After eight weeks of confinement, Ile-de-France deplored this Saturday 27 deaths from the consequences of the coronavirus, bringing the regional toll to 6,441 dead. Another 1,196 Covid-19 patients were in intensive care in hospitals in Ile-de-France, representing almost 43% of severe forms registered in France. The region, which has only 18% of the population, therefore remains particularly affected by the pandemic. But not all departments are affected with the same intensity.
In an attempt to understand this disparity, the Regional Health Agency asked the Regional Health Observatory (ORS) to provide it with "elements of objectification of excess mortality during the month of March in the Ile-de-France departments, in the ascending phase of the epidemic. " A study whose results we are revealing exclusively.
The excess mortality has more than doubled in Seine-Saint-Denis
“Since the start of the pandemic, numerous analyzes have pointed out the disparities in morbidity and survival of people according to their age. But there are other factors of inequality in the face of the disease, which one could qualify as risk factors, on which it is possible to intervene ”, begins the ORS in its introduction. "The idea is to learn from it for the next time, because there will be next times," insists Isabelle Grémy, its director.
Rather than relying on the places of death as the figures communicated daily to follow the evolution of the pandemic, the study relies on the places of residence of the victims to better provide information on the spread of the virus within departmental populations .
First observation, the excess mortality more than doubled in Seine-Saint-Denis (+ 118.4% between March 1 and April 10, compared to the same period in 2019). It is also particularly marked in the other dense departments of the Greater Paris metropolis (+ 101.5% in Hauts-de-Seine, + 94.1% in Val-de-Marne and + 92.6% in Paris ). The increase is less marked in the outer ring, with the exception of Val-d'Oise with + 90.1%.
Three axes emerge: the state of health of the population before Covid-19, the housing conditions, and the share of "key workers", those who are on the front line facing the epidemic.
Housing conditions favoring the circulation of the virus. If "living alone in confinement is a strong psychosocial risk factor", living "in large numbers in a dwelling can also exacerbate tensions, especially if certain household members are among the key workers who continue their professional activity outside the home", summarizes the study. These are "places where the urban fabric is extremely concentrated, in households with many children with whom it is difficult to respect barrier gestures, where the available area is below average", describes Isabelle Grémy.
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This is the case of Val-d'Oise where 11% of households have more than 5 people. In 93, more than a third of the population lives in accommodation with less than one room per person. Who says collective housing says common parts and contact surfaces (elevators, doors ...) and absence of private garden, therefore impossibility of taking the air without leaving home. An environment which therefore increases the risk of transmission.
Precarious health before the coronavirus. Socially disadvantaged areas are also those where health indicators are not very favorable. "The life expectancy of men registers a difference of two years between Hauts-de-Seine and Seine-Saint-Denis, recalls Isabelle Grémy. On the Ile-de-France scale, there is up to 8 years of difference between certain cantons. Not surprisingly, health is more precarious in the most disadvantaged sectors. In Seine-Saint-Denis, we thus observe “higher chronic disease rates, in particular for obesity, diabetes and cardiovascular diseases. These chronic diseases are risk factors for Covid-19. Again, Seine-Saint-Denis and Val-d'Oise have the highest rates of diabetes or respiratory disease.
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Key workers on the front line. Health services, but also food shops, pharmaceutical industries, IT services, law enforcement, firefighters, public transport drivers, water treatment, cleaning, funeral services ... INSEE counted 500,600 "workers keys ”in Ile-de-France (in 2016). Professionals who must continue their activity without telework, exposed to the public despite the confinement. And it is still in Seine-Saint-Denis that they are widely represented (12% of active workers against 8% in Yvelines or Hauts-de-Seine). A department with the most cashiers and sellers (18.7%), cleaners (25.2%) letter carriers (16.5%), delivery people (21.6%) and public transport drivers (22.8% ). Only the police and firefighters, who more often choose the Seine-et-Marne (20%) and the Ile-de-France tobacconists, who take up residence in Paris for 17.9% of them. Active people who are all the more exposed as they make long journeys to reach their place of work, since more than half of them change department.
Even if Seine-Saint-Denis concentrates a lot of aggravating factors, “it is quite premature to speak of excess mortality which would only affect the 93, concludes Isabelle Grémy. It is rather necessary to look at geographical levels as fine as the municipality and even the district. While waiting to be able to examine each of the Ile-de-France departments under a microscope, district by district, the ORS concentrated on Seine-Saint-Denis, the department most affected. And even within this department, the disparities are strong.
Thus, the excess mortality peaks at + 168% in Plaine Commune (9 cities north of Paris) and + 153.8% in Paris Land of flight (8 municipalities between the airports of Roissy and Le Bourget) when it is established at + 55.7% in Grand Paris Grand Est (14 municipalities in the east). "It is therefore very likely that more favored departments have municipalities where the excess mortality is comparable to certain sectors of Seine-Saint-Denis," points out the director of the ORS. The 93, symbol of working-class neighborhoods.
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