At a coronavirus press conference on the 22nd of February the Prime Minister, Boris Johnson, shared his ‘roadmap’ outlining the UK’s route out of lockdown. On several occasions in his presentation, Mr Johnson emphasised that each step to release the unprecedented restrictions must be irreversible. Contrary to previous expressed intentions, let us hope that his resolve on this issue is unshakeable: we must never again lockdown the country.
There are four key reasons why quarantining the healthy in their own homes, along with the shutdown of schools, retail and hospitality businesses, must forever be consigned to that skeleton cupboard labelled, ‘Cataclysmic Government blunders never to be repeated’.
1. LOCKDOWNS DO NOT REDUCE COVID-19 MORTALITY
Prior to March 2020, the World Health Organisation (WHO) and other public health bodies consistently recommended against the imposition of lockdowns as a way of managing a pandemic. For example, a comprehensive review of the available evidence by the WHO in 2019 stated that the quarantining of exposed - but currently healthy - individuals was ‘not recommended under any circumstances’ (p3), and later concluded that ‘There is a very low overall quality of evidence that quarantine of exposed individuals has an effect on transmission of influenza’ (p45).
Recent evidence supporting the assertion that lockdowns save lives largely derives from mathematical modelling, involving hypothetical predictions of the type, ‘If we hadn’t have done x, then y would have happened’. The most prominent proponent of this approach is Professor Neil Ferguson and his team at Imperial College London. Modelling for the purpose of forecasting COVID-19 cases and associated mortality has been widely criticised. The accuracy of such predictions is highly dependent on the assumptions made within the model, omission or inaccuracy of key variables often resulting in wildly pessimistic forecasts.
Undoubtedly, the most reliable data to evaluate the efficacy of lockdowns is that derived from measuring the real-world impact of this intervention. Over 30 studies of this type have now been reported; they have consistently failed to find evidence that lockdowns reduce COVID-19 mortality. A sample of these research reports, along with their conclusions regarding the impact of lockdown, is provided below:
a) Data analysis of 50 countries up until April 2020 deduced that, ‘Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people’.
b) A comparison of the epidemic trajectories in Italy, UK, Spain and France before and after the lockdown found that lockdowns ‘might not have saved any life in western Europe’, nor did they have any impact on infection growth rate. A further finding was that, ‘Neighbouring countries applying less restrictive social distancing measures … experience a very similar time evolution of the epidemic’.
c) Comparing empirical data from states in the USA that had varying degrees of restrictions led the author to conclude that, ‘Lockdowns do not reduce COVID-19 deaths’.
d) An exploration of the all-cause death rates in 24 different countries found ‘No clear association between lockdown policies and mortality development’.
e) An analysis of the data on viral growth rates around the start of the pandemic revealed that, ‘The spread of the coronavirus in Germany receded autonomously, before any interventions became effective’.
f) Analysis of case numbers and COVID-19 deaths led to the assertion that, ‘The currently most reliable data strongly suggest that the decline in infections in England and Wales began before lockdown’.
g) Another exploration of the relevant data reached a similar conclusion, stating that the initial UK lockdown was ‘superfluous’ (in failing to prevent viral spread) and ‘ineffective’ (in failing to slow the death rate).
h) A naturalistic study comparing regions in northern Denmark that imposed markedly different levels of restrictions stated definitively that, ‘Our analysis shows that while infection levels decreased, they did so before lockdown was effective, and infection numbers also decreased in neighbour municipalities without mandates’.
In an attempt to account for these counter-intuitive findings it is sometimes suggested that, in the midst of a viral pandemic, people stay at home voluntarily thereby rendering the lockdown mandates superfluous. However, a very recent study casts doubt on this explanation. Rather than exploring the impact of the severity of lockdowns per se, the authors used Google mobility data to investigate the relationship between the percentage of a country’s population who stayed at home during the pandemic and the number of COVID-19 deaths. They found that, in 98% of their comparisons, there was no significant link.
So overall the evidence strongly suggests that lockdowns do not achieve their primary aim of reducing deaths from COVID-19. This alone would be sufficient reason to never again resort to this draconian measure. But there’s more.
