New Delhi, London, New York, Paris … Little by little, the metropolises of the whole world are decreed dead cities. International airports are emptying, trains are stopped, tourist sites deserted, borders closed. As of today, more than 3 billion people are expected to remain confined to the fight against the coronavirus pandemic. More than a third of humanity.
The count is changing every day, inflated Tuesday by India which requires its 1.3 billion inhabitants to seal off. One by one, the States are coming to the obvious: the health crisis will be long and it must be contained, pending the arrival of treatments or a vaccine. And while the inhabitants of the Chinese region of Hubei, cut off from the world since January 23, gradually come out of their isolation, the rest of the world rallies to the appeal launched on March 2 by the Director General of the Organization World Health Organization (WHO), Tedros Adhanom Ghebreyesus: “Containment is feasible and must remain the top priority for all countries. “
Containment measures are most stringent in Europe, where more than 15,000 people have died from the Covid-19. On the front line, Italy, Spain and France, the countries most affected. Rome thus prohibited traveling from one municipality to another, except in the case of “absolute urgency”. Spanish people are not allowed to go out and play sports. The French have the right to move only with a temporary certificate, dated and signed. Any deviation is heavily penalized. Antoine Flahault, professor of public health at the University of Geneva, recalls that four measures of social distancing have already proven their effectiveness in the past, especially during the Spanish flu epidemic of 1918: “school closings, travel restrictions, gathering restrictions and sanitary cordon around active households. ” Governments are free to implement them more or less drastically, according to their priorities and the advice they receive from their scientific community.
“Firmly invited to stay at home”
Responses to the crisis therefore vary within the same continent. In Latin America, Venezuela or Colombia impose confinement. In Brazil, only certain large cities like Sao Paulo are placed in quarantine. Chile, for its part, imposes a night curfew. Same disparity in Africa: Tunisia or Rwanda border. In Nigeria, the estimated 20 million people in Lagos are “strongly invited to stay at home”. Senegal, Côte d’Ivoire and Sierra Leone have so far opted for the night curfew.
A conductor is missing. The score is a little cacophonic
“A conductor is missingrecognizes the epidemiologist Antoine Flahault. The score is a bit cacophonic because no one is there to recommend when it should be entered into the dance and put in place this or that measure. ” If the WHO had set the pace, would the countries have listened to it?
This discrepancy sometimes arises within a single country: in the United States, more than a third of the inhabitants are invited to stay at their home even though Donald Trump is reluctant to tighten the screw at the federal level: “We cannot let the remedy be worse than the problem itself“Said the US president in a tweet. Global containment is not self-evident for countless reasons, not to mention the feared devastating effects on the economy. How will the Indian giant fare? How to impose it in countries at war? In those where the state is failing, the economy ashore? In countries where there is a lack of drinking water, where people have to move to survive?
“This strict “lockdown” imposed by Beijing on its population is a first, recalls Professor Flahault. Unheard of on such a scale. As it seems to have been effective, democracies have taken it. But we have very little perspective. It’s an invention of the diet authoritarian chinese aimed at strengthening the effectiveness of social distancing measures, without knowing the possible collateral effects on mental health, domestic violence, etc.“As researchers at Imperial College London recalled in a recent publication,”no public health intervention with such disruptive effects on society has been attempted before for such a long period. How people and societies will react remains unclear“
These uncertainties partly explain the reluctance of certain States, which are considering other avenues. Jean-Stéphane Dhersin, specialist in epidemic modeling at CNRS, explains: “It is estimated today that about 60% of the population must be immunized (either because they have already been sick, or because they have been vaccinated) before the virus can stop spreading. This is called collective immunity. ” It is on this principle, and the idea of a controlled spread, of the disease that Sweden in particular relies: to circulate the virus among the youngest, less seriously affected, in order to preserve the old by isolating them. “The problem, reminds Professor Flahault,50% of patients admitted to intensive care because of Covid-19 are under 60 years of age. Young people are also placed in intensive care and health systems are at risk of congestion in the event of a mass influx. ” Sweden, which relies on the discipline of its people, is currently sticking to this more flexible strategy, leaving primary schools, restaurants and bars open. In the meantime, its more stringent neighbors scrupulously control their borders.
Confined, but until when? There are billions of us asking this question. And if the WHO sees the reopening of Wuhan as “hope,” one thing seems certain: containment is only a transitional measure. Imperial College researchers say “to avoid a rebound in transmission, measures should be continued until a large stock of vaccines is available to immunize the population, which could take 18 months or more” When the restrictions are lifted, the way the virus spreads will not have changed. If Covid-19 tanks remain, populations that have not achieved this collective immunity will again become fragile. This is the case in China today, where the epidemic can start again. At the beginning of the XXe century, that of Spanish flu had experienced three rebounds…
“All time-saving steps are worth taking, assures Jean-Stéphane Dhersin, however. Because in the event of a rebound, we will have acquired experience, we will be able to manage better.Taking as an example strategies that have proven their effectiveness: testing everyone, tracking suspicious cases to better isolate them using geolocation data provided by mobile phones, video surveillance cameras, bank statements. This is what Singapore has done. “It would have been difficult to apply these methods from the start in Europe because our countries were less prepared for this type of risk that many Asian states have faced since the SARS or Avian Flu crises. But we will now have to think about it, and prepare for it, maybe next fall“Says Antoine Flahault. With all the limits that these methods imply in terms of individual freedoms.