At the time of writing, the world is starting to emerge from the self-imposed social distancing measures implemented in response to the COVID-19. Countries all over Europe are starting to revert back to a life that was once thought gone when COVID-19 was declared a worldwide pandemic by WHO in March, with cafes sprawling with visitors in masks, soccer leagues such as Spain’s La Liga, Italy’s Serie A, and England’s Premier League resuming play, and a general sense of optimism that Europe may have finally left the worst of the pandemic behind them, with the latest data indicating declining rates of cases. In the United States, however, the consequences of the pandemic have become increasingly regionalized, with the epicenter arguably moving away from the Northeast where New York, Connecticut and New Jersey enjoying consecutive months of declining cases and hospitalizations while the South and the West surge, with Florida, Texas and Arizona seeing the biggest surge in cases on what was an overall record breaking day for cases reported in the United States on June 25th.
While Europe enjoys flatter curves and a return to the “new normal”, the United States continues to treat the coronavirus as a political issue rather than an epidemiological one devoid of partisanship, with lockdowns sparking debates over individual rights and freedoms versus a collective responsibility to protect our fellow citizens from health risks. The virus has become embroiled in a political discourse, becoming attached to President Donald Trump and his administration, and creating divides among the electorate of the United States. Yet despite the politicization of COVID-19, the data concludes that there is one simple conclusion about the results of lockdowns: they worked. Despite this, opponents of lockdowns have pointed to the need to gain herd immunity by letting the virus run its natural course through the population, citing the failed approach Sweden employed, while others dismiss the health impacts and the human costs of the virus, suggesting the virus is no different to a seasonal flu and that lockdowns were an overreaction to just another flu season. In this article, I will use the data available to dismiss these two arguments, an ultimately offer a comprehensive defense of why lockdowns have worked.
“Coronavirus is just the flu”
Except it isn’t and I’m not sure why this argument is still circulating. At this point, it is a dangerous slew of false information that encourages negative behavior against the effort to contain COVID-19 but I will still spend some time addressing it.
First, and most importantly, there is a vaccine for the flu while one for COVID-19 is at least a year away. That means people can become immune to the flu without contracting symptoms and, ultimately, avoid hospitalizations. When enough people get the vaccine, the flu loses hosts to spread effectively through a population, thus protecting people who are not immune to the latest strain of the virus. This is called herd immunity (keep this term in mind, it will be important later). Without a vaccine, the only way to achieve herd immunity against COVID-19 would be to let the virus spread throughout the population and have people build antibodies by naturally fighting off the infection, leading to symptoms which could potentially overwhelm ICU units and ventilator supplies in hospitals if too many infections happen at one time, which lockdowns were designed to prevent by controlling the rate of spread of COVID-19.
Second, the data just does not support the conclusion that COVID-19 is even comparable to the flu. During the 2017-2018 flu season in the United States, a particularly deadly flu season, there were 44,802,609 cases in the United States of the flu that year, resulting in 61,099 deaths, a 0.14% mortality rate. Meanwhile, there have been 2,552,920 cases of COVID-19 in the United States as of the time of writing, resulting in 127,419 deaths, a 4.9% mortality rate. Coronavirus is also more contagious than the flu, with it boasting a contagion factor of 2 to 2.5 (for every one person with the virus, they will spread it to two or three people) while the flu has a contagion factor of just .9 to 2 (for every one person with he flu, they will spread it to one or two people).
In short, the data depicts the profile of the coronavirus being far deadlier and contagious than the flu and the impacts of the coronavirus are further compounded in the absence of a vaccine, with the externalities threatening to overwhelm healthcare systems and impending their ability to effectively treat patients. Lockdowns, through limiting the spread of the virus, helped hospitals stay just barely below the limits of their capacity to treat patients and, inadvertently, saved lives. To continue to compare COVID-19 to the flu is to be willfully ignorant of the data at hand and encourages dangerous behaviors that threaten to undo all the good work lockdowns have done as the data shows that the potency of the virus was necessary to institute them in the first place.
“We must allow the virus to spread to achieve herd immunity”
In theory, this could work, except there are multiple unknown variables that exist that could turn this into a deadly mistake. First, there is no evidence that immunity from the coronavirus is lifelong. While the there is evidence that antibodies are produced after contracting COVID-19, scientists still have no idea how long those antibodies will last. In a world without a vaccine, the only way to achieve herd immunity is through natural infection of the virus. However, without lifelong immunity against the virus, this strategy may at most confer a few years of immunity for a community, though even if the immunity to the virus was somehow lifelong, the human costs accumulated in the meantime would be massive.
