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Artillery Row

Let’s open up debate about lockdowns

There’s no place in all of this for unsubstantiated claims or attempts to dismiss those who encourage the sensible consideration of alternatives

In our article “Welcome to Covidworld” and a subsequent piece, we remarked on the widespread uncritical endorsement of lockdowns and other social restrictions. There is a tendency to simply accept that lockdowns are effective, despite frequent unclarity concerning what they are supposed to achieve, failure to indicate how their effectiveness might be reliably measured, and lack of evidence concerning what effects they have actually had.

Instead, we repeatedly meet with ad hoc, unfalsifiable narratives about pushing down curves and the like, which claim positive effects regardless of how the virus might behave after a lockdown has been imposed. Furthermore, even if certain effects could be reliably discerned, there remains the question of whether lockdowns are morally and more generally appropriate, considering the amount of harm they inflict. Their appropriateness, too, is often accepted without question.

Faith in lockdowns is not always expressed as a complete refusal to engage in debate. We’ve also been struck by a closely related phenomenon: the swift dismissal of alternatives via implausible, often unsubstantiated claims and weak arguments, suggesting a failure to even entertain the possibility that one’s own position might be in any way misguided.

Why are unsubstantiated assertions concerning the merits of lockdowns so widespread?

This latter tendency is exemplified by Ben Bramble’s response to our first article. His case rested entirely on a counterfactual claim: without lockdowns, there would have been far more deaths in countries such as the UK. The science on this, he asserted, was “beyond question”. However, we did question it, and he replied to us again, not by addressing our objections, but by moving the goalposts. Rather than seeking to defend his original claim, he is now advising on UK government policy. It turns out that measures adopted so far in the UK have not worked because we, as a country, were too sloppy. What is now required instead is a much stricter lockdown, lasting four to six weeks, which will virtually eradicate the virus.

We want to start by spelling out why Bramble’s argument doesn’t get off the ground. However, we do this as a way of developing points that have far wider applicability and are of much more general interest. First of all, here’s what Bramble gets wrong:

  1. We stated that, while countries such as Australia may have succeeded in suppressing the virus for now, we still don’t know what the future holds. Without a highly effective vaccine, they will face difficult and painful choices. Bramble responded that these countries are “the envy of the world right now”. Well, that wasn’t the point. We were concerned with what might happen in the future, not what is happening now. He adds that being isolated from the rest of the world for an indefinite time would be a “small price to pay”. In fact, total isolation for an unlimited period would be a very high price indeed and anything less than that risks further outbreaks, followed by further lockdowns. Now, it could well be that a highly effective vaccine arrives soon. We very much hope that it will, and recent news of vaccines that have so far been 90 per cent effective (Pfizer) and 95 per cent effective (Moderna) in Phase 3 trials is certainly heartening. However, it is not yet known whether and to what extent these vaccines will be effective in protecting those most at risk, many of whom will have weak immune systems. It is also unclear whether they will prevent people from spreading the virus or whether they will just reduce the symptoms of infection. It can be added that, even if the Australian strategy ultimately does prove effective, this does not preclude the raising of moral concerns. It remains to be seen how those subjected to the strictest lockdown in Melbourne will be affected by what they endured and how they will evaluate the policies that were implemented. Perhaps the majority will accept that it was all necessary and suffer few, if any, ill effects. On the other hand, perhaps many people will be profoundly affected by the realization that a seemingly benevolent system of government could restrict freedom to such an extraordinary extent and inflict such harm. The prospect of widespread, longer-term mental health problems, and even collective trauma, is not to be dismissed lightly. Assessing the full effects of such measures on societies is likely to take some time and will require much careful research. Triumphant pronouncements about being the “envy of the world” are perhaps best avoided for now.
  2. Bramble disputes our distinction between early and late lockdowns, stating that the Melbourne lockdown also occurred late, when cases were high. Consequently, there is good reason to think that a late lockdown in the UK would be similarly effective. In fact, we were referring to national- rather than state- or city-level lockdowns. Regardless of this, Bramble does not describe the situation clearly enough. He claims that around 20,000 cases were recorded in Melbourne, which is indeed a high number, but he doesn’t say when. In fact, when the Melbourne lockdown was imposed on July 8, there were under 9000 recorded cases in the whole of Australia. In contrast, when the second lockdown began in England on November 5, there were over 1.1 million cases recorded in the UK. Setting aside the different population sizes and different testing regimes, it is quite clear that the two situations are importantly dissimilar.
  3. We think Bramble must have got his numbers muddled. Various measures were introduced and suspended in Melbourne at different times. However, the city is generally reported to have been under a strict lockdown for a sixteen-week period. On the basis of this, Bramble confidently asserts that “there is no reason why a serious four- to six-week lockdown in the UK could not achieve similar results”. In fact, there is every reason to maintain, with great confidence, that it would not. The Melbourne lockdown was in place for ten weeks longer than that. Furthermore, it is well known that the virus is much more difficult to manage during the cold autumn and winter months than during the spring and summer. Why does Bramble not mention this crucial difference between the situations in Australia, where it is late spring, and the UK, where it is late autumn? Consequently, he offers no grounds whatsoever for challenging the increasingly accepted view that eradication of the virus is no longer a realistic goal for a UK lockdown.
  4. Bramble appears to presuppose, throughout his discussion, that lockdowns work and nothing else does. This being an article of faith, he introduces another counterfactual: although lockdowns have significant costs, these same costs would otherwise have been even higher. However, he doesn’t spell out why this is the case. We can only assume that, as he sees no alternative to lockdowns, the higher costs he refers to arise due to lockdowns that later need to be imposed due to a country “prematurely opening up”. Bramble doesn’t consider the possibility that he might just be wrong, that a lockdown long and strict enough to eradicate the virus in the UK (if this were even achievable) could be far more destructive than the virus itself, or that less damaging measures could prove more effective than lockdowns in achieving other goals.

