endemic, people acquire immunity throughout their childhood, meaning that they are generally protected against its most severe outcomes once they reach adulthood. However, pregnant women are an exception because the red blood cells infected with the Plasmodium falciparum parasite responsible for malaria accumulate in the placenta, promoting anemia and gestational hypertension. The disease is also linked to a higher risk of spontaneous abortion, premature birth and intrauterine growth delays which lead to low birth weight and a high rate of neonatal mortality. In Sub-Saharan Africa, 11 million pregnant women were infected with malaria in 2018, with around 900,000 of their babies born underweight.

To tackle this public health problem, a team of researchers from Inserm and Université de Paris led by CNRS Research Director Benoît Gamain has spent the past two decades developing a vaccine for gestational malaria. The goal is to prevent the deaths of up to 10,000 mothers and 200,000 babies each year. “Developing an effective vaccine for young women before their first pregnancy is a priority if we are to reduce malaria-related mortality. An effective strategy could focus on a population similar to that targeted by HPV vaccination, for example, before the women become sexually active”, emphasizes Benoît Gamain.

A safe and effective vaccine

Called PRIMVAC, the vaccine had recently been produced in large quantities in accordance with current regulations. In a clinical trial published in Lancet Infectious Diseases, the researchers provide data on its safety and ability to induce an appropriate immune response, up to 15 months after the initial vaccination.

The vaccine was evaluated in 68 non-pregnant women aged 18 to 35 at the Cochin Pasteur Clinical Investigation Center in Paris, then at the National Center for Research and Training on Malaria (CNRFP) in Ouagadougou, Burkina Faso. The participants were randomly assigned to 4 cohorts, receiving the vaccine at various doses, on 3 occasions over a period of 3 months. These women were then monitored for 15 months in order to identify and treat any side effects and study the immune response induced by the vaccination.

Antibody (green) of a vaccinated volunteer binding to the surface of a human red blood cell infected with the Plasmodium falciparum parasite (blue). Credits: Inserm/Chêne, Arnaud et Semblat, Jean-Philippe

The results of this study show that PRIMVAC is well tolerated. In addition, the researchers have shown that vaccine can produce an immune response, with the production of antibodies in 100% of women vaccinated after only two injections. The antibodies produced are capable of both recognizing the parasitic antigen on the surface of the infected red blood cells and inhibiting their adhesive capacity, which is responsible for their accumulation in the placenta.

“We were able to show that the vaccine is well tolerated, at all the tested doses. The side effects observed were mainly pain at the injection site. We also revealed that the quantity of antibodies generated by the vaccine increases after each vaccination and that they persist for several months. It therefore appears that the vaccine has the capacity to trigger a lasting and potentially protective immune response”, underlines Gamain.

Studying this immune response on the longer term will be the subject of future clinical trials. The researchers want to continue monitoring the 50 Burkinabe volunteers in order to evaluate whether the immune response induced by the vaccination is maintained until their first pregnancy.


[1] The trial was coordinated by the Cochin Pasteur Clinical Investigation Center in Paris and the EUCLID/F-CRIN clinical trials platform in Bordeaux in collaboration with the National Center for Research and Training on Malaria (CNRFP) in Ouagadougou, Burkina Faso, and the European Vaccine Initiative (EVI). Funding: Federal Ministry of Education and Research, through the development bank KfW, Germany; Inserm, and National Institute of Blood Transfusion (INTS), France; Irish Aid, Department of Foreign Affairs and Trade, Ireland.

Inserm’s commitment to the fight against the Covid-19 pandemic

Intracellular observation of reconstituted human respiratory epithelium MucilAir™ infected with SARS-Cov-2 © Manuel Rosa-Calatrava, Inserm ; Olivier Terrier, CNRS ; Andrés Pizzorno, Signia Therapeutics ; Elisabeth Errazuriz-Cerda  UCBL1 CIQLE. VirPath (Centre International de Recherche en Infectiologie U1111 Inserm – UMR 5308 CNRS – ENS Lyon – UCBL1). Colorisé par Noa Rosa C.


1.   Accelerating research to tackle the pandemic

After appearing in the central Chinese city of Wuhan in December 2019, the novel SARS-CoV-2 coronavirus has rapidly spread across the world, leading to the most serious pandemic in recent history. From the very outset of this global health crisis, Inserm has played a leading role in the French and international research spheres, rallying its many experts working on subjects as varied as fundamental research, therapeutic research, and modelling. The Institue also participates in France’s solidarity effort, taking action to distribute tens of thousands of masks, gloves, gowns, shoe covers and reagents to medical teams working in the nation’s hospitals.

