[HN Gopher] Review and meta-analysis of the effects of lockdowns...
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Review and meta-analysis of the effects of lockdowns on Covid-19
mortality [pdf]
Author : k2enemy
Score : 88 points
Date : 2022-02-01 19:02 UTC (1 days ago)
(HTM) web link (sites.krieger.jhu.edu)
(TXT) w3m dump (sites.krieger.jhu.edu)
| nodamage wrote:
| Note that this paper was published by economists (as opposed to
| epidemiologists) and does not appear to have undergone peer-
| review.
| rich_sasha wrote:
| How do they adjust for the reasons for lockdowns? Surely a
| lockdown is introduced because things are bad. Is the analysis
| separating that out adequately?
| sgustard wrote:
| What about just looking at the most vulnerable populations? My
| elderly grandma was certainly safer with her self-imposed
| lockdown, since by avoiding most people she avoided being
| infected. If that population benefitted from the lockdown, how is
| it possible that society as a whole did not benefit?
| tinus_hn wrote:
| If vulnerable people had been told to and had in fact decided
| to lockdown themselves voluntarily society would have had the
| same benefit. That is no reason to force the rest into some
| kind of behavior.
|
| And in fact they would have been better off because society
| would not have incurred the monumental monetary costs of
| lockdowns and would have saved a very large amount of money
| that is now not going to be spent on the elderly.
| erglkjklhrt wrote:
| vladgur wrote:
| I find it unfortunate that most studies that this data meta-
| analyzed were for data periods ending in the Spring or early
| Summer of 2020.
|
| I would want to see longer data periods that would tell me that
| early lockdowns slowed down the spread enough to identify better
| treatment options as well as allow more people to survive till
| vaccines were available in 2021. In other words, whether people
| who caught Covid in the fall 2020/winter 2021 had better survival
| odds than if they caught it in the Spring/Summer of 2020.
| jonnycomputer wrote:
| The lockdown strategy pursued by China has been enormously
| effective, but also quite severe, and economically costly. Not
| sure its sustainable.
|
| https://www.foreignaffairs.com/articles/china/2022-01-26/chi...
| LorenPechtel wrote:
| It was certainly costly at the start but how does it fare in
| the long run?
|
| Also, while it worked well against the earlier strains they
| were already having some trouble with Delta and I think they're
| going to fail spectacularly against Omicron. It seems to be
| outrunning the ring fencing.
| newaccount2021 wrote:
| Barrin92 wrote:
| I think the generalizations of lockdowns as:
|
| _" Lockdowns are defined as the imposition of at least one
| compulsory, non-pharmaceutical intervention (NPI). NPIs are any
| government mandate that directly restrict peoples' possibilities,
| such as policies that limit internal movement, close schools and
| businesses, and ban international travel._"
|
| renders the exercise kind of useless because it conflates
| unsuccessful half-measures implemented in most countries with
| countries that followed lockdown and elimination strategies. For
| China, New Zealand and a few others which largely eliminated the
| disease the almost complete prevention of deaths proposed by the
| models discussed in the articles seems accurate.
|
| And while I suppose you can write NZ off as a small island
| nation, China is the most populous country on earth. Yet it
| appears in the paper once in the introduction.
| LorenPechtel wrote:
| This. It's clearly just another one of the myriad of deceptive
| Covid papers that we have been seeing recently. Get them on a
| pre-print server (no peer review) and spread them to the
| faithful.
|
| Calling masks a form of lockdown is utterly bogus.
|
| And even if they had proven their point all they would be
| showing is that half measures don't work.
|
| Simple thought experiment: If the world had basically been put
| on pause for April 2020--everyone stocks up in March, then
| spends the entirety of April at home where would we be now?
| (Use the stocks of PPE to protect those who have to be at their
| posts or people will die and they do not go home.)
|
| (Now, I'm not sure if there was enough food and the like around
| to actually permit this.)
| nradov wrote:
| Who do you include in "everyone"? First responders? Military?
| Healthcare providers? Farmers? Homeless? Utility workers?
| Garbage collectors?
