|CONTROVERSIES / OPINION
|Year : 2020 | Volume
| Issue : 1 | Page : 48-50
Combating the COVID-19 pandemic: 'Lockdowns' help in working out the solution
Sabyasachi Behera1, Smrutiranjan Nayak2
1 Generating Research Insights for Development (GRID) Council, Delhi NCR, India
2 Generating Research Insights for Development (GRID) Council, Delhi NCR; Department of Community Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
|Date of Submission||11-Jun-2020|
|Date of Decision||15-Jun-2020|
|Date of Acceptance||18-Jun-2020|
|Date of Web Publication||20-Jul-2020|
Dr. Smrutiranjan Nayak
Department of Community Medicine, Kalinga Institute of Medical Sciences, Kushabhadra Campus, (KIIT Campus-5) Patia, Bhubaneswar - 751 024, Odisha
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Behera S, Nayak S. Combating the COVID-19 pandemic: 'Lockdowns' help in working out the solution. J Med Evid 2020;1:48-50
| Background|| |
The lockdowns across countries in response to the COVID-19 pandemic have set the stage for one of the most controversial public health decisions in human history. The decision has indeed affected the quality of life, caused loss of productivity, uncovered and widened inequities and has long-term implications for sustainable human development., But, did the lockdowns not save life-years? Of course, it is difficult to attribute timely credit for preventive measures – one cannot claim position for something that never happened! The worst is just an imagination, but there are aspects to consider.
| The Decision-In-Perspective|| |
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus quickly spread across regions and territories within months of its origin. Even before its potential for human-to-human transmission could be reported (22nd January 2020), it had already crossed borders from China to Thailand (13th January 2020). Countries were inadequately prepared to combat the pandemic. Without a specific treatment or vaccine or even a detailed understanding of the agent–host–environment interactions, nuanced evidence-based interventions were difficult. The virus could quickly breach border controls against risk of importation (except for a few countries in Eastern Europe and Australasia). Consequently, most countries locked down in response to the pandemic. Lockdowns were undertaken majorly with two intentions: to check aggressive transmission of the virus, i.e., 'flatten the curve'/'break the chain of transmission', and to surge capacity for combat by mobilising and allocating resources for COVID-19 care. Across countries, lockdowns served these purposes at least with moderate success. Interestingly, most LMICs took the decision before the epidemic curve peaked, unlike the high-income countries (HICs) that took it as an intervention somewhat later in the course. Perhaps, these were contextual decisions and also a reflection of level of preparedness of health systems and robustness of decision support systems. It must be acknowledged that social and physical distancing is not always practicable in LMIC settings for a gamut of reasons (e.g., awareness, hygiene literacy and living conditions). A lockdown, in such contexts, imposes mass movement restrictions and, consequently, limits the risk of transmission and surge in cases. This safeguards all sections of the society – an aspect of 'equity-levelling' that must be duly considered before criticising lockdowns for 'uncovering vulnerabilities'.
| Defining 'lockdown'|| |
The Oxford COVID-19 Government Response Tracker provides an objective stringency index that is a composite measure of how strictly governments across the globe have implemented containment measures in place. The indicators varies from 0 to 100 (100 = strictest response). A review of the indicators suggests that most countries had an stringency of above 50% by mid-March 2020, which went up to >70% mid-May 2020. Although the index ascribes a score of 100 for complete lockdown, it is difficult to comprehensively define what a lockdown means if we consider the global approaches around it. China's lockdown of Hubei (Wuhan and other cities) was indeed stringent. It has a communist system of governance and legal provisions that bestows authority with the government to take up initiatives that may significantly curtail civil rights. However, the lockdown in China was limited in scale – it was not a nation-wide intervention. It was also brought in at a later stage of the epidemic curve. Simultaneously, it was a decision that China took when human understanding of the novel virus and the disease was too infantile. Personal protection equipment, testing kits, infrastructure and logistics may not have been as readily available. Still, China could control the outbreak in Wuhan once lockdown was announced. South Korea and Germany's lockdowns have been 'brave' for their laxities. Australia and New Zealand have not had an absolute lockdown either. That in the United States of America has been almost voluntary for the citizens and at the discretion of provincial administrations. Unlike any other country, India entered into the lockdown quite early with just over 500 cases and about 10 deaths. The lockdown was extremely stringent in its implementation; it was nationwide with sealing of inter-state and inter-district borders. India also started a rather early exit while cases were increasing rapidly in its states. Most LMICs, unlike India, started with a lockdown that was relatively less stringent almost akin to India after the graded relaxations. They have, however, been able to sustain it without easing off before the epidemic has peaked. Most HICs, e.g., United Kingdom, Russia, Spain and France, with their variegated levels of implementation, also did not ease off the lockdown before the curve started bending down. Decisions on exit strategies from the lockdowns have also been quite complex and heterogeneous., E.g., India gradually expanded relaxations using a zoning strategy by demarcating areas according to case load and clustering. Pakistan, on the other hand, has eased off the lockdown on selected days of the week. The lockdowns also stimulated the governments, especially in the LMICs, to support its vulnerable populations and industry sectors through welfare schemes. These included subsidies, direct benefit transfers, tax reliefs and loan moratoria. With the complexity of the constantly evolving situations, it is difficult to clearly outline the scope of the lockdowns across countries in terms of stringency, scale, timing of entry and exit and associated interventions. Hence, it is unfair to infer lockdowns as 'futile' standalone interventions.
