factor aggravating the negative consequences of confinement

Tribune: Investigation into a paradox highlighted by a study by the University of Edinburgh: the closure of schools and universities would ultimately increase the overall number of victims of Covid19

Containment, what for?

The objective of confinement is to reduce and spread the overload of hospitals, by limiting the wave of hospitalization needs given the constraints of our health system (number of intensive care beds for example).

The impoverishment of our health system[1] results in the number of beds, equipment, drugs but also in the shortage of personnel due to multiple resignations.[2] In addition, the postponement of care that should have been administered early for other patients has now worsened the number of serious patients entering the hospital. [3] [4], creating additional unanticipated constraints.

Paradoxically, the large European countries which have confined the hardest have more Covid19 deaths per million inhabitants than those which have not confined (the Netherlands or Sweden [5] [6]), and more so-called collateral deaths, linked to the absence and delay of treatment for other pathologies, suicides, etc.[7]

One of the causes of this paradoxical result finds an answer in the study of the University of Edinburgh.

Consequences of shutting down schools during confinement

A study by the University of Edinburgh [8] suggests that stopping school activities during confinement is partly responsible for an increase in overall mortality. Let us analyze this mechanism.

In February 2020, doubt prevailed over the contagiousness of children. In March, the closure of schools was decided in reference to influenza epidemics in which school contagion is significant, despite a clash in communication (the Minister of National Education explained in front of the cameras on the morning of Thursday March 14 that the schools would remain open and that the President contradicted him the same evening in his televised speech). We can legitimately assume that the arbitration has leaned towards zero health risk, putting in the background other equally important risks linked to the dropout of millions of children. The reopening of schools was painful, although many international publications have demonstrated the absence of contamination of children or adults by other children. [9] [10] [11] [12] [13] [14] [15] [16] [17]. This did not prevent strong restrictive measures (wearing a mask from 6 years old), not without consequences on the well-being, mental and psychic health of children.

Decisions in France as in other countries seem to have been influenced by an Imperial College model.[18] (N. Ferguson) using the IBMIC program and a setting corresponding to the disease assumptions that predominated in February-March.

The errors of this modeling have been regularly demonstrated[19] and can be seen today. The study would have increased the real risk of the disease by 1,200% and by predicting, in the event of non-containment, 70,000 deaths in Sweden (in reality 6,000)[20] and 100,000 in the Netherlands (just over 8,000 as of 11/15), due to false initial assumptions about actual disease mortality, rate of increase, and significant software errors [21] [22].

Since then, the settings have been improved, indicating (data from report 9) that the closure of schools would paradoxically increase the total number of deaths during the second wave for which the confinement is responsible. [23].

To verify the results of Report 9, the study authors took the curriculum from Imperial College and averaged 10 cycles of simulation with the same starting random numbers as used in Ferguson’s original Report 9.

The mitigation scenarios in Report 9 took into account breeding numbers of R0 = 2.2 and R0 = 2.4. the results obtained are not exactly identical to those of report 9, because it is an average of 10 random realizations. The algorithm used to assign individuals from households to other places such as schools, universities and workplaces has been changed to be determinative. Deaths were estimated for all waves, not just the first.

In the scenario of isolation of clinical patients, household quarantine and social distancing of over 70s, but without the closure of public places, only one peak is observed. Younger people contribute the most to the total number of cases, but deaths mainly occur in older groups.

The scenario described above to which is added the closure of public places would allow a decrease in the intensity of the initial peak, but lead to a second peak of cases in young people. This then leads to a more deadly increase in contaminations affecting the elderly. The postponement of the spread of covid-19 means that more people are still contagious and available to infect older groups, a much larger fraction of whom are then at risk of dying.

The scenario that adds to the precedents the closure of schools and universities would result in more deaths than the other scenarii.

Finally, the same goes for the scenario of the confinement of the population which would increase the total number of deaths compared to the social distancing of the over 70s only.

Conclusion

The emergency closure of schools and universities in March to fight Covid19 can now be put into perspective thanks to the study from the University of Edinburgh.

The consequences on mortality of the various confinement scenarios including schools and universities are quantified and appear positive. They should make it possible to inform political action and the strategies adopted.

