The health impacts of lockdowns caused by COVID-19 are not as harmful as the impact of the pandemic itself, according to an analysis published today.
Writing in today’s BMJ Global Health, an international team of doctors examined the impacts of lockdowns on mortality, routine health services, global health programs, and suicide and mental health, to establish if government interventions or the lethality and infectiousness of SARS-CoV-2 are to blame for negative health consequences.
They conclude that although it is “challenging” to determine, “it is unlikely that government interventions have been worse than the pandemic itself in most situations”.
Looking at excess mortality statistics, the authors suggest that lockdowns are not associated with large numbers of deaths in countries such as Australia and New Zealand, which avoided large COVID-19 epidemics.
However, countries with few COVID-19 restrictions, such as Brazil, Sweden, Russia, and at times certain parts of the USA, have had large numbers of excess deaths throughout the pandemic.
“What is clear is that locations that locked down without experiencing large epidemics of COVID-19 (e.g. Australia, New Zealand) did not have large numbers of excess deaths, which provides strong evidence that lockdowns themselves are not sufficient to cause such surges in deaths,” the authors say.
Looking at reduced access to and use of healthcare services, the authors say while there has been a reduction in attendance for vital non-COVID health services during lockdowns, “it is yet again challenging to disentangle whether the association relates to restrictions intended to prevent COVID-19 cases or the epidemic itself”.
They suggest the association may be related to lack of capacity of healthcare services during the pandemic, redeployment of healthcare staff and facilities to managing COVID-19 patients, or the public staying away from hospitals for fear of becoming infected by SARS-CoV2.
Data from England and Australia show emergency department activity was suppressed weeks before stay-at-home orders were implemented and remained suppressed well after they were lifted.
There is also robust evidence that government interventions to control COVID-19 have not been associated with increased deaths from suicide, but there is evidence that mental health has declined in the population since the onset of the pandemic and the authors again say it is “extremely challenging” to ascertain whether or not these declines were caused by government interventions or driven by the pandemic itself.
They also point out that the equally important link between large-scale COVID-19 outbreaks and depression and anxiety is often overlooked.
Global health programmes in low- and middle-income countries have been severely impacted by the pandemic: 80% of HIV programs and 75% of TB programs have reported disruption to their services, and by May 2020, childhood vaccination campaigns had been disrupted in 68 countries.
These disruptions have been caused by multiple complex direct and indirect consequences of COVID-19, not just stay-at-home orders, the authors write.
They say stringent control measures aimed at reducing disease mortality and morbidity will be accompanied by negative consequences in many sectors of the economy.
“These harms are real, multifaceted and potentially long term, and are therefore an important factor for policy makers to consider when choosing which intervention packages to implement,” they say.
“It is often extremely difficult to separate the potential impacts of ‘lockdowns’ from those of the pandemic itself.
“Often the most that it is possible to say is that there are harms associated with both large COVID-19 outbreaks and government interventions to prevent the disease. The causal relationships are, unfortunately, extremely difficult to untangle.
“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 minimise the impact of both.”
Meyerowitz-Katz G, Bhatt S, Ratmann O et al. Is the cure really worse than the disease? A narrative review of the health impacts of lockdowns during COVID-19. BMJ Global Health 20 July 2021
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