Research and case studies have shown that lockdowns were generally effective at reducing the spread of COVID-19, therefore flattening the curve.[5][6][7] The World Health Organization's recommendation on lockdowns is that they should be very brief, short-term measures to reorganize, regroup, rebalance resources, and protect health workers who are exhausted.[citation needed] To achieve a balance between restrictions and normal life, the WHO recommends a response to the pandemic that consists of strict personal hygiene, effective contact tracing, and isolating when ill.[8][better source needed]
In addition to the health effects of lockdown restrictions,[9] researchers have found the lockdowns have reduced crime and violence by armed non-state actors, such as the Islamic State, and other terrorist groups.[10] They have also had profound negative economic impacts, and have been met with protests in some territories.
Efficacy
Several researchers, from modeling and demonstrated examples, have concluded that lockdowns were somewhat effective at reducing the spread of, and deaths caused by, COVID-19.[5][6][11][7][12][13][14][15][16] Lockdowns are thought to be most effective at containing or preventing COVID-19 community transmission, healthcare costs and deaths when implemented earlier, with greater stringency, and when not lifted too early.[17][18][19][20][21]
A study investigating the spread based on studies of the most common symptoms such as loss of taste and smell in France, Italy and the UK showed a marked decrease in new symptoms just a few days after the start of confinement on the countries (Italy and France) with the strongest lockdowns.[22] Modelling on the United States pandemic suggested "the pandemic would have been almost completely suppressed from significantly taking off if the lockdown measures were implemented two weeks earlier" and that the second wave would have been less severe had the lockdown lasted another two weeks.[17]
The stringent lockdown in Hubei in early 2020 proved effective at controlling the COVID-19 outbreak in China.[15][23] The relatively high number of cases and deaths in Sweden, which has kept much of its society open during the pandemic, when compared to its neighbours with comparable demographics Norway, Denmark and Finland that did enforce lockdowns, is thought to be at least partly attributable to this difference in policy.[24][25][26][27][28][29][30] Similarly, modelling on Australian data concluded that achieving zero community transmission through a strict lockdown lowers healthcare and economic costs compared to less stringent measures that allow transmission to continue, and warned that early relaxation of restrictions have greater costs.[19][20] This "zero community transmission" approach was adopted in Australia, and a strict four month lockdown in the state of Victoria during an outbreak in Melbourne, combined with other measures, averted a wider outbreak in the country in 2020.[31]New Zealand and Vietnam also adopted a "Zero-COVID" strategy throughout 2020 that included targeted lockdowns.[32][33]
The emergence of the highly transmissible SARS-CoV-2 Delta variant in 2021 has led some commentators to suggest that although lockdowns continue to reduce the spread of COVID-19, they have become less effective at containing it. Lockdowns in Australia and Vietnam in response to Delta outbreaks proved less effective at containment than previous lockdowns were against the spread of other variants.[34][35][36]
One study led by an economist at the University of Chicago found that involuntary lockdowns had little impact, with voluntary distancing making up nearly 90% of the fall in consumer traffic as people feared the virus itself.[37] Similarly, a National Bureau of Economic Research study found stay-at-home orders increased staying at home by just 5–10%.[38] Another study from Yale University found that most social distancing was voluntary, driven primarily by "media coverage of morbidity and mortality".[39]
On the other hand, some studies have argued[14][40] that coercive measures probably decreased interactions, while accepting that most of the reduction may have been voluntary. One of those two studies, by Flaxman et al., has been criticized, among other things for having a country-specific adjustment factor, without which the model would predict a massive number of deaths for Sweden.[41] One widely cited economic simulation asserting that shelter-in-place orders reduced total cases three-fold, however, held voluntary distancing constant.[42] Another study found a 30% difference among border-counties where stay-at-home orders were imposed.[43]
Another study that compared the impact of 'less restrictive interventions' on the spread of COVID-19 in Sweden and South Korea, with mandatory stay-at home orders in 8 other countries, such as France and Spain, did not find evidence for greater disease control in the countries with more restrictions.[44] However, the findings of the study have been questioned due to its numerous limitations, including the small sample size of countries.[45][46]
Some research has also found that an "advisory" approach is not adequate to control COVID-19 outbreaks. An analysis of an outbreak in northern Italy found that an effective reduction in community transmission occurred during a strict national lockdown, and that earlier less stringent measures were ineffective at reducing mobility to a level low enough to reduce the spread of COVID-19.[18]
