At least 3,237 people have died from COVID-19 in the country’s nursing homes since early March, according to the most recent official statistics published Tuesday. That was an increase of 820 from the day before and brings France’s death toll to over 10,000.

Nursing homes statistics were not updated Wednesday because of a “technical issue” with the reporting system, Health Minister Olivier Véran said.

The number of deaths in nursing homes is “objectively chilling,” said Benoît Ribadeau-Dumas, the prime minister’s head of Cabinet, in an email dated Sunday to Aurélien Rousseau, head of the Regional Health Agency (ARS) for the Paris region.

The medical community, pensioners’ families and local elected officials have tried for weeks to sound the alarm on the dire situation faced by elderly people, their relatives and employees in some of the country’s over 7,000 residential facilities.

But a lack of accurate and up-to-date information has made health authorities’ task harder when it comes to providing crucial operational support.

The first data on cases and deaths in nursing homes, released only last Thursday, was — by the government’s own admission — based on “incomplete figures.”

“I am flagging a specific difficulty with certain groups which do not report [their] cases enough in the daily reporting exercise that we do,” Rousseau told the prime minister’s cabinet in an email dated Sunday.

He added that he and his team had called several private nursing home networks over the issue, including the Korian group, one of the leaders in the sector in Europe.

“It is an issue which is going to surface publicly because it seems to be a strategy,” Rousseau said.

Nursing home federations have pointed to the extra administrative work created by multiple reporting systems, and sometimes discrepancies between guidelines from the national government and regional agencies.

“Like all of the sector’s stakeholders, we are abiding by the [latest] guidelines from the health ministry,” Korian said in a statement.

The internal emails seen by POLITICO discuss the government’s new testing strategy in nursing homes, announced Monday by Véran, and a wider action plan to try to limit the spread of the disease in hard-hit nursing homes, including by mobilizing hundreds of additional medical staff.

The email exchanges also shed light on the executive branch’s sensitivity to the situation.

“We must of course communicate about all of this,” Benoît Ribadeau-Dumas, Philippe’s head of Cabinet, replied to Rousseau, referring to the action plan, “because concern is rising and we have to reassure the French [public].”

“We can clearly see things are going to shift from hospitals ... to residential care facilities, where things are more difficult because they are less structured,” Ribadeau-Dumas said in the same email, also dated Sunday.

“The figures are objectively chilling but, without trying to minimize it, we need to remind [people] of how many deaths there are every day in normal times,” he added.

Delays in data collection impeded the timely deployment of additional resources to assist pensioners and contain the spread of the disease in these facilities, and increased levels of concern among health administration officials in charge of monitoring the situation.

“We don’t know what is happening in there,” said one health official, speaking on condition of anonymity. “Nursing homes’ directors are supposed to write to us every day if a case is detected, but in some cases there were already deaths that had never been reported to anyone.”

Many families have struggled to keep informed about the situation in individual nursing homes since the prime minister decided to ban visits last month to protect pensioners. Over 600,000 elderly people currently reside in such facilities in France.

Some complain of a lack of transparency regarding coronavirus outbreaks in facilities where their relatives live.

Three nursing homes from the Korian group have been the targets of such criticism — in Clamart, a Paris suburb, in Marseille and in Mougins on the French Riviera, where 34 people died in one of the worst-affected nursing homes in the country.

“Every facility informed all of the families of the presence of COVID-19 [cases] in the facility,” Korian said in a statement. “The health care staff regularly informed the trusted person for the patients affected.”

For weeks after first cases were reported in France, no countrywide report was available on deaths in nursing homes. In late March, the health ministry launched a new, national daily reporting tool to help monitor the situation regarding cases and deaths.

“Private facilities are obviously part of this reporting system,” a press official for the health ministry said. “If some dysfunctions are witnessed, [health administration] teams make a point to correct them, in coordination with stakeholders, as soon as possible.”

The new system coexisted with an existing platform used by regional health agencies to monitor the same data but also, crucially, requests for operational support such as additional medical staff or protective equipment.

“What’s very difficult today ... is that we have requests for multiple officials and each interlocutor wants [the data],” said Annabelle Vêques, director of the FNADEPA, a federation of directors of institutions and services for the elderly.

Some nursing homes didn’t share data in accordance to official guidelines, which since March 28 have required data to be submitted through specific platforms to regional health agencies and national health authority Public Health France, according to several documents seen by POLITICO.

For instance, in the Paris region, at least four Korian nursing homes and one from DomusVi group — the country’s third biggest private network — failed to update the regional platform as required by official guidelines for several days, despite multiple cases and several deaths among pensioners, according to internal documents.

“We communicate in real time to regional health agencies, however, switching from one system to another may account for some delays of one to two days,” a Korian spokesperson said.

DomusVi didn’t respond to requests for comment.

The executive branch reacted swiftly Sunday to try to remedy the issue once the gaps in reporting had been flagged.

“We’re going to set up a call today or tomorrow with the major federations and groups,” Ribadeau-Dumas said in the same email to Rousseau.

All seem to agree the situation on the ground is critical.

“We’ve been alerting on the situation in nursing homes for weeks but everything has been focused on intensive care units,” said the health administration official who spoke on condition of anonymity.

“We call to find personnel but we don’t have protective equipment for them so they don’t want to go,” added the official, citing a lack of masks among other things.

Asked by POLITICO about the email exchanges and nursing homes’ delays in reporting data, the prime minister’s office said: “We didn’t worry about the lack of data on deaths, we worried about the lack of data on [nursing homes’ operational] needs.”

One of the difficulties facing health authorities as they try to support facilities for the elderly, Rousseau said in his email, is that “volunteer health care workers fear going to nursing homes more than going to hospitals.”

He assessed the need to mobilize 400 people from the Réserve sanitaire of volunteers among unemployed or retired health care workers.

Rousseau’s office, as well as regional health agencies for the Paris and Marseille regions, where gaps in reporting appeared, did not respond to multiple requests for comment.

SYNERPA, a federation which represents private nursing home networks like Korian, DomusVi and Orpéa, sent a letter to Véran, the health minister, on April 3 criticizing the two reporting systems as red tape and calling for them to be streamlined and for guidelines to be clarified.

“As you know, nursing homes are on the frontline in the management of this health crisis,” the letter reads. “Staff from these facilities can’t afford to get bogged down filling in multiple reporting tools and questionnaires which gather the same data.”

The letter also said they were advising their members to stop submitting numbers of deaths and confirmed cases to any reporting system other than the national platform.

This story was updated.

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