One of the most shocking elements of the global response to Covid-19 has been the involuntary confinement of entire populations to their homes – barring certain exceptional activities such as essential shopping, exercise, and medical attention. Lockdown measures of this sort are usually associated with wartime, and should not be taken lightly, not only because of their impact on citizens’ freedom of movement, but also because their devastating impact on the economy and their risks to the health and livelihood of tens of thousands of citizens.
Conventional wisdom seems to suggest that generalized lockdown, in the early stages of the pandemic, is the best way to slow the spread of a pandemic and reduce the case load in emergency departments. But not all scientists and governments agree. The Swedish government, in particular, is a striking outlier: it has decided to follow the advice of its chief epidemiologist, Anders Tegnell, whose recommendation is “to let the virus spread as slow as possibly, while sheltering the elderly and the vulnerable until much of the population becomes naturally immune or a vaccine becomes available.”
It is too soon to tell for sure whether Sweden’s unconventional approach will pay off. So far, its death rate is far lower than Italy’s or Spain’s, but higher than Norway’s and Denmark’s. In any case, how Sweden’s rather permissive strategy plays out will undoubtedly weigh heavily with policymakers in Ireland and elsewhere, as they attempt to transition out of full lockdown, and consider how to handle future waves of the Covid-19 pandemic.
As the Swedish case demonstrates, the jury is very much still out on whether or not total lockdown is actually having a significant impact on the rate of contagion or, more importantly, the rate of disease, hospitalization, and death.
Even if the contagion or hospitalization curve in Ireland or other countries under lockdown begins to “flatten,” that does not demonstrate that full lockdown was necessary to achieve such a result. It is possible, for example, that a more moderate and focused lockdown, targeting vulnerable groups such as over 60s and those with respiratory diseases, combined with more effective public health measures, might have been equally effective at mitigating the more severe forms of the disease.
What most experts do agree upon is that even if the contagion subsides this summer, we are not out of the woods yet. Epidemiologists repeatedly warn us that this sort of pandemic tends to come in waves, and that we should be preparing ourselves for a second or even third wave, most likely starting this winter. We are likely to be confronted with future outbreaks of the disease, and will be compelled to take measures to slow the contagion rate and keep the death toll to a minimum.
It may be tempting to impose nation-wide lockdowns every time the virus raises its ugly head, but that would probably be ill-advised, for several reasons:
First, total lockdown, given its implications for civil liberties and its cripping effects on the economy, can only be justified as a last resort. In the face of a completely unknown virus, a temporary lockdown might be justified as a ploy to buy time and learn how to better adapt and better protect the health and lives of citizens. But as knowledge about Covid-19 and its behaviour accumulates and is shared globally, this sort of defense is no longer convincing.
Second, there are many other tools available for combating Covid-19 that are probably at least as effective as all-out lockdown and considerably less costly. Some of these tools, such as antibody blood tests, are not yet available, but many others, such as large-scale testing and contact tracing for vulnerable individuals and their carers, could have been made available early on, if the Irish government had done its job.
Tools we may rely on going forward, and that may be perfectly effective without a general lockdown, include:
(1) the gradual cultivation of so-called “herd immunity,” as a large section of the population – 60-70% is considered sufficient – contracts the virus and develops immunity;
(2) the confinement of vulnerable groups to their homes and to outdoor activities with social distance restrictions;
(3) the systematic and periodic testing of healthcare professionals, caregivers, and individuals in regular contact with vulnerable groups such as the elderly, diabetics, and those with respiratory or immunological diseases;
(4) the establishment of clear quarantine and testing protocols for nursing homes, and the creation of subsidized housing arrangements for carers who need to be isolated;
(5) contact tracing and testing for individuals who have had contact with those testing positive for Covid-19;
(6) the expansion of intensive care units and hospital capacity and staffing to ensure full preparedness for future waves of covid-19
(7) effective information-sharing and state-of-the-art medical research to ensure that hospitals have access to the best available treatment methods for patients with covid-19. Since a safe and effective vaccine may take years to develop, the discovery of more effective treatments could be a game changer.
(8) the subsidization of alternative living arrangements for those sharing homes with vulnerable individuals who need to self-isolate;
(9) the provision of fully effective protective equipment to medical professionals and caregivers, so that they themselves are not infected, and do not transmit the virus to others; and
(10) the development of antibody blood tests to determine how much immunity has developed in the general population.
We have seen the relative futility of lockdown measures in countries such as Spain, Italy and the United Kingdom, where they have either been poorly timed or have not been accompanied by (a) adequate testing, contact tracing, and quarantine protocols, especially for critical sections of the population and those in close contact with them, and (b) adequate protective equipment and regular testing for nursing homes and hospitals.
We cannot undo the errors of the past, but we can surely learn from them. So, as we prepare for the next wave of Covid-19, let’s be smart and bring our full set of policy tools to bear with as much precision as we possibly can. We should think twice before relying on crude and counterproductive solutions such as total lockdown, which undermine people’s physical and mental health, send economies into free-fall, and substantially reduce government income, making future healthcare cuts virtually inevitable.