Non-Pharmacological Interventions for Pandemic Mitigation- What you should know (Part 5)

Lockdowns

Lockdowns are extreme measures that restrict social and economic activity by enforcing:

  • Closure of schools, playgrounds and most businesses
  • Prohibition of travel except for food and medicine/ essentials
  • Prohibiting face-to-face socializing outside one’s immediate household.

The trade-off is between reducing fatalities due to COVID-19 and preserving people’s livelihoods.

There are several arguments against lockdowns, and I present some of them below.

Effectiveness

At best, estimates indicate that lockdowns save a very modest number of lives. This is why such measures are not recommended except as a last resort in very severe pandemics.

Lockdowns are ineffective in preventing or containing disease spread when

  • They are imposed in urban areas/ cities with a large proportion of overcrowded dwellings and neighbourhoods (slums/ shanty towns, etc.). In such locations, lockdown results in ‘social compression’ instead of physical distancing. The situation is worsened by the lack of access to water and soap in such locations.
  • They instigate large-scale population displacement from urban to rural areas, spreading the virus along the way.

Costs

Lockdowns carry excessive economic and human costs because

  • They can put the families of informal workers at the risk of starvation, crime and disease. Regardless of location, informal workers, without unemployment insurance, paid leave or savings, would rather work and face the risk of infection than starve.
  • They can lead to mass unemployment and bankruptcies. Most low and middle-income countries do not have the means to assist/ aid businesses and people in a deep economic recession. This is due to the presence of
    • large levels of external debt,
    • low tax revenues, and
    • high credit risk.
  • The situation is compounded by a drop in commodity prices due to the pandemic.
  • They cause an immense loss of opportunity cost of public and private resources, especially in low and middle-income countries. This loss can substantially worsen poverty and (economic) vulnerability.
  • They may create conditions for unrestrained domestic violence- from abusive parents/ spouse/ partner.
  • They can be manipulated to suppress political opposition and legitimate social unrest in authoritarian and dictatorial regimes. In addition, politicians may exploit the situation to pass controversial legislation without adequate discussion. Often, such pieces of legislation make sweeping changes and contain provisions that deprive citizens of their rights.

Sustained lockdowns carry a health toll in addition to that experienced due to COVID-19- mental health problems, malnutrition, resurgence of non-COVID health conditions, etc.

Unemployment and the deep economic recession caused/ catalysed by a sustained lockdown will harm the next generation as well. Recent reports indicate that the world’s major economies are already experiencing a contraction ranging from -7.6% (Japan) to -23.9% (India). This is likely to result in a deep global recession, from which nations will take years to emerge.

Already, a World Bank report estimates that under the baseline growth scenario, 24 million fewer people will escape poverty across East Asia and the Pacific (EAP) in 2020 than would have in the absence of the pandemic (using a poverty line of USD 5.50/day).

If the economic situation deteriorates further, then poverty in East Asia and the Pacific (EAP) is estimated to increase by around 11 million people.

Governments will find it difficult to restore economic activity to pre-pandemic levels within a short time, and will have access to limited tools to stimulate/ revive their economies. In the medium to long term this will translate to less funds for health, education, social welfare, etc. worsening disparities and inequities.

Lockdowns will most severely affect economies that have a large informal sector- most low and middle-income countries. Ironically, the countries that can least afford lockdowns are the ones most aggressively implementing such measures.

The real tragedy is not the distress caused by lockdowns, but that even prolonged lockdowns have not dented the spread of COVID-19, making lockdowns a very expensive failure on multiple counts.

Useful Links:

Links to previous articles in this series:

https://communitymedicine4all.com/2020/08/05/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-1/

https://communitymedicine4all.com/2020/08/12/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-2/

https://communitymedicine4all.com/2020/08/19/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-3/

https://communitymedicine4all.com/2020/08/26/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-4/

Links to journal articles and other sources on influenza mitigation:

http://www.upmc-biosecurity.org/website/resources/publications/2006/2006-09-15-diseasemitigationcontrolpandemicflu.html

https://www.cdc.gov/mmwr/volumes/66/rr/pdfs/rr6601.pdf

https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf?ua=1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600239/pdf/07-1437_finalPR.pdf

https://journals.plos.org/ploscompbiol/article/file?id=10.1371/journal.pcbi.1001076&type=printable

Links to articles on the economic situation and lockdowns:

https://www.worldbank.org/en/region/eap/publication/east-asia-pacific-economic-update

https://theincidentaleconomist.com/wordpress/econ-covid-1/

https://theincidentaleconomist.com/wordpress/econ-covid-2/

https://blogs.worldbank.org/developmenttalk/smart-containment-and-mitigation-measures-confront-covid-19-pandemic-tailoring

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