A Running List of Studies Showing Lockdowns Do Not Slow the Spread of COVID-19 and Are Harmful
Here is a running list of studies showing that lockdowns do not help to prevent or slow the spread of COVID-19 and are extremely harmful.
1. European Journal of Clinical Investigation [January, 2021] [CASE GROWTH]
TITLE: Assessing Mandatory Stay‐at‐Home and Business Closure Effects on the Spread of COVID‐19
METHODS: “Using first‐difference models with fixed effects, we isolate the effects of mrNPIs by subtracting the combined effects of lrNPIs and epidemic dynamics from all NPIs. We use case growth in Sweden and South Korea, two countries that did not implement mandatory stay‐at‐home and business closures, as comparison countries for the other 8 countries (16 total comparisons).”
CONCLUSION: “While small benefits cannot be excluded, 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.”
“Because of the potential harmful health effects of mrNPI — including hunger, opioid-related overdoses, missed vaccinations increase in non-COVID diseases from missed health services, domestic abuse, mental health and suicidality, as well as a host of economic consequences with health implications it is increasingly recognized that their postulated benefits deserve careful study. One approach to evaluating NPI benefits uses disease modeling approaches. One prominent modeling analysis estimated that, across Europe, mrNPIs accounted for 81% of the reduction in the effective reproduction number, a measure of disease transmission. However, in the absence of empirical assessment of the policies, their effects on reduced transmission are assumed rather than assessed. That analysis attributes nearly all the reduction in transmission to the last intervention, whichever intervention happened to be last, complete lockdowns in France, or banning of public events in Sweden.”
2. The Lancet [July 21, 2020] [MORTALITY]
TITLE: A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes
METHODS: Information on COVID-19 policies and health outcomes were extracted from websites and country specific sources. Data collection included the government’s action, level of national preparedness, and country specific socioeconomic factors. Data was collected from the top 50 countries ranked by number of cases. Multivariable negative binomial regression was used to identify factors associated with COVID-19 mortality and related health outcomes.
CONCLUSION: “Increasing COVID-19 caseloads were associated with countries with higher obesity (adjusted rate ratio [RR]=1.06; 95%CI: 1.01–1.11), median population age (RR=1.10; 95%CI: 1.05–1.15) and longer time to border closures from the first reported case (RR=1.04; 95%CI: 1.01–1.08). Increased mortality per million was significantly associated with higher obesity prevalence (RR=1.12; 95%CI: 1.06–1.19) and per capita gross domestic product (GDP) (RR=1.03; 95%CI: 1.00–1.06). Reduced income dispersion reduced mortality (RR=0.88; 95%CI: 0.83–0.93) and the number of critical cases (RR=0.92; 95% CI: 0.87–0.97). Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns (RR=2.47: 95%CI: 1.08–5.64) and reduced country vulnerability to biological threats (i.e. high scores on the global health security scale for risk environment) (RR=1.55; 95%CI: 1.13–2.12) were significantly associated with increased patient recovery rates.”
3. Emergency Radiology [August, 2020] [DOMESTIC VIOLENCE]
TITLE: Exacerbation of Physical Intimate Partner Violence during COVID-19 Pandemic
METHODS: “The demographics, clinical presentation, injuries, and radiologic findings of patients reporting physical abuse arising from IPV during the statewide COVID-19 pandemic between March 11 and May 3, 2020, were compared with data from the same period for the past 3 years.”