2. LOCKDOWNS CAUSE HUGE ‘COLLATERAL DAMAGE’
While placing the healthy population under house arrest appears to be ineffectual in reducing COVID-19 mortality, it is clear that lockdowns result in widespread damage to our physical health, livelihoods and wellbeing. Although it is difficult to reliably distinguish the specific contribution of lockdowns to the collateral carnage – the Government’s decisions to reduce resources for non-COVID illnesses and to strategically inflate fear levels will also have had an impact – it is reasonable to conclude that the unprecedented decision to close non-essential businesses and coerce healthy people to stay at home will be responsible for a major proportion of these negative consequences.
It has been estimated that, during the first lockdown alone, there were 21,000 excess deaths that were not caused by the SARS-COV-2 virus. A recent Government report delivers an even more striking statistic, anticipating that around 100,000 additional people could die from non-COVID causes – these are human beings who would have lived had it not been for the restrictions.
There is evidence that lockdowns, along with the Government’s scary messaging to enforce them, has discouraged many people from seeking help with urgent non-COVID illnesses. In March 2020 there were 128,000 fewer admissions to hospitals in England via A&E departments than in March 2019. One survey reported that more than 1-in-3 people had postponed seeking medical assistance for health concerns unrelated to COVID-19. It seems that many people died – unnecessarily – in their own homes because they were too scared to seek help, some of whom may have been children. The Office of National Statistics calculated that, between March and September 2020, around 25,000 non-COVID excess deaths occurred within private dwellings. Many of these collateral casualties will have succumbed to cardiac problems and strokes , with a significant number of these victims residing in care homes.
Prolonged periods spent at home can have dire consequences for those at risk of domestic violence. The first three weeks of the initial lockdown witnessed the largest number of killings of women over any 21-day period in the last decade. Around the same time there was a marked increase in the incidence of children’s head trauma.
The NHS’s narrow focus on SARS-COV-2 and little else resulted in a 60% fall in cancer detections compared to pre-COVID times. Subsequent delays in diagnosis will result in increased mortality for all types of cancer over the next five years, ranging from 5% (lung) to 16% (colon). In numerical terms, one senior oncologist has predicted that disruption to services could cause up to 30,000 excess cancer deaths.
In the long term, the economic fallout of lockdowns – unemployment, poverty and less to spend on health care - is likely to result in worldwide collateral harms on a much greater scale. In the UK, the Gross Domestic Product fell by 10% in 2020, the biggest drop since records began, as compared to a drop of 2.6% in Sweden, a country that imposed much less severe lockdowns. The United Nations International Labour Organisation predicted that half the global workforce were at risk of losing their jobs. Translating these impacts into human terms, a recent economic study made the grim prediction that US unemployment will result in the deaths of 900,000 Americans over the next 15 years.
The collateral damage associated with lockdowns is not restricted to physical harms; the negative effect on the mental health of the nation has been ubiquitous. School closures will impair our children’s social and educational development, impacting on their aspirations and mental wellbeing for years to come. A year of COVID-19 restrictions has led to unprecedented levels of loneliness, fear and uncertainty about the future. This toxic mix impacts us all, causing an escalating risk of suicidal crises. A survey in July 2020 found that 1-in-6 children were exhibiting a significant mental health problem, many for the first time. By winter, 1-in-4 young people felt unable to cope. Adults of all ages suffered a substantial rise in anxiety and depression during the first lockdown, and almost 1-in-3 people have increased their alcohol intake. The loneliness of prolonged lockdown isolation is likely to have evoked mental defeat in elderly people with dementia, often resulting in premature death. More recently, further evidence of the mental health costs of restrictions has emerged with reports of significantly increased anxiety and depression in post-natal mothers and a rise in disabling tic disorders in children.
Undoubtedly, the lockdown experiment offers a powerful illustration of a scenario where the ‘cure’ is far worse than the disease.
3. VIRAL TRANSMISSION IS MUCH MORE LIKELY INDOORS
We are far more likely to contract the SARS-COV-2 virus when indoors as compared to outside in the fresh air. This aspect of viral transmission has long been recognised, the World Health Organisation – in its comprehensive literature review of 2019 – recommended against locking down the healthy, stating, ‘… household quarantine can increase the risks of household members becoming infected’ (p46).
The environments of highest risk with regards to contracting the virus are care homes and hospitals. Based on 22 countries, as of January 2021, an average of 41% of all COVID-19 deaths occurred in care homes. In the UK, it has been estimated that 39% of first-wave COVID-19 mortality was in care homes, while a similar proportion of infections were acquired in hospitals. A Chinese study found that 80% of identified outbreaks involving three or more cases took place in the home environment.