By April 13, 2020, Inserm had already participated in 44 scientific publications on COVID-19 (including preprints), reflecting the energy and proactiveness of its researchers. This research primarily concerns potential therapeutic approaches, the search for a vaccine, epidemiology, the deployment of telemedicine, predicting the spread of the virus in various countries, and its transmission. A large part of the research published has been funded by the REACTing consortium.

A key player in fighting the COVID-19 pandemic, REACTing – which stands for REsearch and ACTion targeting emerging infectious diseases – was launched and coordinated by Inserm since 2013 under the Aviesan banner. A number of task forces (New Therapeutic Approaches, COVID-19 Vaccines, Animal Models, Modelling, and Digital) have been created in order to identify the main research priorities and evaluate the projects submitted to the consortium by research teams across France and in other countries.

In addition, Inserm researchers are participating in various World Health Organization (WHO) working groups, the Scientific Advisory Board consulted by the government, and the Analysis, Research and Expertise Committee (CARE) set up by the Ministry of Solidarity and Health.

Never has Inserm’s mission – Science for Health – been so important as it is right now. Although many questions remain unanswered regarding the evolution of the pandemic, Inserm will continue its efforts to inform public decision-making with research of excellence that combines rigor and ethics. The information contained in this press kit is likely to change as research progresses.

2.     Treating patients

Within REACTing, the New Therapeutic Approaches Task Force meets weekly to evaluate the many projects it receives regarding research into treatment avenues. Experts are invited in order to enrich discussions, as well as members of CARE, the Health Directorate, MESRI, and the REACTing COVID-19 Scientific Advisory Board.

The antivirals approach: focus on the Discovery trial

Of all the research projects linked to treatments, it is most certainly the Discovery trial coordinated by Inserm that is generating the most public interest and questions. Discovery is a European project, whose French component has started thanks to REACTing seed funding, paid jointly by MESRI and the Ministry of Solidarity and Health. It is also funded by the Program for Clinical Research in Hospitals (PHRC) and has been incorporated in the WHO international Solidarity trial.

The trial evaluates the efficacy of various antiviral treatments in limiting the viral multiplication observed in some hospitalized patients whose immune response is too weak, and whose condition deteriorates often around the seventh day of the disease.

It intends to recruit 3,200 European patients with moderate to severe COVID-19, at least 800 of whom in France, admitted to a medical department or directly to intensive care.

– The treatments

The objective of Discovery is to evaluate the efficacy and safety of various experimental therapeutic strategies which, according to current scientific knowledge, have been identified as potential therapeutic candidates for COVID-19. As a recap, it involves testing and comparing the following five strategies:

  • optimal standard of care;
  • optimal standard of care plus remdesivir;
  • optimal standard of care plus lopinavir and ritonavir;
  • optimal standard of care plus lopinavir, ritonavir and interferon beta;
  • optimal standard of care plus hydroxychloroquine.

Therefore, none of the patients enrolled in the trial is left without treatment and none of the patients is receiving placebo.

Why an open-label randomized trial?

Discovery is a randomized trial, meaning that the treatment is not chosen by the doctor but assigned randomly. Each arm of the clinical trial is assigned an equal number of patients so that it is balanced, with sufficient data obtained for each treatment tested.

An open-label trial design was chosen in order to save valuable time in these times of pandemic. It must be remembered that the molecules tested are not all available in the same dosage forms. For a double-blind trial to be possible, it would take a long time to prepare placebos that resemble each of the treatments being tested, therefore delaying the start of the trial.

However, in order to limit bias, although the patients and doctors know which treatment is being administered, the researchers responsible for statistical analysis do not. This controlled, open-label trial design will therefore make it possible to obtain results as rapidly as possible whilst respecting a rigorous and high-quality methodology.

The immunomodulation approach: focus on Corimuno-19

Some hospitalized patients present a specific profile in which the deterioration in their condition does not seem to be due to the multiplication of the virus but to their excessive immune response to the infection. One avenue currently being explored by Inserm researchers is to understand and evaluate the effect on COVID-19 patients of treatments that would modulate this response.

This is the challenge of the Corimuno-19 project, a cohort of open-label, randomized and controlled trials. The overall objective of this large-scale study is to test various treatments (especially immunomodulator treatments) and determine which present the most favorable risk/benefit ratio in adult patients hospitalized for COVID-19 pneumonia – diagnosed either at the moderate to severe stage and requiring no mechanical ventilation, or at the critical stage requiring mechanical ventilation.