| thenayr wrote:
| azakai wrote:
| I was curious how claims like this line up with the incredibly
| stark difference between, say, the US and New Zealand:
|
| https://91-divoc.com/pages/covid-visualization/?chart=countr...
|
| The PDF here actually mentions New Zealand, as one of the studies
| is about it. But reading that, it doesn't compare New Zealand to
| other countries, but does within-country analyses (different
| parts of the same country, like US states, or the same parts at
| different times).
|
| I am not an expert on this topic, but isn't it fair to say that
| New Zealand's massively lower death rate is due, in part, to
| lockdowns? Without a lockdown to get things under control things
| likely would have progressed as in almost all other countries.
|
| With that said, I think it's possible that for most countries
| lockdowns might have a minor effect. If say California goes into
| lockdown but other states don't, for example, then the spread
| might reach it anyhow eventually. So I would bet that both things
| are true: lockdowns can be a critical part of a COVID response,
| even if on average perhaps they are not.
|
| Regardless, all this is moot at this point. The early lockdowns
| were critical for reasons like US hospitals not having enough
| masks and other protective equipment, and vaccines were far off.
| Lockdowns bought us time - they were justified back then. The
| situation is obviously different now, and perhaps they are not
| justified today in most places.
|
| (Again, caveats that I am not an expert on any of this.)
| gruez wrote:
| > I was curious how claims like this line up with the
| incredibly stark difference between, say, the US and New
| Zealand:
|
| From the discussion section of the paper:
|
| >We propose four factors that might explain the difference
| between our conclusion and the view embraced by some
| epidemiologists.
|
| >First, people respond to dangers outside their door. When a
| pandemic rages, people believe in social distancing regardless
| of what the government mandates [...]
|
| >Second, mandates only regulate a fraction of our potential
| contagious contacts and can hardly regulate nor enforce
| handwashing, coughing etiquette, distancing in supermarkets,
| etc. [...]
|
| >Third, even if lockdowns are successful in initially reducing
| the spread of COVID-19, the behavioral response may counteract
| the effect completely, as people respond to the lower risk by
| changing behavior. [...]
|
| It's plausible that new zealand was already predisposed to
| contain a pandemic well (because they're well isolated) and/or
| that their citizens are conscientious.
| slg wrote:
| Aren't the first and second point in conflict?
|
| Point 1 is basically "lockdowns are unnecessary because
| people will behave in a safe manner regardless".
|
| Point 2 is basically "lockdowns are ineffective because they
| don't stop all forms of dangerous behavior".
|
| If people are willing to continue some dangerous behavior as
| part of point 2, why do we think they would stop other
| dangerous behavior without the lockdown enforcing that
| decision?
| inimino wrote:
| There's certainly no logical contradiction there, right?
|
| You have one group of Careful Carlas who always behave
| safely, lockdown or not. You also have a group of Reckless
| Rogers, standing too close to people in supermarkets and
| not washing their hands. If either of these two groups is
| too big, you won't see a positive effect from lockdowns.
| slg wrote:
| Is your argument that lockdowns have no impact on the
| behavior of the Reckless Rogers? If that is the case, why
| is there any objection to lockdowns when they can be
| ignored?
| cuteboy19 wrote:
| The objection would be that they are a needless
| inconvenience
| slg wrote:
| How are they inconvenient if they have no impact on
| behavior?
|
| Either one can ignore the lockdown and continue their
| usual behavior or one can't ignore the lockdown and their
| behavior changes.
| tomp wrote:
| I'd argue that most is due to at-border quarantines, not
| within-country lockdowns.
| jdrc wrote:
| You could say that NZ, australia and china did something very
| different from the partial lockdowns in the west. they decided
| to eradicate the virus, while that was never the goal in
| europe/us
| gilbetron wrote:
| From the study:
|
| "Overall, our meta-analysis fails to confirm that lockdowns have
| had a large, significant effect on mortality rates. Studies
| examining the relationship between lockdown strictness (based on
| the OxCGRT stringency index) find that the average lockdown in
| Europe and the United States only reduced COVID-19 mortality by
| 0.2% compared to a COVID-19 policy based solely on
| recommendations. Shelter-in-place orders (SIPOs) were also
| ineffective. They only reduced COVID-19 mortality by 2.9%."