Less than a year ago, a national lockdown would have been unthinkable in a democratic country like the UK

But why have we run through all of this? Our aim is not so much to repudiate Bramble’s claims as to draw attention to a larger, more important question that they make salient: why are questionable and unsubstantiated assertions concerning the merits of lockdowns so widespread, when we are confronted by issues of great importance in a situation of considerable uncertainty? Among policy makers, those advising them, and the general public, it is often taken for granted that lockdowns and other extreme social restrictions are not merely effective, but also the only morally respectable game in town.  With this unwavering conviction in place, there’s no need to bother entertaining alternative perspectives or offering careful arguments.

Consistent with this, Bramble warns us that questioning orthodoxies can “present dangers”, by giving “intellectual respectability to an extremely harmful policy”. There are, he says, “powerful interests” invested in challenging lockdowns and it is important not to add “fuel to their fire”. As an unspecified alternative might prove more harmful, we should not feel free to openly question the most dramatic curtailment of civil liberties ever seen in democratic societies. Doing so would risk furthering the interests of conservatives and certain businesses.

To us, this sounds unsettlingly authoritarian. Moreover, perhaps it doesn’t occur to Bramble that continuing lockdowns might equally advance various questionable interests. A striking editorial in the British Medical Journal – hardly a typical vehicle for tinfoil-hat conspiracism – last week warned of worrying patterns of secrecy and suppression of scientific research concerning Covid-19. The drivers of that behaviour are all-too familiar, like conflicts of interests, commercial incentives, and political opportunism.

It is time to stop pitching the contrast between lockdowns and alternative options in terms of something that is obviously morally virtuous versus something else that is obviously morally reprehensible. Things are far murkier than that. Remember that, less than a year ago, a national lockdown would have been unthinkable in a democratic country like the UK. Then, somehow, when Wuhan was locked down and Italy followed, much of the rest of the world fell in line. Nevertheless, although lockdowns may have become the new orthodoxy, we don’t see why they should occupy the moral high ground. In fact, a national lockdown could just as well be construed as an extraordinary – and quite reckless – gamble with people’s lives.

