Is a new COVID-19 social contract appropriate?
Authors: Guy La Ruche, Daniel Pérez
Journal: The Lancet Public Health (2021)

We read with interest the Correspondence by Laetitia Atlani-Duault and colleagues,1Atlani-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 in which they proposed a so-called new COVID-19 social contract to deal with immune evasion. Atlani-Duault and colleagues, who are all members of the French Scientific Council of COVID-19, had pleaded a month earlier for a generalised curfew with local confinement or generalised confinement,2Avis du Conseil scientifique COVID-19Entre vaccins et variants: une course contre la montre.https://solidarites-sante.gouv.fr/IMG/pdf/avis_conseil_scientifique_12_janvier_2021_actualise_13_janvier_2021.pdfDate: Jan 13, 2021Date accessed: February 21, 2021Google Scholar advice that was dismissed by French President Emmanuel Macron. Their proposed new social contract1Atlani-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 is based on the self-confinement of the most vulnerable groups—older people and people at risk of the severe form of COVID-19. As a result, the younger generations would be able to live freely while continuing to respect preventive measures (eg, masks and physical distancing). This proposal was already present in the January 2021 recommendations of the French Scientific Council, but only as an additional measure besides local or generalised confinement.2Avis du Conseil scientifique COVID-19Entre vaccins et variants: une course contre la montre.https://solidarites-sante.gouv.fr/IMG/pdf/avis_conseil_scientifique_12_janvier_2021_actualise_13_janvier_2021.pdfDate: Jan 13, 2021Date accessed: February 21, 2021Google Scholar Atlani-Duault and colleagues' recommendation calls for several criticisms. First, such a self-confinement is already being applied by a part of the population who know that they are at risk and who have already reduced their social interactions for several months. Second, the at-risk population in France is nearly 23 million people if we include, as recommended by the French health authorities, people older than 65 years and people who have comorbidities3Haute Autorité de SantéStratégie de vaccination contre le Sars-Cov-2—recommandations préliminaires sur la stratégie de priorisation des populations à vacciner.https://www.has-sante.fr/upload/docs/application/pdf/2020-11/strategie_de_vaccination_contre_le_sars-cov-2_2020-11-30_10-40-59_242.pdfDate: Nov 27, 2020Date accessed: February 21, 2021Google Scholar—ie, a third of the French population. Thus, a third of the population would need to be confined until they are vaccinated. Given the vaccine shortage, self-confinement will persist for many more months. Third, the effectiveness of such a recommendation is unknown and highly questionable. Older people or people at risk of severe COVID-19 will continue to require help from the outside and, hopefully, meet their families. The risks of transmission will therefore persist as it is difficult to maintain physical distancing within close family. Furthermore, there are often people at risk and people without risk of severe COVID-19 in the same household, which makes it challenging to isolate the at-risk family members for a long time. Although not specifically mentioned by the authors, it is probable that governments would lift some restrictive measures (eg, reopening bars and restaurants) to reduce the economic impact of the crisis in light of this new social contract. With such relaxation of restrictions, the circulation of SARS-CoV-2, including its variants, would increase without benefit as long as vaccination coverage is not sufficient, which could take at least 6 months in France. Finally, such a discriminatory recommendation poses a major ethical problem. Can we ask a third of the population to isolate itself so that the other two-thirds can live almost normally? Far from being a fulfilling social contract, it would call into question intergenerational solidarity. We declare no competing interests. Is a new COVID-19 social contract appropriate?In their Correspondence, Laetitia Atlani-Duault and colleagues1 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. Full-Text PDF Open AccessImmune 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 Access