The antibodies approach: focus on Coriplasm

Coriplasm – one of the Corimuno-19 clinical trials has received a lot of media attention.  It is sponsored by the Paris hospitals group (AP-HP). With the support of Inserm and REACTing, the French Blood Establishment (EFS) is deploying a process to enable the collection, qualification, preparation and provision to the clinical teams of plasma from convalescent patients. The idea is to evaluate whether their plasma is capable of immediately transferring this immunity to other patients, as had been the case when treating various infectious respiratory diseases such as SARS-CoV-1, MERS-CoV or H1N1 influenza. The objective is to determine whether this strategy reduces the frequency of severe forms of COVID-19 and their associated mortality.

Other treatment repurposing initiatives

Therapeutic repurposing is about finding new therapeutic indications for treatments that are well-known, safe and already available. Within the context of the COVID-19 pandemic, a number of teams are testing molecules used for other diseases on SARS-CoV-2, in order to evaluate their effects. The team of Inserm researcher Manuel Rosa-Calatrava at the International Center for Research in Infectious Diseases (Inserm/Université Claude-Bernard Lyon 1/CNRS/ENS Lyon) is working on the development and validation of a strategy to repurpose drugs for new antiviral therapeutic indications. Having already repurposed in vitro two molecules available on the market for respiratory viruses, including MERS-CoV, the researchers are now testing them against SARS-CoV-2 on cell lines and on an ex vivo model using reconstituted human respiratory epithelium.


3.     Finding an effective vaccine

Although phase I clinical trials to test candidate vaccines have now been launched in the USA and China, many questions remain regarding the immune response to the virus and to a potential vaccine.

Throughout the world, over one hundred teams are working on the development of vaccines, including a number of French groups. Of the thirty or so teams working on the candidate vaccines in France, twelve are from Inserm. Although their development work remains in the early stages for the most part, their efforts are important to improve our knowledge of the virus and vaccine research as a whole.

In order to support them and identify research priorities, REACTing has set up a dedicated COVID-19 Vaccines Task Force. Its role is to collect information on the progress of the various candidate vaccines, to catalogue the actions of the French teams, and to discuss the most relevant measures to deploy in the national context.

The group has defined a set of criteria for assigning priority to the French teams’ COVID-19 candidate vaccine development initiatives, which include the speed of the vaccine production cycle, minimization of the risk of disease exacerbation caused by immune mechanisms, the potential for producing the vaccine on a very large scale, and the availability of preclinical test results suggestive of the induction of disease protection.

The search for a new vaccine

REACTing Vaccination Task Force member Frédéric Tangy (Institut Pasteur) heads up a team that is working on a COVID-19 candidate vaccine at quite an advanced stage of development. It uses as a platform the attenuated measles vaccine that had already been used in the development of certain candidate vaccines, notably against Chikungunya. A phase I clinical trial is scheduled for September 2020.

The Vaccine Research Institute under the supervision of Inserm also has a role to play in vaccines research within the context of the COVID-19 pandemic. Its researchers are mobilized for the accelerated development of an SARS-CoV-2 coronavirus vaccine based on its expertise and the technology developed for other infectious diseases, such as HIV. The novel approach of the Institute is based on the targeting of dendritic cells, key cells in immune response.

Thanks to the involvement of this institute in French Covid-19 – the national cohort of patients infected with SARS-CoV-2, coordinated by REACTing in line with 56 hospitals in France (including Henri-Mondor Hospital in Créteil), the objective of the research conducted there is to characterize patient immune response. Understanding this aspect of the infection is an essential prerequisite for the development of any vaccine.

The BCG vaccine to protect medical staff?

Several studies suggest that some live vaccines, such as BCG or the oral polio vaccine, have non-specific beneficial effects on certain infections. Therefore it is possible that BCG could reduce the intensity of SARS-CoV-2 infection by stimulating the memory of innate immunity, the first line of immunity in the face of infection, and thereby inducing “trained innate immunity”. Furthermore, what few contraindications there are to the use of this vaccine are well known, and its very low cost is an advantage.

An Inserm team is preparing the implementation of a French double-blind trial to test the non-specific protective effects of the BCG vaccine. The idea is to evaluate whether it could offer medical staff a certain level of protection against COVID-19. Collaboration between this team and Spanish scientists who are also conducting research in the area would enable large-scale comparison of the benefits of BCG versus a placebo in to both countries. Should such a trial go ahead, the participants would need to be followed up for several months in order to obtain reliable data.


