July 21, 2021 -- Lockdowns imposed during the pandemic undoubtedly are linked with harms to health, but the level of impact is unlikely to be worse than the health effects of COVID-19, according to an international team who reviewed the evidence globally.

Findings that conclude government restrictions are "far less damaging
than some have suggested" were published online July 19 in BMJ Global Health.

Researchers led by Gideon Meyerowitz-Katz, an epidemiologist and PhD candidate from the University of Wollongong in New South Wales, Australia, analyzed the effect of lockdowns on mortality rates, use of routine health services, global health programs, suicide, and mental health to try to determine whether government restrictions or SARS-CoV-2, the novel coronavirus, are to blame for harms to health.

They used data from the World Mortality Dataset, the largest international databank for all-cause mortality, which includes data updated through to mid-2021 from 94 countries that have imposed and not imposed COVID-19 restrictions.

The authors acknowledged that measuring the harms of lockdowns versus no lockdowns and untangling the causes of harm is "challenging."

That said, "The fact that there are no locations anywhere in the world where a lockdown without large numbers of COVID-19 cases was associated with large numbers of excess deaths shows quite convincingly that the interventions themselves cannot be worse than large COVID-19 outbreaks, at least in the short term,” they wrote, using Australia and New Zealand as examples.

Conversely, locations with few COVID-19 restrictions, such as Brazil, Sweden, Russia, and some parts of the United States, have had large numbers of excess deaths at various points throughout the pandemic.

John Swartzberg, MD, professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley, says the article makes the case that "the cure is not worse than the disease."

He points out that the review findings help dispute claims of the Great Barrington Declaration, an anti-lockdown movement he says is "dangerous" in light of the benefits lockdowns or government restrictions have demonstrated.

The current article has limitations in terms of the inconsistent accuracy of how data are recorded globally, Swartzberg says.

"But [the researchers] used the best source available and their analysis of that data based upon the best source is sound," he says noting the methodology does not compare with a randomized, double-blind controlled study.

He points out that his city of San Francisco was the first large metropolitan area in the United States to lock down, and the city "has had fewer deaths than any other part of the country."

In some ways, lockdowns have reduced expected mortality, say Meyerowitz-Katz and colleaguesThe World Mortality Dataset, for instance, shows that countries with concerted restrictions may have reduced yearly deaths "by 3%–6% from eliminating influenza transmission alone."

Benefits of Lockdowns

In addition to the reduction of flu and auto accidents when people stay home, Swartzberg says the authors could have included the potential for fewer pollution-related illnesses and death as well.

"There are some terrible downsides to a lockdown — psychological, fiscal. There's no question," Swartzberg says. "But I think they pale in the face of consequences of not locking down. Look at the U.S.: We're the world leader in number of deaths and a lot of this has occurred in areas that didn't follow lockdowns very well."

The world has learned much about how to impose government restrictions more effectively, just as more has become clear about mask wearing and aerosol spread, he notes.

Proper use of restrictions will be important once again as the Delta variant numbers rise and more restrictions become likely, Swartzberg says.

One common claim is that lockdowns have resulted in decreased use of healthcare services. But the authors suggest that lower use of services is more likely attributable to lack of capacity of the healthcare system to handle both COVID and non-COVID populations and patients staying away for fear they would become infected with the virus.

The authors cite data from England and Australia that show emergency department visits were down weeks before stay-at-home orders were issued and stayed low after they were lifted.

Lockdowns Have Not Increased Suicide Rates

Although evidence has shown that COVID-19 restrictions by the government have not increased suicide rates, there has been a widespread decline in mental health during the pandemic. But the causes of the mental health decline are difficult to untangle.

The researchers note that suicide rates have increased in Japan, but that has been found to be associated with unemployment which occurred well after the government had lifted restrictions.

"While the relationship between mental health and lockdowns is commonly discussed, the equally important link between large-scale COVID-19 outbreaks and depression and anxiety is often overlooked," the authors wrote.

For instance, missing school affects children's mental health, but so does losing a loved one to COVID.

The authors cite a study that estimates 43,000 children in the U.S. have lost a parent to COVID-19 and 2 million children have lost at least one grandparent.

David Dowdy, MD, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, says he agrees that in the narrow scope of health effects of lockdowns, the harms are not worse than those of COVID-19.

But what's missing, he says, are all of the effects, including negative effects on economic well-being, privacy intrusions with contact tracing, and even potential lack of access to necessities, including food, when transportation shuts down.

"Without access to transportation, some people can't get to the market to get food, and the people selling the food can't get to the market. That can have major impact on people's well-being — disproportionately on the people who have the fewest resources to start with," Dowdy says. "I don't think you get a full picture of the impact of lockdowns just by looking at impacts on mortality, for example.”

The authors emphasized that this article's conclusion is not that lockdowns don't cause harm.

Rather, "The reality is that whether lockdowns and other government interventions have a net benefit is a challenging question which requires evaluating social, economic,
and health aspects," they wrote. "Furthermore, the question poses a false dichotomy. Governments were not faced with the choice between the harms of lockdown and the harms of COVID-19, but rather sought to find the means to [minimize] the impact of both."