Is a new COVID-19 social contract appropriate?
Authors: Cédric Annweiler, Sophie Moulias, Federico Palermiti, Jean-Marie Robine, Dominique Somme
Journal: The Lancet Public Health (2021)

In their Correspondence, Laetitia Atlani-Duault and colleagues1Atlani-Duault L Lina B Chauvin F Delfraissy JF Malvy D Immune evasion means we need a new COVID-19 social contract.Lancet Public Health. 2021; 6: e199-e200Google Scholar advocated for voluntary self-isolation of older and vulnerable groups. The French Society of Geriatrics and Gerontology strongly opposes such generational segregation, which symbolically places the responsibility for health and the economic situation on individuals according to their age. Older people (≥70 years) have already adopted self-isolation over the past year in the spirit of solidarity and responsibility towards younger people. Although general confinement is effective,2Pan A Liu L Wang C et al.Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China.JAMA. 2020; 323: 1915-1923Google Scholar we acknowledge that its complications (eg, psychological morbidities and delays in care)3Salje H Tran Kiem C Lefrancq N et al.Estimating the burden of SARS-CoV-2 in France.Science. 2020; 369: 208-211Google Scholar are mostly age-related and can be amplified by isolation measures limited to older people, without evidence of mortality benefits to the population.4Rice K Wynne B Martin V Ackland GJ Effect of school closures on mortality from coronavirus disease 2019: old and new predictions.BMJ. 2020; 371m3588Google Scholar Moreover, claiming that self-isolation would help the economy disregards that older people are themselves an important part of economic recovery.5WHOWorld report on ageing and health.https://apps.who.int/iris/handle/10665/186463Date: 2015Date accessed: February 25, 2021Google Scholar Rather than reinforcing antagonisms, we need an inclusive and united society to fight the COVID-19 pandemic. For the French Society of Geriatrics and Gerontology four principles are needed to control COVID-19. First, the social contract of not exposing oneself and others is justified during the pandemic and corresponds to scrupulously respecting physical distancing and barrier gestures. This social contract therefore applies to everyone. Second, mass screening should be expanded to appropriately isolate contact cases and patients tested positive. Third, mass vaccination, including isolated older people, is a priority. Pathogenic variants should not precipitously question vaccination policies. Finally, vaccination should systematically be accompanied by effective person-centred care and support plans, particularly in nursing homes. We declare no competing interests. We thank members of the French Society of Geriatrics and Gerontology listed in the appendix. Download .pdf (.23 MB) Help with pdf files Supplementary appendix Immune evasion means we need a new COVID-19 social contractThe collective benefits of herd immunity have become similar to a mantra in mass vaccination strategies, repeated by governments and researchers. However, the prominence of herd immunity being touted as a solution to the pandemic might be about to change with the emergence of immune evasion, a virological game changer that is as important as the arrival of SARS-CoV-2 variants. Dealing with immune evasion will require a re-evaluation of public health strategies, and the creation of a new, evidence-based social contract. Full-Text PDF Open AccessIs a new COVID-19 social contract appropriate?We read with interest the Correspondence by Laetitia Atlani-Duault and colleagues,1 in which they proposed a so-called new COVID-19 social contract to deal with immune evasion. Full-Text PDF Open Access