So just how big would those costs be? Well, thanks to the data we have, we can calculate just how many deaths we would have for the United States to achieve herd immunity. While most scholars agree the threshold to achieve herd immunity for a population for COVID-19 is between 70-80%, a recent study from the University of Nottingham suggests the threshold could be lower, ranging from 43-60%. For the sake of playing devil’s advocate, let us take the lowest possible figure available, which is 43%. The current United States population is estimated to be 328,200,000 people. To estimate how many cases we would need to achieve herd immunity, all we need to do is figure out what number 43% of the population is, which would be 141,126,000 cases. Now, since we know the current mortality rate for COVID-19 in the United States is 4.9%, we can estimate that, if we have a total of 141,126,000 cases of COVID-19 and the mortality rate stays constant, we would have about 6,915,174 deaths as a result, and that doesn’t even take into account healthcare systems becoming overwhelmed due to uncheck spread and infections of the virus. Keep in mind, this is using the lowest possible threshold estimation available and it still would result in the unnecessary deaths of millions.
Even if these hypotheticals are not enough to disprove the dangerous folly of the herd immunity strategy, we can look at the failure of Sweden and the strategy employed by their head epidemiologist, Dr. Anders Tengell. While most countries across Europe imposed Draconian lockdown measures, Sweden allowed for most sectors of their lives to remain open, with bars, cafes, and even schools allowed to stay open. The results were devastating for Sweden. Compared to their Scandinavian neighbors, Sweden reported 39.57 deaths per 100,000 residents, while Norway and Finland, who instituted much stricter lockdown measures, reported fewer than 6 deaths per 100,000 residents. Despite all of this, an antibody survey conducted in Stockholm found that only 7.5% of the population in Stockholm had antibodies for the coronavirus, a far cry from even the lowest threshold of 43% needed to achieve herd immunity. While lockdowns have allowed for other European countries to begin resuming life, Sweden’s failure shows that chasing after the folly of herd immunity through natural infection creates unnecessary deaths for little payoffs and only ends up delaying the return to the “new normal”, which was the ultimate goal of the lockdown.
So why do lockdowns work?
The answer is simple really and has been alluded to multiple times already through the course of this article. Lockdowns slow down the spread of the virus through limiting human traffic and activity, allowing for hospitals to replenish supplies and effectively treat patients below capacity, all the while limiting deaths and buying time to develop a vaccine.
To further illustrate exactly how lockdowns worked, it is necessary to understand exactly how COVID-19 spread. Studies have shown that in local communities, 80% of COVID-19 infections were spread by only 20% of people infected with the virus. In other words, even though coronavirus itself is highly contagious, it thrives mostly through a few “superspreaders” or people who are asymptomatic or pre-symptomatic (yes, there is a difference) that typically interact with large amounts of people per day in highly confined spaces. By closing businesses and restricting the movement of people to all but essential workers, lockdowns were necessary to prevent “superspreaders” by restricting the activities they can do and thus limit the amount of people they can come into contact with to potentially spread the virus. Once the number of active cases begin to decline, it becomes possible to slowly allow people to re-enter society in a controlled fashion as seen in the success of the phased reopenings seen in Connecticut, New Jersey and New York compared to the failures of Florida, Texas and Arizona who reopened all sectors of their economy at once, allowing for the virus to once again spread unchecked due to the potential of multiple “superspreaders” which have caused these states to pause their reopenings. While the process itself is painful, it is clear that lockdowns were the necessary to return to the new normal, and the latest data of Florida and Texas compared to the Northeast shows just how important it is to have informed policymaking to dictate the pace of states’ reopenings to become further closer to the “new normal”.
The New Normal
So, what is the new normal then? I have thrown this phrase around but have not properly defined it. To put it simply, the new normal is an acknowledgement that, while it may be possible for us to reclaim most of our normal lives and routines that were lost during the start of the coronavirus pandemic, there are new adaptations and procedures that will stick with us long after states ease their restrictions.
For one, we can expect to wear masks in public for a long time. Recent studies have shown that face masks by 0.9% five days after mandates to wear them and a full 2% after three weeks. As businesses continue to adapt their social distancing policies, it is becoming increasingly common for them to mandate their own mask-wearing polices as they just may be the key to slowing down the spread of COVID-19 while allowing for society to slowly reopen. So while it may be weird to have to wear a mask when visiting the movies or going bowling with friends, until a vaccine is found, this may be the “new normal” we may all have to embrace as we slowly emerge from our lockdowns.