4.     Modelling and monitoring the epidemic

The Mathematical Modelling of Infectious Risks Task Force has been set up very quickly. 

Modelling the spread of the epidemic

Since January 2020, work by the team of Inserm researcher Vittoria Colizza has made it possible to model the spread of the epidemic from China to Europe and Africa, the objective being to better orient prevention policies and improve surveillance of the epidemic.

Their first publication, in the journal Eurosurveillance, looked at the risk of importing the virus into Europe. This was based data emerging from all Chinese provinces declaring more than ten cases at that time as well as on data from January 2019 on air travel flows from these regions to Europe, produced by the OAG (a global leader in the collection of flight data). Another study published by the group mid-February in The Lancet evaluated the risk of importing the virus into Africa, with Egypt, Algeria and South Africa presented as the countries most at risk.

Another major research avenue explored by Colizza and her team in collaboration with telecommunications group Orange is the impact of the lockdown on population mobility, by studying aggregated and anonymized cell phone network data. The researchers are particularly interested in spontaneous changes in mobility occurring before and during the lockdown, and their impact on the evolution of the pandemic. The data will also be integrated into models of pandemic spread developed by the team. This is to improve predictions of how the virus will spread and identify regions at risk of becoming clusters and of having their healthcare systems overwhelmed.

The team is also working on the modelling of potential lockdown exit scenarios in order for quarantine to be lifted under the most favorable conditions. In a report published mid-April on the EPIcx laboratory website, the researchers stress the need to support all these strategies with measures involving mass testing, the identification of those having been in contact with confirmed cases, and the isolation of detected cases.

Surveillance of the epidemic intensified with Covidnet

Established in 2012 by the Sentinelles network (Inserm/Sorbonne Université) and the French Public Health Agency, the study is a comprehensive information resource for epidemiologists wishing to monitor the evolution of seasonal influenza. Each year, the network collects epidemiological data on influenza directly from the population, anonymously via online questionnaires. began its ninth season at the end of November 2019 and has over 7,200 participants so far, who each week declare the symptoms that they had or had not experienced since they last logged on. For better monitoring of the current epidemic, the study has now become Based on questionnaires sent to the volunteers of the cohort, it is currently the only health surveillance system in France that makes it possible to study the symptoms presented by patients who have sought assistance from the healthcare system.

Risk of hospital transmission

The research also includes studies that aim to model the risk of SARS-CoV-2 transmission in the hospital setting (nosocomial risk). One such study is being conducted by Didier Guillemot and Lulla Opatowski, researchers at the Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases laboratory (Inserm/Institut Pasteur/Université de Versailles Saint-Quentin-en-Yvelines).

5.     Study the lockdown and its impacts

The Sapris study and the social challenges associated with the lockdown

Sapris, a vast survey based on five large, national, general-population cohorts (Constances, Étude familiale E3N-E4N, Elfe / Epipage 2, NutriNet Santé) conducted in close coordination with the leaders of those cohorts, looks at the epidemiological and social challenges posed by the exceptional prevention measures deployed against COVID-19. Coordinated by Nathalie Bajos, Inserm Research Director and sociologist-demographer, and Fabrice Carrat, Professor of Public Health at Sorbonne Université in collaboration with the Public Health Agency, the study involves a multidisciplinary group of researchers from Inserm, France’s National Institute for Demographic Studies (Ined), National Center for Scientific Research (CNRS), Université Paris-Saclay, Sorbonne Université, Sorbonne Paris Nord and Université Paris Dauphine-PSL, National Health Insurance Fund (CNAM), Institut Gustave Roussy and the National Research Institute for Agriculture, Food and Environment (INRAe), covering fields as varied as epidemiology, sociology, demographics and economics.

By means of a questionnaire sent out at the start of April, which will be repeated several times during the lockdown and after it has ended, participants are asked about the specific challenges they are facing related to the epidemic and to these quarantine measures. The main themes studied are the incidence of COVID-19 symptoms and other health problems, the use of treatment for other health conditions or failure to seek treatment, the perception of risk, the effects of the prevention measures on daily life, social relationships, work, and the education of children. In addition, once serological tests become available, the researchers would like to establish the prevalence of COVID-19 based on self-sampling offered to the study participants, which will provide information on prevalence on a national scale.

