Viruses roam the dark streets at night …


On March 17, 2020, France declared its first confinement in front of the Covid-19, killing 4,512 out of a population of 66 million inhabitants, in a country that suffers about 180,000 deaths from respiratory infections every year. Not enough to panic. Were the death statistics alarming? On the contrary, the 2019-2020 influenza season turned out to be almost non-existent. In short, nothing was happening and yet, obeying mysterious injunctions around an unknown virus which caused no apparent damage, France like many others applied a foreign device to all specialists in infectious diseases: containment.

Has this confinement had an impact on the dangerousness of COVID-19? Let us look at the mortality in France and Sweden. Sweden is one of the few European countries to have refused to confine its population. There is no significant difference in mortality in these two countries: in 2020, Sweden suffered a mortality of 9.43 ‰ and France of 9.95 ‰. Overall, even though France suffered from the worst situation, the difference is minimal. In Sweden, 53% of those over 70 who have officially died of COVID19 have died in nursing homes and not in hospitals. Half of those over 70 have not benefited from hospital care (1), which tends to show that the determining factor in controlling COVID-19 mortality is the quality of care. medical charge. We can reasonably think that from a health point of view confinement does not bring any benefit. But is it harmful in terms of health?

An article by Aaby and Leeuwenburg (2) examines how the measles virus affects secondary cases infected at home differently than primary cases infected outside. In this case, patients infected at home are three times more likely to die than those affected outside. The authors draw attention to the influence of the intensity of exposure to the pathogen on its lethality, which appears to be greater in confined environments such as domestic environments. SARS-CoV-2 is of course not comparable to measles; but this work highlights the harmful role that a containment strategy could have on a viral disease. In the case of measles, containment such as it was applied in 2020 would have caused a massacre. Containment is therefore not at all a self-evident approach in a viral context. It would still seem that SARS-CoV-2 would spread more within a confined population. At least this is the conclusion of a large sero-epidemiological study carried out by the Spanish Ministry of Health in collaboration with the Carlos III Health Institute (3), the health services of the autonomous communities and the National Institute of statistics. The SARS-CoV-2 contamination rates were measured in different categories of the population. The infected did not necessarily fall ill; but all crossed the virus so as to develop characteristic antibodies. Confined populations were infected with the virus in a proportion of 6.3%, while workers were infected at 5.3%. The difference is significant; it shows that SARS-CoV-2, like measles, is more virulent in a confined population.

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We observe a posteriori that the confinement of populations increases the spread of the SARS-CoV-2 virus. An article by Bendavid, Oh, Bhattacharya and Ioannidis, published in January 2021 (4), studies the relevance of containment strategies to control the spread of COVID-19. The authors compare the respective policies of different countries: England, France, Germany, Iran, Italy, the Netherlands, Spain, South Korea, Sweden and the United States . Of these countries, only South Korea and Sweden have not practiced containment. The conclusion of this work is that containment strategies did not seem to bring any benefit in the health management of COVID-19.

However, the adverse effects of confinement were noted by the French authorities. The EPIPHARE scientific interest group was formed at the end of 2018 by the ANSM and the CNAM to carry out pharmacoepidemiology studies based on health data. He has published several reports regarding the use of drugs during the COVID-19 epidemic. Report 4 of October 5, 2020 (5), covering the confinement period from March 16 to May 10, 2020, summarizes the situation in these terms: “The Covid-19 epidemic with all its organizational consequences in the healthcare sector and on the general population has profoundly destabilized the consumption of city drugs in France. This study confirms a very marked decrease in the delivery and use of products which require administration by a healthcare professional (with the exception of anxiolytics and antidepressants). This collapse in consumption over the entire period of confinement and after was not caught up. Vaccination also shows a strong deficit six months after the start of confinement. The introduction of cardiovascular and antidiabetic treatments for new patients has sharply decreased during confinement. The consequences of such declines are not immediately apparent, but they will undoubtedly be revealed later.

From an epidemiological point of view, containment therefore seems unnecessary. From a political point of view, it responds to the anxieties of the concerned powers. Effective techniques for controlling infectious diseases are all based on separating healthy people from sick people. To dilute the virus, not concentrate it, which the aggregate methods of containment and curfew do. Containment spatially concentrates people and curfews temporally concentrate activity. In both cases, these steps concentrate the virus by promiscuity. They respond to a desire for political control of the populations by subjecting individual activities to the authority of the State; but they have neither a priori nor a posteriori any connection whatsoever with medicine.

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[1] Socialstyrelsen, « Statistics on number of COVID-19 deaths», onglet «Place of death», lien sur le site du Socialstyreslen.
[2] Aaby Peter, Leeuwenburg Johannis, « Patterns of Transmission and Severity of Measles Infection: A Reanalysis of Data from the Machakos Area, Kenya », The Journal of Infectious Diseases, vol. 161, no. 2, 171–174 (février 1990), www.jstor.org/stable/30126070. Accessed 3 Feb. 2021. Journal of the Royal Statistical Society Series B, vol. 13 no. 2, 238–241 (mai 1951), https://www.jstor.org/stable/30126070.
[3] ENE-Covid, “Estudio ENE-Covid-19: primera ronda”, Estudio Nacional de seroEpidemiología de la infección por SARS-CoV-2 en España (ENE-Covid), first round report (13 May 2020), link on the site of the Spanish Ministry of Health.
[4] Bendavid Eran, Oh Christopher, Bhattacharya Jay, Ioannidis John P. A., « Assessing mandatory stay-at-home and business closure effects on the spread of COVID-19 », European Journal of Clinical Investigation (5 janvier 2021), doi :10.1111/eci.13484.
[5] EPIPHARE, “Use of city drugs in France during the Covid19 epidemic – update until September 13, 2020”, report 4 (October 5, 2020), link on the EPIPHARE website.

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