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1/Lots of discussions about #lockdown vs no lockdown in medicine, politics, around dinner tables, just about everywhere. @fordnation says he needs more evidence. I just reviewed the topic for a debate @accpchest. So I'll oblige. https://www.theglobeandmail.com/canada/article-ontario-issues-new-restrictions-for-hotspot-bars-restaurants-gyms/?utm_medium=Referrer:+Social+Network+/+Media&utm_campaign=Shared+Web+Article+Links
2/I'll start by stating the obvious: lockdowns work. This was shown in multiple Spanish Flu pandemic studies, including this one demonstrating reduced excess flu mortality with earlier, more aggressive lockdown, comparing 43 US cities: https://pubmed.ncbi.nlm.nih.gov/17684187/
3/100 years later, evidence holds. COVID-19 lockdowns reduce transmission, hospitalizations/ICU, deaths. Shown in modelling, pre/post, interrupted time series, contemporaneous group predictor studies, across continents, countries. Excellent meta-analysis: https://www.bmj.com/content/370/bmj.m2743
4/ Lockdowns have downsides. They exact health, social, and emotional consequences that are still being measured. They disproportionately punish the disadvantaged. Although economic toll is often cited as a reason to avoid them, the economic impact data paint a different picture.
5/ Repeated studies show that the pandemic depresses the economy - not the lockdown. This Spanish Flu study shows that economic activity in cities that intervened earlier/more aggressively was no worse during pandemic, rebounded faster after pandemic: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561560
6/Again, 100 years later, the evidence holds. This graph shows a clear correlation between drop in GDP and confirmed death per million. Where you want to be is bottom right - countries with tighter lockdowns = less deaths, less economic decline.
7/ The story is similar for Sweden- the "no lockdown" poster child. Compared to Nordic countries (ie similar geography, health systems, population densities, genetics, etc), all of which had tighter lockdowns, Sweden suffered more deaths per capita and a deeper drop in GDP:
8/ If you're sick (or worse), or taking care of a sick child or parent, you can't contribute to the economy. So lockdowns don't only protect people from the virus - they protect the economy from being hollowed out by the virus.
9/ Lockdowns have many features: school/workplace closures, restrictions on gatherings (eg restaurants/clubs/gyms), public transit closure, movement restriction (e.g. shelter-in-place). Are all needed? Hopefully not. But as long as the #s keep rising, more are definitely needed.
10/Some colleagues have issued a letter calling for an end to lockdowns. Some call the 2nd wave a "casedemic" affecting the young, who are mostly just fine. Yet case positivity rates in >40 yr olds and hospitalizations are both clearly rising. There is no "young people" bubble.
11/A balanced and data-driven approach is needed. Heed the lessons of past pandemics and this one. Extend current lockdown measures, but don't lock down everything. Lock down settings where transmission is occurring. Do this now, to prevent the need for a painful full lockdown.
12/To do this, we need data which (in Ontario) so far have not materialized. In which settings are outbreaks occurring? With half of cases untraceable, and contact tracing now essentially halted, how can we take the "surgical" approach we need?
13/ . @fordnation: economy vs health is a false dichotomy. To protect our people and our fragile economy, invest heavily in #TestTraceIsolate (hire+train contact tracers), use transmission data to guide our lockdown, and do it now to protect health systems from being overwhelmed.
