Lockdown Lunacies
National Review Online, September 25, 2020
COVID-19 is again advancing in Europe, “despite” (I will get to those scare quotes later) earlier lockdowns.
European countries are likely to impose more restrictions on public life in the coming days as the number of daily coronavirus infections rises rapidly, analysts said.
France reported 10,569 new cases Sunday (down from more than 13,000 new cases reported the day before), Reuters reported, while the U.K. reported almost 4,000 new cases on Sunday. Italy saw close to 1,000 new infections and Germany reported 1,345 new cases Sunday, and a further 922 cases Monday. Spain has yet to post its weekend case tallies, but reported almost 4,700 new cases Friday.
On Monday, German Health Minister Jens Spahn said rising coronavirus infection numbers in countries like France, Austria and the Netherlands were “worrying” and that Germany would sooner or later import cases from there, Reuters reported. He added that countries like Spain had infection dynamics “that are likely out of control.”
“Despite” because the initial lockdowns were never going to suppress the virus, not in the longer term.
Nevertheless, they were easy enough to defend — for a short time. We knew a lot less about COVID-19 then. And there was also an understandable fear that health-care systems would be overrun. The idea was to buy time to flatten the curve, not to eradicate the virus. In the absence of a vaccine, there was no chance that COVID-19 would simply go away. A lockdown could postpone the spread of the disease, but it could never have been sustained for long enough to have any chance of reducing it to, at most, a nuisance, without destroying the economy. Rather, prolonging lockdowns kept the virus at bay for long enough to ensure that its recurrence would coincide with the onset of flu season and trashed the economy while it was at it. And the cost must be calculated in more than dollars.
To take one example (from Statnews):
The director of the National Cancer Institute believes the Covid-19 pandemic is posing a danger to cancer patients across a wide spectrum of care and research. People — and their health care providers — are postponing screening measures like mammograms and colonoscopies. Fewer cancers are being diagnosed, and treatment regimens are being stretched out into less frequent encounters. Clinical trials have seen patient enrollment plummet.
An NCI model looking just at breast cancer and colorectal cancer predicts there will be 10,000 excess deaths in the U.S. over the next 10 years because of pandemic-related delays in diagnosing and treating these tumors. That’s about a 1% increase over the number of expected deaths during that time span, with most of the rise coming in the next two years. And that assumes cancer care depressed by the coronavirus rebounds after six months.
One (very) mild consolation is that behavioral changes brought on by the coronavirus may also slow down the seasonal spread of the flu this winter.
While brief, early lockdowns could be justified; what should have been done thereafter was devising protocols to live “with” the virus, combining more modest restrictions, focused above all on the most vulnerable, with extensive test-and-trace programs on the South Korean and German models, all the time remembering that (as Germany is now demonstrating) the latter is no panacea.
Instead the U.K. (but not just the U.K.) reinforced panic-mongering with coercion — lockdowns that were too late, too prolonged, and too draconian. Making matters even worse was the way the residents of care or nursing homes were treated, and again, not just in the U.K. Infamously, New York State sent recovering COVID-19 patients to nursing homes, with predictably disastrous consequences. For its part, Sweden was reluctant to dispatch care-home residents for hospital treatment, something that undoubtedly contributed to the higher death rate seen there (particularly when compared with its Nordic neighbors, a number that may have been further boosted — the ”dry tinder” thesis — by lower rates of flu in Sweden than elsewhere in the region in the immediately preceding years), and thus provided ammunition to those who were either genuinely opposed to Sweden’s less heavy-handed approach (which, incidentally, owed quite a bit to protections contained in the country’s constitution) or fearful that its success might represent a massive political embarrassment.
Sweden is Sweden, a society that still operates in an unusually cooperative manner. What worked in Sweden — low levels of compulsion combined with high compliance with advisory guidelines — would not work everywhere. Nevertheless, its record bears examining even if the Swedish authorities have stressed that their methods cannot be properly assessed until the end of the pandemic, an argument that implicitly rests on whether Sweden avoids a significant second wave.
This (from Sweden’s The Local) is worth noting:
One of Denmark’s most prominent epidemiology researchers has said that the coronavirus pandemic in Sweden “may be finished” due to immunity in the population, even through [sic] the country remains far from the classic 60 percent threshold.
“There are indications that the Swedes have gained an element of immunity to the disease, which, together with everything else they are doing to prevent the infection from spreading, is enough to keep the disease down,” Kim Sneppen, professor of biocomplexity at the Niels Bohr Institute in Copenhagen, told the Politiken newspaper.
According to figures collated by OurWorldinData, Sweden on Friday had registered a daily average of 23 cases per million people over the the [sic] preceding seven days, compared to 61 cases in Denmark and 20 in Norway.
Sneppen acknowledged, however, that the country had suffered a much higher death rate in April, May and June than that seen in Denmark.
