Could territorialized deconfinement work?

Health Minister Olivier Véran said on Tuesday to be in favor of deconfinement territory by territory. “When considering removing a certain number of constraints, we must look at the epidemic situation in each territory, the hospital situation and, in general, the level of saturation of hospitals in France,” he argues in an interview. the newspaper The Telegram. A number of reductions in measures against the coronavirus could begin “from mid-May”, in addition to the reopening of schools, then colleges and high schools scheduled respectively in one and two weeks.

Could this territorialized deconfinement work? 20 minutes make the point.

Why choose this option by territory?

Quite simply because the situation is very diverse in France. Thus, in terms of incidence (number of cases per 100,000 inhabitants), the department of Finistère is only 88.7, while Seine Saint-Denis has an incidence of 665.7. Without counting overseas, 14 departments have an incidence of less than 200, while six have an incidence of more than 500.

The saturation of intensive care beds is also very different depending on the region. Nouvelle-Aquitaine has “only” 63.8% of its intensive care beds occupied by Covid patients, against 159.6% in Hauts-de-France (this kind of figure is possible because the percentages are made according to the number of beds before the Covid crisis).

This disparity raises questions about the relevance of national measures. “At the present time, it is difficult to understand why Finistère is still under curfew or has the same constraints as Paris”, takes as an example Marie-Aline Bloch, researcher in management sciences at the École des Hautes Etudes. in Public Health.

For the moment, no figure or objective has been given for deconfinement. But whatever the required criteria, “it is certain that some territories will reach them before others. Perhaps even some they already tick all the boxes ”, supports the researcher.

What are the advantages of deconfinement by territory?

As said above, this would make it possible to deconfin certain territories much earlier than based on the national average. “And given the economic, social and physical cost of confinement, this can relieve a large part of the population”, pleads Marie-Aline Bloch.

Nevertheless, the economic impact should be put into perspective. By deconfining according to the average of each territory and not the national average, we inevitably delay the deconfinement of regions with the highest viral circulation (because regions with low circulation no longer come to compensate their figures). Thus, if deconfinement is set at an incidence of 200 for example, Paris would be deconfined much more quickly in a national approach (the incidence of the country is currently 342.2) than in a territorial approach (the incidence of Paris is 518). However, the regions with a high incidence are among the most important economically (Hauts-de-France, Ile-de-France and Paca). Deconfinement by territory could therefore be more costly for the country than national deconfinement.

Sanitary on the other hand, “deconfining by territory precisely makes it possible to avoid too early deconfining regions with high viral circulation on the pretext that the national average is low. It is therefore a fairer and more secure system, ”according to Marie-Aline Bloch. All the more so since it makes it possible to test in deconfined territories what works – and does not work – in order to best prepare the future deconfinements of the most at-risk territories (such as Seine Saint-Denis, where the density of the population as well as its precariousness are seen as two additional risk factors for high viral circulation).

Can it work?

Since this deconfinement by territory would make winners and losers, the whole question is how to avoid population exoduses from confined regions to deconfined regions? An effect observed with each differentiated measure, especially in Ile-de-France.

For Marie-Aline Bloch, it will depend on the difference between the confined and deconfined territories: “We can attest that the confinement is already less heavy than that of March 2020. In addition, the schools will reopen, the curfew will surely still be shifted by one hour, and perhaps even the terraces will reopen in confined territories. With liveable confinement, the risk of exodus is lower. “

Of course, the researcher also pleads for many checks between regions, tests, etc. As last May: “A deconfinement by region had already been carried out during the first wave, and there had been no exodus or deportation of incidence” – even if the viral circulation was much lower in France than it will be during this deconfinement, which makes any comparison difficult. A year ago, the differences were smaller between territories: terraces and sports halls open only three weeks in advance, then inside restaurants versus only exteriors in “red” territories. Territorialized deconfinement, yes, but not too differentiated if it wants to work.