Rethinking lockdowns: The risks and trade-offs of public health measures to prevent COVID-19 infections

Ari Joffe:

Early in the COVID-19 pandemic, there was contagion of fear and lockdown policies across the world. Modeling in March (based on inaccurate disease estimates) suggested there could be 510,000 deaths in Great Britain and 2.2 million deaths in the US by mid-April, with cases surpassing intensive care demand by 30 times. Non-pharmaceutical interventions spread to around 80 percent of OECD (Organisation for Economic Co-operation and Development) countries within a two-week period in March 2020, mainly predicted by prior adoptions of a policy among spatially proximate countries.

Most countries in the world implemented lockdowns, restricting their population’s movements, work, education, gatherings, and general activities in attempt to reduce transmission and thus ‘flatten the curve’ of COVID-19 cases. Cognitive biases largely drove the response, and resulted in the triumph of groupthink (the desire for harmony and conformity prevailed, and we became less willing to alter our course of action). My own cognitive biases made me (like others) focus on controlling one disease, COVID-19, to the exclusion of important broader considerations discussed below; thus, I was an initial proponent of lockdowns (see Kumar et al. 2020)…

…What should we do?

We must take an ‘effortful pause’ from our cognitive biases and calibrate our response to the risks and trade-offs discussed above. To do otherwise risks only magnifying the many costs outlined above. A recalibrated response might involve the following:

1. 1. Educate the public and policy-makers on the risks and trade-offs involved. Alleviate unreasonable fear with accurate information.
   2. Focus on cost-benefit analysis. Repeated or prolonged lockdowns cannot be based on COVID-19 numbers alone.
   3. Focus on protecting people at high risk: people hospitalized or in nursing homes (e.g., universal masking in hospitals reduced transmission markedly), in crowded conditions (e.g., homeless shelters, prisons, large gatherings), and equal to and greater than 70 years old (especially with multiple severe comorbidities). Do not lock down everyone, regardless of their individual risk.
   4. Keep schools open: children have very low morbidity and mortality from COVID-19, and (especially those 10 years old and younger) are less likely to be infected by SARS-CoV-2 and have a low likelihood to be the source of transmission of SARS-CoV-2.
   5. Consider increasing health care surge capacity if forecasting, accurately calibrated repeatedly to real-time data (up to now, forecasting, even short-term, has repeatedly failed), suggests it is needed. With universal masking in hospitals, asymptomatic health care workers can continue to work…”