On March 15, 2020, days after the declaration of COVID-19 as a pandemic by the World Health Organization (WHO), states across the U.S. and countries across the world began issuing some form of lockdown or stay-at-home orders. These orders differed in severity across the U.S. and the world, from general suggestions to avoid crowded public places to mandates that fined individuals for being out of their homes without a valid reason. In New York, as well as many other states, lockdowns mainly sought to keep people at home by closing schools and “non-essential” businesses such as restaurants, bars, and clubs to the public.
These lockdowns were promoted as both a way to “stop (or slow) the spread” of infection within the community and “flatten the curve” by reducing and delaying the number of new cases to ease the burden faced by hospitals and medical professionals. However, these measures were not met without controversy and many have questioned their effectiveness.
From an epidemiological perspective, lockdowns aim to reduce the basic reproductive number R0. R0 is a mathematical measure of a disease’s contagiousness, calculated by multiplying the probability of transmission per contact, the number of people in contact with an infected person, and how long a person stays infectious. If R0 is less than 1, each infection causes less than one new infection, meaning that the spread of disease is slowed and, eventually, stops. Lockdowns were intended to decrease the contact rate by reducing the number of people with whom a potentially infected person came in contact.
Were lockdowns the right choice to reduce that number? Dr. Ronald Bayer, a public health ethics expert at the Columbia University Mailman School of Public Health (full disclosure, Bayer is a former professor of this reporter), told the AmNews in an interview, “As far as the lockdowns are concerned I think they were done…when that seemed, given the evidence available, the most reasonable thing to do.”
Public health historian Dr. David Rosner, also at Columbia, agreed that there was a reason for these orders, but highlighted the disparities lockdowns produced: “There was obviously a rationale for it. It did probably help stop disease, but the burden of that kind of social stigma of having to be protected from the very people you depended upon [essential workers] was manifest in the ways we organized our services…We called them essential workers and yet there was a certain level of distrust in depending upon them.”
Some critics of lockdown measures claim that they did not work to reduce the spread or flatten the curve. Sweden, a country that did not institute lockdowns in the same way as other countries, is often used to illustrate this perspective. However, Sweden did implement similar measures and, as a whole, people were willing to voluntarily stay at home without government orders. Even so, the country faced higher mortality rates than neighboring Norway, which had instituted a lockdown.
Some countries avoided lockdowns in favor of early and robust mitigation efforts, but the lack of a unified public response in the U.S. may have necessitated them.
In addition to claims that lockdowns were ineffective, additional critiques come in two main forms: health-based and economics-based. In terms of health, the claim is that lockdowns only worsened existing health conditions because people were isolated and had reduced access to medical care. Economic concerns have focused primarily on the U.S.’s gross domestic product (GDP), but also the overall economic impact on non-essential businesses that were forced to close. Neither of these claims is without merit: Certain health conditions, particularly mental problems, were exacerbated as people were isolated from friends, family, and communities.
There were economic effects, particularly on GDP and unemployment. Some of the economic impact was partly mitigated by efforts like stimulus checks, unemployment insurance relief, eviction moratoriums, and student loan forbearance, which Bayer deemed as necessary.
“It was inconvenient for many, many people,” Bayer said. “Many people suffered financially because of it, and in the world of public health ethics, there is a language that talks about reciprocity. If you impose limits on someone in the name of public health, you —that is, the state—have an obligation to compensate them in some way; to guarantee that they have access to food, that they don’t get evicted because they can’t pay their rent.”
Ultimately, it can be difficult to thread the needle between economic and health interests.
Did lockdowns work? In short, yes. The same study that found impacts on GDP and unemployment also found that lockdowns reduced infections by 56%, and, if no states had implemented lockdowns, it is estimated that there would have been five times the number of cases between the beginning of the pandemic and April 30, 2020.
A cross-country analysis similarly found that countries that implemented lockdowns fared better in reducing new cases. In the U.S., states that responded to early initial crises with lockdowns tended to have lower death rates by July compared to states that remained open; a Politico analysis had similar results.
Other studies have confirmed that lockdowns reduced R0 and worked, but may have had diminishing effects over time, potentially as a result of “lockdown fatigue.” In other words, as time passed and fewer people complied with lockdowns, the benefits in preventing disease spread were reduced.
Finally, returning to the question of economic versus health impacts, a cost-benefit analysis found that the number of deaths prevented by lockdowns was greater than the number of deaths potentially occurring as a result of economic consequences.
However, while lockdowns may have been the right choice at the time with the information that was available, they were not without consequences. The longer answer is that COVID lockdowns worked from the perspective of preventing infection, but also incurred certain consequences that should not be overlooked.
Bayer emphasized that some countries, specifically China, may have gone too far, but added, “I don’t think that characterizes anything that has gone on in the States, or in Great Britain, in terms of protecting the public [and] closing those venues where the disease can spread.”
Rosner said he could not think of a time that, on a large scale, lockdowns completely stopped a worldwide epidemic: “Disease has a sneaky way of getting around border controls” and re-emphasizing the social consequences of lockdowns, particularly on those deemed essential workers: “Only when we are forced to recognize them because of an unusual circumstance do we acknowledge their worthiness.”
However, even with these caveats, it has to be noted that if lockdowns had not occurred, more people probably would have fallen ill and potentially died, which, in addition to being a tragedy on a human level, would also have had its own economic effects.
Additional social and economic support from the government would have relieved some of the pressure felt from lockdown. Similarly, the mental health impact of COVID is not solely a result of lockdown-induced isolation, but also anxiety about the pandemic itself and experiences of collective grief due to the enormous loss experienced by everyone.
Bayer explained that the ethical decision has to weigh what happened with what would have happened if lockdowns had not occurred. In his view, it would have been worse not to act: “We know that the epidemic had disproportionate impacts on the suffering of Black people. It is obvious and it should never, ever be denied or ignored. But the question is, and now what? And I think it would have been a lot worse to not do the things necessary to control the spread of disease and to have more Black people die.”
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