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Sunday, June 27, 2021

Explaining the fetish for covid lockdowns

It is said that the covid lockdowns which have been enacted - and continue to be imposed, more than a year in - all over the world are just "following the Science(TM)".

Yet, this is a deeply flawed claim.

For one, in a commentary in Nature Human Behavior, Alex Stevens points out we should be very skeptical of politicians who claim to be "following the science", since this is probably just code for trying to evade responsibility while the "science" is manipulated behind the scenes to get the desired results.

For another, science does not tell you what to do - it tells you what to do if you want to achieve a certain outcome.

Indeed, if we actually "follow the science", we realise that lockdowns are not effective - if your aim is to reduce covid deaths. Here're just 6 out of many peer reviewed studies which tell us that lockdowns don't save lives.

"Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people." (A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes)

"Stringency of the measures settled to fight pandemia, including lockdown, did not appear to be linked with death rate." (Covid-19 Mortality: A Matter of Vulnerability Among Nations Facing Limited Margins of Adaptation)

"Internal lockdown requirements and viral testing policies and levels were not associated with mortality" (Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks)

"Forecast deaths from epidemiological models are not valid counterfactuals, due to poor identification. Instead, I use empirical data, based on variation amongst United States counties, over one-fifth of which just had social distancing rather than lockdown. Political drivers of lockdown provide identification. Lockdowns do not reduce Covid-19 deaths." (Government mandated lockdowns do not reduce Covid-19 deaths: implications for evaluating the stringent New Zealand response)

"The results suggest that lockdowns were superfluous and ineffective." (Effectiveness of Corona Lockdowns: Evidence for a Number of Countries)

"Full lockdowns, border closures, and high rate of COVID-19 testing were not associated with reduced number of critical cases or overall mortality." (Country level analysis of COVID-19 policies)

Granted, I found a couple of papers claiming that lockdowns were effective, but in science you are supposed to look at the weight of the evidence (besides, those papers were generally smaller in scope - one only looked at US states, and over a relatively short period, for example).

Tellingly, even the WHO does not advocate lockdowns, only seeing them as a last resort to prevent a health system from collapsing.

If you want to pursue an eradication strategy, lockdowns might be useful - but then you'll need to shut out the outside world forever for fear of (re)introducing covid, and there's always still the potential for (re)introducing it, as Australia and New Zealand have shown, so the countries praised for their covid "success" will likely be worse off in the long term. As Rupali Limaye, director of behavioral and implementation science at the International Vaccine Access Center at Johns Hopkins School of Public Health, points out, "The whole world is not going to be Covid Zero" and in these "covid havens", as Peter Collignon, a professor of infectious diseases at the Australian National University Medical School adds, "The fear has almost gotten out of proportion to what the risk is". Donald Low, Professor of Practice in Public Policy at the Hong Kong University of Science and Technology, thinks that "the earlier ‘victory’ of these places over Covid-19 [might] have been a Pyrrhic one".

To explain the popularity of lockdowns, then, we must look at politics - not science.

Political incentives reward government conservatism, which leads to self-perpetuating lockdowns. Donald Low points out elsewhere that governments are loss averse, which is borne out by research.

This explains why models which over-estimate deaths have driven policy in some places, seemingly without proper understanding of the inherent limitations of modelling.

There are also cognitive biases like confirmation bias, sunk cost bias, common practice bias and status quo bias. There is a suggestion that China tricked the world into locking down and committing economic suicide. Whatever you think of this theory, it is pretty clear that lockdowns became a thing because China started them first, then Italy followed China, and the rest of the world followed Italy.

Lockdowns may have been more justified in the early part of the pandemic, when we didn't know much about the virus, or how ineffective lockdowns were at reducing covid deaths. But now that we know how pointless they are, they have become shamefully self-perpetuating due to these biases.

Lockdowns can also be seen as a form of governmental signalling, or in other words, "the performance of bureaucratic competence rather than the act of actually being competent". Dow Constantine, a politician from King County in the US state of Washington thought that closing schools was a way of sending a message, for example. This explains covid restrictions that pretty much all experts agree are pointless, like the closing of outdoor playgrounds as happened (for a while) in California and Ontario, Canada, or Spain's 3-month-long outdoor mask mandate.

