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 Table of Contents  
CONTROVERSIES / OPINION
Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 51-53

Combating the Coronavirus disease 2019 pandemic: 'Lockdowns' amplify the problem


1 Generating Research Insights for Development (GRID) Council, Delhi NCR; Department of Public Policy and Administration, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
2 Generating Research Insights for Development (GRID) Council, Delhi NCR, India

Date of Submission11-Jun-2020
Date of Decision18-Jun-2020
Date of Acceptance19-Jun-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Dr. Archisman Mohapatra
D-401, Saket Dham Apartments, Sector-61, Noida - 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_93_20

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How to cite this article:
Balabantaray SR, Mohapatra A. Combating the Coronavirus disease 2019 pandemic: 'Lockdowns' amplify the problem. J Med Evid 2020;1:51-3

How to cite this URL:
Balabantaray SR, Mohapatra A. Combating the Coronavirus disease 2019 pandemic: 'Lockdowns' amplify the problem. J Med Evid [serial online] 2020 [cited 2020 Oct 25];1:51-3. Available from: http://www.journaljme.org/text.asp?2020/1/1/51/290149




  Background Top


The lockdowns across countries in response to the coronavirus disease 2019 (COVID-19) pandemic have rapidly converted a public health crisis into a multisectoral crisis.[1] The approach is counter-intuitive – though misperceived as 'aggressive', lockdowns pose a very defensive and non-sustainable combat to the pandemic. COVID-19 has caused universal psychosocial impact by causing mass anxiety, economic burden and financial losses – lockdowns have only accentuated these.[2] Set against the backdrop of global economic slowdown, the decision of countries to lockdown has brought human development to a standstill. It has increased hardship for individuals, communities, countries and the world at large.[3] The compromised quality of life, loss of productivity and widened social inequities will have long-term implications for sustainable human development. If not reversed in time, the impact of lockdowns will be reckoned as a man-made catastrophe in the history of public health science and the practice of evidence-based politics.


  The Decision-in-Perspective Top


Unfortunately, as the severe acute respiratory syndrome-coronavirus-2 virus quickly spread across regions and territories, countries were found underprepared – health systems were stretched thin and overwhelmed.[4] In a connected and interdependent global economy, governments had failed to appreciate the importance of implementing international travel restrictions in a timely manner. International trade and travel had continued mostly as usual in early 2020, leading to fast dispersion of the virus before the impending doom.[5] Countries where governments were more proactive, managed the pandemic without absolute lockdown. These either took a strong stand against it (e.g., Sweden, Germany and, initially, the United Kingdom) or did it in follow-up to very strong border control measures (e.g., New Zealand, Australia, Croatia and Greece). Nevertheless, governments worldwide came under tremendous pressure from within their countries and from concurrent actions undertaken by one another, to declare 'lockdowns'. Beyond an epidemiological combative response, this was perhaps a political decision by governments, showcasing commitment to the welfare of citizenry.[6] The timing and stringency of the lockdown have been variegated and controversial.[7],[8]


  Are 'lockdowns' Overrated? Top


Given the uncertainty around the unfolding pandemic, the decision to lockdown was commonly without a strategy for implementation, exit and impact mitigation. Low- and middle-income countries (LMICs) where the lockdowns caused conspicuous socioeconomic disruptions, should have carefully weighed the option. Their health and other systems are chronically resource starved and face challenges that cannot be quickly fixed.[9] No duration of lockdown would provide enough time for this. Lockdowns can bid some time for surge response, but it cannot be adequate in these settings. Without a specific treatment or vaccine or even a detailed understanding of the agent–host–environment interactions and adequate testing for epidemiological evidence, 'lockdown' is not convincing enough as an effective strategy to 'flatten the curve' or 'break the chain of transmission' and sustain it. The economic sacrifice is huge![1] It also increases the vulnerability of the weaker sections of the society who do not have a political voice.[10] It may be further difficult for governments to identify their plight and plan mitigation with immediacy and outreach. Long-term lockdown can cause unavailability of community services and collapse of many industries, leading to a negative impact on the local and national economic stabilities.[11],[12] At the individual level, loss of livelihood can lead to functional impairment and mental health issues.[13]


  The Collaterals Top


Lockdowns impart enormous authority to the government at the cost of individual rights. Governments cannot declare lockdowns without legal provisions, and a lot depends on the format of governance. China could do it effectively with strict impositions. Contrarily, democracies (where majority of the world's population resides) usually react to mass interventions either in frank support or in opposition. The COVID-19 lockdowns across democracies also incited reactions. While countries in Europe showed increased trust in their governments following the decision,[14] India experienced reverse migration from the cities by its workers despite rolling out of hardship mitigation packages by the state and union governments besides flouting of lockdown norms by some, Honduras saw violence, the USA saw mass protests, South Africa lost to public litigations and Malaysia drew criticism from Human Rights Watch for prison-overcrowding by violators of the lockdown. Italy, Spain and France saw popular compliance to the lockdown orders. In most places, the lockdown was partial (unlike India, where it was near absolute). Depending on the stringency of the lockdown, people experienced disruption in essential services, supplies and logistics. Provisioning and access of medical care suffered (including routine and emergency services). People felt anxious as they could not reach out to their near and dear ones even during distress. There were reports of mob attacks on healthcare workers and the police, as well as police atrocities. Industrial sectors that could not accommodate work-from-home strategies, got severely affected. Agriculture took a hit as the lockdowns coincided with the Spring/Summer harvest amidst crunched labour supply and transport logistics. People lost jobs and livelihoods. Reports of stress, anxiety, depression and suicides and domestic violence increased. Students' education calendars got derailed, and career planning became difficult. Some of the countries declared lockdown at an extremely short notice (e.g., India and Italy) – there were panic purchases among the people, leading to overcrowding in the markets; people who were travelling had to shelter-in-place away from their homes. It is anticipated that lockdowns can potentially trigger troublesome and even prolonged adverse mental consequences in children.[15] Public anxiety showed up in plummeting stock market investments across the globe.[16] The long-term impact of lockdown has been obvious, potentially pushing countries off-track for the Sustainable Development Goals.[17]


