Since the start of the COVID-19 pandemic, many people have been telling a single story. It’s a very compelling narrative, playing into our worst fears and greatest hopes about the pandemic, and it has inspired numerous politicians, scientists, and other experts to try and take action.
The story is simple: the pandemic might be bad, but lockdowns must be worse.
Some have approached this account with some objectivity, and tried to argue that despite the incredible harms of an uncontrolled global pandemic lockdowns are more harmful. Many have, instead, tried to downplay the harms of the pandemic and pretend that it never happened, which has resulted in some truly bizarre arguments about whether people were even actually getting sick (spoiler: they were).
But after 12 months and a huge amount of data, we can now actually take a look at the harms of government interventions against COVID-19, and see whether they have been a tragedy or a triumph.
While the answer is incredibly hard to come by — none of this is certain, and it will take us decades to truly unpick the impacts of lockdowns vs the pandemic itself — it seems clear that the situation is far less negative than some might have you believe.
The first and most obvious question is a fairly simple one — have lockdowns killed people? The answer is also fairly simple — quite clearly not, at least in the short term.
Let me explain.
There’s been a strong narrative that lockdowns are deadly, and while I’ll get to cancer and heart disease in a moment, here I’m just talking about death specifically. If lockdowns/COVID-19 interventions, were associated with an immediate increase in mortality, what we would expect to see is that places with more restrictive interventions would have more EXCESS deaths (i.e. deaths from any cause) than those without, regardless of COVID-19 cases.
Instead, based on this study of global excess mortality, what we see is precisely the opposite. Places with lots of COVID-19 cases always have an excess of mortality, but places with no COVID-19 don’t, even if they have incredibly intense restrictions.
A very good example is the country of Australia. Despite some of the most restrictive interventions against COVID-19 in the world, including one of the longest single lockdowns of any place in the Australian state of Victoria, there was no uptick at all in overall mortality. Indeed, according to the Australian Bureau of Statistics, mortality decreased with these heavy restrictions, rather than increasing.
Suicide and Mental Health
I’ve already written quite a bit about suicide, and while the data is still rolling in, the evidence is pretty clear that there has been no association between government interventions against COVID-19 and an increase in suicides.
So that’s good, but it’s hardly the whole story when it comes to mental health. It’s clear from study after study that there is an association between high numbers of COVID-19 cases, government intervention, and problems with mental health. There is strong evidence that in most places that locked down in early 2020 there were substantial increases in depressive thoughts, anxiety, and other issues, although interestingly there is also some evidence that stress, suicide, and divorce were less on people’s minds.
But the problem here is that, while there is an association between lockdowns and some mental health issues, it is enormously challenging to determine whether this is causally related or is simply a consequence of the pandemic itself. For example, one study that looked at this association found that the effect of lockdowns on depression was no longer statistically significant once correcting for COVID-19 cases and deaths. While they concluded that there was an effect, it appeared to only be present for women, and even then there was quite a bit of uncertainty remaining in the estimates.
The point here is not that lockdowns haven’t caused mental health issues, it’s that this stuff is really hard. Being confined to a small space for long periods of time is awful for your mental health, but so is an out-of-control epidemic of COVID-19. Separating these two impacts, as well as all the other issues of the pandemic, is a staggeringly challenging task.
Disruptions To Health Services
Have government interventions caused deaths due to disruptions to health services? In this arena, chronic health issues and cancer are a huge problem. These are diseases that are often substantially mitigated if caught early, but are usually life-threatening and deadly if left without treatment for long periods of time. Distressingly, there is a lot of evidence that, during the pandemic, diagnostics for these diseases, particularly cancer screening programs, have been delayed or even stopped.
That’s not great, and it gets worse — a paper in the Lancet estimated that missed screening and diagnostic appointments would be associated with a huge increase in cancer mortality in the coming years. Similarly, there appears to be evidence that during the pandemic people have avoided care for heart disease even if they had acute issues that needed immediate help.
The thing is, these changes are not necessarily related to government action. For example, the Lancet paper linked above hypothesized that the main reason people were missing cancer screenings in the UK was because the medical staff who usually run those services were busy taking care of people with COVID-19. The paper referenced on heart disease postulated that a likely cause of increased cardiovascular mortality was undiagnosed COVID-19, rather than simply people avoiding care.
Moreover, these impacts can’t be chalked up just to COVID-19 interventions. In Australia, for example, ED attendances were lowest during lockdowns, but started dropping before interventions were even announced and remained low for months after restrictions were eased. In the UK there is a similar pattern , with people avoiding A&E the most during lockdowns but not attending in their usual numbers even once they were free to go.
In other words, this is yet another difficult question. Yes, lockdowns have almost certainly caused some disruptions to health services, but it is clear that the pandemic and its general anxiety have caused concerns as well. Disentangling this relationship — pointing to exactly how much of an impact governments have had compared to the virus and its associated fear — is another nightmarishly complex body of work.
Another common refrain is that COVID-19 has destroyed lives through damages to global health programs such as tuberculosis and vaccine efforts. There’s some strong evidence that these programs have been negatively impacted in the last 12 months, with a recent UN report estimating that 1.4 million people have missed out on tuberculosis treatment during COVID-19.
The challenge is, yet again, untangling the complexities of government actions vs disruption that is a consequence of the pandemic itself. Many of the worst-impacted countries in terms of tuberculosis detection are also those without long-lasting lockdowns. For example, tuberculosis screening has declined the most in Indonesia, a country famous for its lack of government intervention against COVID-19 throughout the pandemic.
The global economic situation is similarly complex. As I’ve written before, the International Monetary Fund has attempted to answer the question of whether lockdowns help or harm and concluded that it’s pretty hard to say. Some lockdowns probably have done economic damage, but some may have had overall benefits. It’s not as simple as we’d like it to be.
If there is anything that we can say for sure, it’s that there are no easy answers. This is true for almost every public health problem in the history of human existence, and COVID-19 is no different.
We know with some certainty that there is no immediate rise in deaths associated with government intervention, but that says little about the long-term impact. Yes, the massive waves of deaths predicted by some have failed to eventuate, but that does not mean that the long-term impacts will not be large.
It’s almost certain that COVID-19 control measures have harms. I wrote about this at the very start of the pandemic, and my opinion hasn’t changed — there are costs (albeit, sometimes minimal ones) to any intervention, be they lockdowns, school closures, or even just testing more people.
That being said, there are also harms to not intervening. Often, these harms intertwine, because the problems caused by an overwhelmed healthcare system bleed into many of the same places that government orders to shut down society do. It is immensely difficult to accurately differentiate damage caused by government interventions and that caused by the pandemic itself.
Ultimately, the only thing we can be really sure of is that anyone perfectly confident about their opinion is probably wrong. If someone says that lockdowns definitely do hurt people overall, or that they definitely don’t, they’re expressing certainty where none exists.
Public health exists in shades of grey.
So what are the negative effects of lockdowns for COVID-19?
As with many things, it depends.