A new paper in BMJ Global Health purports to debunk lockdown sceptics’ claim that “the cure is worse than the disease”. However, it misses the big picture; in fact, it hasn’t shifted my priors one jot.
The paper contains no new data or analysis. Rather, it comprises a review of the existing literature. The authors focus on the claim that “lockdowns cause more health harms than COVID-19 by examining their impacts on mortality, routine health services, global health programmes and suicide and mental health”.
In other words, they attempt to show that lockdowns do not cause more health harms than they prevent. Notice: this is not the same as showing that lockdowns pass an overall cost-benefit test. Even if lockdowns were a net positive for public health, they could still be a massive net negative for society (taking into account their effects on the economy, education and civil liberties).
The strongest argument the authors make (with which I was already familiar) is that excess mortality in countries like Australia and New Zealand – which managed to contain the virus – was zero or negative last year. Since these countries did not experience an epidemic of COVID-19, but did see weeks or even months of lockdown, the lack of excess mortality suggests that lockdowns themselves do not cause many deaths.
However, some lockdown sceptics would argue that – even if lockdowns don’t cause many deaths in the short-term – they do cause more deaths in the long-term, via missed cancer screenings, drug overdoses etc. And here the authors are much less persuasive.
They concede that “the connection between lockdowns and missed contact with health systems is very well established”. However, they claim this association “may be related to lack of capacity of healthcare services or impacts of the pandemic itself rather than measures taken by governments”.
There is “no doubt”, the authors admit, “that global health programmes have been disrupted”. But they argue such disruptions were caused by “multiple complex direct and indirect consequences of COVID-19, not just stay-at-home orders”.
So they acknowledge that lockdowns do have harmful long-term effects. And given that those long-term effects are yet to be quantified, the authors have little basis for concluding that lockdowns are “unlikely to be causing harms more extreme than the pandemic itself”.
But this is mostly academic, since – as noted above – the positive health effects of lockdown could be massively outweighed by impacts on the economy, education and civil liberties. Society has functions other than simply extending people’s lives for as long as possible. If it did not, we’d spend a much higher fraction of GDP on healthcare, and we’d ban alcohol, smoking and extreme sports.
Moreover, the authors set up a false dichotomy between lockdowns on the one hand and an “unmitigated epidemic” on the other. Yet I and most other lockdown sceptics weren’t in favour of simply “letting the virus rip”. Rather, we backed a focused protection strategy – like the one outlined in the Great Barrington Declaration.
Outside of countries that managed to contain the virus, there is little evidence that lockdowns have substantially reduced mortality from COVID-19. And in the West, all the countries that did achieve containment are small, less dense and/or geographically peripheral – basically Norway, Finland and a handful of islands.
In this regard, the authors neglect to consider any countervailing evidence. For example, they claim that “government interventions have a strong impact on COVID-19 cases and deaths”, citing three studies, including the heavily criticised paper by Flaxman et al. But they don’t mention any of the studies finding little or no relationship between lockdowns and mortality.
They also claim that Sweden – which took the most relaxed approach of any Western country – had “large numbers of excess deaths throughout the pandemic”. Yet if they’d looked at age-adjusted excess mortality, and had taken account of the “dry tinder” effect, they’d know that Sweden did not have an exceptionally bad year.
The authors of the BMJ Global Health set out to show that the health benefits of lockdowns outweigh the harms. However, all they really prove is something that most of us already knew – lockdowns do not cause many deaths in the short term.
When we consider things like disruption to vaccination programs in the developing world (which the authors concede were at least partly due to lockdowns) it’s not at all clear that any health benefits will outweigh the long-term harms.
What’s more, available evidence suggests the costs of the U.K.’s lockdowns almost certainly outweighed the benefits, and a focused protection strategy could have saved more lives with far less collateral damage.