Fighting Covid-19 pandemic: Show us the evidence that lockdowns work

Lockdowns were an unnatural experiment, and they have not worked in achieving their major health objective of fewer infections or slower pace of infections

Fighting Covid-19 pandemic: Show us the evidence that lockdowns work
Today, cases are 40 times, and deaths 24 times higher.

It is now slightly more than 300 days since Covid-19 exploded on an unsuspecting, and unprepared, world. The second wave is upon us, and we are again faced with Lenin’s existential but practical question: “What is to be done?” The previous time around, in mid-March, epidemiological experts advised whoever was willing to listen, and the world did listen with rapt attention, that schools, businesses, etc. should close shop and the virus will be contained.

January 22 was the first unnatural experiment—Wuhan, China entered into a lockdown. On March 10, Italy went into a lockdown, and, over the next month, the world followed.

On the advice of experts, the world confronted the virus in an unprecedented manner—closures of schools and workplaces and lockdowns became commonplace. The effectiveness, or lack thereof, of lockdowns in containing the spread of the virus, is examined in a detailed paper, Lockdowns vs. Covid-19: Covid Wins, a preliminary version of which is available on my website, Herewith, some highlights about the lockdown crisis that deserve mention.

WHO director Tedros Adhanom Ghebreyesus said as early as March 11 that history does not have a precedent for controlling a pandemic. Yet, lockdowns were recommended. By end-March, 170 countries had closed their borders, 140 countries had several WHO containment measures, as compiled by OxGRT (border closures, restrictions on gatherings, etc) in place, and there were 8,81,000 Covid-19 cases and 43,000 deaths. With lockdowns, cases were expected to reach their terminal level (perhaps 10 times higher at 8.8 million?). Today, cases are 40 times, and deaths 24 times higher. This has occurred during the most intense period of lockdowns and controls around the world. These are not statistics about even partial success; rather, indicators of massive failure.

The world has gone through many pandemics since the Spanish Flu of 1918. In the six-month October 1957-March 1958 period, excess deaths in the US numbered 62,000. In the three-month February-April 1963 period, excess deaths numbered 57,000. In these two instances, excess deaths were 36% and 30% higher than “normal”. In the US, at the peak of the crisis in March-May, excess deaths were 1,22,300 and Covid-19 deaths around 95,000. Expected deaths? Around 6,60,000.

So, excess deaths were about 18%. Eighteen per cent too many deaths, but what did the US do to confront the nearly-double excess deaths in both 1957-58 and 1963?

It did absolutely nothing. It is worth quoting a paper by David Henderson and his colleagues that was published in 2009, Public Health and Medical Responses to the 1957-58 Influenza Epidemic. The late Dr Henderson played a major role in setting up the CDC influenza surveillance programme in the US: His stature as an authority was similar to Anthony Fauci today. The paper explicitly rejects even partial lockdowns and states:

The 1957-58 pandemic was such a rapidly spreading disease that it became quickly apparent to US health officials that efforts to stop or slow its spread were futile. Thus, no efforts were made to quarantine individuals or groups, and a deliberate decision was made not to cancel or postpone large meetings such as conferences, church gatherings, or athletic events for the purpose of reducing transmission. (Public Health and Medical Responses.., p. 7, emphasis added)

More evidence against the unexpected and unprecedented world and WHO response to the crisis in 2020 is provided in this 91-page 2019 WHO report titled “Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza”. The word “lockdown” (one form of a non-pharmaceutical intervention or NPI) does not appear in this report. Nor does the WHO report even recommend masks (a favourite 2020 NPI) in case of an epidemic, though it does advocate their use for symptomatic individuals.

On the effect of NPIs, the report stated: “The evidence base on the effectiveness of NPIs in community settings is limited, and the overall quality of evidence was very low for most interventions. There have been a number of high-quality randomised controlled trials (RCTs) demonstrating that personal protective measures such as hand hygiene and face masks have, at best, a small effect on influenza transmission, although higher compliance in a severe pandemic might improve effectiveness.” (emphasis added). Yet, for Covid-19, NPIs were recommended in bundles by WHO and other experts.

As is universally acknowledged, the WHO is the apex body for advice and guidance for health problems. It houses leading epidemiological experts, and before Covid, they were advocating policies reminiscent of earlier confrontations with viruses.

Given this history, it remains a mystery as to why the world entered into a lockdown. In my paper, I report the result of various studies on the effectiveness of lockdowns; except for a few, most of these studies report that the lockdowns were highly successful in saving hundreds of thousands of lives. Since the average death rate from Covid-19 is 2.5%, these results imply that somewhere between 10 to 20 million less infections resulted from this unnatural experiment.

Examination of the contradiction between the observed reality of 40 million cases, and the experimental reality of lockdown research, is the purpose of my above-mentioned paper. We replicate the variety of tests available in the literature and add the following important test of lockdowns—a before and after comparison for over 150 countries, and for one, two, and three months from the date of lockdowns. No matter what the test, the dominant result is that not only lockdowns were not effective, but that, in a large majority of cases, lockdowns were counter-productive. i.e., led to more infections and deaths, than would have been the case with no lockdowns. My analysis stops in end-July and, therefore, ignores the post-July second-wave of infections. If these data are included, the fate of lockdowns would be a lot worse.

My analysis makes a small contribution towards documenting what did not work. Unfortunately, there are no answers to the more important question of what would have worked in confronting a virus without a vaccine. Note that in the late 1950s, influenza vaccines were available in the US and yet excess deaths were higher than the 2020 episode of no vaccine.

It is not as if no scientist forecast that lockdowns would be a disaster. Sweden, for one, followed the herd-immunity approach, the same approach that was followed by the US (and all other nations) in all previous epidemics. An epidemic is like an earthquake—it hits you hard, and then you do the best you can, and live with it.

John Ioannidis, professor of medicine at Stanford University, has shouted himself hoarse against the advocates of lockdown. In a short piece (with colleagues, titled Forecasting for Covid-19 has failed: “Failure in epidemic forecasting is an old problem. In fact, it is surprising that epidemic forecasting has retained much credibility among decision-makers, given its dubious track record. Modeling for swine flu predicted 3,100-65,000 deaths in the UK… Eventually only 457 deaths occurred.” Another example of prediction failure: Up to 10 million animals were slaughtered because 1,50,000 deaths were expected from foot-and-mouth disease—eventually only 50 deaths occurred.

It is likely that post the COVID crises, epidemiological experts will suffer a worse fate than economists did after their Waterloo in 2008. In the iconic movie Jerry Maguire, a talented player asks his manager to “show him the money” in order to retain the contract to manage him. The world is now asking the lockdown experts—show me the evidence.

The author is Executive director, IMF, representing India, Sri Lanka, Bangladesh and Bhutan. The views expressed are those of the author and do not necessarily represent the views of the IMF, its Executive Board, or IMF management

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First published on: 24-10-2020 at 07:00:00 am