PARIS | containment decided against the COVID-19 has undoubtedly avoided the dead, but its impact will cost of other lives around the world, in the longer term. An equation with multiple unknowns with an ethical dimension.
“It’s a calculation very difficult to do”, tells the AFP Sarah Burgard, a sociologist at the university of Michigan, noting that “the best epidemiologists and social scientists” are working on the issue to inform the policy decision-making.
“Among the difficulties, there is the evaluation of the number of deaths related to the disease COVID-19 itself, the number of deaths due to the chaos and the consequences of the crisis of the COVID-19 (on the health system), compared to deaths attributable to the economic effects of the containment and its impact on individuals and businesses”, she continued.
In a study published in 2000, the american economist Christopher Ruhm asked a question, at first provocative: “recessions are good for health?”.
“My assumption was that when the economy goes bad, people’s health deteriorates. So I was surprised to discover that I was largely wrong,” he says 20 years later.
On one side, the suicides and the stress increases with the unemployment, accompanied by abuse of harmful substances, from tobacco to illicit drugs. On the other, with the slowdown, the number of road accidents and the pollution of the air decreases, the physical health improves with the time available for physical activity in particular, according to these studies.
Result, even if some of the indicators of public health, degrade and if mental health problems are “under-estimated”, “when unemployment is high, mortality is low,” says the Pr Ruhm in a conference video posted in April on the site of the university of Virginia.
In any case in the developed countries, and during a “normal” recession. Because today “we’re in an unknown situation”, he insists.
“It is risky to extrapolate, says Sarah Burgard, because this crisis is unprecedented “threat number of +positives+ to the usual economic downturns”.
For example, activities intended to mitigate the impact on health of job loss are impossible in containment: do sports, walk around, spend time with his friends.
And “the social support that one can receive or give can be limited, increasing the isolation and making it more difficult to maintain good physical and mental health”, adds the sociologist.
On the other hand, the postponement of certain treatments or screening tests on patients frightened to go to the hospital could also cost lives.
And 80 million children under the age of one year are at risk of contracting diphtheria, measles, or polio, alarmed the Unicef, WHO and the Alliance of the vaccine, whereas the campaigns of mass immunization have been suspended in several countries.
Beyond the specifics of this pandemic, the studies that conclude to a positive impact of recessions on mortality relate mainly to the rich countries.
“The opposite seems to be true for many countries with low or moderate incomes, where the mortality increases during a recession”, tells the AFP, Thomas Hone, a researcher in public health at Imperial College London.
“The clues seem to show that systems of strong health and social safety nets are vital to protect the population from the negative effects of the recession,” he continues.
The world food Program has also warned against the risk of explosion in the number of people on the brink of starvation, which could double by 2020 to more than 250 million”.
Then all these potential deaths in the long term they will be more numerous than the number of lives saved by the containment?
Variables to take into account are legion, and no consensus: some models predicting a massacre were they alarmist? The official number of dead from the COVID-19 is it correct? How many deaths have been avoided by the containment?
In work published on Monday, the Imperial College of London is estimated to be 3.1 million the number of deaths avoided 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? This would be ethically and politically complex,” stresses Sarah Burgard.
“The question is political,” predicted Arthur Caplan, of the school of medicine, Groceman of the University of New York. But for this specialist of bioethics, forecasts dramatic mortality made it difficult for an alternative to the containment.
Politically, the lives threatened in the long term “have no voice”, he says.
For these future dead, “we will not have the director-general of health counting off each evening to the statistics of the excess mortality by suicide or stroke,” says in The World the sociologist Didier Fassin.
“These lives lost and those lives wasted, nobody, or almost, do not weep”.