COVID-19 lockdowns and spread

With claims floating around that COVID-19 lockdowns have led to countless deaths and caused more harm than the disease itself, a new review by an international team researchers has examined whether there was any evidence to back up these views.

The narrative review1, which was published in BMJ Global Health in July, examined what evidence there was out there on the impacts of COVID-19 lockdowns on mortality, routine health services, suicide and mental health and found it was unlikely that the effects of government-imposed restrictions had been worse than those stemming from the pandemic itself.

“While it is likely that lockdowns do have negative effects, the fact that there are no locations anywhere in the world where a lockdown without large numbers of COVID-19 cases was associated with large numbers of excess deaths shows quite convincingly that the interventions themselves cannot be worse than large COVID-19 outbreaks, at least in the short term,” the researchers wrote.

Gideon Meyerowitz-Katz, epidemiologist from the University of Wollongong, led the review and found that it was difficult to disentangle the effects of lockdowns from those that came from the spread of COVID-19 itself.

“What we found is that, in general, the harms that have been attributed to lockdowns are inseparable from the harms of having many cases of COVID-19, because obviously the time when you implement a lockdown or very significant restrictions of any kind is the same time that you have lots of COVID-19. So it’s very hard to say that lockdowns specifically cause these issues or that they are worse than the disease,” he told Lab Down Under.

Separating the impacts of COVID-19 lockdowns from the disease

Meyerowitz-Katz said the impetus for conducting the review stemmed from a claim, commonly repeated in certain media outlets, that lockdowns had killed more people than the COVID-19 pandemic.

“There haven’t been any formal appraisals of whether that’s true, so we wanted to see what the evidence was for the idea that lockdowns cause more harm than COVID-19, what the evidence was against that idea, and how could we review that.”

While it was difficult to separate the impacts of COVID-19 lockdowns from the impacts of the disease itself, the researchers managed to say that, in general, these lockdowns actually provided more health benefits than harm.

For instance, there were claims that lockdowns caused terrible mental health impacts. While it is true that anxiety and depression stem from social isolation, Meyerowitz-Katz pointed out that mental health effects can be caused by both restrictions imposed in a lockdown and from the spread of COVID-19.

“Large numbers of COVID-19 cases come with the challenge that lots of people are getting sick, some of them are dying, that is also not good for mental health. So when you look at the literature, what you find is that mental health is damaged both due to COVID-19 and due to lockdowns, and the impacts from COVID are probably worse.”

For instance, while missing school affected a child’s mental health, so did losing a loved one to COVID-19. In the United States alone, it is estimated that 43,000 children have lost a parent to COVID-19 while two million have lost at least one grandparent.

One common mistake by those who claimed COVID-19 lockdowns did more damage than good is that they were comparing the effect of lockdowns with life “as normal” before the pandemic. This was the wrong comparison to make, Meyerowitz-Katz said.

“What it really comes down to is that the alternative to a lockdown or to government restrictions against COVID-19 is not life as usual, which is how it’s commonly presented. The alternative to restricting our behaviour to prevent COVID-19 cases is more COVID-19 cases and, in that context, lockdowns tend to be better than the alternative.”

COVID-19 lockdowns, healthcare access, suicide and more

Meyerowitz-Katz said excess mortality statistics suggested that lockdowns were not associated with large numbers of deaths in countries such as Australia and New Zealand which had so far avoided large-scale COVID-19 epidemics.

“There are no locations anywhere in the world where a lockdown without large numbers of COVID-19 cases was associated with large numbers of excess deaths. This shows quite convincingly that the interventions themselves cannot be worse than large COVID-19 outbreaks, at least in the short term,” he said.

On the other hand, countries with less restrictive COVID-19 measures, like Brazil, Sweden and Russia had larger numbers of excess deaths throughout the pandemic.

The researchers also examined access to healthcare, which critics of COVID-19 lockdowns claim is reduced with restrictions imposed on society. However, it was difficult to tell whether a decrease in attendance for vital non-COVID health services was associated with lockdowns or with the spread of the virus itself.

“There is clearly an association between large outbreaks of COVID-19, government interventions and reductions in attendance for vital non-COVID health services, and thus the connection between lockdowns and missed contact with health systems is very well established,” the researchers wrote.

“However, this association may be related to lack of capacity of healthcare services or impacts of the pandemic itself rather than measures taken by governments to reduce cases. It may also simply be caused by the public perception of risk due to fear of the pandemic (ie, people may fear becoming infected by SARS-CoV-2 in healthcare settings and thus they stay home rather than attend health services).”

For example, data from Australia and the United Kingdom showed that emergency department activity was reduced two weeks prior to stay-at-home orders and remained low even after these restrictions were lifted.

Finally, there was “robust evidence” that there was no associated link between government interventions to control COVID-19 and an increased number of suicides, the researchers found.

Despite limitations, review could lead to better policy decisions

Meyerowitz-Katz was quick to point out that the review was only based upon evidence to date before June 2021, and that it was hard to make predictions about the potential effects of lockdown measures in the future, with countries like the UK deciding to now remove many of its restrictions.

“It’s hard to draw inferences for the future because the situation in the UK is a bit different now, it’s very different to the situation that they experienced during their last lockdown because they’re currently around 70 per cent fully immunised. That’s at a very high level which substantially reduces the impact of the virus itself.”

Results from the paper should only be taken in a general manner, Meyerowitz-Katz added, saying that different countries (and even different states, provinces or regions within those countries) had different measures in place to restrict the spread of COVID-19, and that the phrase ‘lockdown’ was a kind of “catch-all” term to describe a wide range of policies.

“It is possible, plausible and perhaps even likely that some lockdowns have had overall net negative impacts and some lockdowns have had net positive impacts even in the past. Our paper says, generally speaking, that lockdowns have not caused more harm than they’ve prevented, but it is certainly possible within that to say that some lockdowns have caused more harm.”

The review also only looked at the health effects of COVID-19 lockdowns and the spread of the virus, and did not examine the economic impacts of government-imposed restrictions.

“We do not mean for the conclusion of this paper to be that lockdowns cannot cause any harm. The reality is that whether lockdowns and other government interventions have a net benefit is a challenging question which requires evaluating social, economic and health aspects. Furthermore, the question poses a false dichotomy. Governments were not faced with the choice between the harms of lockdown and the harms of COVID-19, but rather sought to find the means to minimise the impact of both,” the researchers said.

With this in mind, Meyerowitz-Katz hoped that we could now engage in a fairer assessment of these types of measures.

“This is mostly about looking at places that are currently relatively unvaccinated and weighing the harms and benefits of COVID-19 outbreaks. That’s what we were looking at. In that context, the arguments that lockdowns are going to kill millions doesn’t seem to hold up at all. So we can have a fairer assessment of the benefits and harms of government interventions against COVID-19,” he said.

Meyerowitz-Katz was funded by the NSW state government and the Commonwealth of Australia.

Researchers who took part in the review came from University of Wollongong, University of Copenhagen, Imperial College London, University of Oxford, James Cook University and Duke University.

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1 Meyerowitz-Katz G, Bhatt S, Ratmann O, Brauner JM, Flaxman S, Mishra S, Sharma M, Mindermann S, Bradley V, Vollmer M, Merone L, Yamey G. Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19. BMJ Global Health 2021;6:e006653

Featured image: Covid-19 Closed Pandemic Coronavirus Lockdown. Picture from Max Pixel. Used under a Creative Commons Zero – CC0 licence.

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