|
| But there is some nuance in there, worth reading.
| eli wrote:
| At least based on my experience in the US the "lockdown" orders
| in practice were not significantly more strict than the
| government issuing very strong recommendations.
| brg wrote:
| I agree on a social behavior point of view. However, there is
| nuance. Very strong recommendations don't close public and
| private schools, day care, public parks and beaches, nor
| significantly curtail economic activity in restaurants and
| other non-essential businesses.
| eli wrote:
| Schools here had already been closed for two weeks before a
| stay-at-home order was issued, but I get your point.
|
| That said, in April 2020 I assure you that economic
| activity in restaurants and non-essential businesses would
| have been severely disrupted regardless of government
| action. Most were already closed or take-out only.
| aantix wrote:
| The first few months where everything was closed, including
| parks and beaches?
| ryandrake wrote:
| I don't recall any point, at least in my region: Bay Area,
| CA, when people universally complied with these closures. I
| think OP's point is: regardless of whether things were
| ordered closed, enough people were out and about horsing
| around, ignoring the closures, that nothing was effectively
| closed.
|
| There was no real lockdown in the USA, if you go beyond
| just looking at the mandates and take into account people's
| actual behavior. So I'm not sure how they review effects of
| a lockdown that never happened.
| aantix wrote:
| I have no idea about your area.
|
| Here in Lincoln, NE, everything was locked down to the
| point where open air parks had bright orange fencing
| around the playground equipment.
|
| Grocery stores, Home Depot and Walmart were all that were
| open.
|
| Walmart had a block long line, socially distanced of
| people waiting to get in. A Walmart employee was
| controlling the flow and ensuring masks.
|
| The streets were empty. You couldn't go anywhere even if
| you wanted to.
| erglkjklhrt wrote:
| concinds wrote:
| Unless you plan on deploying the U.S. military on every
| street and beach during the next lockdown, what we saw
| _was_ what happens when a lockdown is declared. They 're
| measuring the efficacy of an intervention: _lockdowns
| being declared_ ; high/low compliance is irrelevant to
| the intervention's effectiveness, since compliance isn't
| within the government's control.
| landemva wrote:
| 'There was no real lockdown in the USA '
|
| Not really true.
|
| Hawaii closed parks, trails, and beaches.
| https://www.travelandleisure.com/travel-news/hawaii-
| coronavi... ' Honolulu, city parks were closed on Aug. 8
| along with beaches and state parks and indoor attractions
| like bowling alleys and arcades. '
|
| Colorado closed all ski areas.
| https://coloradosun.com/2020/03/14/jared-polis-executive-
| ord...
| epgui wrote:
| The problem is that the effectiveness of lockdowns
| depends on the degree to which you are able to
| compartmentalize. If some regions have a lockdown and not
| others, but people are able to freely move from one
| region to another, then the least strict policy will be
| the one (roughly speaking) limiting disease transmission.
|
| The stringency index should be aggregated as the minimum
| of all areas that allow for freedom of movement.
| eli wrote:
| Closing parks and beaches is definitely something but is
| it fair to call that a "real lockdown"? Compared to
| places with curfews and travel restrictions?
| sharken wrote:
| Well, here a recommendation have been the same as "You must
| do this".
|
| Only the legislation does not support using that wording, so
| recommendation was chosen.
| manwe150 wrote:
| I would be curious to know if they were sufficiently able to
| remove confounding variables to make this claim. For comparison
| to another statistical quirk: someone I know made this chart
| which fails to show any correlation between vaccination rates
| and death rates in the last 14 days on a state-by-state basis
| in the US:
| https://docs.google.com/spreadsheets/d/1x9sKFsr-3VpdjvjZqHql...
|
| Now, we have evidence from other sources that the vaccine is
| definitely highly effective in every particular state (this
| should not require a citation, but here you go anyways:
| https://covid.cdc.gov/covid-data-tracker/#rates-by-
| vaccine-s...). But it seems there are too many confounding
| variables here (age, population density, etc.) such that
| attempting a simple region-by-region comparison over any
| particular time period might incorrectly conclude that the
| vaccine does not work.