| The Collaterals|| |
Nature has rejuvenated during the lockdown days. With massive reduction in human activities, and subsequent reduction in fuel demands, emissions and intrusions, environmental pollutions have come down and some of the non-human life forms have revived conspicuously. Even for humans, road traffic accidents and crimes have come down. People have spent more time with family at home than ever before. Could this have led to better coping during the otherwise distressing pandemic times? The mass movement restrictions definitely averted deaths for some more time. Medical capacity could be surged, meanwhile, for saving furthermore lives. People became increasingly aware and adoptive of preventive practices (this could have taken much longer without the lockdown). The benefits of these tangible and intangible collaterals must be adjusted into models by researchers reviewing the impact of lockdowns.
| Conclusion|| |
It may not be possible to comment on prudence of lockdown as an intervention of choice during the COVID-19 pandemic. The strategies varied from country-to-country, and frequently, the interventions were not standalone. Concomitant co-operation by the public and mitigation-recovery interventions by the governments made the difference in experience. There is clear evidence that curves flattened in most countries that locked down. If governments knew how and where the virus would stop once border controls were breached, they might have implemented more effective alternative strategies. However, in the absence of these critical insights and lapses in exerting early combative action, countries had to balance the decision with their contextual situations, e.g., governance processes, legal provisions, resources and reserves and civil society – law keeping authority and army interactions (e.g., Thailand). Lockdowns helped mobilise time for practice of evidence-based policy, leveraging accruing scientific wisdom on SARS-CoV-2 and COVID-19 and transform decision-making processes. Governments could reposition their advisory committees and take a better stock of the fast-evolving situations. Without a lockdown, the response time would have been very short. Consequently, the response would have more likely been (further) erratic, inefficient and ineffective. Nevertheless, lockdowns are 'costly and controversial' approaches; preparedness plans for future pandemics must chart out better strategies for decision-making and implementation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ceylan RF, Ozkan B, Mulazimogullari E. Historical evidence for economic effects of COVID-19 [published online ahead of print, 2020 Jun 4]. Eur J Health Econ 2020;1-7. doi:10.1007/s10198-020-01206-8.
Schmidhuber J, Qiao B. Comparing crises: Great Lockdown versus Great Recession. Food and Agriculture Organization of the United Nations; 2020. Available from: http://www.fao.org/documents/card/en/c/ca8833en
. [Last accessed on 2020 Jun 11].
McKee M, Stuckler D. Preparing for a responsible lockdown exit strategy. Nat Med 2020;26:640-2.
Alfano V, Ercolano S. The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis [published online ahead of print, 2020 Jun 3]. Appl Health Econ Health Policy 2020;1-9. doi:10.1007/s40258-020-00596-3.
Hodgins S, Saad A. Will the higher-income country blueprint for COVID-19 work in low- and lower middle-income countries? Glob Health Sci Pract 2020;8:8.
Dickens BL, Koo JR, Wilder-Smith A, Cook AR. Institutional, not home-based, isolation could contain the COVID-19 outbreak. Lancet 2020;395:1541-2.
The Lancet. India under COVID-19 lockdown. Lancet 2020;395:1315.
Pulla P. Covid-19: India imposes lockdown for 21 days and cases rise. BMJ 2020;368:m1251.
Colbourn T. COVID-19: Extending or relaxing distancing control measures. Lancet Public Health 2020;5:e236-e237.
Paital B. Nurture to nature via COVID-19, a self-regenerating environmental strategy of environment in global context. Sci Total Environ 2020;729:139088.