A narrative review published in BMJ Global Health looks at the health impacts of lockdowns.
Sarah Shenow, Head of research at MQ Mental Health research, said:
“The findings of this study are reflective of what we have seen at MQ Mental Health Research. Whilst many people’s mental health has deteriorated over the last 18 months, there have been instances where people have found a marked improvement to their mental health due to lockdowns and changes to lifestyle. As this paper finds, the impact to mental health is difficult to untangle.
“What has been extremely apparent is that the impact of the pandemic on mental health is far from uniform. For vulnerable people, such as minoritized groups, children and young people and those living in economic instability, the effects of lockdowns have been far worse than in the general population.
“Disentangling which factors have contributed to these effects is complex, and requires substantial funding for research that uses robust methods.
“Lack of investment in mental health research and services has been a long term problem and the result is that when this crisis occurred we were unprepared to support the people who needed it most. As we enter further economic uncertainty and a prolonged tail to the pandemic at home and around the world, we cannot continue to make this mistake, we need to urgently invest in mental health now so that we can avoid the inequality gap continuing to grow.”
Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:
“The commentary by Meyerowitz-Katz and colleagues is a descriptive account of the authors’ interpretation of the impact of COVID-19 lockdown on, primarily, mortality.
“The authors reach the unsurprising conclusion that the short term impact of lockdown on mortality rates is considerably less than the impact of Covid-19, while correctly acknowledging that it is extremely difficult to disentangle the direct and indirect effects of either.
“This is a useful exercise but falls far short of demonstrating that the cure will not prove to be worse than the disease in the long term. This remains a distinct possibility, first highlighted in an Office of National Statistics study in April 2020.
“The policy implication is surely that this type of study should be undertaken BEFORE such a drastic intervention as lockdown is put in place.”
Dr Dean Burnett, Honorary Research Associate at Cardiff University, said:
“This extensive study cuts to the heart of the debate about whether lockdowns do more harm than good, particularly with regards to the impact on the mental health of populations. It has always been something of a false dichotomy, because the debate typically assumes that we have a choice between lockdown or pandemic, and that is not the case. The decision has always been pandemic with lockdown, and pandemic without lockdown, which is a very different thing.
“As this study shows, much of the problems often attributed to lockdowns cannot be easily distinguished from those caused by the pandemic itself. People being unable to travel, go to work, or having to avoid social contact is undeniably stressful and has mental health impacts (as well as physical ones, as people avoid hospitals etc.), but these aspects can just as easily stem from the presence of a deadly virus in the community. As the study shows, people were avoiding schools, not showing up for hospital appointments etc often before lockdown rules were introduced and enforced.
“The results are often the same whether brought about by government intervention or a plague, with the latter causing behavioural changes due to self-preservation rather than legal restrictions. But as the data suggests, the health impacts of strong lockdown rules seem to be much lower than those found in countries with more lax or absent lockdown rules. Sure the restrictions of lockdown are harmful and stressful, but leaving the pandemic progress unchecked leads to the same outcomes, but with added uncertainty and much more risk of illness and death, things which are known to directly harm mental health.
“The main takeaway is that ‘deciding’ between lockdown or pandemic is a very flawed premise. The pandemic exists, whether there’s a lockdown or not. While lockdown may have a number of negative consequences for mental health, there’s little or no evidence to say that these consequences are any worse than what we’d see in the same situation in the absence of lockdown. It’s far more likely that the opposite would be true.”
Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:
“This commentary provides an updated review of the literature around the direct and indirect impact of the pandemic. The authors cover the main available sources of data, for example looking at mortality and excess mortality across multiple countries, and discussing surveillance programmes, for example of routine childhood immunisation.
“They (and us as readers of the paper) are limited by how much they and we can infer. It is a commentary, essentially a pragmatic overview of the evidence base thus far. The evidence base of course evolves and surveillance and monitoring of local, national and global situations must continue. Real-time data is a precious asset in a pandemic, and the last 18 months has shown how fragile and limited the global data infrastructure really is.
“From what we do know about the pandemic, the harm caused by uncontrolled outbreaks includes extensive COVID-19 mortality, hospitalisation and prevalence of long covid. However, there are also consequences for other areas of health – for example, many UK trusts are reporting that they are once again cancelling operations and outpatient appointments due to beds and resources being taken up with COVID-19 patients. An inability to access healthcare during the pandemic has significant consequences across the health system.
“There have been suggestions by a very small number of scientists that naturally-acquired herd immunity is the best approach. This is not backed up by the evidence we have, for example as discussed in the ‘John Snow Memorandum’, and rebuttals from numerous other expert groups. The WHO pointed out such plans were ‘scientifically problematic and unethical’. The tragic example of India would suggest that uncontrolled outbreaks are indeed not an appropriate direction for policymakers.“This novel coronavirus has been, and continues to be, catastrophic for the world. Efforts to control outbreaks are clearly for the public good.”
Rebuttals to the herd immunity idea
John Snow Memorandum
Or SAGE – https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928740/S0810_Summary_of_SAGE_advice_on_segmentation.pdf
Or Independent SAGE https://www.independentsage.org/a-deliberate-population-immunity-strategy-before-a-vaccine-why-it-wouldnt-work-and-why-it-shouldnt-be-tried/)
Prof Paul Hunter, Professor in Medicine, The Norwich School of Medicine, University of East Anglia, said:
“This is an important review where the authors searched for evidence on whether lockdowns caused more harm to public health than would have been the case if the epidemic had been allowed to follow its course. As the authors clearly state in their paper proving this either way beyond reasonable doubt is not easy. Nevertheless, this paper takes a balanced approach to the collection and analysis of the evidence and their conclusions are reliable.
“The authors addressed four questions of relevance.
“As regards the impact of lockdowns on “Short-term mortality” and on “Suicide and mental health” the authors found robust evidence that lockdowns did not lead to increased short-term mortality or have a negative impact on suicide and mental health.
“The evidence on the issues around “disruption to health services” and on “global health services” was somewhat more nuanced. Yes there were such negative impacts observed but it was not possible to blame these on the lockdown rather than on the impact of the pandemic itself. In countries that did not impose many restrictions health services were overwhelmed far more severely than in those countries that did impose such measures.
“As the authors point out, this does not mean that lockdowns have not had any adverse impacts on public health but that the adverse public health impacts, and not just directly from COVID, would have been worse without them.”
‘Is the cure really worse than the disease? The health impacts of lockdowns during COVID-19’ by Gideon Meyerowitz-Katz et al was published in BMJ Global Health at 23:30 UK time on Monday 19 July.
DOI: doi 10.1136/bmjgh-2021-006653
All our previous output on this subject can be seen at this weblink:
Dr Michael Head: “I am a signatory to the John Snow Memorandum, though not a co-author on the original Lancet article.”
None others received.