[What are the determinants of viral outbreaks and is it possible to predict their emergence?]

Epidemiological geography at work: An exploratory review about the overall findings of spatial analysis applied to the study of CoViD-19 propagation along the first pandemic year

The present work aims to give an overview on the international scientific papers related to the territorial spreading of SARS-CoV-2, with a specific focus upon applied quantitative geography and territorial analysis, to define a general structure for epidemiological geography research. The target publications were based on GIS spatial analysis, both in the sense of topological analysis and descriptive statistics or lato sensu geographical approaches. The first basic purpose was to organize and enhance the vast knowledge developments generated hitherto by the first pandemic that was studied "on-the-fly" all over the world. The consequent target was to investigate to what extent researchers in geography were able to draw scientifically consistent conclusions about the pandemic evolution, as well as whether wider generalizations could be reasonably claimed. This implied an analysis and a comparison of their findings. Finally, we tested what geographic approaches can say about the pandemic and whether a reliable spatial analysis routine for mapping infectious diseases could be extrapolated. We selected papers proposed for publication during 2020 and 209 articles complied with our parameters of query. The articles were divided in seven categories to enhance existing commonalities. In some cases, converging conclusions were extracted, and generalizations were derived. In other cases, contrasting or inconsistent findings were found, and possible explanations were provided. From the results of our survey, we extrapolated a routine for the production of epidemiological geography analyses, we highlighted the different steps of investigation that were attained, and we underlined the most critical nodes of the methodology. Our findings may help to point out what are the most critical conceptual challenges of epidemiological mapping, and where it might improve to engender informed conclusions and aware outcomes.

[Ethical approach to the issue of confinement of the elderly in the context of the COVID-19 pandemic: Prevention of frailty versus risk of vulnerability]

La pandémie à COVID-19 touche particulièrement les personnes les plus âgées et expose à un risque de mortalité les plus fragiles. Des mesures de confinement, de distanciation sociale et d’isolement ont été mises en place pour limiter la propagation virale. S’il existe un rationnel clair pour réduire la contagiosité de l’infection par ce biais, les conséquences néfastes de cet isolement social, en particulier pour cette population hétérogène, âgée et fragile sont difficiles à appréhender. En particulier, la rupture avec les structures habituelles de support et de soutien à domicile ou en institution, mais aussi le risque d’une diminution de « l’empowerment » de la personne âgée par rapport à ses propres décisions de santé et de vie sociale, imposent une vigilance particulière pour éviter un risque d’âgisme sociétal. Il peut ainsi exister, en regard de cette population particulière, des conflits de valeurs entre protection individuelle et collective, d’une part, et respect de l’autonomie et de l’indépendance, d’autre part. Cet article propose une réflexion éthique de la question du confinement des personnes âgées à risque de fragilités, s’appuyant sur des principes de l’éthique médicale, pour ouvrir les pistes de réflexion qui permettent une approche positive de la vulnérabilité, garante du respect de la dignité de la personne et de l’équité dans l’accès aux soins.