CONCLUSION: “There was a higher incidence and severity of physical intimate partner violence (IPV) during the coronavirus disease 2019 (COVID-19) pandemic compared with the prior 3 years. These results suggest that victims of IPV delayed reaching out to health care services until the late stages of the abuse cycle during the COVID-19 pandemic.“
“A total of 26 victims of physical IPV from 2020 (mean age, 37 years ± 13 [standard deviation]; 25 women) were evaluated and compared with 42 victims of physical IPV (mean age, 41 years ± 15; 40 women) from 2017 to 2019. Although the overall number of patients who reported IPV decreased during the pandemic, the incidence of physical IPV was 1.8 times greater (95% CI: 1.1, 3.0; P = .01). The total number of deep injuries was 28 during 2020 versus 16 from 2017 to 2019; the number of deep injuries per victim was 1.1 during 2020 compared with 0.4 from 2017 to 2019 (P < .001). The incidence of high-risk abuse defined by mechanism was two times greater in 2020 (95% CI: 1.2, 4.7; P = .01). Patients who experienced IPV during the COVID-19 pandemic were more likely to be White; 17 (65%) victims in 2020 were White compared with 11 (26%) in the prior years (P = .007).“
4. European Psychiatry [September, 2020] [MENTAL HEALTH]
TITLE: Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network
METHODS: “The COvid Mental hEalth Trial (COMET) network includes 10 Italian university sites and the National Institute of Health. The whole study has three different phases. The first phase includes an online survey conducted between March and May 2020 in the Italian population. Recruitment took place through email invitation letters, social media, mailing lists of universities, national medical associations, and associations of stakeholders (e.g., associations of users/carers). In order to evaluate the impact of lockdown on depressive, anxiety and stress symptoms, multivariate linear regression models were performed, weighted for the propensity score.”
“The final sample consisted of 20,720 participants. Among them, 12.4% of respondents (N = 2,555) reported severe or extremely severe levels of depressive symptoms, 17.6% (N = 3,627) of anxiety symptoms and 41.6% (N = 8,619) reported to feel at least moderately stressed by the situation at the DASS-21.
According to the multivariate regression models, the depressive, anxiety and stress symptoms significantly worsened from the week April 9–15 to the week April 30 to May 4 (p < 0.0001). Moreover, female respondents and people with pre-existing mental health problems were at higher risk of developing severe depression and anxiety symptoms (p < 0.0001).”
CONCLUSION: “Although physical isolation and lockdown represent essential public health measures for containing the spread of the COVID-19 pandemic, they are a serious threat for mental health and well-being of the general population. As an integral part of COVID-19 response, mental health needs should be addressed.“
5. Medrxiv (“med-archive”) preprint [May, 2020] [DAILY DEATHS]
TITLE: Full lockdown policies in Western Europe countries have no evident
impacts on the COVID-19 epidemic.
METHODS: “To assess the efficiency of lockdown policies, we first compute the growth rate γ(t) from the daily deaths observations and apply linear regression to estimate its trend before the lockdown should have any visible effects (t < Tld + Td, where Tld is the start date of the lockdown measures). We then predict values for each variable of interest after the lockdown should have visible effects by extrapolating the linear evolution of γ(t) after this date. This allows us to compare observed values of growth rate, daily deaths, doubling time, and total fatalities number, with the values expected from the pre-lockdown trend (what would have happened if nothing had changed).”
CONCLUSION: “This observational study, using a generalized phenomenological method based on official daily deaths records only, shows that full lockdown policies of France, Italy, Spain and United Kingdom haven’t had the expected effects in the evolution of the COVID-19 epidemic. Our results show a general decay trend in the growth rates and reproduction numbers two to three weeks before the full lockdown policies would be expected to have visible effects. Comparison of pre and post lockdown observations reveals a counter-intuitive slowdown in the decay of the epidemic after lockdown. Estimates of daily and total deaths numbers using pre-lockdown trends suggest that no lives were saved by this strategy, in comparison with pre-lockdown, less restrictive, social distancing policies. Comparison of the epidemic’s evolution between the fully locked down countries and neighboring countries applying social distancing measures only, confirms the absence of any effects of home containment. Evolution of the epidemic in Sweden however indicates that, in the absence of any social distancing measures, the epidemic’s decay may be subject to larger fluctuations. This work thus suggests that social distancing measures, such as those applied in the Netherlands and Germany, or in Italy, France, Spain, and United Kingdom before the full lockdown strategies, have approximately the same effects as police-enforced home containment policies.”