|
| Was JHU able to address that data collection and comparison
| problem here?
| thenayr wrote:
| sharken wrote:
| If the majority of people receiving the vaccine are new to
| the vaccine and from 5-25 years, then you won't see any
| correlation between vaccination rates and death rates.
|
| It's also interesting that lockdowns seem to be a wasted
| effort. Much suck for Ireland that imposed some of the worst
| lockdowns.
|
| https://m.belfasttelegraph.co.uk/news/health/coronavirus/nis.
| ..
|
| Thankfully all restrictions have just been lifted here in
| Denmark.
| IHLayman wrote:
| It's hard to consider .2% reduction in mortality non-
| significant. Nearly 6 million people have died from COVID as of
| now. 0.2% of that is nearly 12,000 lives. Calling SIPOs
| ineffective as well because they only reduced mortality by 2.9%
| is a bit deceptive since that is nearly 174,000 lives.
| concinds wrote:
| Those percentages only apply during active lockdowns; your
| premise is that there's been a continuous, worldwide lockdown
| for the past 2 years. The actual numbers will be far less.
|
| Also, this study only measures impacts of lockdowns on Covid
| mortality, and doesn't include the human and financial costs
| of lockdowns.
| thisisnotatest1 wrote:
| LorenPechtel wrote:
| I'm not at all surprised.
|
| The high level of noncompliance we saw made it pretty much
| useless. Half measures cause economic pain without providing much
| benefit.
|
| The careful people wear masks anyway, the reckless won't obey the
| protective measures.
| thisisnotatest1 wrote:
| eli wrote:
| I don't follow this argument. If, say, half the people
| completely ignored the rules then doesn't that make them only
| half as effective and cause half the economic pain?
|
| Lots of people don't comply with speed limits but that doesn't
| prove speed limits ineffective.
| manwe150 wrote:
| If a business is half fixed costs and half profit, then
| cutting their revenue in half will cut their profit to zero.
|
| Speed limits are a good counter-example though, where they
| can provide a baseline expectation (eg mask wearing is good
| in crowded places) and then begins the negotiations from
| there for what is expected social behavior.
| eli wrote:
| That's perhaps an argument against lockdowns, but not an
| argument that lockdowns don't work because of
| noncompliance.
| manwe150 wrote:
| I did not mean to imply it was an argument either way. I
| meant it more as a way of demonstrating that we need to
| be careful to be precise about the actual relative
| impacts of each option, since they each have non-linear
| side-effects (including rates of compliance). So we
| should not get caught making absolute statements that
| something is always better or that it never works in
| this case, but instead look at the Pareto optimality
| frontier for each particular region when making policy
| recommendations and analysis.
| amluto wrote:
| Not even close, sadly. Consider New Zealand, Taiwan, and
| China: if you take extreme measures and eliminate _all_
| COVID, then there is no COVID. It doesn't appear from
| nowhere. (Just like in 2018 there was no COVID.) On the other
| hand, if you eliminate half the transmission of a highly
| contagious disease, everyone may well still get it, and while
| you have flattened the curve, you haven't actually saved many
| lives.
|
| For those who remember Chicken Pox, almost everyone got
| chicken pox. To the extend any NPIs reduced transmission
| (e.g. keeping kids out of school), the primary result was
| delaying chicken pox or avoiding major outbreaks, and
| delaying chicken pox may have been a bad thing.
|
| As a different analogy, if you have a Windows XP system in
| the Internet, it will get pwned. If you update it to Vista,
| you get a worse UI and it still gets pwned. Sometimes half
| measures are much less than half effective.
| cassianoleal wrote:
| > if you eliminate half the transmission of a highly
| contagious disease, everyone may well still get it, and
| while you have flattened the curve, you haven't actually
| saved many lives.
|
| Assuming all other things are equal in both cases, sure.
|
| In reality though, by flattening the curve we have avoided
| greater collapse of health systems, we got more time to
| understand better what works and what doesn't when fighting
| the disease, we got more vaccinated people, etc. These
| things combined might have saved a lot of lives.
|
| I'm not sure why delaying chicken pox may have been a bad
| thing, what do you mean by that?
| abakker wrote:
| I agree that flattening the curve should have benefitted
| society and saved lives.
