The elephant: No evidence total “lockdowns” work better than other methods against coronavirus

March 28, 2020 · by Seth Frantzman · in coronavirus, Uncategorized. ·

 

By SETH J. FRANTZMAN

As more countries put in place draconian “lockdowns” to slow or stop the spread of coronavirus (Covid-19) there is emerging evidence that these procedures, now in place for weeks in areas like Italy, are not more effective than other measures.

South Africa joined the growing list on March 26 with measures that prevent people from leaving home for basic things like walking their pets. Once again a country, rather than encourage and enforce social distancing measures, has enforced anti-social measures meant to simply remove people from everywhere. Ghana also ordered a lockdown in cities on March 27.

In previous posts (see here and here and and here and here) I’ve documented the studies that governments relied on to choose the lockdown procedure. Besides the Imperial College study there was also the February 25 China-WHO press conference and study that looked at Wuhan and new Lancet studies that have examined Singapore‘s experience.

These studies did not support nationwide lockdowns. Imperial College noted on March 16: “Combining all four interventions (social distancing of the entire population, case isolation, household quarantine and school and university closure) is predicted to have the largest impact, short of a complete lockdown which additionally prevents people going to work.”

The February 16-24 China-WHO study, which has informed other governments even if it was  flawed, looked at using a regional lockdown and supported China’s Wuhan approach. “The main strategy was to reduce the intensity of the epidemic and to slow down the increase in cases. In Wuhan and other priority areas of Hubei Province, the focus was on actively treating patients, reducing deaths, and preventing exportations.” In their assessment China had already rapidly reduced the spread of the virus. “China is already, and rightfully, working to bolster its economy, reopen its schools and return to a more normal semblance of its society, even as it works to contain the remaining chains of COVID-19 transmission.” It recommended “conduct multi-sector scenario planning and simulations for the deployment of even more stringent measures to interrupt transmission chains as needed (e.g. the suspension of large-scale gatherings and the closure of schools and workplaces).” Of course, China achieved this by sending 1,800 teams of epidemiologists with a minimum of five per team to trace the spread. Some 40,000 healthcare workers were sent. Cases had been reduced from 2,479 a day to 409 a day over two weeks.

South Korea is held up as a model. It didn’t do nationwide lockdowns. South Korea regional lockdowns began around February 21. By March 13 museums and sites were re-opening. It began the lockdown in the southern cities of Daegu and Cheongdo which were declared “special care zones”. The streets of Daegu were mostly deserted by January 21.  ‘South Korea is a democratic republic; we feel a lockdown is not a reasonable choice,’ says Kim Woo-Joo, an infectious disease specialist at Korea University.

Singapore, without a lockdown, was also successful.  “Researchers from the National University of Singapore saw a dramatic drop in projected cases when all three physical distancing measures were done at once. But they warned that if a large number of infected people in the community had no symptoms, or if infection rates were very high, the policies had a much reduced effect. Singapore has used a policy of testing and tracing of COVID-19 patients to limit the spread of the virus, without ordering a widespread lockdown of society and the economy.” The study at The Lancet Infectious Diseases journal looked at quarantine plus workplace measures, plus school closure, as effective.

Lockdowns may be worse than other methods

Lockdowns destroy the economy and may lead to other problems such as increased domestic violence rates and even starvation. They traumatize the public. Yet countries have zombie-like embraced them despite their own evidence showing that they may not be the best combined measures.

For instance the Johns Hopkins data and Financial Times graphics of the trajectories of cases illustrate that lockdowns show no benefit to the countries that did them and may be worse. Lockdowns in Spain, France and Italy show no difference in their “curve” of rising infections and deaths compared to countries such as Sweden and Iceland that did not lockdown (Sweden’s has been called an “experiment“). Italy, in lockdown since March 9, has not seen a rapid decrease in cases or deaths like the Wuhan model predicted. They have “hope” but no plan B. They were told that the lockdown would stop the spread of the virus on March 19. Ten days later it hasn’t happened. Germany, which brought in lockdowns as well, has been pleading with citizens that the magic two weeks will help slow the spread. Bavaria was already in lockdown since March 20. How long will it last, people wonder. There is no answer from the government. Austria is also on lockdown, but its trajectory hasn’t changed. Belgium declared a lockdown for the entire country over the coronavirus crisis from 18 March until 5 April, and extended  it to April 19. In short: It didn’t work as planned. Belgium had 7,200 cases on March 28 and 289 deaths. They had 1,400 cases when the lockdown began. Their “curve” is no more flat than countries that did not do a lockdown. In addition in some countries there are concerns that giving police arbitrary powers to enforce lockdowns can lead to human rights abuses. More flexibility (as in Holland) and proactive education might reduce this tendency. Some leaders are questioning the draconian policieswhile others show officials debating what to close.

