The al­ter­na­tive to con­fin­ing peo­ple to con­tain out­break

Calgary Herald - - PANDEMIC - STU­ART THOM­SON Na­tional Post sx­thom­

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 promi­nently, 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.


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.


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.



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.”


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.


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.”


A pro­tester out­side the On­tario leg­is­la­ture in Toronto last Satur­day as he de­mands the re­moval of re­stric­tions that have been put into place due to the coro­n­avirus pan­demic.

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