Since the beginning of the pandemic, Google has consistently collected data on movements, showing rapid declines in public activity long before legal restrictions were imposed.[47] An April 2020 poll found that 93% of Americans voluntarily chose to only leave home when necessary, regardless of legal restrictions.[48]
Reception
A February 2021 review of 348 articles concluded there was acknowledgement of the importance of non-pharmaceutical interventions in controlling the spread of COVID-19.[7] However, later research also acknowledges high societal costs, though in some circumstances less than the costs of allowing the pandemic to spread without mitigation.[6][5][7]
Related to epidemiology
Epidemiological evidence supports generalized non-pharmaceutical interventions to curb the spread of COVID-19.[7][49][50][51]
During the early stages of the pandemic in Europe and the United States, statistical modeling which advised that restrictions were helpful to prevent a large number of deaths were used as the basis for lockdowns.[16] This includes an Imperial College projection, led by epidemiologist Neil Ferguson.[52] Despite some criticisms, academics defended the Imperial projection as fundamentally sound, while admitting the code was "a buggy mess".[53] Retrospective evaluation of lockdowns and computer modeling has verified that they have significantly contributed to reducing mortality and morbidity from COVID-19.[54]
A notable opponent of lockdowns has included Sweden's state epidemiologist Anders Tegnell, who has frequently criticised the strategy.[55][56] The Swedish government's approach has included minimal restrictions and has been controversial in part due to the relatively high death toll due to widespread transmission.[57][58] However, the Swedish government began considering enacting a lockdown in early 2021.[59][60]
While arguing in August 2020 for the need for further lockdowns in the United States, physicians Ranu Dhillon and Abraar Karan argued for "smarter lockdowns" that impose restrictions on areas with high levels of transmission, and to increase support to vulnerable populations in these locations to offset the economic costs.[61]
A number of medical experts signed the Great Barrington Declaration in October 2020 which called for "Focused Protection" on high risk groups and minimal restrictions on the general population to achieve herd immunity through COVID-19 infection. However, the majority of medical experts and the WHO have strongly criticised this proposed strategy for its lack of scientific basis and for being unethical.[50][62][63] The declaration has also attracted controversy over its funding and the authenticity of its signatures.[49][64]
Some researchers have noted that COVID-19 pandemic restrictions have come with mental health costs, compounded by those caused by the COVID-19 pandemic itself.[7][69][70][71][72]
Due to their closure, educational institutions worldwide transitioned to online learning. Teachers and faculty had to learn new ways to engage with students while in a COVID-19 pandemic. Examples of online teaching tools are podcasts, videos, and virtual classrooms.[73][better source needed]
UN Women warned in an April 2020 report that COVID-19 pandemic restrictions exacerbate gender inequalities and have led to an increase in domestic violence.[74] Many women were being forced to 'lockdown' at home with their abusers at the same time that services to support survivors are being disrupted or made inaccessible.[75] For instance, in France there was around a 30% spike in cases of since the lockdown in March 2020.[74]
Telehealth had an important role to allow physicians not to miss the follow-up of patients with different chronic diseases and potentially helped to contain SARS-CoV-2 spreading among both patients and healthcare providers [76] During the COVID-19 pandemic, video-communications became an easy-to-use quick-to-learn tool for many people, and the anxiety to contract COVID-19 could have counterbalanced some patients’ low level of trust in technology. For these reasons, most patients accepted to receive a video-consultation in spite of the traditional in-person visit and trusted telemedicine. [77]
Some economists supported increased government funding for mitigation efforts, even at the cost of tolerating a very large economic contraction.[78] They agreed that lockdowns should continue until the threat of resurgence has declined, even when considering only the economic impact.[79] There was a general agreement, at least in some economic circles, that "severe lockdowns — including closing non-essential businesses and strict limitations on people's movement — are likely to be better for the economy in the medium term than less aggressive measures".[80]
Both the World Food Programme (WFP) and the World Health Organization (WHO) have published statements noting the impact of the lockdowns on livelihoods and food security, and David Nabarro, WHO Special Envoy on COVID-19 stated in October 2020 that "lockdowns just have one consequence that you must never ever belittle, and that is making poor people an awful lot poorer".[81][82][83]
^Restrictions were further eased on the 1st of June 2021, however during the time between then and the 12th of May 2021, "Stay at home orders" were not active and hence this period didn't constitute what is internationally considered a "lockdown".