It is reasonable to conclude that spending extended periods of time in our private homes, cooped up with family members, is a relatively high risk situation for contracting COVID-19, a view supported by the New York governor’s observation that two-third of the city’s COVID-19 hospital admissions were from people who had been at home. It therefore makes little sense to impose blanket lockdowns while at the same time prohibiting, for example, amateur sport (football, cricket, golf) and children’s outdoor play. Furthermore, confining people to their own homes will disproportionately increase the risk for people in the lower socio-economic groups and ethnic minorities, both of whom are more likely to live in multi-occupancy households.
4. LOCKDOWNS COULD LEAVE US MORE VULNERABLE TO INFECTION
Human beings have lived alongside viruses since the very beginning of our time on earth and, as a direct result of this intimacy, we have evolved a very sophisticated immune system to protect us from the threats posed by these microscopic invaders. Extended periods of lockdown, during which our viral exposure is much reduced, may – paradoxically – leave us more vulnerable to infection with SARS-CoV-2 (and any other circulating pathogen). There are two ways in which this can happen, one a well established explanation, the other more speculative.
First, the isolation of the healthy will significantly slow the speed by which a population acquires herd immunity. Prior to the start of 2020, public health responses to respiratory viruses were underpinned by the assumption that the most effective way of minimising harms to a population was to let the pathogen circulate among the healthy, encourage those with symptoms to self-isolate, and to protect (or at least offer effective shielding options) to those deemed to be at high risk of serious illness should they contract the virus. By following this strategy, the sophisticated immune systems of the low-risk majority learn to recognise the virus and are therefore able to repel it on future occasions. Once the majority of a population have developed this ‘herd immunity’, the vulnerable within our society can more safely circulate again in the knowledge that they are less likely to encounter an infectious individual. This traditional approach to respiratory viruses resembles the ‘focused protection’ strategy recommended in the Great Barrington Declaration. Unfortunately, the unprecedented implementation of lockdowns – effectively isolating the fit and healthy – will have created a situation where far less people have natural immunity. Consequently, anyone that a vulnerable person meets is significantly more likely to be infectious.
Second, by creating an environment where it is more difficult for a virus to find a new host, we might be inadvertently conferring an advantage on mutants that are more transmissible or more virulent. Under normal – pre-lockdown – circumstances, evolutionary pressures would not have aided the more dangerous viral strains. Thus, if potential new hosts are plentiful, the more transmissible strains do not have the upper hand on the less infectious variety as there is little competition between the original virus and its mutants. When new hosts are hard to find, such as when lockdowns are in place, the more transmissible mutant has a distinct advantage and is therefore likely to gain ascendancy.
As for the more virulent mutations, under normal circumstances they would be at a disadvantage, as it is not usually in the virus’s interest to kill or incapacitate the host – a very sick or dead victim tends to come into contact with fewer people than an infected person with a minor illness. Under a lockdown scenario, this may be reversed; people with mild infections remain at home, while most of the severely ill go to hospital where they potentially infect other patients (the finding that COVID-19 has often been contracted in hospital settings supports this possibility).
Concluding comments
A year after the initiation of unprecedented country-wide lockdowns, the evidence is clear: mass quarantining of the healthy is both an ineffective way of protecting people against a viral threat, and one that inflicts a huge amount of collateral damage. In time, it is likely that we will view lockdowns as the most disastrous political decision in peacetime history.
This calamitous public-health experiment was initiated, and sustained, by a potent mix of factors. Blinkered and fanatical public health scientists - whose careers and livelihoods have been built around pandemic management – are clearly implicated alongside weak, panic-prone political leaders. Government psychologists, and a slavish mainstream media, devised and delivered a communication strategy to evoke panic and mass hysteria and, therefore, are also culpable. In due course it will become clear as to which other groups' agendas were opportunistically advanced on the back of the crisis. Hopefully, a truly independent public enquiry will identify all of the key players. Or perhaps – more likely – those implicated will have sufficient power to prevent such an investigation. Either way, one thing is plain: the locking down of a whole country in response to a novel virus must never happen again.
Photo courtesy of Rux Centea - Unsplash