Lockdowns are also surprisingly popular among the general population (the same psychological biases that affect governments affect people in general too), so the link to politicians' fondness for them is clear.

Polls in several US states show that lockdowns are (or at least were) politically popular. Even in Texas (which has been comparatively aggressive), 76% of Texans supported a new lockdown in mid-2020, and in late October 2020, 64% of Americans did. In the UK in January 2021, 80% did. In Canada, 55% supported very strict lockdowns in November 2020. And in France, in March 2021, 54% supported a new strict nationwide lockdown.

This is almost certainly because many or most people imagine covid is more serious than it really is.

The Franklin Templeton–Gallup Economics of Recovery Study found that in the US,

"Americans overestimate the risk of death from COVID-19 for people aged 24 and younger by a factor of 50; and they think the risk for people aged 65 and older is half of what it actually is (40% vs 80%)."

Notably, even Republicans think covid is more serious than it really is. Whereas it's estimated between 1% and 5% of those who get covid need to be hospitalised,

"Forty-one percent of Democrats and 28% of Republicans answered that half or more of those infected by COVID-19 need to be hospitalized. Republicans were also far more likely to get the correct answer, with 26% correctly identifying the risk compared to just 10% of Democrats."

The catastrophising of covid is not unique to the US.

In the UK, almost half of respondents thought that 1% of Great Britain's population had died of covid, and more than 20% thought 5% or more had. The true figure? 0.1%.

In the Netherlands, respondents thought that Covid was closer in severity to Ebola than influenza. In France respondents thought 1 in 6 people who caught covid died.

There's also a lot of fear over covid side effects. A popular Quora answer that has been shared widely outside Quora claims that up to 18% of people who get covid "will have permanent heart damage for the rest of their lives". In reality, this is a vast over-estimation based on a misunderstanding of the data, and it's probably closer to 0.087%. In any event, covid deaths would be correlated with serious covid side effects, so lockdowns probably won't reduce these much (if at all).

In reality, we know that covid is not very deadly, especially for the non-elderly. According to a peer reviewed paper published by the WHO and authored by John Ioannidis, a Stanford professor who's worked in medicine and epidemiology,

"Results I included 61 studies (74 estimates) and eight preliminary national estimates. Seroprevalence estimates ranged from 0.02% to 53.40%. Infection fatality rates ranged from 0.00% to 1.63%, corrected values from 0.00% to 1.54%. Across 51 locations, the median COVID-19 infection fatality rate was 0.27% (corrected 0.23%): the rate was 0.09% in locations with COVID-19 population mortality rates less than the global average (< 118 deaths/million), 0.20% in locations with 118–500 COVID-19 deaths/million people and 0.57% in locations with > 500 COVID-19 deaths/million people. In people < 70 years, infection fatality rates ranged from 0.00% to 0.31% with crude and corrected medians of 0.05%."

Even other reviews which give higher estimates for the infection fatality rate (IFR) don't go that much higher. Certainly not Ebola levels (average case fatality rate of 50%, and in this case since asymptomatic Ebola is rare, this is going to be close to the IFR)

Covid has also become moralised. A study found Americans and New Zealanders view harms from controlling covid to be more acceptable than the very same harms in other contexts. One could view this as a perverse reformulation of Blackstone's formulation: It is better that ten people die due to lockdowns than that one person gets covid. And a natural corollary is that if you are against lockdowns, you are seen as not just wrong but a bad person.

The impacts of lockdowns are also uneven. If you know that you're going to continue to get paid during a lockdown, and that you might even get to work less, you might very well support one. It's no surprise, then, that teachers unions have been vehemently against schools reopening and public servants seem to be much more supportive of them than private sector employees. If you have financial support (as in the UK with the furlough scheme) you might even be happy with lockdowns, as per the "third of British employees who have been furloughed but who now work one day a week or are volunteering", but this is plainly unsustainable.