“Although Epidemic outbreaks are complex dynamical systems, the daily new cases number most generally follows a similar time evolution: after an exponential growth, infections slow and eventually decay exponentially as, whether group immunity is reached, or seasonal factors or public actions slow the virus reproduction. This behavior has been observed for seasonal influenza, H1N1 as well as for recent coronavirus epidemics such as SARS or MERS. It is usually well described by exponential functions such as the logistic distribution or the Gauss function.“
6. PLOS ONE [October, 2020] [PSYCHOLOGICAL EFFECTS]
TITLE: Psychological impact of mass quarantine on population during pandemics—The COVID-19 Lock-Down (COLD) study
METHODS: “A cross sectional survey design was adopted to assess the psychological state of general population in India, during the COVID-19 mandatory lockdown period, with the help of a validated questionnaire.” n = 1,395
CONCLUSION: “The reported prevalence of depression was around 30.5%, which was the highest among the variables of psychological health. Anxiety was reported by 22.4%, followed by stress which was seen in 10.8% of respondents. In the third week the incidence of depression (37.8% versus 23.4%; p<0.001), anxiety (26.6% versus 18.2%; p<0.001) and stress (12.2% versus 9.3%; p<0.045) was reported to be significantly higher as compared to second week.”
“Our results suggest a progressively detrimental impact of lockdown on various aspects of psychological health. We noticed around eight to ten fold increase in the prevalence of depression (30.5%) and anxiety (22.4%) during lockdown, as compared to baseline statistics in Indian population (3·1–3·6% for depressive disorders and 3·0–3·5% for anxiety disorders).”
7. Journal of Public Economics [February, 2021] [DOMESTIC VIOLENCE]
TITLE: Intimate partner violence under forced cohabitation and economic stress: Evidence from the COVID-19 pandemic
METHODS: “Using an online survey data set, we find a 23% increase of intimate partner violence during the lockdown. Our results indicate that the impact of economic consequences is twice as large as the impact of lockdown. We also find large but statistically imprecise estimates of a large increase of domestic violence when the relative position of the man worsens, especially in contexts where that position was already being threatened. We view our results as consistent with the male backlash and emotional cue effects.
To overcome the limitations of the available statistics and contribute to a better understanding of a phenomenon of such social importance, we have carried out an online survey and asked Spanish women about the relationship with their partner during confinement. This survey provides unique data on domestic violence episodes, reported or unreported to the police, on a national sample of 13,786 women in Spain. The survey contains two parts. In the first part, women aged 18 years and older were asked questions about their economic situation before and after the lockdown, in addition to other demographic characteristics. In the second part, the same women responded to questions about different situations that according to experts are strong indicators of mistreatment. This set of questions allows us to construct a measure of “technical abuse”. We included nine different situations, that were obtained from a larger set of situations in the last Survey on Violence Against Women in Spain.9 We ask whether any of those situations has occurred with the current partner before and during the lockdown and the frequency of occurrence. We define our main variable of interest, technical abuse, as a dummy variable that takes value 1 if any of these 9 indicators occurs “frequently” or “sometimes”.”
CONCLUSION: “Domestic violence is a global public health problem and human rights violation with high economic and social costs. Using a unique data at individual level, which includes both reported and unreported events of IPV, we find that as consequence of the Covid-19 pandemic, the incidence of IPV increases 23.38% during the 3 months of lockdown in Spain. This effect is bigger than recent estimates based on reported events, which highlights the importance of taking into account unreported events.
We also show that during the extreme circumstances of a pandemic, IPV increases due to two independent factors: the lockdown and the economic stress. Although we cannot rule out that other factors (such as stress due to health concerns or working under pressure in essential occupations) may also explain the increase in IPV, our findings unveil one unintended consequence of lockdowns, i.e., that a lockdown, per se and independent from economic stress, causes more violence against women. Specifically, forced cohabitation increases psychological violence, that is, the type of violence less likely to be reported to the police.
