Saturday, Sept. 17, 2022

Even as the WHO suggests that the pandemic may be coming to an end, researchers are grappling with the dilemma of what worked and what didn’t and what we might do differently next time. By now we have accumulated a number of studies on the controversial measure of lockdowns, implemented early in the pandemic. A recent article in Nature (Sept. 7, 2022) had the promising title, “What scientist have learnt from COVID lockdowns,” and then hedged in the subtitle: “but weighing up the ultimate costs and benefits of lockdown measures is a challenge.” Yes, indeed. But why is this so difficult?

Lockdowns can be generally defined as a non-pharmaceutical intervention that restricts the everyday movement of a population. They can require that people stay in their own homes all the time (as China is doing in some cities today), or have exceptions for grocery trips and exercise (as Spain and the UK did early on), or after a specified curfew (as South Africa did during the Omicron surge). They can be voluntary or enforced by the police or even the military. Lockdowns also include closing “non-essential” businesses, churches, schools, and/or mass gathering events.

In April, 2020, when I was living in Orange County, California, the lockdown was absolute for nonessential businesses, but voluntary for the person at home. When I first heard the California governor announce that seniors over 65 should stay home all the time. I was worried, but soon found that this was basically a recommendation and I was free to go out if I wished. When I did, I found empty parks, closed playgrounds, and restaurants offering takeout only.

Lockdowns are harsh measures, both economically and personally. And yet they are the oldest weapon against epidemics in history. In 789 CE Charlemagne barred lepers from contact with the general population. Some of the walled lazarettos used to enclosed them were later used to isolate plague victims. In the Middle Ages, cities would close their gates in times of plague to keep the disease from entering their walls.

The Lazaretto of Milan, 1488

To take a more modern example, businesses, entertainment, meetings, and churches were shut down during the 1918 influenza epidemic. This precaution was referred to as “quarantining” in the Los Angeles Times (Feb. 9, 1919), for example as in: “Quarantining has been found to be the most efficient means in keeping down the number of cases, the mask having failed to find favor except in San Diego, San Luis Obispo, and Stanislaus Counties.”

Lockdowns seem to be an intuitive measure to take to prevent an epidemic from spreading. But is intuition good enough? What makes their effectiveness so hard to evaluate with all the experience we’ve had? Here are some of the issues that make scientific measurement of lockdowns a “challenge:”

  1. Other non-pharmaceutical measures, such as masks and social distancing, were implemented around the same time. How can you isolate the variables?
  2. As people heard about the spread of the coronavirus many began to stay indoors and avoid crowds before lockdowns were even required. Cellphone data has been used in studies to verify this.
  3. The definition and enforcement of lockdowns varied from place to place.
  4. The effect of lockdowns varies depending on whether the population usually shops and works outdoors in the community or whether they have the resources to stay in a house, order groceries, and work from home.
  5. Countries varied on their consistency of lockdown implementation. Some countries, like New Zealand, Australia, and Viet Nam, had low numbers to start and worked to eliminate the incidence entirely, so even one or two cases triggered lockdowns. Others, such as the United States, the UK, and Germany tolerated a higher case incidence as the pandemic continued, and discontinued lockdowns even in the face of increasing cases, as vaccines became available.
  6. The continual emergence of variants in different countries and communities had an evolving impact on the spread and virulence of the virus. Can you compare April 2020 to July 2021?

One major reason why lockdowns fail historically is failure to understand how a particular disease spreads. Is it spread by flea-infested rats, like the plague, by contaminated water like cholera, or by mosquitos, like malaria and yellow fever? Not a simple question, when you consider that for several months we were told that COVID-19 was not airborne, but was spread by droplets (hence the widespread use of cloth masks and the six-foot rule, now rescinded) and contaminated surfaces (leading to wiping off every horizontal surface in sight).

I agree with the Nature article that initial lockdowns did prevent wider spread of the coronavirus, when we didn’t know what we were dealing with. However, I also think it’s important for us to gain a more scientific understanding of lockdowns–when they work and when they don’t–especially in light of their economic and psychological damage. Besides, if our next pandemic is spread by mosquitoes, outside dining might be a really bad idea.

Today’s Notable Headlines

“What scientists have learnt from COVID lockdowns,” Nature, Sept. 7, 2022. https://www.nature.com/articles/d41586-022-02823-4

“Xinjiang residents complain of hunger after 40-day COVID lockdown,” Al-Jazeera, Sept. 15, 2022. https://www.aljazeera.com/news/2022/9/15/xinjiang-residents-complain-of-hunger-after-40-day-covid-lockdown

“Weekend Reads | Learning from Lockdowns,” Sept. 17, 2022. https://southseattleemerald.com/2022/09/17/weekend-reads-learning-from-lockdowns/

Additional Sources

“Evaluating the effects of shelter-in-place policies during the COVID-19 pandemic,” PNAS, March 25, 2021. https://www.pnas.org/doi/full/10.1073/pnas.2019706118

“A year of living distantly: global trends in the use of stay-at-home orders over the first 12 months of the COVID-19 pandemic,” The Royal Society, Oct. 12, 2021. https://royalsocietypublishing.org/doi/10.1098/rsfs.2021.0041

“Coronavirus: The world in lockdown in maps and charts,” BBC News, April 7, 2020. https://www.bbc.com/news/world-52103747

“Southland Almost Free,” Los Angeles Times, Sunday, Feb. 9, 1919. (archives)

Why am I doing this?

The coronavirus pandemic is a classic watershed historical event. People will be referring to “before the pandemic” or “after the pandemic” for decades to come. Since March 11, 2020, this blog has examined the modern pandemic experience, drawing on my background as a medical technologist, a historian, and an ordinary person living through an extraordinary world crisis. My sources, both primary and secondary, are documented with links for easy reference.

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