Lockdown has also become a politicised issue (despite the lip service about following the science). This has become increasingly apparent as some liberals are reluctant to move out of lockdown despite the science, seeing lockdowns as an expression of their political identity; tellingly, re-opening schools has been framed as "motivated by white supremacy", and there is an association between left wing political views and covid-linked psychological distress.

So given that people think covid is much more serious than it really is, that it has become a moral issue and that whether out of ideology or self interest some people like lockdowns, it is no surprise that they support lockdowns, which are intuitively appealing (since they are "common sense" - most people are not going to be willing and able to look up the scientific research on whether they work).

Why might people catastrophise covid? A study found that 91% of covid stories by US major media outlets were negative in tone (vs 54% for non-US major sources and 65% for scientific journals), another found that the British media engaged in fear-mongering and yet another that the Czech media was "pessimistic", which affected the public's metal health.

Meanwhile media and social media exposure have been found to contribute to fear, panic and psychological harm related to covid, with social media being especially poisonous, since "People who relied on social media as their main source of information on the coronavirus pandemic had the most “erroneous and distorted perception of risk”".

Covid catastrophising might be a product, then, of the modern media environment. As the saying goes, "if it bleeds, it leads", and this is as true of social media as regular.

Salience bias also means people are very aware of covid harms (graphic media reports don't help); "in times of a contagious pandemic if you make that disease salient then participants overestimate their risk in all domains". Meanwhile, they ignore the damage that measures meant to control covid cause. Ironically, this is mirrored by those who imagine the covid vaccines to be unsafe based on a few examples of serious adverse effects.

Governments also actively spread fear about covid. In the United Kingdom, the Scientific Pandemic Influenza Group on Behaviour said that ministers needed to increase “the perceived level of personal threat” from Covid-19 because “a substantial number of people still do not feel sufficiently personally threatened”, and politicians delivered. While some now admit that this was “unethical” and “totalitarian”, the damage continues to be felt. This is not surprising, as the economist Robert Higgs points out that governments use fear to increase their power.

Ironically given the fetish for lockdowns, there's even one peer reviewed study which finds that lockdowns don't even reduce cases

"we do not find significant benefits on case growth of more restrictive NPIs. Similar reductions in case growth may be achievable with less restrictive interventions" (Assessing mandatory stay‐at‐home and business closure effects on the spread of COVID‐19)

Indeed, if you read the paper, there is some evidence that lockdowns *increase* covid transmission since you coop people up indoors

Even if we ignore this possible ironic consequence of lockdowns, lockdowns and covid hysteria are not cost free. People die due to disrupted medical care, as well as the recessions that come about from wrecked economies. The real tragedy is that lockdowns due to covid hysteria result in more deaths in the long run:

"the strategy of restriction followed by gradual relaxation is likely to result in a net cost, in terms of average human lives lost, that will be comparable with the UK's sacrifice over the six years of World War Two. A policy of lockdown followed by gradual relaxation is likely to do much more harm to the nation's health than good" (The length and severity of the coronavirus recession estimated from the dynamics of relaxing lockdown)

The author summarises his finding elsewhere as lockdown results in killing more than 10 times as many people as the worst case scenario for covid deaths.

And that's for deaths alone. Due to school shutdowns, even in the best circumstances, "students made little or no progress while learning from home" and "Learning loss was most pronounced among students from disadvantaged homes", and an entire generation may very well have been damaged. To say nothing of the impact of lockdowns on mental health, the fight against more dangerous diseases and more. Indeed, another researcher finds that "a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be".

The end result of the moral panic over covid has been that public health has abdicated its mandate of considering overall harm in favor of a singular obsession over direct covid harms, resulting in "a dominant narrative of pandemic mitigation at all costs", when in reality "the task for public health is not simply to consider the lives that may be saved by policy efforts to limit viral spread, but more importantly, to consider the total number of lives saved and lost as a result of the epidemic and responses to it".

In other words, it's not that covid is harmless or trivial: it's that lockdowns are worse.

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