Evaluating the contacts of French people during lockdown

A population survey to collect and analyze data concerning the contacts between French people during the lockdown has been launched by Institut Pasteur in collaboration with Inserm and several universities. Called SocialCov, this study is based on online questionnaires focused on people’s contacts before and during the lockdown, with the aim of gaining deeper insight into its impact on our social and professional lives. More specifically, the survey will make it possible to identify the number of contacts we have each day, their frequency, and to distribute these results by age group.

Supporting mental health during the lockdown

The measures of social distancing, and particularly the lockdown of the French population, will have an impact on mental health and wellbeing. Several studies have already examined this issue such as a literature review published in The Lancet suggesting that the lockdown is associated with a harmful psychological impact, characterized by mood disorders, confusion, and in the most extreme cases by the manifestation of post-traumatic stress disorder.

For a deeper insight into these effects, Anne Giersch, Inserm researcher and head of the Cognitive Neuropsychology and Pathophysiology of Schizophrenia laboratory in Strasbourg, is conducting a study in healthy volunteers. Its objective is to explore the positive and negative effects of the lockdown, particularly when it comes to mental health. The participants are asked to answer anonymous questionnaires on their general health, their concerns about infection risk, their social network before and during the lockdown, and also on their mood, emotions and stress levels.

In order to help the general population deal with anxiety related to the pandemic, Inserm researchers have also developed a COVID-19 extension of the StopBlues initiative. This initiative, which can count on a freely accessible website and app, was developed in 2018 by the Eceve-Inserm research team led by Karine Chevreul. Its users can be helped to identify whether they are suffering from mental health issues, to look for the possible causes and to find concrete solutions. Within the context of the pandemic, the COVID-19 extension of Stop-Blues includes the publication of short videos describing the emotions that can be felt during the pandemic and faced  with social isolation and family conflicts.


6.     Testing the population and protecting medical staff

Inserm allows the use of its laboratories

Inserm is participating in the population testing effort. A Decree and an Order published on April 5 authorize French prefects to conduct a requisition a public research laboratories for COVID-19 testing. The CNRS and Inserm have prepared for this by making inventories of the equipment available and the number of such tests that could be performed each day in their labs under the conditions set by the government. 

Inserm launches a project to recycle masks

In close collaboration with Tours Regional University Hospital, Inserm Research Directors Nathalie Heuzé-Vourc’h and Mustapha Si-Tahar are leading a proof-of-concept study on an effective decontamination process for surgical and FFP2 masks, to enable their reuse. In the current context in which masks are in short supply, various decontamination processes are being compared. The team has already shown that when 70°C moist heat is applied for a period of one hour, there is no deterioration in the structure of the masks. The decontamination appears to be effective, destroying several viruses and bacteria tested in the proof-of-concept study. Also, the properties of the masks are similar to the untreated masks. These findings must now be consolidated by testing the process on masks contaminated with SARS-CoV-2.

Aphro-Cov, a project to strengthen the diagnosis and management of COVID-19 patients in five Sub-Saharan African countries

As part of the support given by France in response to the Coronavirus crisis, Rémy Rioux, Chief Executive of the French Development Agency (AFD) and Gilles Bloch, Chairman and Chief Executive Officer of Inserm announced in March the launch of a joint initiative to improve the health surveillance and management of suspected cases of COVID-19 in five African countries (Burkina Faso, Gabon, Ivory Coast, Mali, Senegal). Called Aphro-Cov, this program steered by REACTing is focused on the laboratories, early warning system, clinical departments, and – by means of raised awareness and reinforced communication – the population as a whole.

Because research is needed more than ever to protect the health of everyone and to address the challenges posed by this new pandemic, Inserm has set up a platform for donations and is calling on public generosity. The funds collected will be used to sustain and complete these different research projects.


To make a donation and support the work of our researchers:

Inserm in the fight against fake news

Fighting fake news and publishing clear and high-quality scientific information are key concerns for Inserm. This is particularly the case with the COVID-19 pandemic, given the various rumors and scientifically unfounded information circulating on social media and other platforms. To counteract this and give the public the most accurate information possible, Inserm has, since January 2020:

  • Aired an episode on its Canal détox channel discussing the false information most often encountered.
  • Published information bulletins with the most important news regarding the Institute and international research, and which also takes a look at a number of fake news online.
  • Each week, the REACTing consortium prepares a thorough review of the scientific literature concerning SARS-CoV-2 and COVID-19. The group provides a summary of high-quality scientific publications for those wishing to follow the scientific research more closely.

