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Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19

Countries
World
Sources
BMJ
Publication date
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Gideon Meyerowitz-Katz, Samir Bhatt, Oliver Ratmann, Jan Markus Brauner, Seth Flaxman, Swapnil Mishra, Mrinank Sharma, Sören Mindermann, Valerie Bradley, Michaela Vollmer, Lea Merone, Gavin Yamey

Summary box

  • Restrictive non-pharmaceutical interventions against COVID-19 (known as ‘lockdowns’) are associated with health harms

  • However, it is challenging to determine whether lockdowns have caused the harms or whether these harms are a direct consequence of the underlying health disaster of the pandemic

  • Careful analysis of excess mortality suggests that lockdowns are not associated with large numbers of deaths in places that avoided large COVID-19 epidemics (eg, Australia, New Zealand)

  • This evidence must be weighed against the very severe harms caused by COVID-19 itself, as seen for example in Brazil and India

  • It is unlikely that government interventions have been worse than the pandemic itself in most situations using data collected to date

Introduction

During the pandemic, there has been ongoing and contentious debate around the impact of restrictive government measures to contain SARS-CoV-2 outbreaks, often termed ‘lockdowns’. We define a ‘lockdown’ as a highly restrictive set of non-pharmaceutical interventions against COVID-19, including either stay-at-home orders or interventions with an equivalent effect on movement in the population through restriction of movement. While necessarily broad, this definition encompasses the strict interventions embraced by many nations during the pandemic, particularly those that have prevented individuals from venturing outside of their homes for most reasons.

The claims often include the idea that the benefits of lockdowns on infection control may be outweighed by the negative impacts on the economy, social structure, education and mental health. A much stronger claim that has still persistently appeared in the media as well as peer-reviewed research concerns only health effects: that there has been a large toll of death and disease attributable directly to government action against COVID-19, a toll larger than that of COVID-19 itself. The tagline for this claim is that “the cure is worse than the disease”.

Here, we consider 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. We examine the evidence regarding whether government interventions are to blame for negative health consequences, or whether the lethality and infectiousness of SARS-CoV-2 is as much or more of a driver behind adverse health impacts. The grave harms from ineffectively mitigated epidemics have been clearly seen in places such as India and Brazil.4 Given the benefits from government intervention against COVID-19—slowing spread and preventing COVID-19 deaths—we explore whether the harms of lockdowns are likely to exceed the harms of COVID-19, or if the health harms sometimes attributed to lockdowns may instead be explained directly by the pandemic itself.