|
| Regarding chickenpox, it becomes more and more dangerous
| the later in life you catch it. Getting it as a 5yo is
| annoying. Getting it at 15 can be quite a bit more
| dangerous. getting it for the first time at 40 can be
| lethal.
| cassianoleal wrote:
| I see what you mean.
|
| How does that work out in reality though? There are
| always people in all those age groups in society and if
| you let the disease run amok, that just means the 40yo of
| now are more likely to catch it before there's a vaccine
| or better treatments, doesn't it? OTOH if you slow down
| the kids getting it, they will be less likely to spread
| it to the teens and middle-aged kids :D until those are
| available. i.e. pretty much the same, is it not?
|
| Disclaimer: I'm pulling those ideas out of my arse, I
| have no real data or knowlege to back my thoughts.
| abakker wrote:
| When I was kid, before the chickenpox vaccine, it was
| common practice to ensure your kids got it by
| intentionally exposing them. I guess our parents had all
| had it, so there was no risk of getting it again.
|
| Now we have a vaccine so I assume this doesn't happen
| anymore.
| cassianoleal wrote:
| Ah interesting. I didn't know that, but it does make
| sense.
|
| > I guess our parents had all had it, so there was no
| risk of getting it again.
|
| This is not the case with COVID though. Everyone is
| getting infected for the first time, and we're still
| unsure how long and how strong immunity-through-exposure
| is. In fact, there are multiple reports of people
| catching it multiple times (I know of a person who had it
| 5 times :-o ).
| nradov wrote:
| There is no serious doubt that most infections produce
| durable cellular immunity, just as with all similar
| viruses. Of course patients will occasionally be
| reinfected, but symptoms are typically less severe. With
| any disease that has infected billions of people there
| will be occasional statistical outliers.
|
| https://peterattiamd.com/covid-part2/
| LorenPechtel wrote:
| Statistical outliers??
|
| Sorry, but not too long ago I ran into a figure that 2/3
| of Omicron cases had previously been infected with
| another variant.
|
| Covid is mutating fast enough that prior infection
| provides only limited protection. If you're lucky your
| body locks onto the spike protein and the protection
| works pretty well against all pre-Omicron variants. But
| you're not guaranteed that, your body might go for a much
| less stable target and do little against a variant.
|
| We are seeing this with the Chinese vaccines. They're
| killed-virus vaccines, they worked well at first. Not
| anymore.
| nradov wrote:
| That is misinformation. Did you even listen to the above
| linked explanation by infectious disease expert Dr.
| Monica Gandhi?
|
| Reinfections are meaningless. What matters is severity of
| symptoms. Infection by earlier variants gives most
| recovered patients durable cellular immunity against
| Omicron.
|
| https://www.nature.com/articles/s41591-022-01700-x
| mikevm wrote:
| > if you take extreme measures and eliminate all COVID,
| then there is no COVID.
|
| This is false because COVID also has animal reservoirs. It
| will never get eradicated like polio or smallpox, which
| only had human reservoirs.
|
| It appears that in 2022 it is now finally understood that
| COVID-19 will not get eradicated, the vaccines do not
| prevent transmission or infection (in fact, the original
| RCT never even showed it -- it was just assumed!), and that
| cloth masks have much more limited effectiveness than
| initially assumed. Omicron is highly contagious (but much
| milder!) so it appears that almost everyone will get it
| eventually.
| cobookman wrote:
| > that cloth masks have much more limited effectiveness
| than initially assumed
|
| I recall multiple studies early on stating cloth masks
| were not effective and should be avoided if you have
| access to surgical or n95 masks.
|
| My impression is that the (US) government didn't want to
| nuisance this discussion as it'd only open further
| criticism of mask mandates.
| manwe150 wrote:
| Nearly everyone will eventually be immune to it, but CDC
| data still is showing that the majority of vaccinated
| people will not get sick with it to get there.
| Izkata wrote:
| > It will never get eradicated like polio or smallpox,
| which only had human reservoirs.
|
| Quick aside, polio hasn't been eradicated. Only smallpox
| and a cat virus I forget the name of.