“That is what they have paid. On the positive side, they may now be finished with the epidemic.”
Such optimism may yet be shown to be premature. There has recently been an uptick of cases in Stockholm, and Sweden’s chief epidemiologist has talked about a possible need for additional measures to be taken in response. Stockholm’s health-care director clearly does not agree that the country is “finished” with the epidemic, commenting (Bloomberg reported) that “the pandemic is still ongoing, and I am pretty exasperated by people who act as if this is over.”
That said, Stockholm currently has 27 coronavirus patients being treated in the region’s hospitals, compared with a peak of 1,100 in April.
Back to The Local:
At a press conference on Tuesday, Denmark’s state epidemiologist Kåre Mølbak warned that Denmark was still in the “first wave of infection” because the wave in the spring did not have time to “develop completely because we went into hibernation.”
Where “hibernation” means lockdown, a state that Denmark had entered early.
And speaking of Sweden and Denmark, here is Wolfgang Münchau, writing in the Financial Times on September 13:
The infection rate in Sweden also showed strong geographical variation. Most of the Swedish cases were concentrated in two regions, including Stockholm. Meanwhile, the southern Swedish city Malmö is close to the Danish capital, Copenhagen, separated by the narrow Oresund Strait. Malmö’s rates look good by comparison with Copenhagen, even though the two operated under different lockdown regimes.
I don’t know why regional gaps were so strong, and my interlocutors in Sweden do not either. If you want to make grand pronouncements about Swedish lockdown policies and infection rates, you should probably make an effort to understand this first.
Policy in times of Covid-19 amounts to decision-making under extreme uncertainty. The latest Swedish numbers do not prove or disprove anything. But before policymakers order something as extreme as another lockdown, they should have had incontrovertible statistical evidence, not just a bunch of numbers that feed their confirmation bias. As long as statistical doubt persists, we certainly do not want to do this twice.
We certainly do not want to do this twice.
And yet that may well be where some countries are headed. In the past week or so, the U.K. has introduced a series of coercive measures, including restricting gatherings, whether inside or outdoors, to six people, and instituted mandatory closing at 10 p.m. for pubs, restaurants, and other such dens of iniquity.
As the BBC explained, this may not seem like much of an imposition, “but the hospitality industry is warning it will have [a] devastating impact”:
“People have this vision, it’s just a few blokes standing at a bar at 10.30. What does it matter?” says Oliver Vaulkhard, who runs venues across north east England. “10 o’clock doesn’t sound dreadful, but it does halve your revenue,” he said. . . .
Businesses must also ensure customers are served at tables of no more than six and groups are not permitted to mingle.
Making matters worse was the U.K. government’s reversal of its earlier encouragement to abandon working from home, something that British workers have been unwilling to do. A survey at the end of August found that the return-to-office rate there was running at less than half that in other major European countries.
What is more, the government’s new measures will last for a while: “Unless we palpably make progress,” said Prime Minister Boris Johnson, “we should assume that the restrictions I’ve announced will remain in place for, perhaps, six months.”
Six months.
Quite what “progress” means is anyone’s guess, given the way that word has been redefined. Flattening the curve one week, stamping out the virus the next?
Business groups have been dismayed. The Confederation of British Industry (CBI) described it as a “crushing” blow, and it is yet more bad news for beleaguered city centers, London’s most of all.
While this is not (yet — Johnson has warned that “if people don’t follow the rules we have set out, then we must reserve the right to go further”) a rerun of the U.K.’s tougher strategy from earlier this year, the British government has still failed to grasp the implications of its first lockdown’s longer-term failure: “Insanity,” as Albert Einstein didn’t actually say, “is doing the same thing over and over again and expecting different results.”
Nor, for that matter, does Britain’s governing Conservative Party appear to have fully thought through how devastating the damage identified by the CBI might be. March’s lockdown came at enormous cost, but the economy was much healthier then than it is now. The economy is not in a good position to handle a second lockdown, even if it is (for now) less extensive than before. And that is before considering the blow that might be coming from failure to reach an agreement with the EU over a new trading relationship when the Brexit transition period expires at year-end.
The U.K. may not be alone in its woes. As noted above, CNBC was reporting on Monday about expectations of renewed restrictions in continental Europe. How severe such controls may turn out to be is unclear, but it is not encouraging to read that the Spanish government has requested the army’s help in enforcing a coronavirus lockdown imposed in some parts of Madrid. Johnson too has talked about using the army, albeit in a backup role.
In his Financial Times article, Münchau warned that “the lockdown reflex [is] currently the biggest threat to western capitalist democracies.” He is not wrong about that, and not just because of the possibility of troops on the streets. To believe that the widespread civil disorder on both sides of the Atlantic this summer was not made worse by the lockdowns would take remarkable naïveté.