The lockdowns take little into account in regional differences. However, mapping urban areas or subnational regions shows there are major differences in spread of the virus. Yet governments have taken little interest in that, imagining that it’s better to be cautious and apply the Wuhan model to whole countries than even attempt to do what China supposedly did. They have all ignored South Korea, Japan or Singapore as a model. They have, oddly, embraced Italy as a model, despite the lockdown not working there. What they say is  that they needed to “lockdown earlier” prior to deaths surpassing the hundred mark. By March 27, more than 20 countries had more than 10 deaths. We are reminded that the Wuhan lockdown began after 30 deaths in January and saw rapid results.

Most countries are on a  similar trajectory regardless of lockdowns. The Financial Times concluded that the difference  between success in South Korea,  Japan, Singapore and China was down to a few other factors: Hong Kong used school closures, Singapore had strict tracing and quarantine, Japan had “strong social norms of obedience and mask wearing” and South Korea had a huge test and trace program.

Few other countries tried these models. Their lockdown models are more of a triage or attrition war of the kind farmers use with sick animals that spread viruses. It reminds us more of the opening scene from Unforgiven(1992) where the man character tells his son to move the hogs that  have fever away from the others.
MUNNY What is it, son? WILL Two more hogs got the fever. Munny winces. The Kid ignores the interruption. THE KID You shot Charlie Pepper, didn’t you? And you’re the one killed William Harbey an’ robbed the train over… MUNNY (sharply) Hold on, mister. (to Will) Son, this here pig gotta be moved outta this pen, away from them others. Penny, you give yer brother a hand…
 

Many countries think the best way to deal with the coronavirus is not what expert  studies say  or past experience shows, but rather what their public health czar dire warnings say about overwhelmed hospitals. This raises many questions.

Lockdowns are not about “flattening the curve”: The lockdowns were not actually designed to follow a Wuhan-curve of flattening and reduction. That is clear because other methods worked better at “flattening the curve” in South Korea.

Lockdowns are not about reducing death toll: Many countries have a very low death toll from the virus. While some lockdown countries such as Italy, France and Spain have the worst death tolls, others such as Germany (with a lockdown or Sweden (without a lockdown) have lower tolls. That shows that lockdowns don’t prevent deaths and they aren’t even designed to do this. They also don’t reduce the numbers in hospital or the “flattening” of the curve. They do enable governments to simply stop people moving. Among developed  countries, Saudi Arabia, Taiwan, UAE and Australia have low death tolls.  Australia did not conduct a lockdown, although pressure is on for them to do so on March 28. The UAE and Saudi Arabia have been more strict. Some in Taiwan are urging a “total lockdown” but the country had resisted these measures by March 28. Estonia also has a very low death rate and has used mixed measures during a state of emergency.

In contrast Israel, which was supposedly prepared for the pandemic and acted early to prevent flights from abroad, trace cases using anti-terror technology, and began a lockdown in mid-March, has seen a rapid increase in cases. The dogmatic, “we are on the early part of the curve,” is not borne out by evidence. Israel’s case shows that reactive government policies that seem smart do not change the trajectory. Israel could have not “locked down” and the trajectory would be largely the same.  For instance my aunt in New England says most of her neighbors observe social distancing and go for  walks in parks at a distance without police enforcing a “lockdown.” Education and closing businesses, following  the South Korea model, has worked better so far. A more proactive approach, such as establishing field hospitals for cases or enforcing regional measures, might have been better. Israel has few deaths, but hundreds of more cases a day despite ordering people not to go within 100 meters of their house. In Ireland a person can at least exercise within 2km of their house. The trajectories of both countries will not be different, whether you allow people to go for a walk up to 2km or 100 meters.

Lockdowns are not the only way, or best way to stop the virus and they have proven they don’t work better than other methods, but they are the easiest way for countries to appear to be doing something while not actually preparing for or managing the crises. This is because most governments don’t want to build new hospitals, like China did, or actually trace cases and distribute masks. New York City is now creating a temporary hospital at the Javits Center with the army’s help. That might be better than a lockdown.

The key to lockdowns is mostly about governments wanting to insulate themselves from criticism. They also don’t want their own failures to be recognized by having their medical systems, which they boast about but didn’t invest in, revealed to be incapable. Only too late are many countries doing things like consulting mass corporations and the military on how to rapidly address problems. That appears to be the US model now. The US has invoked a “production law” and is calling up the reserves and National Guard.

Lockdowns  may rely on problematic data: Many countries that saw lockdowns as a magic wand followed a model that didn’t work for them. They were supposed to see changes in two weeks. The dogmatic talk about the “curve” is largely a mythical. The “curve” in Wuhan showed that once lockdowns were in place in the city in late January the number of cases rapidly flattened and reduced. This has not been repeated. It didn’t happen. Anywhere. Except Wuhan. A better model was South Korea, a democracy with transparent data that didn’t lockdown. An even better  model might have been a regional response. Bizarrely, few countries tried to do the regional response that China and South Korea did. There is little discussion in advanced western democracies about even looking at another mixed approach.