| eli wrote:
| Wouldn't you MUCH rather get covid today than in April
| 2020?
| amluto wrote:
| Yes.
|
| I'm not claiming that NPIs are useless. I'm saying that
| half an NPI may be vastly less than half as effective. I
| think the OP can speak for itself.
| chucksta wrote:
| Extreme measures would have to remain in place until the
| threat has been mitigated, which is not realistic because
| the world is not capable of taking equal measure like that
| on a global scale
| [deleted]
| [deleted]
| tinus_hn wrote:
| It's the old no true lockdown argument; if the lockdown fails
| it's because it wasn't tough enough or because it was
| followed or enforced strictly enough.
|
| An easy fallacy to handwave away the possibility that the
| lockdown strategy just doesn't work so well. Which is kind of
| obvious if you think it through; either the result is you
| eradicate the virus completely or the lockdown just delays
| the inevitable. And it should be clear by now that
| eradication is simply impossible and from very early on in
| the pandemic was just never going to happen.
| zwieback wrote:
| At this point that's kind of what COVID feels like - nothing we
| tried really worked except one thing: vaccinations mean you don't
| get sick/die. Everything else is super muddy.
|
| What about contact tracing? We're figuring out that masks,
| lockdowns, hygiene, etc. don't have that much of an effect. But
| where do people get COVID, shouldn't we have pretty good data on
| that now? It seems like a few superspreader events have a lot to
| do with it but that's the only anecdote that stuck with me.
| sjg007 wrote:
| >masks, lockdowns, hygiene, etc. don't have that much of an
| effect.
|
| Clearly you haven't looked at the death rates in Japan or
| Australia.
| zwieback wrote:
| Sure, some countries are doing better but why? That's what
| the article is asking, is it because Japan/Australia's
| citizens are better behaved, something else? That's the
| question behind the obvious but wrong conclusion "good
| country A is doing X this so X must be good"
| sjg007 wrote:
| It's b/c of lockdowns, masks and vaccines. In China you
| have authoritarian enforcement. Australia is less so but
| still you had businesses actually locked down.
|
| In that set you have 3 different "cultures" already. Plenty
| of controls.
| javagram wrote:
| Australia's biggest success was controlling the virus at
| the border, also. They spent large parts of the pandemic
| without ever locking down, and when there were lock downs
| after early 2020, it was localized to a specific city or
| state where the virus had escaped containment rather than
| the whole country (sometimes people seem to not realize
| this).
|
| There was never really an analogous situation in the USA
| since we maintained open borders to the virus (US
| citizens were allowed to come back from Europe even after
| the travel ban in March 2020, seeding the virus across
| the country.)
| pasabagi wrote:
| >However, if lockdowns have a notable effect, we should see this
| effect regardless of the timing, and we should identify this
| effect more correctly by excluding studies that exclusively
| analyze timing
|
| This seems like a really weird take. The entire concept of a
| lockdown is _solely_ about timing, since the whole purpose of the
| exercise is to reduce the R value in order to buy time for
| healthcare services.
| Izkata wrote:
| > in order to buy time for healthcare services.
|
| By that part alone I'd call them a total failure: Healthcare
| didn't take advantage of it to prepare, instead the lockdowns
| just kept going on.
|
| If anything the opposite has happened, with hospitals firing
| nurses and ending up with _reduced_ capacity.
| pasabagi wrote:
| I think it depends on which lockdowns you are talking about.
|
| I've been living in Germany, where lockdowns seem to happen
| at the time you expect them to happen (when cases start to
| spike), and the deaths-per-capita are about half that of the
| UK, where they happened at the last minute (after cases had
| peaked).
|
| In countries like Korea, Japan, and China, they had very
| early lockdowns, and have had basically negligible Covid
| impact.
|
| I would really like it if everybody sat down and started
| consciously copying the states with approaches that worked,
| rather than trying to solve the problem from first
| principles. Public health is complicated, but what's not
| complicated is that some states are obviously way better at
| it, and these successes should be emulated.
| JaimeThompson wrote:
| Has their been a study on the effects on our medical systems if
| Covid-19 had spread thru the population much faster?
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(page generated 2022-02-02 23:01 UTC)