The case against lockdowns
The alternative to confining people to contain outbreak
As anti- lockdown protests swarmed over capitol buildings in the United States last month, demonstrators showed their patriotism by donning the uniform of the Continental Army that fought the American Revolution, including one man wearing what, on closer inspection, was actually the coat worn by the Beast in Disney’s The Beauty and the Beast.
When similar anti- lockdown protests came to Toronto, Ontario Premier Doug Ford labelled the rebels a “bunch of yahoos” and dismissed their calls to lift the stay-at-home orders issued by his government.
So far, the case against lockdowns has not been well- articulated and it has been received poorly. An Angus Reid poll earlier this month showed that only nine per cent of Canadians believed public health officials should be more concerned about the harm to the economy than public health and safety.
In the background, though, and with fewer flamboyant costumes, some academics, public health officials and politicians around the world have been making the case that these strict lockdowns aren’t necessary. The case isn’t always just about avoiding economic pain, either. Many of them are concerned about the mental health toll of the lockdowns and others are simply trying to find the best way to fight a resilient and deadly virus.
Most prominent ly, Sweden has taken a relaxed view on the government’s response to the COVID-19 outbreak, allowing bars and restaurants to stay open, along with schools for younger children. People in Hong Kong have taken the virus seriously and reacted diligently, wearing masks and closing schools, but the city is not shut down the way most of the western world is.
Lyman Stone, a researcher with the American Enterprise Institute, lives in Hong Kong and wonders if most of the world is deploying a sledgehammer to defeat COVID-19 when a few wellplaced hammer blows would do the job, along with a lot less collateral damage.
“It seems like the lockdowns don’t add a whole lot after you’ve done other social distancing measures,” said Stone in an interview with National Post. On the other hand, “the research on isolation and centralized quarantine is extensive and compelling. We know this works.”
Stone’s argument is that, aside from a few yahoos, people are pretty good at physical distancing even without the government making them do it.
THE SITUATION IN HONG KONG
Stone, a former international economist at the U. S. Department of Agriculture, spoke to National Post from his home in Hong Kong while his wife went for a late-night stroll on the beach with a friend.
“As long as your life doesn’t require you to be gathered in large groups, life here is pretty normal,” he said. Schools have closed and workers have been encouraged to work from home, but restaurants are still open and the malls are bustling.
Canadians, meanwhile, have been staying at home for more than six weeks, with only essential trips to the grocery and drug stores.
Locked down Canadians may be surprised to learn that in Hong Kong, with a population of 7.5 million and in close proximity to the source of the outbreak in China, only four people have died from COVID-19. Canada suffered nearly 3,000 deaths by the end of April, amid a strict lockdown.
During the 2003 outbreak of SARS, nearly two- fifths of the deaths happened in Hong Kong and that crisis has been seared into the memory of the people there. People wear masks at the slightest hint of a cold or flu and they are quick to adopt physical distancing measures when a new outbreak is reported.
A study published on April 17 in The Lancet medical journal surveyed people on how they were adapting to the COVID-19 outbreak and found that 85 per cent were avoiding public places voluntarily and almost 99 per cent were wearing face masks outside.
The measures put in place by the government and the behavioural changes of people in Hong Kong have had a big effect on the transmission of both the new coronavirus and the flu. Before school closures and physical distancing, each person with the flu was infecting 1.28 people and after the measures that number was 0.73. The researchers believe that a similar effect is likely for COVID-19 and the Hong Kong government estimates that the infection rate is somewhere below 0.5.
“By quickly implementing public health measures, Hong Kong has demonstrated that COVID- 19 transmission can be effectively contained without resorting to the highly disruptive complete lockdown adopted by China, the U. S. A., and Western European countries,” said Benjamin Cowling, a professor at the University of Hong Kong, in a press release announcing the study.
WHAT IS A LOCKDOWN?
Although some protesters are demanding a full reopening of the economy and a return to normalcy, there are few experts arguing that we should do nothing to fight COVID-19.
Sweden’s response has sometimes been mistakenly characterized as no response at all and the country’s public health officials have pushed back on the idea that they are letting the virus swamp society to obtain “herd immunity.”
Stone defines a lockdown as a situations where people are ordered to stay home, except for essential trips and people aren’t allowed to mingle with anyone outside of their own household. In a lockdown, many businesses are forced to close and most activities are temporarily banned.
Western countries were likely quick to adopt stayat- home measures based on guidance from the World Health Organization, which was basing its advice on the early situation in China.
“Ideas go viral. When something works people imitate it and it appeared that the lockdown in Wuhan worked,” said Stone, although he points out that the success in China followed a whole host of measures that were deployed at once. Fundamentally, though, politicians and public health officials are risk-averse.
“If you follow the official guidance you never lose the lawsuit,” said Stone.
DO LOCKDOWNS WORK?
