How to make the isolation of patients and contact cases work better?

A PCR test in France.

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• The number of new cases increases every day or almost in France, yet the isolation of patients is difficult to be respected.

• It cannot be made mandatory, but it may be better monitored, by reducing the duration of isolation, for example.

• For the researcher in social psychology interviewed by

  20 Minutes

  , this must also involve an awareness of young people, who have difficulty isolating themselves while the disease is not very lethal at home and at home.

After masks and tests, it is the new weak link in the fight against the coronavirus in France: the isolation of infected people and “contact cases”, people who have crossed them.

The Scientific Council drew up on Wednesday a "failure report" of the quarantine system, which currently lasts fourteen days.

"Today few people isolate themselves" and this "weakens our ability to control the chains of contamination" of the coronavirus, regretted Laëtitia Atlani, anthropologist and member of the Scientific Council, during an online press conference.

Why it does not work ?

Because isolating oneself is “costly psychologically and socially for people,”

Jocelyn Raude, professor and researcher in social psychology at the School of Public Health Studies

, told

.

However, at fourteen days of quarantine, the cost becomes "extremely high", he says.

And therefore, the instructions are less well followed.

This is nothing very new either.

Concealment

“During the Ebola crisis, remembers Jocelyn Raude, when we had isolation measures that turned out to be too coercive, even if they are scientifically based (which is not necessarily the case). for the fourteen days), we had phenomena of concealment of cases or patients, because it is too costly socially for individuals.

"

"Sometimes the best is the enemy of the good", says the researcher again to designate this old dilemma as public health: "Where do we put the cursor between the effectiveness of a measure and its social acceptability? ?

This cursor is all the more difficult to place as it differs from one country to another, cultural differences playing a full role.

Discrimination

“France has a very egalitarian cultural background and we do not support anything that is perceived as a form of discrimination.

There are two titles of approaches in public health: targeted strategies, on groups at risk, and universal strategies, on a whole population and in general this approach works quite well in France.

In other countries, more targeted approaches are preferred.

French containment is a good example.

"

The isolation, by definition solitary, of positive people or who could be positive, then appears as a kind of discrimination for some or some.

In the spring, we remember for example that the simple rumor of a continuation of confinement only for people at risk, that is to say the oldest, had aroused an outcry and had been quickly dismissed.

In this context, the probable announcement of a reduction in the quarantine to seven days appears as good news for Jocelyn Raude: "We nevertheless significantly reduce the effects on the professional and personal level".

Organization

To make this isolation even more effective, it would still be necessary to allow the people concerned to be supplied with food, even medicines, without having to go to the street or to shops, of course.

Would it be possible to deliver the isolated ones?

Some town halls already deliver meals, in normal times, to elderly people.

It remains to be seen whether extending this type of operation is credible.

More generally, the question of logistics arises.

Jocelyn Raude relates this to the strategy on testing.

“It works well, until we reach a critical size, and then we see that the system is running out of steam or collapsing.

The deadlines are lengthening in this case, and therefore we lose the effectiveness of the device and this is exactly what could happen with an "isolation system" which would be the victim of its success.

No doubt that at the beginning, or when there are available resources, it works quite well but from a certain threshold one apprehends the limits of the system or finally it is a little chaotic.

"

Last challenge: to convince young people to submit to this isolation, if ever they are positive or have contact.

“Most young people understood that the disease was very mildly lethal for them.

So the heuristic of fear, which is one of the main drivers of behavior change, recedes or slows down in young people.

When it comes to taking very restrictive measures when their own health is not at stake, but rather the health of others, we come across altruistic considerations that have not been mobilized much so far.

Because we live in a society more and more curled up on an individual ground, this requires reactivating notions of solidarity that have been somewhat undermined in recent years.

"

Health

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Miscellaneous

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• Confinement

• Covid 19

• Coronavirus

• epidemic

• Health