  Conclusion Top


The way the COVID-19 pandemic has unfolded is not an epidemiological enigma. Things were predictable. In fact, a cursory search of medical literature guides us to publications over the past years that suggest that RNA viruses threatened as the next potential pandemic.[18] Several sources had forewarned about potential flu pandemics in recent years.[19] It is to be noted that the World Health Organization has been coaxing countries to come up with structured and regularly updated influenza pandemic preparedness plans for quite many years. However, most countries, and especially the LMICs, have not responded to this in time.[20] Consequently, the combative responses have not been optimal. Embracing lockdowns in its various formats is one such suboptimally planned response that will remain debatable for times to come, calling for accountable public decision support systems. As of now, it seems that countries have to live through the pandemic crisis and the lockdowns may have just delayed the inevitable at an enormous avoidable cost.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
    
2.
Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19 [published online ahead of print, 2020 May 27]. Diabetes Metab Syndr. 2020;14:779-88. doi:10.1016/j.dsx.2020.05.035.  Back to cited text no. 2
    
3.
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].  Back to cited text no. 3
    
4.
WHO Releases Guidelines to Help Countries Maintain Essential Health Services During the COVID-19 Pandemic. Available from: https://www.who.int/news-room/detail/30-03-2020-who-releases-guidelines-to-help-countries-maintain-essential-health-services-during-the-covid-19-pandemic. [Last accessed on 2020 Jun 11].  Back to cited text no. 4
    
5.
Chinazzi M, Davis JT, Ajelli M, Gioannini C, Litvinova M, Merler S, et al. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science 2020;368:395-400.  Back to cited text no. 5
    
6.
Knowledge@Wharton. The Politics of Pandemics: Why Some Countries Respond Better Than Others. Wharton, University of Pennsylvania; 2020. Available from: https://knowledge.wharton.upenn.edu/article/politics-pandemics-countries-respond-better-others/. [Last accessed on 2020 Jun 02].  Back to cited text no. 6
    
7.
The Unusual Ways Countries are Managing Lockdowns. BBC News; 2020. Available from: https://www.bbc.com/news/world-52109792. [Last accessed on 2020 Jun 11].  Back to cited text no. 7
    
8.
Perry J. Nicaragua's response to COVID-19. Lancet Glob Health. 2020;8:e898. doi:10.1016/S2214-109X(20)30218-7.  Back to cited text no. 8
    
9.
Mills A. Health care systems in low- and middle-income countries. N Engl J Med 2014;370:552-7.  Back to cited text no. 9
    
10.
Shammi M, Bodrud-Doza M, Towfiqul Islam ARM, Rahman MM. COVID-19 pandemic, socioeconomic crisis and human stress in resource-limited settings: A case from Bangladesh. Heliyon 2020;6:e04063.  Back to cited text no. 10
    
11.
Rubin GJ, Wessely S. The psychological effects of quarantining a city. BMJ 2020;368:m313.  Back to cited text no. 11
    
12.
Pulla P. COVID-19: India imposes lockdown for 21 days and cases rise. BMJ 2020;368:m1251.  Back to cited text no. 12
    
13.
Subbaraman R, Nolan L, Shitole T, Sawant K, Shitole S, Sood K, et al. The psychological toll of slum living in Mumbai, India: A mixed methods study. Soc Sci Med 2014;119:155-69.  Back to cited text no. 13
    
14.
Blais A, Bol D, Giani M, Loewen PJ. COVID-19 Lockdowns have Increased Support for Incumbents, Trust in Government, and Satisfaction with Democracy; 2020. Available from: https://voxeu.org/article/rallying-effect-lockdowns. [Last accessed on 2020 Jun 11].  Back to cited text no. 14
    
15.
Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet Mar 2020;395:945-7.  Back to cited text no. 15
    
16.
Liu H, Manzoor A, Wang C, Zhang L, Manzoor Z. The COVID-19 Outbreak and Affected Countries Stock Markets Response. Int J Environ Res Public Health 2020;17:2800. Published 2020 Apr 18. doi:10.3390/ijerph17082800.  Back to cited text no. 16
    
17.
KPMG. COVID-19 crisis: The SDGs can't be under “lockdown” too. 2020 May 12;5. Available from: https://home.kpmg/ie/en/home/insights/2020/05/covid-19-sdgs-cant-be-under-lockdown-too-sustainable-futures.html. [Last accessed on 2020 Jul 3].  Back to cited text no. 17
    
18.
Carrasco-Hernandez R, Jácome R, López Vidal Y, Ponce de León S. Are RNA viruses candidate agents for the next global pandemic? A review. ILAR J 2017;58:343-58.  Back to cited text no. 18
    
19.
Friedman U. We Were Warned. The Atlantic; 2020. Available from: https://www.theatlantic.com/politics/archive/2020/03/pandemic-coronavirus-united-states-trump-cdc/608215/. [Last accessed on 2020 Jun 11].  Back to cited text no. 19
    
20.
Strategic Partnership for IHR and Health Security (SPH), World Health Organization. Pandemic Influenza Preparedness Plan. Available from: https://extranet.who.int/sph/influenza-plan. [Last accessed on 2020 May 21].  Back to cited text no. 20
    




 

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