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COVID-19: The range of Death Rates in Lockdown and Non-Lockdown Countries - One Outcome Measure of Lockdown Policy
EDITORIAL PART ONE
The 2020 lockdown policy, to control and limit damage of a coronavirus pandemic, was largely adopted globally, as a public health intervention.
The policy in the U.K. was adopted from March to July, (approximately) and is, without doubt, the most expensive public health intervention ever undertaken in the U.K. The associated costs will include a furlough costs, social benefits, lost revenue from workers and business, unemployment, impacts on health through delayed surgery etc. A full bill of costs has yet to be added up, but public borrowing incurred as of July 2020 is estimated to exceed £360 billion. The UK’s universal health scheme, the NHS, costs £140 billion to run every year. The costs of borrowing for 2020 alone would exceed the cost of running the entire NHS for 2.5 years.
We need to consider whether the investment in this health intervention has been a wise investment.
What have been the health outcomes associated with lockdown?
This is difficult to ascertain at this time, but there is evidence to indicate that the relevant coronavirus, COVID-19 has been triggering cases of infection in various countries since at least December 2019. The virus has therefore been widespread for over six months, and largely international numbers of cases and deaths have peaked and fallen, with countries like the UK leaving lockdown.
One widely available measure of outcome would be to look at deaths reported as a result of COVID.
There are limitations to this approach, but prevention of death is obviously a key desire for the public, and unquestionably one of the aims of the lockdown. [If not, then what other purpose might there be? A desire to avoid overwhelming the NHS might an early aim of lockdown, but the Nightingale field hospitals were never filled, and some left unoccupied - untroubled by a surge in cases that never came.]
Mortality figures, death rates, whatever you call them are absolute and feasibly quantifiable measures. Other measures, such as morbidity, often require qualitative methods of measurement e.g. prevalence of PTSD.
One obvious method of ascertaining whether lockdown had the desired effect (to prevent death) would be to compare countries that had lockdown for COVID with countries that did not have a lockdown for COVID.
A limitation to that would be that most countries adopted a lockdown process and few did not.
If we return to the idea of comparing figures for lock down countries with non-lockdown countries in 2020 two angles might be explored.
Limitations for the exercise of comparing countries is that there are for more countries that adopted lockdown than countries did not. This is not something that a retrospective study can alter and we can only work with the figures we have, which is much the same response to any criticism that different countries might measure deaths differently. By this I mean that some countries might ascribe deaths to COVID that other countries would not. If your threshold for counting a death is based on a case being possible based on symptoms or probable based on symptoms and a past positive test and an additional serious health condition, probable based on symptoms and a past positive test without an additional serious health condition or definite based on symptoms, doctors opinion that COVID is the sole reason for death at the time of death and positive test just before death – all these thresholds may affect the recorded casus of death. Some countries may assiduously assess the cause of death, others less assiduously. Some may wish to emphasise or massage figures for political reasons. This again is not something that this study can necessarily control for and we can only work with the publicly available figures we have. Although the Government of one non-lock down country has reportedly denied the existence of a pandemic and not reported any figures. This country could not be incorporated into the analysis, for obvious reasons.
The first angle we can look at is to separate the groups of countries in two – Group A and Group B according to whether lockdown policy was an adopted. Then we can look at the range of death rates (deaths per million) in each group.
Our hypothesis would be that in a locked down country there should be fewer deaths and that accordingly the range of death rates would differ between Group A and Group B. The non-lockdown group would see a range of death rates that perhaps overlapped the lockdown group but were shifted towards the highest death rates.
We might therefore expect:
Lockdown Group Death Rates (IN RED):
LOW ------------------------------------------------------------ HIGH
LOW _______________________________________ HIGH
Non Lockdown Group Death Rates (IN BLUE)
The objective figures (deaths/million) observed from the Statista.com website on 23rd July 2020 were:
| LOWEST DEATH RATE | HIGHEST DEATH RATE | |
| GROUP A | 3 | 549 |
| GROUP B | 0.1 | 858 |
Which group do you think represents the lockdown group of countries and which is the non-lockdown group?
The answer is given in the second part of this linked editorial.
Copyright Priory Lodge Education Limited 2020
Editorial by Professor Ben Green
Accepted 18th July 2020
First Published 22nd July 2020
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