COVID-19 and Confinement: A Large-Scale French Survey of Social Challenges and Health

©Helloquence on Unsplash

For a deeper insight into the social and epidemiological challenges posed by the exceptional prevention measures taken in response to the COVID-19 pandemic – particularly confinement – a multidisciplinary group of researchers has joined forces with Inserm and the Public Health Agency to launch a survey of around 200,000 participants from five major French cohorts.

In response to the COVID-19 pandemic that is currently raging across most of the world, exceptional prevention measures are being implemented – with possibly the most striking example being the confinement of a large part of the population. In the face of this measure, on such an unprecedented scale in our history, many questions are emerging in regard to health, quality of life, social relationships, and the education of children. In order to obtain answers to these questions, deepen our understanding of the short and long-term consequences of the measures, and better describe the frequency of COVID-19 symptoms in the general population, the role of the scientific community is of primary importance. These efforts complement the clinical studies being conducted in hospitals to identify the most effective treatments and understand the outcomes of hospitalized COVID-19 patients.

A multidisciplinary group of researchers from Inserm, France’s National Institute for Demographic Studies (Ined), National Center for Scientific Research (CNRS), Université Paris-Saclay, Sorbonne Université, Sorbonne Paris Nord and Université Paris Dauphine-PSL, National Health Insurance Fund (CNAM), Institut Gustave Roussy and the National Research Institute for Agriculture, Food and Environment (INRAe), covering fields as varied as epidemiology, sociology, demographics and economics, has been established in order to study the principal epidemiological and social challenges of this epidemic via a major national study conducted in the population. Approved by the French Data Protection Authority (CNIL), this study is part of an accelerated procedure implemented in order to tackle the challenges of this health crisis.

The SAPRIS study (“Santé, pratiques, relations et inégalités sociales en population générale pendant la crise COVID-19 – General population health, practices, relationships, and social inequalities during the COVID-19 crisis“) is coordinated by Nathalie Bajos, Inserm Research Director, sociologist and demographer, and Fabrice Carrat, Professor of Public Health at Sorbonne Université, in collaboration with the French Public Health Agency.

It is based on the five large national general population cohorts (Constances – Etude familiale E3N-E4N – Elfe / Epipage 2 – NutriNet Santé) and is being conducted in close coordination with their leaders. 

“The advantage of these cohorts is that they concern several tens of thousands of people who have been followed up for years already, whose pre-epidemic lifestyles, dietary habits, health, treatment consumption, work activities and biological data are finely detailed”, enabling the researchers to study the impact of confinement by documenting social and geographic inequalities of risk exposure and living conditions, and to characterize the factors relating to vulnerability to and severity of the infection, emphasize Bajos and Carrat.

Using a questionnaire filled in at the start of April, which will be repeated several times during confinement and once it has ended, the SAPRIS study will ask the participants about the specific challenges of the epidemic and the confinement measures. Particular attention will be paid to the incidence of COVID-19 symptoms and other health problems, the use of treatment for other health conditions or failure to seek treatment, the perception of risk to oneself and in general, the effects of the prevention measures on daily life, social relationships, work, and the education of children.

Once serological tests are available, it will be possible to establish the prevalence of COVID-19 based on self-sampling offered to the study participants, which will provide information on prevalence on a national scale.

Inserm and the African Countries: Partners in Fighting COVID-19

Image de microscopie du  Coronavirus SARS-CoV-2 responsables de la maladie COVID-19 accrochés aux cellules épithéliales respiratoires humaines

Coronavirus SARS-Cov-2 responsible for COVID-19 disease attached to human respiratory epithelial cells©M.Rosa-Calatraval/O.Terrier/A.Pizzorno/E.Errazuriz-cerda

Furthering scientific knowledge knows no frontiers. Therefore, Inserm would like to reaffirm that the countries of Africa are – more than ever – key scientific partners and that:

  • Inserm has long been committed to numerous research projects with African countries concerning a variety of diseases, including Ebola, malaria, and HIV.





  • Inserm, through the Reacting consortium, has an ethical charter for research conduct in emerging infectious disease epidemics.

Electronic Death Certificates to Improve Accuracy of COVID-19 Mortality Figures

©National Cancer Institute on Unsplash

In order to obtain accurate mortality figures on the COVID-19 pandemic, the data provided by the various entities authorized to issue death certificates – health care establishments, community doctors, emergency medical service (SAMU), and care homes for the elderly – need to be collected quickly. Although it is possible to declare deaths electronically in France, this channel is underutilized despite the considerable time-saving it represents for data processing on a national scale. The widespread deployment of electronic death certification made possible by Inserm through its CertDc application should enable rapid acquisition of the figures needed, in order to improve monitoring of the pandemic.