^ abStage 3 lockdown imposed on 8 July; Stage 4 lockdown imposed on 2 August 2020
^End-date of lockdown is subject to the vaccine rollout. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^All of Victoria except Melbourne, Greater Shepparton, Ballarat, Greater Geelong, Surf Coast Shire and Mitchell Shire
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^Applies for all others Regional NSW outside Greater Sydney, Hunter Region, Dubbo, Central West, South Coast, Goulburn, Queanbeyan-Palerang and Snowy Monaro
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^End-date of lockdown is subject to the vaccine rollout or 0 cases for 14 days. Restrictions are set to be eased when 70% of the eligible population has been vaccinated
^Initially to last until 13 April 2020, included closures of universities, schools, restaurants and other establishments, a ban on mass gatherings, suspension of sports competitions for more than two months, certain temporary restrictions on the free movement of citizens, but no strict "Stay at home order".[209] A number of lockdown measures were already eased or lifted in April[210] and May 2020.[211]
^Depending on the strictness of the definition for a lockdown; some sources such as Politico Europe consider it to have ended by 9 May, with a total duration of 57 days.[214]
^Closures of all educational institutions, restaurants and other establishments, a ban on most cultural events, all excursions and forms of group tourism, children forbidden to participate in organized sports events, no "Stay at home order", described as a "soft" or "partial" lockdown and officially entered into force at 23:30 on 27 November.[217]
^The lockdown was initially to end on 21 December 2020, but was subsequently extended until 31 January 2021, though with a few of the restrictions relaxed, such as children in kindergartens and in grades 1-4 being able to attend in-person classes from January 2021.
^Preceded by some measures on the regional level, no "Stay at home order".[220]
^A full third lockdown was declared from 30 December and was repeatedly extended.
^Lockdown was first started in Northern Italy on 8 March 2020, then expanded to the rest of Italy the following day
^The lockdown was suspended on 28, 29, 30 December 2020 and 4 January 2021
^Lockdown was started in the regions of Erongo and Khomas but effectively enforced countrywide. On 14 April the lockdown was extended to 4 May and to all of Namibia.
^Except in Cebu City only where it was extended to 16 days
^ abLockdown was extended to areas under high risk COVID-19 zones
^Lockdown was started in Metro Manila, but expanded to the rest of Luzon two days later, 17 March 2020
^In most Luzon areas only, except Metro Manila and selected areas of Luzon are on high risk COVID-19 zones
^Lockdown was extended to Metro Manila and remaining areas of Luzon
^Applies for mandatory holidays and further measures in each Russian region
^England has followed an incremental easing of restrictions since 8 March 2021. Most lockdown restrictions were lifted between March and June, July 19 is the date set for the expiry of most legal restrictions in England. Although some sources describe this date as the "end" of lockdown, March 28 was the date in which the "stay at home orders" were ended. This fits the most internationally accepted definition of what constitutes a lockdown.
^Most lockdown restrictions were lifted between March and June. March 13 was the date in which the "stay at home orders" were ended. This fits the most internationally accepted definition of what constitutes a lockdown.