Finally, our findings suggest that the end of the lockdown will not necessarily translate into a rapid decrease of IPV. By contrast, as the economic consequences of the Covid-19 pandemic becomes more evident, the incidence of IPV may increase for this reason. This is particularly worrisome given that we find that economic stress increases most types of abuse. Special attention should be devoted to couples without previous levels of violence, with children and of a low socio-economic status, since these are the couples where we see the largest effects.”
8. The British Medical Journal [October, 2020] [EFFECTS ON CHILDREN]
TITLE: Effect of School Closures on Mortality from Coronavirus Disease 2019: Old and New Predictions
METHODS: “CovidSim performs simulations of the UK at a detailed level without requiring personal data. The model includes millions of individual “people” going about their daily business—for example, within communities and at home, schools, universities, places of work, and hospitals. The geographical representation of the UK is taken from census data, so the distribution of age, health, wealth, and household size for simulated people in each area is appropriate. The model also includes appropriate numbers, age distribution, and commuting distances of people in the simulated schools and workplaces, each in line with national averages. The network of interactions is age dependent: people interact mainly with their own age group and with family, teachers, and carers. The virus (severe acute respiratory syndrome coronavirus 2) initially infects random members of this network of interacting coworkers, strangers, friends, and family. Whenever an infected person interacts with a non-infected person, there is a probability that the virus will spread. This probability depends on the time and proximity of the interaction and the infectiousness of the person according to the stage of the disease. Infected people might be admitted to hospital and might die, with the probability dependent on age, pre-existing conditions, and stage of the disease. This extremely detailed model is then parameterised using the best available expert clinical and behavioural evidence, with coronavirus specific features being updated as more coronavirus specific data become available from the worldwide pandemic. Therefore, the model has the required complexity to consider non-pharmaceutical interventions, which would reduce the number of interactions between simulated people in the model.”
CONCLUSION: “We therefore conclude that the somewhat counterintuitive results that school closures lead to more deaths are a consequence of the addition of some interventions that suppress the first wave and failure to prioritise protection of the most vulnerable people.
When the interventions are lifted, there is still a large population who are susceptible and a substantial number of people who are infected. This then leads to a second wave of infections that can result in more deaths, but later. Further lockdowns would lead to a repeating series of waves of infection unless herd immunity is achieved by vaccination, which is not considered in the model.
A similar result is obtained in some of the scenarios involving general social distancing. For example, adding general social distancing to case isolation and household quarantine was also strongly associated with suppression of the infection during the intervention period, but then a second wave occurs that actually concerns a higher peak demand for ICU beds than for the equivalent scenario without general social distancing.”
“We confirm that adding school and university closures to case isolation, household quarantine, and social distancing of over 70s would lead to more deaths compared with the equivalent scenario without the closures of schools and universities. Similarly, general social distancing was also projected to reduce the number of cases but increase the total number of deaths compared with social distancing of over 70s only. We note that in assessing the impact of school closures, UK policy advice has concentrated on reducing total number of cases and not the number of deaths.
The qualitative explanation is that, within all mitigation scenarios in the model, the epidemic ends with widespread immunity, with a large fraction of the population infected. Strategies that minimise deaths involve the infected fraction primarily being in the low risk younger age groups—for example, focusing stricter social distancing measures on care homes where people are likely to die rather than schools where they are not. Optimal death reduction strategies are different from those aimed at reducing the burden on ICUs, and different again from those that lower the overall case rate. It is therefore impossible to optimise a strategy for dealing with covid-19 unless these three desirable outcomes are prioritised.”
