Professor of Global Health & Public Policy @DukeU. Director, Center for Policy Impact in Global Health. TIME magazine columnist. DJ @wxdu. Views are my own
The smiley faces, cherry blossoms, Great Barrington Declaration fans, "natural herd immunity" enthusiasts & anti-maskers do not approve of our new @GlobalHealthBMJ analysis on lockdowns 😉
So, here's a long-ish thread on what we did & did not find 1/n
Why did we do this analysis?
Some folks claim that the death toll from public health measures has been greater than the death toll from COVID-19 itself (they say 'the cure is worse than the disease').
We wanted to see if there was evidence for their claim.
We state clearly there can be negative consequences of measures such as stay-at-home orders.
Governments were faced with a deadly pandemic. Measures were needed to curb infection, illness, disability (long COVID) & death. They had to balance these harms vs harms of lockdowns 3/n
What we do in our paper is to ask: can we find evidence for the bold assertion that excess mortality from lockdowns was greater than excess mortality from Covid itself?
Excess mortality is mortality greater than the anticipated modeled number of deaths given existing trends. 4/n
We did not find evidence for such an assertion.
We state: "Careful analysis of excess mortality suggests that lockdowns are not associated with large numbers
of deaths in places that avoided large COVID-19 epidemics (eg, Australia, New Zealand)."
Conversely, we note that "places with few COVID-19
restrictions such as Brazil, Sweden, Russia or at times
certain parts of the USA have had large numbers of
excess deaths throughout the pandemic."
The high excess mortality in countries with few restrictions (or less voluntary behaviour change) isn't
surprising given the high infectiousness and fatality
rate of COVID-19 (e.g. see what happened in Manaus, Brazil).
In fall & winter 2020, the United States did not impose highly restrictive sets of non-pharmaceutical
interventions ("lockdowns") to contain SARS-CoV-
2 spread. And indeed "COVID-19 became the leading cause of death in the USA for several months in late 2020 and early 2021." 10/n
1⃣ Service disruption has clearly occurred. Health professionals & services were redirected to management of huge numbers of patients with Covid. Hospitals were often overwhelmed. Services for non-Covid illnesses were disrupted.
Some folks assert that lockdowns themselves are the sole reason for reduced access to & use of healthcare services during Covid. However, we looked at the available evidence to date; we found it does not reliably nor consistently support this assertion. 13/n
There's also evidence that "people fear becoming infected by SARS-CoV-2 in healthcare settings and
thus stay home rather than attend health services"
See references 13, 14, & 15 in our paper (showing avoidance of accident and emergency services during NON lockdown periods) 14/n
"There is consistent and robust evidence from many countries that government interventions to control COVID-19 have not been associated with increased deaths from suicide."
We see no evidence of a global "tsunami" of suicides due to lockdowns in 2020.
3⃣Global health programs:
We know there has been disruption in services for HIV, TB, malaria, & child vaccination programs (our team @DukeCPIGH led a recent paper on this topic: journals.plos.org/plosmedicine/a…
@DukeCPIGH ...Brazil, India and S Africa have seen huge waves
of COVID-19 that have put enormous strain on
their health systems & disrupted non-COVID
In nations with a high burden of TB, at least 40% of national TB programs used TB facilities for the COVID-19 response. 17/n
Finally, I repeat: the harms of stringent control measures are real. We don't dispute these! We say they're "real, multifaceted, potentially long term, and are therefore an important factor for policymakers to consider when choosing which intervention packages to implement" 19/n
But it is very clear:
Government interventions have a very strong impact in reducing COVID-19 cases and deaths, & such public health measures have "become even more pertinent as new, more dangerous variants of the disease have emerged."
There *is* an "association between large outbreaks of COVID-19, government interventions & reductions in attendance for vital non-COVID health services." But the association may be related to lack of capacity of healthcare services or impacts of the pandemic itself. 14/n
@EpiEllie Oh, wow, that’s a big honor & very humbling. Pinging my GREAT co-authors, who will be as excited as I am: @GidMK @DrSamirBhatt @LeaMerone @ImperialMaths @JanMBrauner @flaxter @creswapi @MrinankSharma @sorenmind @valeriecbradley & Dr Michaela Vollmer at Imperial (not on Twitter)
@GidMK @EpiEllie @DrSamirBhatt @LeaMerone @ImperialMaths @JanMBrauner @flaxter @creswapi @MrinankSharma @sorenmind @valeriecbradley Or even compliment
(sorry, I couldn't resist, once an editor always an editor; edito ergo sum 😉)
Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email email@example.com he/him
New paper out in BMJ Global Health with a brilliant team of researchers on the health impacts of lockdowns
Long story short - lockdowns aren't ideal, but COVID-19 outbreaks are probably much worse 1/n
2/n What did we do in this paper?
It's a narrative review, so basically represents our knowledge and opinions about the topic, using all of the data that we could find ourselves pic.twitter.com/x72YPKQvgr
5/n Places WITH lockdowns but WITHOUT COVID-19 epidemics did not see excess deaths. There are numerous examples of this, and it largely invalidates the idea that lockdowns in and of themselves cause fatalities pic.twitter.com/sW7kB6jA2v
6/n Importantly, this DOES NOT MEAN that lockdowns necessarily prevented deaths, as comparisons such as the UK vs Sweden show, but that it is not consistent with the evidence to claim that lockdowns have large impacts on short-term mortality pic.twitter.com/UBfKZsvaCv
8/n To cut a long story short, the evidence for all of these is mixed. There's some data showing impact of government interventions. There's also data showing that large numbers of COVID-19 cases are bad as well
10/n That being said, there's also evidence that people dying from COVID-19 in large numbers is not, uh, ideal for mental health, and disentangling those two impacts is extraordinarily hard pic.twitter.com/9JRg7HQt8y
12/n If government interventions against COVID-19 work, then it's likely that they are beneficial on the whole. There may be lockdowns that have been both good and bad, and it will take us a long time to solve that riddle
13/n The bottom line is pretty simple really - all of this is far more complex than a simple yes/no. Rather than the tedious rhetoric of "lockdowns bad", we should be asking WHICH lockdowns were good/bad, and WHY
14/n All that being said, based on current best evidence we do not think it is possible to say definitively what harms lockdowns do have to health, but we can say that it is likely that these harms are not worse than the disease itself
Our new paper on lockdowns, led by @GidMK, just published in @GlobalHealthBMJ‼️
Lockdowns can cause harms. But critics go further, asserting “the cure is worse than the disease” (asserting deaths from lockdowns exceed deaths from Covid). We find no evidence for their assertion. twitter.com/GidMK/status/1…
"It appears clear from evidence to date that government interventions, even more restrictive ones such as stay-at-home orders, are beneficial in some circumstances and unlikely to be causing harms more extreme than the pandemic itself"
Interesting new paper, worth a look 👇 twitter.com/GidMK/status/1…
Excellent paper by @GidMK @GYamey and colleagues to dispel with the nonsense that lockdowns cause more harm than COVID. (Lockdowns DO cause harm btw).
Is the cure really worse than the disease? The health impacts of lockdowns during COVID. gh.bmj.com/content/6/8/e0…