After analyzing the measures imposed in Spain, France and Italy, Stone found that COVID-19 deaths in Spain plateaued around 10 to 15 days after the lockdowns were imposed. Because it takes about 20 days to die from the disease from the day of infection, that means deaths were declining in Spain before the lockdowns even started.
In Spain, a tighter fit to the mortality decline is the “state of alarm” declared on March 13 and the school closures that happened on March 12. The week before, the government had banned large assemblies.
People were adjusting their behaviour based on new information about the disease well before the government forced them to do it.
You find similar patterns in the United States after the NBA season was cancelled and Tom Hanks confirmed that he was positive with COVID-19.
Information from trusted sources seems to have a huge effect on people’s behaviour, especially if it’s combined with the jolting effect of a state of alarm or a beloved celebrity falling prey to the disease.
“Information is the most powerful tool we have,” said Stone. “Getting good information out there is important.”
IF NOT LOCKDOWNS, THEN WHAT?
Stone argues that one of the best methods to fight an epidemic is to close schools. Along with keeping children, who are inherently bad at physical distancing, away from each other, it sends a powerful signal to the entire population.
School closures are hugely important for influenza epidemics because children are some of the biggest spreaders. We don’t know for sure how children play into the COVID-19 outbreak yet but Stone says there’s no better way to shock the system of parents than to send their kids home.
Travel restrictions, even between provinces and states, are another important non-lockdown tactic. It’s a move taken early in Asian countries that were in close proximity to the early outbreak in China. Vietnam, for example, immediately imposed travel restrictions, which bought them time to deploy other measures and the country has experienced zero deaths.
Another mild inconvenience in non- lockdown countries is a ban on large gatherings, usually of 50 to 100 people, although people in Hong Kong can still eat at restaurants as long as there is a healthy distance between the tables.
In Canada, these measures are already in effect along with our broader stayat-home measures.
The key difference is that centralized quarantine and widespread mask usage have been in effect in many Asian countries since the outbreak whereas in Canada they seemed like afterthoughts.
In Taiwan, South Korea and Hong Kong a sophisticated system to track, isolate and feed people in a centralized quarantine area could be the key reason they have battled the pandemic with such success.
A centralized quarantine means people who have tested positive or been in contact with someone who tested positive would be isolated in a hotel or a custom- built space for somewhere between seven to 21 days. It’s a measure that requires widespread testing and a certain amount of trust in the government, as it severely limits the freedom of a small number of people.
In general, non-lockdown countries are enthusiastic mask-wearers, too.
In Canada, there were conflicting messages from public health officials at the beginning of the crisis but most jurisdictions are now recommending people wear masks. There was no confusion in Asian countries.
THE SWEDISH EXPERIMENT
Sweden has become the poster boy of non- lockdown countries. And although it’s not quite the COVID slacker that it has been portrayed as, Sweden has looser measures than even the anti-lockdown proponent Stone recommends.
The country has kept its borders open and allowed schools for younger children to stay open. Bars and restaurants are open and people can still gather in groups of up to 50 people. A New York Times reporter found people drinking beer on patios and having picnics in public parks and noticed that Swedes stare at people wearing masks as if they had “just landed from Mars.”
In essence, the government’s strategy is to trust its people to behave appropriately.
Some people are worried, though. One doctor accused the government of playing “Russian roulette” with the population and there have been other experts urging stricter measures. Deaths in Sweden have been higher than in neighbouring Scandinavian countries, too.
By the end of April , Sweden had about 256 deaths per million citizens, compared to 38 per million in Norway and 76 per million in Denmark. The Swedes argue that the amount of deaths will even out in the end, but with less pain inflicted on their economy and people’s mental health.
Stone’s own research suggests that Sweden will have more deaths than its neighbours, but mostly due to the fact that they had an earlier, more severe outbreak.
“Simulations show that the overall burden is expected to be similar across countries, resulting in about 528 to 544 deaths per million,” wrote Paul W. Franks, a professor of genetic epidemiology at Lund University. “Unlike its peers, Sweden is likely to take the hit sooner and over a shorter period, with the majority of deaths occurring within weeks, rather than months.”
Franks points out, though, that Sweden is embarking on a high- risk experiment. If Sweden can avoid letting its intensive care units from getting overwhelmed the country will be vindicated. If not, “health care professionals in Sweden will face the fight of their lives.”
In an interview, with the British news website unHerd, Swedish professor Johan Giesecke argued that few of the measures being taken to battle COVID-19 in western countries “have a shred of evidence” to support them and lauded his government’s plan to avoid a full lockdown.
Giesecke said Sweden’s higher death rate was due to the larger nursing homes in the country and said he agreed with simulations that showed the total number of per capita deaths would be very similar in the end.
Lockdowns simply aren’t sustainable in the long term, he said.
“How long in a democracy do you think you can keep a lockdown?” said Giesecke. “After three or four weeks, people will say I want to go out. I want to go to the pub.”