Organization: National Bureau of Economic Research
METHODS: ‘What is the cumulative effect of the COVID-19 unemployment shock on life expectancy and the age-adjusted death rate at a 5-, 10-, 15-, and 20-year horizon? To answer this question, we rely on our state-space model to produce a measure of the unemployment shock experienced by the US economy. Despite the estimation sample ending in 2017, unemployment data for 2018, 2019, and (partially for) 2020 are available for the overall population and for each group. At the time of this draft, the historical unemployment rates are available up to October 2020. We use the ten-month average of the available monthly unemployment rates as a proxy for the 2020 annual unemployment rate. Conditional on the posterior coefficient estimates and the 2018-2020 values of the unemployment rates, we can filter out the reduced-form shocks (based on the state-space model. We can do so by treating the 2018-2020 values of the life expectancy and death rate as missing observations. We then apply a transformation based on the Cholesky decomposition to the inferred reduced-form shocks to back out the structural unemployment shocks. The implied COVID-19 unemployment shock distributions are provided in Table 4. This empirical approach aims at distinguishing and isolating the consequences for human health of the economic distress related to the COVID-19 pandemic as compared to the COVID-19 pandemic itself. Obviously, the original shock that led to the increase in unemployment is a health shock, but our goal here is to only consider the consequences for human health of the COVID-19-related increase in unemployment. In this context, unemployment acts as a readily available proxy for the overall economic distress. Based on our approach, the COVID-19 unemployment shock is about 3.17 standard deviations larger (about 2.68% in magnitude) than the typical shock to the unemployment rate
CONCLUSION: “We examine the historical relation between life-expectancy, death-rates, and unemployment for the overall US population and groups organized based on race and gender. We use a VAR that allows for observation errors and we find that increases in unemployment are followed by statistically significant increases in death rates and declines in life-expectancy. A sizable fraction of the variation of these two variables can be accounted by unemployment shocks. We then use this historical relation to form predictions about the potential impact of the recession caused by the COVID-19 pandemic on human health. Our results suggest that the toll of lives claimed by the SARS-CoV-2 virus far exceeds those immediately related to the acute COVID-19 critical illness and that the recession caused by the pandemic can jeopardize population health for the next two decades. Based on our findings, African American citizens and women will be suffering more profoundly from the coronavirus-driven recession, adding on to their disproportionate adverse outcome in the setting of acute SARS-CoV-2 infection, Garg et al. (2020). Based on our findings, large, sustained and swift government maneuvers to support the currently unemployed labor force and to abate unemployment will be as equally important as the massive efforts focused on limiting and eventually eradicating transmission of SARS-CoV-2 with effective vaccination strategies that are finally into place.”
8. Medrxiv (“med-archive”) preprint [January, 2021][CASE GROWTH]
TITLE: Lockdown Effects on Sars-CoV-2 Transmission – The evidence from Northern Jutland
METHODS: “In this paper, we approach these challenges by using evidence offered by a quasi-natural experiment in the Danish region of Northern Jutland. After the discovery of mutations of Sars-CoV- 2 in mink – a major Danish export – seven of the 11 municipalities of the region went into extreme lockdown in early November, while the four other municipalities retained the moderate restrictions of the remaining country. Incidentally, the infection numbers in the two groups are relatively comparable and counted in the hundreds, i.e., the data set has strong statistical power. This situation provides us with a unique data set of an intra-country (homogenous population) comparison with a direct case control, highly focused in both time and space (thus reducing confounding factors to the maximal extent possible).
“As seen in the following, the seven municipalities did not have significantly different infection development prior to the intervention than the four municipalities that were not locked down. The infection levels decreased already at least a week before the lockdown would have any effect, and there was also a decline in case numbers in the neighbour municipalities. Test behaviour was very distinct, with the locked-down areas subject to several weeks of mass testing, but we show that this did not affect the infection dynamics, since infection curves before and after mass testing were similar in the two groups. Possible reasons behind this finding are discussed. We conclude that efficient infection surveillance prior to lockdown combined with voluntary compliance produced similar effects as mandated lockdown, although we cannot separate the relative contribution of these two effects.”
CONCLUSION: “Almost all Western countries used societal lockdown as a primary policy instrument in 2020. While surely having some effect on viral transmission, the specific gain of a full lockdown vs. voluntary behavioural changes and other simultaneously enforced milder NPIs remains a matter of debate due to lack of actual empirical control cases for the same populations. Modelling studies, despite the important insights they give into infection transmission and control, suffer from uncertain counterfactual curves, and country-comparisons, although analysing epidemiological data, suffer from major confounder effects.