Not to pile on, but Spain too (like many other continental European countries) had gone through an onerous lockdown in the pandemic’s earlier stages. When Ildefonso Hernández, a professor of public health, argued that Spain “had a very strict lockdown, then relaxed this too quickly in a country with a high propensity to socialize and for family networks to stay very close,” there were echoes of the claim that it cannot be said that communism doesn’t work, because it has never really been tried. It is long past time to face the fact that hard national lockdowns are not the answer.
This is not to say that nothing should be done. Moderate restrictions, as well as guidance on issues such as social distancing, can play a part: We are not a self-destructive species. People should get a flu shot (I have) so as to reduce the risk of double attack from both flu and COVID-19. Even if bars were to reopen (inside) in New York City, I would — as someone in his early sixties — give them a miss for now. We also know (or, at least, hope) that there are various pills that we can be popping prophylactically, from zinc to, perhaps, amusingly, nicotine tablets (bleach, alas, is not going to do the trick). Wash your hands! Mask-wearing also, to me, seems like a small thing to ask, if more (absent N-95s) as a matter of reducing the risk to others than of protecting oneself. And, yes, I can see the case, on occasions, for local lockdowns, something that the Swedes now seem prepared to countenance, on a very narrowly defined basis
As mentioned above, more emphasis should be placed on targeting the truly vulnerable. We also need to do a better job of remembering that the calculation of risk and reward is forever shifting. Thus, shutting down the economy in October would be even more destructive than it was six months ago. On the other hand, while COVID-19 remains, for some, a potentially highly dangerous disease, we should also bear in mind that we know somewhat more now how to treat it. While not too much should be made of data showing better rates of recovery (which can be partly explained by improved testing picking up milder cases) they do offer some grounds for hope.
But all too often, neither these changes nor these lessons have registered. Commenting on the behavior of the Bourbons on their return to France after the fall of Napoleon, Talleyrand is said to have commented that “they have learned nothing and forgotten nothing.” I wonder what he would have made of this tweet on Wednesday morning by Matt Hancock, Britain’s hapless health minister, in support of his government’s six-month standstill:
We must act to suppress this virus — while protecting our economy & education — until a vaccine, or mass testing, is ready.
“Waiting for a vaccine” is not a strategy; it is an evasion, a flight from decision. The reference to “mass testing” is presumably a nod to Johnson’s “Operation Moonshot,” a plan, as the Washington Post put it, “to test 10 million Brits every single day, or everyone in the country every week, at a cost of $130 billion. That $130 billion (a number calculated on a somewhat mysterious basis) isn’t chump change, but there’s a suspicion that the moonshot may be based on chump science. As the Post also notes:
The Moonshot planning documents acknowledge: “Delivering testing at the scale and level of ambition set by the prime minister is likely to mean developing, validating, procuring, and operationalizing testing technology that currently does not exist.”
Oh.
The Post continues:
As [Johnson] tells it, by early 2021, new “simple, quick and scalable” tests using saliva or nasal swabs would deliver results while you wait, in as little as 20 minutes.
Early 2021.
But the U.S. is by no means immune to this sort of thinking. In early August, Neel Kashkari, the president of the Federal Reserve Bank of Minneapolis, and the rather more qualified Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, wrote an op-ed for the New York Times, which began as follows:
In just weeks we could almost stop the viral fire that has swept across this country over the past six months and continues to rage out of control. It will require sacrifice but save many thousands of lives.
We believe the choice is clear. We can continue to allow the coronavirus to spread rapidly throughout the country or we can commit to a more restrictive lockdown, state by state, for up to six weeks to crush the spread of the virus to less than one new case per 100,000 people per day.
At that point, they maintained, “we will be able to limit the increase in new cases through aggressive public health measures, just as other countries have done.”
The resurgence of the virus in Europe got going just a few weeks later.
Then there was Joe Biden, speaking toward the end of last month.
Democratic presidential nominee Joe Biden said he would do “whatever it takes” to combat the spread of coronavirus within the country — including locking down the U.S. if deemed necessary.
“I would shut it down; I would listen to the scientists,” Biden told ABC’s David Muir in a joint interview with his running mate, Sen. Kamala Harris, to air Sunday. “We’re going to do whatever it takes to save lives.”
President Biden would, of course, be right to “listen to the scientists,” but he cannot cower behind them, which is what his words appear to imply. And “doing whatever it takes to save lives” is a formulation that seems to include very little recognition of the cost in lives, whether directly or indirectly, that another lockdown would bring, whether it is from the neglected treatment of other diseases or as a consequence of the devastation that such a lockdown would bring to an already battered economy and an already fraying society, devastation that would bring ruin to millions of livelihoods, and thus lives, ruin that would not just be financial.
And all in the pursuit of a policy that has been shown not to work.