Any packaged medication will come with a leaflet that warns of possible side effects. Manufacturers have to err on the side of caution, so they report pretty much every symptom that has been observed during clinical trials, even if most were probably unrelated to the medication. The only pills without side effects are those that don’t produce any effects at all, such as homeopathic remedies, which contain nothing but water or sugar.
But what about the side effects of the restrictions imposed by governments in their efforts to contain the Covid-19 pandemic? How much damage is being done by travel bans, closing restaurants and bars, mask mandates, lockdowns and other non-pharmaceutical interventions (NPIs)? Quite a lot. Stay-at-home orders increase loneliness, depression, anxiety and domestic abuse. The economic downturn is pushing thousands of people into poverty, shuttering hundreds of businesses, many of them permanently, and having devastating effects on the culture and entertainment industries and on children’s schooling.
Yet to claim that the cure is worse than the disease, as many lockdown sceptics have, is to make a grave mistake. To see why, we have to ask what would have happened without the lockdowns and other restrictions.
To start with, many more people would have died of Covid-19. Since ICUs would have been overwhelmed and have had to turn down first elderly and then younger patients, there would have been more deaths among younger people, too. Lockdown sceptics sometimes point to the fact that the reported numbers of Covid deaths are not much greater than those caused by a severe flu season. But to work out the true costs and benefits of lockdowns, curfews and other NPIs, you can’t just look at the number of people who have died: you have to take into account the people who would have died if such measures hadn’t been taken. If your dentist is halfway through extracting one of your teeth, it’s silly to ask, This doesn’t hurt much, so what was the point of stabbing me with that anaesthetic needle?
A paper published in Nature has estimated that Covid restrictions averted more than 3 million deaths in 11 European countries during the first wave of the pandemic (up to 4 May 2020): i.e. about 24 times the number of actual deaths up to then. It’s difficult to differentiate the effects of lockdowns from those of other NPIs, but the Nordic countries present an interesting test case. Norway, Finland and Sweden have very similar topographies, cultural norms and population densities. The first two resorted to lockdowns in 2020, but Sweden did not, though it used a gamut of other measures. By the end of 2020, Sweden had recorded 9 times as many deaths as Finland, and 10 times as many as Norway.
But what many people don’t appreciate is that Covid restrictions have averted a lot of other damage as well. If the virus were allowed to spread unchecked, the collateral damage would be even greater than that of the non-pharmaceutical interventions. Anyone who thinks that lifting the restrictions would end our economic and social misery hasn’t thought things through. Because the coronavirus itself has major side effects.
Take the economy. We know from data on consumer spending and mobility that there were massive spontaneous shifts in behaviour in the weeks before the first lockdowns of last year: people were already traveling less, eating out less, purchasing less and going to parties less and some had already started keeping their children out of school because they had decided that they would rather not get infected or infect others. If we were to lift all restrictions today, in no time half the active population would be ill at home in bed or at hospital, which wouldn’t be great for quarterly GDP figures either. And the more the virus spreads, the less the uninfected would want to go out and spend money at a restaurant or bar. By March 2020, when most European countries announced some form of lockdown, a big economic and social hit was inevitable, with or without government-imposed lockdowns. Even Sweden—which never instituted a full-blown lockdown and even kept its restaurants open—saw its economy decline as dramatically as those of many other European countries (and slightly more than its Nordic neighbours). As economist Mathias Dewatripont puts it: “It’s the virus, not the lockdown, that kills the economy.”
Then there’s the indirect health damage. In a recent op-ed in the Dutch newspaper NRC, four ICU doctors opposed their government’s Covid policy because these measures result in regular medical care being delayed or cancelled. But in fact the opposite is true. It’s the virus itself that causes treatment delays by flooding the hospitals. In a few cases, such as in Bergamo and in New York City last spring, hospitals have been completely overwhelmed. One of the main purposes of the current restrictions is precisely to avoid such a catastrophe. The more you let the virus spread, causing acute strain on your healthcare system, the less capacity you have to treat more chronic problems, such as cancer and heart disease. Those who want to relax the restrictions, such as the signatories of the Great Barrington Declaration, are rightly worried about the social and psychological ravages wrought by these measures. Nobody wants to be forced to live in a cramped apartment with multiple children to home-school, be trapped at home with an abusive spouse or have to worry about their income drying up. But, without lockdowns and other restrictions, almost everybody would have had a parent or other close relative either dying or fighting for her life in a chaotic, overrun hospital. Eventually the schools would have been forced to close anyway. Would that really have been less damaging to our collective mental health?
The most persistent misconception, almost as hard to eradicate as the virus itself, is that public health and the economy are communicating vessels, that policymakers are caught in a zero-sum trade-off between debilitating physical illness and terrible psychological damage. Many have argued against stricter measures because they wish to spare the economy and people’s psychological well-being. Toby Young recently took the radical line that, since policy responses to the pandemic cause “catastrophic harm,” the “whole panoply of NPIs” should be suspended. But allowing the virus free rein just means more collateral damage further down the line.
Those countries that took early and swift action (notably South Korea, Japan, Taiwan and New Zealand) have had the lowest numbers of deaths, and their economies have largely rebounded. Economic historians have documented the same pattern in US cities during the Spanish flu epidemic of 1918–19: the earlier and stronger the response, the swifter the economic recovery.
The sceptics are right that Covid measures, and especially lockdowns, cause a lot of indirect damage to our health and economy—though not as much as the virus itself would, if left unchecked. But if governments prematurely relax measures and reopen the economy too soon, we risk remaining stuck in a yo-yo cycle of repeated reopenings and lockdowns.
Last summer, in almost every European country, a loose coalition of people started to oppose NPIs, such as the wearing of face masks, restrictions on travel and bans on public gatherings, because they felt that the cure was worse than the disease and that we needed to learn to live with the virus. By the end of September, the Belgian movement had acquired enough political clout to persuade the government to relax the restrictions just when infection rates were clearly rising again, with the result that Belgium experienced the deadliest second wave in Western Europe.
Because of their short-sightedness, the sceptics ended up bringing about their own worst nightmare: another long and costly lockdown. And that just made all the side effects—which they were right to be concerned about—even worse.
There is an important lesson here for the third wave that is sweeping across Europe, mainly as a result of the emergence of the highly contagious B.1.1.7 strain (the British or Kent variant). People are understandably fed up and the public appetite for another round of restrictions is extremely low. However, there’s no negotiating with an exponentially growing virus. If you try to minimize your response in order to save the economy, as several European countries are currently doing, you will end up harming both the economy and public health. There is a very real danger that, within a few weeks, you will have to pull the emergency brake yet again, at which point the high cost of that brief period of freedom will become painfully clear. The higher you allow the infection and hospitalization curves to rise, the longer it will take to bring them down again. Then you get the worst of both worlds: economic and social damage, combined with a healthcare system in tatters. The harm that we are all being asked to accept might be unpleasant, but the final cost will be far higher if we don’t. With mass vaccination just around the corner, we have to double down and not give the virus a third chance.