Consider an oft-stated goal of lockdowns and other extreme social restrictions: to “flatten the curve”. When contemplating such a strategy, we think the following points merit serious consideration:

  • We know that extreme social restrictions have the effect of killing many people (such as those in care homes who are deprived of interpersonal contact that is vital for their health and well-being) and also inflict significant and diverse harms on many others.
  • The reproduction rate or “R” of the virus is not homogeneous across a population. If we divide that population into those most at risk and those least at risk, R is likely to be much higher among the latter, given that they are generally more active and more likely to socialize with lots of others in high risk environments, such as pubs and clubs.
  • If extreme social restrictions do succeed in “flattening the curve” for a time, they will significantly reduce the difference in “R” between these populations, by preventing social activities that would raise R in the lower-risk population.
  • Hence, although R for the population as a whole might be reduced by social restrictions, if the ultimate outcome involves much the same percentage of the population becoming infected, lockdowns will skew the distribution of infections towards the most vulnerable. Therefore, they will have the effect of increasing the infection-fatality rate and consequently the number of deaths, even though the deaths will occur over a longer period.
  • Many of the most vulnerable people are exposed through the hospital and care home system. The longer the virus is circulating at high levels in the wider community, the longer the period during which hospitals and care homes will face a significant risk of new outbreaks.
  • More disadvantaged members of society will also be disproportionately exposed, as they are less likely to be in jobs that allow them to work from home.

If something along these lines is right, then it is lockdowns that involve taking an enormous risk, rather than alternative strategies that involve managing the virus in a more discerning way and learning to live with it. Lockdowns risk causing more Covid-19 deaths, along with more deaths due to other causes, while also exacerbating inequalities. So, once the lockdown path is pursued, everything then hinges on a highly effective vaccine being approved and distributed sooner rather than later. Perhaps the gamble will pay off and, after all that people have been through, we hope that it does. Nevertheless, even if this is how it ends, we might still want to ask whether or not the actions taken were morally defensible.

At this point, one might object that the current lockdown in England has a more specific aim: to flatten the curve in order to prevent the NHS from being overwhelmed. However, it is important to be very specific about what, exactly, the predicament of “being overwhelmed” amounts to. Presumably, it is altogether different from all the NHS “surges”, “crises”, “collapses”, “overwhelmings”, and “meltdowns” that have occurred or been predicted to occur on so many other occasions over the years,  none of which were taken nearly so seriously.

It is important to fully acknowledge the suffering caused by ongoing social restrictions

The principal causes of any anticipated crisis should also be made clear. They are likely to include not just Covid-19, but also staff shortages, exacerbated by the effects of measures implemented during the epidemic. Another important issue to consider is that of how many serious cases of Covid-19 are occurring due to transmission within the healthcare system (where an especially high percentage of those exposed will be vulnerable), and whether seeking to reduce transmission in the wider community is the most effective way of addressing this problem. We might also wonder how much weight should be given to a variety of alarming predictions generated via abstract, simplified disease models, given that such models can be wildly off the mark. At the very least, their assumptions and limitations need to be reflected on carefully, before their predictions are allowed to motivate highly destructive policies.

News reports of “chatty rats”, hastily made decisions, and subsequently revised data do not inspire confidence. Even so, let us suppose that all of the above issues have been considered with appropriate diligence. Strong evidence is still needed to support the claim that a lockdown is likely to achieve a specific effect, while less extreme measures are not. But, instead of being presented with such evidence, we’re told that we need to behave ourselves for this to work, the implication being that the efficacy of lockdowns is not in any doubt. Failure can only be attributed to our lack of self-discipline, for which we will pay the price. In the event that the lockdown is declared to have done its job, good evidence is needed here too. This is not an acceptable argument: “Cases started dropping at some point. Therefore, the lockdown was responsible.”

Even if convincing evidence can be provided for the claim that the current lockdown is very likely to have certain desired effects, we also need to be confident that benefits will outweigh the increasingly manifest and projected costs. There are findings to suggest that national lockdowns may ease pressure on health service capacity, while not ultimately leading to “reductions in the number of critical cases or overall mortality”. If that is indeed the case, then it has considerable bearing on the issue.

Regardless of whether the current English lockdown ends up achieving certain goals, it will also cause a great deal of damage.  It therefore remains unclear why alternative strategies are so often hastily dismissed. What we see again and again is a peculiar sort of faith in lockdowns and other extreme social restrictions. Take the onslaught of negative publicity surrounding the Great Barrington Declaration, which sets out the alternative strategy of “focused protection”.