In the war against the COVID-19 pandemic, unprecedented in its scale, reliable indicators are needed more than ever in order to monitor numbers of diagnosed cases and deaths. These are the figures that provide the public authorities, doctors and researchers with an overview of the situation and orient their decisions. High quality mortality data is also essential for epidemiological studies. Since 1968, Inserm has been tasked with producing statistics on the medical causes of death in France.

Every day, the country’s Health Directorate publishes the latest data at its disposal, with the mortality indicators communicated to the public having been collected primarily through the hospital system and health care establishments. The number of severe cases admitted to hospital intensive care departments is also shared in order to give a more comprehensive picture. Then there is the Public Health Agency, which measures the impact of the epidemic on both the health care system and mortality. It uses various sources, including the electronic death certificates that give a better idea of the characteristics of those who have died from COVID-19.

To further improve the reliability of the figures to reflect as closely as possible the national mortality rate associated with the COVID-19 pandemic, better use needs to be made of community medicine data. Since 2007, Inserm via its Epidemiological Center on the Medical Causes of death (CépiDc) has provided the CertDc app, which enables doctors to produce and electronically certify death certificates, and as such provide rapid notification of information on the causes of death and the profiles of the deceased (sociodemographic and administrative information). In 2019, this data channel represented only 20% of deaths on French territory, with the majority of certificates still being issued by doctors in paper format.

In the current health emergency context, the more widespread use of electronic death certification would minimize delays in accessing COVID-19 mortality data and make it possible to more rapidly obtain accurate and reliable mapping of the pandemic.

The widespread implementation of electronic death certification is therefore encouraged, with work being done to raise the awareness of the various health care players via the Regional Health Agencies, in order for all data to be notified under better time conditions. The real-time arrival of these mortality data is essential if we are to gain a better understanding of the scope of this pandemic and how best to fight it.

Health and environmental crises: a CNRS- Inserm joint initiative

©Branimir Balogović on Unsplash

The CNRS and Inserm, in association with the CPU, INED, INRAE and IRD, under the umbrella of ATHENA and AVIESAN1, are joining forces to raise key scientific questions on health and environmental crises and combine the initiatives of the humanities, social sciences and public health research communities arising from the current COVID-19 crisis.

The COVID-19 outbreak is generating a strong mobilisation of the humanities, social sciences and public health research communities. Calls within the scientific communities and the numerous initial proposals for research projects are evidence of their commitment to advancing science, and to helping address and understand the current health crisis, its long-term effects and the health and environmental crises that may arise in the future.

The initiative launched by the CNRS and Inserm, ‘Health and Environmental Crises – Humanities, Social Sciences, Public Health’ (HS3P-CriSE), is collaborative and multidisciplinary. It will focus on the situation in France and more broadly on the situation in other countries, with a particular interest in the countries of the southern hemisphere.

It will complement current initiatives in France and Europe, by providing scientific proposals and support to the positioning of teams on some central research issues. Although anchored in this current crisis, its action plan is envisaged as being long term.

Under the responsibility of Marie Gaille for the CNRS and Rémy Slama for Inserm, a committee of around ten researchers, bringing different perspectives and disciplinary skills, will meet for the first time within the coming days.


1 CPU : Conférence des présidents d’université ; Ined : Institut national d’études démographiques ; Inrae : Institut national de recherche pour l’agriculture, l’alimentation et l’environnement ; IRD : Institut de recherche pour le développement ; Athéna : Alliance thématique nationale des sciences humaines et sociales ; Aviesan : Alliance nationale pour les sciences de la vie et de la santé.

Publication of a study in the journal The Lancet Infectious Diseases, covering the first five cases of Covid-19 identified in France and in Europe, between 24 and 29 January 2020

©Hush Naidoo on Unsplash

The teams of the Infectious and Tropical Diseases Hospital Bichat AP-HP and the University Hospital of Bordeaux, in collaboration with researchers from University of Paris, Inserm IAME UMRS-1137 (University of Paris / INSERM / University Sorbonne Paris Nord), the Institut Pasteur, the Hospices Civils de Lyon, CNRS – UMR 5308, Ecole Normale Supérieure de Lyon and University Claude Bernard Lyon, published a study based on the monitoring of the first five patients diagnosed Covid-19, admitted to Bichat hospital and the University hospital of Bordeaux. Despite the very limited number of patients, the work carried out, which were the subject of a publication March 27, 2020  in The Lancet  Infectious Diseases , have identified three very different types of clinical presentations.