Any measures which are voluntary rather than enforceable by law
The pandemic has resulted in the largest number of shutdowns/lockdowns worldwide at the same time in history.[522]
By 26 March, 1.7 billion people worldwide were under some form of lockdown,[523] which increased to 3.9 billion people by the first week of April – more than half of the world's population.[524][525] Lockdowns affect 93% of workers worldwide. 30% live in nations with complete workplace closures, save for critical businesses, and 42% in countries with partial closures. Nearly 20% live in nations with recommended but not compulsory workplace shutdown.[526]
Major restrictions first began in China,[527] with other countries in East Asia like Vietnam soon following it in implementing widespread containment measures. Much of Europe, North America and Africa took much longer to bring in tough measures. Lockdowns between and within nations are of varying stringency.[528]
By mid April, nearly 300 million people, or about 90 per cent of the population, were under some form of lockdown in the United States,[529] with around 100 million in the Philippines[530] and about 59 million in South Africa,[531] while around 1.3 billion were under lockdown in India, which was the largest of all lockdowns.[532][533]
By the end of April, around 300 million people were under lockdown in various countries of Europe, including but not limited to Italy, Spain, France, and the United Kingdom; while around 200 million people were under lockdown in Latin America.[530] In Germany, 35% of workers did work from home in addition to their regular on-site duties, while 26% did so exclusively.[534]
Variation by countries and territories
A drive through COVID-19 testing site in South Korea in February 2020. South Korea did not implement any lockdown measures; its K-Quarantine strategy included rapidly developing mass testing capacity and infrastructure.
Countries and territories around the world enforced lockdowns of varying stringency in response to the COVID-19 pandemic.
Some include total movement control while others have enforced restrictions based on time. In many cases, only essential businesses are allowed to remain open. Schools, universities and colleges have closed either on a nationwide or local basis in 63 countries, affecting approximately 47 percent of the world's student population.[535][536]
Beginning with the first lockdown in China's Hubei province[537] and nationwide in Italy in March, lockdowns continued to be implemented in many countries throughout 2020 and 2021. On 24 March 2020, the entire 1.3 billion population of India was ordered to stay at home during its lockdown, making it the largest of the pandemic.[538] The world's longest continuous lockdown lasting 234 days took place in Buenos Aires, Argentina in 2020. As of October 2021, the city of Melbourne, Australia, and certain cities in Peru and Chile spent the most cumulative days in lockdown over separate periods, although measures varied between these countries.[539][540]
^ abGrafton Q, Kompas T, Parslow J, Glass K, Banks E, Lokuge K (2 September 2020). "Health and economic effects of COVID-19 control in Australia: Modelling and quantifying the payoffs of hard versus soft lockdown". medRxiv10.1101/2020.08.31.20185587v1.
^Juranek S, Zoutman F (27 April 2020). "The Effect of Social Distancing Measures on Intensive Care Occupancy: Evidence on COVID-19 in Scandinavia". SSRN3588314.
^Baker MG, Wilson N, Anglemyer A (7 August 2020), "Successful Elimination of Covid-19 Transmission in New Zealand", New England Journal of Medicine (letter), 383 (8): e56, doi:10.1056/nejmc2025203, PMC7449141, PMID32767891
^Ferguson NM, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, Bhatia S, Boonyasiri A, Cucunubá Z, Cuomo-Dannenburg G, Dighe A, Dorigatti I, Fu H, Gaythorpe K, Green W, Hamlet A, Hinsley W, Okell LC, van Elsland S, Thompson H, Verity R, Volz E, Wang H, Wang Y, Walker PG, Walters C, Winskill P, Whittaker C, Donnelly CA, Riley S, Ghani AC (16 March 2020). "Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand"(PDF). Archived(PDF) from the original on 16 March 2020.
^Hincapié MA, Gallego JC, Gempeler A, Piñeros JA, Nasner D, Escobar MF. Implementation and Usefulness of Telemedicine During the COVID-19 Pandemic: A Scoping Review. J Prim Care Community Health. 2020 Jan-Dec;11:2150132720980612. doi: 10.1177/2150132720980612. PMID: 33300414; PMCID: PMC7734546.
^Costantino A, Noviello D, Mazza S, Berté R, Caprioli F, Vecchi M. Trust in telemedicine from IBD outpatients during the COVID-19 pandemic. Dig Liver Dis. 2021 Mar;53(3):291-294. doi: 10.1016/j.dld.2020.10.035. Epub 2020 Nov 5. PMID: 33187917; PMCID: PMC7644233.
^Fages VM (29 May 2020). "Here are 4 ways Viet Nam has managed to control COVID-19". World Economic Forum. Archived from the original on 31 May 2020. Retrieved 31 May 2020. Vietnam relied on four relatively cost-effective solutions to combat the virus, including strategic testing, contact tracing through apps and effective public communication campaigns. As well as these, it implemented a national lockdown between 1st and 22nd April.
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