The aim is not to let people die, but to do a far better job of protecting them

Why should this proposal be condemned as irresponsible, rather than – at the very least  carefully considered by policy makers as a backup plan? It would surely be prudent to have such a plan, in case vaccines prove insufficiently effective against current or new strains of the virus (a concern made salient by recent reports of a new strain of SARS-CoV-2 circulating in Danish mink). Crude caricatures of irresponsibly “letting it rip” grossly misrepresent the proposal. The strategy outlined in the declaration is not to seek “herd immunity” as a goal, but to manage the virus until that outcome is arrived at one way or another, either through a build-up of natural immunity in populations or through this combined with effective vaccines. Furthermore, the aim is not to let people die, but to do a far better job of protecting them, by directing our resources where they will count the most. An approach of this kind would have been regarded as orthodox before the newfound faith in lockdowns.

Focused protection is often dismissed as unworkable, on the basis that we cannot or should not incarcerate all of those who are vulnerable for an indefinite period. But that’s just lockdown-thinking projected onto an approach that is importantly different in ethos. Protecting people does not have to involve locking them up or depriving them of vital social opportunities.

Instead, we, as a society, could draw on the diverse expertise of logistics experts, designers, tech entrepreneurs, artists, medical practitioners, psychologists, and a host of others in seeking to devise national, regional, and community level approaches to protection than actually enhance quality of life, aiming to alleviate rather than cause loneliness. We could come together in solidarity and strive not only to preserve but also to enrich the lives those most at risk. Why not at least investigate such possibilities seriously, rather than pumping out fear, hiding in our homes, and facing a future that appears increasingly devoid of meaningful life-possibilities?

Of course, there remain important and difficult questions to address concerning the risks associated with any such strategy (a point that applies equally to lockdowns). For instance, there are issues to consider regarding the nature, diversity, and longevity of immune responses, the risks posed by post-Covid syndrome (or “Long Covid”) and whether they differ significantly from risks associated with other, well-established viral illnesses, and how reliably the most vulnerable people can be identified and supported. But shouldn’t we at least think about this, carefully and systematically, rather than staying resolutely committed to an unprecedented gamble?

With all this in mind, it is important to fully acknowledge the suffering caused by ongoing social restrictions, including the serious harms inflicted on precisely those we aim to protect. In the UK, it has been widely reported that there have been many thousands more dementia deaths than usual this year. For instance, during the first lockdown, there were approximately 5,000 excess dementia deaths in care homes, over 50 per cent more than would ordinarily be expected. These are deaths that were not caused by Covid-19.

The accepted explanation is that the health of many people with dementia, indeed the majority, has declined rapidly and quite substantially due to the dissolution of social routines and regular interactions with loved ones that play absolutely vital roles in sustaining health, well-being, and hope. The health of many other elderly people will also have deteriorated due to lockdowns and other measures, which have brought loneliness, misery, fear, and despair. Yet, at the same time, it has been suggested that policies such as preventing or significantly restricting visits to care homes are based on little evidence and of questionable efficacy.

There’s no place in all of this for dogmatic, unsubstantiated claims

To adopt a wider-ranging perspective, in the UK this year, over 500,000 people in total will die, as happens every year due to a variety of causes. How many of these people will have had the last weeks or months of their lives ruined by lockdowns and other restrictions? How many will have been deprived of opportunities to see family members, hug grandchildren, and conclude the narratives of their lives with friends and relatives? How many of those friends and relatives now struggle with a grief that is intensified, prolonged, and riddled with guilt, due to the circumstances in which relatives died, their own inability to prevent their loves ones’ suffering, and subsequently being prevented from spending time with others in ways that shape and regulate grieving processes?

It should not simply be accepted, without question, that – in the situation we currently face – it is right to keep inflicting these and so many other forms of harm upon people. Moreover, the casualties include not only those who are nearing the end of their lives, but many others as well, including our children.

There are surely intellectual and moral obligations to consider the evidence, the arguments, and the alternatives carefully before advocating radical and highly damaging policy measures. There’s no place in all of this for dogmatic, unsubstantiated claims or attempts to dismiss those who might question orthodoxy and encourage the careful, sensible consideration of alternatives.

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