Countries have told their citizens that hiking in the forest alone is “dangerous” while locking people into cities is “safe”:  Countries have used no logic behind their lockdowns. Rather than following social distancing guidelines, they simply preferred the pig farmer method, separate the pigs into their own little kennels and keep them there. It is perhaps no surprise that the current state of affairs feels more like an Orwellian dystopia than a modern response.

The Elephant in the room of why lockdowns may not work

The real problem with the lockdowns is not only that it went against existing models, has not shown itself to be more effective than other measures, and has taken longer than it should, it is that it  may have a fundamental flaw.

I live in Jerusalem where there is a lockdown. This means people are prevented from leaving their homes except to get groceries. However when I drive around I see the groups that are allowed to leave: Municipal workers, police, deliverymen and food industry workers, among others. Many of those who are not under lock down do not observe social distancing measures. Some don’t have proper personal protective equipment. This presents a problem. An elephant. In a country where millions are locked down, there are hundreds of thousands who are not. This is the same in other places. Another elephant in the room are groups of homeless, the poor or vulnerable populations, or undocumented groups, that don’t have access to health care or social distancing. Remember the “Calais jungle” and its 8,000 residents. In L.A in the US there are 58,000 homeless. What happens to these groups during a pandemic? If lockdowns are supposed to stop the spread and you have people outside them who are spreading the virus then their data should no inform the lockdown logic, because they aren’t even locked down.

The measure of “success” in a lockdown is not entirely clear, but one measure is to reduce the increasing daily infections. The problem is the bar is quite high in terms of this decrease being “successful.” That means governments want to see a low level of daly infections, but they may never get there and they won’t get to zero. That means their concerns and hysteria could keep lockdowns ongoing for months with no measure to escape them. In Israel there are only a few hundred new infections a day. But that is seen as way too many. Even if it were ten a day it likely would be seen as too many and a reason to extend lockdowns into the future. The problem is that the elephant in the room, the hundreds of thousands who are still not locked down and who also don’t observe social distancing measures, may be bringing the virus home to law abiding families.  That can account for a few cases a day, which alarm the authorities and then punish the 90% of citizens who are locked down. This creates a cycle.

The problem with reactive policies, such as lockdowns, is it doesn’t address the things that successes in South Korea addressed. In successful examples it was the authorities who observed their own guidelines. In many western countries the prevalence of the virus among officials, such as the Prime Minister of the UK Boris Johnson, Prince Charles, Spain’s Deputy Prime Minister Carmen Calvo, the wife of the Prime Minister and others shows that many officials don’t observe their own social distancing guidelines.  In short: Countries  locked down 90% of their citizens while 10% go on with business as usual, accounting for some (maybe many) of the new cases, and creating the reason to keep the 90% locked down longer.

While officials, municipal workers and security forces are one area that cases may continue to percolate, another area is in hospitals. In Spain the La Paz hospital in Madrid, “one of the largest in Spain’s capital, 426 employees, 6 percent of the medical staff, are isolated at home.” On March 16 in Israel it was reported that “medical personnel make up at least 19 of the 250 coronavirus cases in the country. There are said to be over 2,600 medical staff in quarantine.” What if a number of the new cases are among the very medical personnel who are part of the fight, and that these numbers are factored into reasons to keep others home? The wrong group is being kept home when there may be no evidence that keeping them home is reducing infections.

In many cases the data showing an increase in cases must take into account the fact that medical  personnel and others can’t “socially distance” and that they will be infected. Yet when countries choose to extend “lockdowns” based on the fact that some of those infected are politicians, officials, medics and others, they are extending a lockdown solution against precisely the wrong population. Governments may be using the wrong data set to make decisions with lasting consequences. Obviously they can’t lock down medics and others so they use an easy fix to lock down populations that could easily observe the social distancing guidelines without such draconian measures.

A catch-22 cycle  from which there is no escape: The only countries that were able to relax restrictions are precisely those countries that the lockdown countries did no follow. China, South Korea, Singapore, Japan are where there were no lockdowns and where the curve was flattened and an apparent solution was found. No other country has done so well. Total lockdowns didn’t flatten curves more than other methods. Stopping all flights  didn’t end the spread  more than other methods. None of the countries extending their lockdowns for months have accounted for what their goal is. Is it to reduce the spread by 90% to a few cases a day. That is  what Singapore’s model is. Do they end lockdowns when there are less than 100 new cases a day? They don’t say because now that they put their citizens in a gulag they don’t know if they can let them out. They don’t trust their own citizens to even obey normal guidelines.

It isn’t clear how the lockdownland can escape its  self-imposed prison. It doesn’t see that its methods are not the best and it doesn’t wan to consult South Korea or success stories. Western leaders don’t obey the strictures they put their citizens in. Their own medical staff or workers or soldiers and police, and delivery people may account for too many cases for them to ever leave a lockdown that didn’t work as the magic wand they thought it would.