[1] Qui leur avait pourtant été souligné par l’ampleur des mouvements de protestation et d’une grève des urgences de près de 18 mois qui n’avaient reçu comme réponse que mépris et répression avec matraques, gaz lacrymogène et lanceur de balles
[2] 180000 infirmières formées ne pratiquent plus et seule une revalorisation réelle des rémunérations et surtout une suppression du harcèlement des directions énarchiques à mille lieux de la réalité pourra les ramener vers le soin
[3] Le conseil d’état contestera le bien-fondé juridique de l’interdiction de la prescription de l’hydroxychloroquine par tout médecin, mais le mal sera fait et la pression monstrueuse de l’ordre des médecins et de la CPAM transformera pendant cette crise les médecins libéraux en bourreaux et robots obéissants, à l’exception de certains d’entre eux  ( peut-être plus nombreux que supposés) qui coute que coute et malgré les risques personnels (suspension par l’ordre du droit d’exercer ) sont restés fidèles à Hippocrate et sauver la grande majorité de leurs patients. Il suffisait de les soigner !
[4] http://www.francesoir.fr/societe-sante/covid-19-hydroxychloroquine-aucun-obstacle-sa-prescription-ni-delivrance-et-engagement
[5] https://docteur.nicoledelepine.fr/non-aux-reconfinements-mortiferes-meme-locaux/
[6] https://docteur.nicoledelepine.fr/autopsie-dun-confinement-aveugle/
[7] https://docteur.nicoledelepine.fr/confinement-meurtrier-tout-ce-que-lon-ne-vous-a-pas-dit-aberration-humaine-sanitaire-economique/
[8] Ken Rice Effet des fermetures d'écoles sur la mortalité par coronavirus : anciennes et nouvelles prévisions BMJ .2020 ; 371 : le 7 oct.2020 doi :  10.1136 / bmj.m3588
[9] Haiyan Qiu Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China : an observational cohort study Lancet Infect Dis. 2020 25 mars ; S1473-3099 (20) 30198-5.
[10] Danis K, Epaulard O, Bénet T, Gaymard A, Campoy S, Bothelo-Nevers E, et al. Cluster of coronavirus disease 2019 (Covid-19) in the French Alps, 2020. Clinical Infectious Diseases. 2020.
[11] Arnaud Fontanet et al SARS-CoV-2 infection in primary schools in northern France : A retrospective cohort study in an area of high transmission medRxiv preprint doi : https://doi.org/10.1101/2020.06.25.2014017
[12] RIVM Institut national de la santé publique et de l'environnement rapports de patients COVID-19 reçus des services municipaux de santé publique (GGD) aux Pays-Bas
[13] Heavey L, Casey G, Kelly C, Kelly D, McDarby G. No evidence of secondary transmission of COVID-19 from children attending School in Ireland, 2020. Euro Surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2020 May ;25(21).
[14] (NCIRS). COVID-19 in schools – the experience in NSW [Internet]. Sydney : NCIRS ; 2020. Available from : http://ncirs.org.au/sites/default/files/2020-.
[15] Dub T, Erra E, Hagberg L, Sarvikivi E, Virta C, Jarvinen A, et al. Transmission of SARS-CoV-2 following exposure in school settings : experience from two Helsinki area exposure incidents. MedRxiv. 2020 :2020.07.20.20156018
[16] H C. Maltezou Transmission dynamics of SARS-CoV-2 within families with children in Greece : a study of 23 clusters
[17] Benjamin Lee et William V. Raszka Transmission du COVID-19 et enfants : l'enfant n'est pas à blâmer
[18] Imperial College Rapport 9 : Impact des interventions non pharmaceutiques (INP) pour réduire la mortalité et la demande de soins de santé de covid-19
[19] http://www.economiematin.fr/news-rapport-confinement-ferguson-secret-critique-decision-politique-delepine
[20] http://www.economiematin.fr/news-suede-coronavirus-gestion-crise-exemple-democratie-efficacite-delepine
[21] Sue Denim (pseudonyme) Code Review of Ferguson ’s Model May 2020. 6 https://lockdownsceptics.org/code-review-of-fergusons-model/
[22] Martin Armstron I have reviewed ferguson code, It is a joke.2020 5 8  https://www.armstrongeconomics.com/world-news/corruption/i-have-reviewed-fergusons-code/
[23] Une deuxième n’a jamais été observée lors de l’évolution naturelle d’une épidémie virale ; la 2ème vague de la grippe espagnole était une vague bactérienne et non pas virale. La 2ème vague actuelle n’est qu’une des conséquences du confinement et mélange allègrement des covid probables avec des grippes et des malades aggravés par l’absence de prise en charge depuis plusieurs mois. Parler de « vague » est donc inadapté.

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