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Confined against the Covid-19: lives saved or deaths postponed?

The containment against the Covid-19 may have saved lives, but its repercussions will cost other lives around the world in the longer term.

The containment against the Covid-19 has undoubtedly prevented deaths, but its repercussions will cost other lives around the world in the longer term. An equation with multiple unknowns with an ethical dimension. “It is a very difficult calculation to make,” said AFP Sarah Burgard, sociologist at the University of Michigan, noting that “the best epidemiologists and social scientists” are working on the issue to inform the political decision.

“Among the difficulties is the assessment of the number of deaths linked to the Covid-19 disease itself, the number of deaths attributable to chaos and the consequences of the Covid-19 crisis (on the health system) , compared to the deaths attributable to the economic fallout from containment and its impact on individuals and businesses, “she said.

Recession and health
In a study published in 2000, the American economist Christopher Ruhm asked a question, at first provocative: “are recessions good for health?”. “My hypothesis was that when the economy goes bad, the health of people are deteriorating, so I was surprised to find that I was largely wrong, “he explains 20 years later.

On the one hand, suicides and stress increase with unemployment, accompanied by abuse of harmful substances, from tobacco to illicit drugs. On the other hand, with the slowdown, road accidents and air pollution decrease, physical health improves thanks to the time available for physical activity in particular, according to this work.

Result, even if some public health indicators deteriorate and if mental health problems are “underestimated”, “when unemployment is high, mortality is low”, assures Professor Ruhm in a video conference posted in April on the University of Virginia website. In any case in developed countries, and during a “normal” recession. Because today “we are in an unknown situation”, he insists. “It is risky” to extrapolate, continues Sarah Burgard, because this unprecedented crisis “threatens many of the + positive + usual sides of economic downturns”.

For example, activities supposed to mitigate the health impact of losing a job are impossible in confinement: playing sports, going for a walk, spending time with friends. And “the social support that one can receive or give can be limited, increasing isolation and making it more difficult to maintain good physical and mental health,” adds the sociologist.

On the other hand, postponing certain treatments or screenings on patients afraid of going to the hospital could also cost lives. And 80 million children under the age of one are at risk of contracting diphtheria, measles or polio, alarm UNICEF, WHO and the Vaccine Alliance, while mass immunization campaigns have been suspended in several countries.

“No voice”
Beyond the specifics of this pandemic, the studies which conclude that recessions have a positive impact on mortality mainly concern rich countries.

“The opposite seems to be true for many low- and middle-income countries, where mortality increases during a recession,” said Thomas Hone, a public health researcher at Imperial College in London. “Evidence suggests that strong health systems and social safety nets are vital to protect people from the negative effects of the recession,” he said.

The World Food Program has also warned of the risk of an explosion in the number of people on the brink of starvation, which could double in 2020 to “more than 250 million”.

So will all of these possible long-term deaths outnumber the lives saved by confinement?

The variables to be taken into account are legion and none of them is consensus: were some models predicting a massacre too alarmist? Is the official Covid-19 death count correct? How many deaths have been avoided by containment?

In work published on Monday, Imperial College London estimates that 3.1 million deaths have been averted in 11 European countries. But there is no certainty, since the difference is calculated on the basis of a first estimate, that of the deaths that the epidemic would have caused in the absence of any control measure. And even if it were possible to arrive at a clear result, “what would we do with such a figure? It would be ethically and politically complex, ”insists Sarah Burgard.

“The question will be political,” predicts Arthur Caplan of the Groceman School of Medicine at New York University. But for this bioethics specialist, the dramatic mortality forecasts made it difficult to make a choice other than confinement. Politically, long-term threatened lives “have no voice,” he said.

For these future deaths, “we will not have the director general of health gnawing every evening the statistics of excess mortality by suicide or stroke,” comments in Le Monde the sociologist Didier Fassin. “These lost lives and these wasted lives, nobody, or almost, will mourn them”.

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