This work aimed to evaluate clinical disease models and viral load from different nasopharyngeal samples of blood, urine and feces that were obtained once a day for three days from admission to hospital, and once every two or three days until the patient is discharged. All samples were refrigerated and shipped in the National Center laboratory virus respiratory infections Reference (Institut Pasteur and Hospices Civils de Lyon), where RNA extraction, real-time RT-PCR were performed to quantifications and for the isolation and sequencing of the virus. These analyzes were conducted on 5 patients initially detected by the Pasteur Institute, three men (aged 31, 48 and 80) and two women (aged 30 years and 46 years)

This work has identified three very different types of clinical presentations:

– The first is a clinical presentation frustrating, very few symptoms with rapidly favorable spontaneous evolution despite the strong presence of SARS-CoV virus-2 in nasopharyngeal early in the disease.  

– The second type of presentation is biphasic with a reassuring initial phase and a secondary aggravation approximately 10 days after the onset of the disease despite a decrease in viral load during this period in nasopharyngeal samples.  

– The third type is a serious presentation outset rapidly evolving to multiple organ failure with persistent high viral load in the lower respiratory tract and upper and virus detection in plasma.

These three clinical-virological phenotypes appeared in profiles distinct patient enough, shape frustrated in both patients, the two-phase form in both young patients and the severe form immediately in the elderly. The clinical and virological confrontations do not seem correlated; spontaneous clearance of virus in 10 days for forms frustrated, worsening symptoms of secondary unrelated to the virus, prolonged persistence of viral shedding for severe forms of comorbid field.

“Despite the passage of time and events have passed since the first description of these cases, the classification of different clinical presentations seems to be confirmed through clinical experience of the epidemic phase. It seems interesting to better understand the natural history of the disease Covid-19 and contribute to the therapeutic management for each situation. It suggests that the vast majority of patients do not need treatment. It illustrates the need to rapidly identify patients that could worsen secondarily based on a particular field (the male gender seems to be confirmed as a risk factor of gravity) and early markers of more inflammatory than virological detection elsewhere. “says Professor Xavier Lescure first author of the study and Assistant Professor Yazdan Yazdanpanah, head of infectious diseases and tropical Bichat Hospital, and last author of the study initiated under the Reacting network, both members of Inserm team IAME UMRS 1137 (University of Paris / Inserm / Université Sorbonne Paris North).

If these works bring us many indications, no conclusions can be drawn directly from the work therapeutically. 

The BCG vaccine against COVID-19 – really?

Injection d’un vaccin avec une seringue pré-remplie. © Inserm/Depardieu, Michel


There has been a lot of talk over the past few days that the BCG tuberculosis virus is a promising ally in the war against COVID-19. But is this actually the case?

Interestingly, epidemiological studies have shown a correlation between rates of BCG vaccination and rates of COVID-19 morbidity and mortality. While most of these studies point in the same direction, a causal relationship cannot be concluded because major biases remain, particularly in terms of differences in living standards and healthcare policies between countries with high and low vaccination rates.

However, BCG had in the past been found in children to demonstrate a non-specific protective effect against infections, particularly respiratory infections. Live vaccines, such the BCG, measles and oral polio vaccines, are thought to have non-specific beneficial effects on some infections. Therefore it is possible that BCG could reduce the intensity of SARS-CoV-2 infection by stimulating the memory of innate immunity, the first line of immunity in the face of infection, and thereby inducing “trained innate immunity”.

With over 3 billion people vaccinated worldwide, BCG is very well known; a lot of data is available and its few contraindications (notably immunodeficiency) have been well characterized. It is also one of the most inexpensive vaccines in the world.

Armed with these observations, researchers in various countries have launched large-scale clinical trials (with 1,000 participants in the Netherlands, 4,000 in Australia) in people at high risk of exposure (notably healthcare personnel).
France is also working on the subject. Camille Locht, Inserm Research Director at Institut Pasteur in Lille, is preparing the implementation of a French double-blind clinical trial. A collaboration with Spain, which is also conducting research in a project of this type, could enable the large-scale comparison of the benefits of BCG vaccination with a placebo common to the two countries. Should the trial go ahead, the participants will however need to be followed up for 2 to 3 months in order to ensure that the data are reliable.

The researchers remain cautious: while BCG represents a very interesting prospect, it still needs to be explored within the framework of rigorous clinical trials. At present, there are no data recommending this vaccine as a means of protection against COVID-19.