“In this study, we take advantage of a quasi-natural experiment that occurred in the Danish region of Northern Jutland in the late Autumn of 2020. Owing to a potential mutation of Sars-CoV- 2 in mink, seven of the 11 municipalities in the region went into extreme lockdown by November 6, which included a travel ban across municipal borders, closing schools, the hospitality sector and other venues. The municipalities going into lockdown did not exhibit higher infection rates prior to the lockdown and can therefore be compared to those that remained relatively open. We first and foremost alert the community to the existence of this dataset and invite other views on it with open eyes, as it is to our knowledge the most time- and space-focused empirical dataset available with sufficient statistical power, adequate and homogeneous control group, nearly complete testing, and with the smallest possible confounder pollution imaginable in a real setting.
“In our own analysis of this dataset, which we invite others to investigate, we did not find evidence of any effects of the lockdown on the development of infection rates across Northern Jutland, relative to the control. In other words, we find that an extreme version of societal lockdown had no effect on virus development: Although infections fell over time, they did so before the mandate was implemented (and even before it was announced), and the decline experienced in Aalborg, the main driver of the case control group without mandate, was comparable.
“Test-corrected incidences (test positivity or intermediate methods such as power law fits), as sometimes appropriate at moderate testing levels, is shown to be inadequate in this case because 1) testing was saturated and almost all cases were identified much below mass testing levels and 2) the two groups did not follow the same test-positivity behaviour during the 2 weeks of mass testing, but do so before and after, and 3) test positivity rapidly converged back to the control group levels once mass testing stopped in the lockdown municipalities. As a final comment, we also looked at the infection levels during December. From their lows, both groups of municipalities experienced a rapid 5-fold increase in PCR positives that confirms our general conclusion that the overall infection dynamics in the two groups of municipalities have not been greatly affected, neither short-term, nor longer-term.”
9. The Lancet Psychiatry [July 21, 2020][PSYCHOLOGICAL EFFECTS]
TITLE: Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population
METHODS: n this secondary analysis of a national, longitudinal cohort study, households that took part in Waves 8 or 9 of the UK Household Longitudinal Study (UKHLS) panel, including all members aged 16 or older in April, 2020, were invited to complete the COVID-19 web survey on April 23–30, 2020. Participants who were unable to make an informed decision as a result of incapacity, or who had unknown postal addresses or addresses abroad were excluded. Mental health was assessed using the 12-item General Health Questionnaire (GHQ-12). Repeated cross-sectional analyses were done to examine temporal trends. Fixed-effects regression models were fitted to identify within-person change compared with preceding trends.
CONCLUSION: Waves 6–9 of the UKHLS had 53 351 participants. Eligible participants for the COVID-19 web survey were from households that took part in Waves 8 or 9, and 17 452 (41·2%) of 42 330 eligible people participated in the web survey. Population prevalence of clinically significant levels of mental distress rose from 18·9% (95% CI 17·8–20·0) in 2018–19 to 27·3% (26·3–28·2) in April, 2020, one month into UK lockdown. Mean GHQ-12 [General Health Questionnaire] score also increased over this time, from 11·5 (95% CI 11·3–11·6) in 2018–19, to 12·6 (12·5–12·8) in April, 2020. This was 0·48 (95% CI 0·07–0·90) points higher than expected when accounting for previous upward trends between 2014 and 2018. Comparing GHQ-12 scores within individuals, adjusting for time trends and significant predictors of change, increases were greatest in 18–24-year-olds (2·69 points, 95% CI 1·89–3·48), 25–34-year-olds (1·57, 0·96–2·18), women (0·92, 0·50–1·35), and people living with young children (1·45, 0·79–2·12). People employed before the pandemic also averaged a notable increase in GHQ-12 score (0·63, 95% CI 0·20–1·06).
By late April, 2020, mental health in the UK had deteriorated compared with pre-COVID-19 trends. Policies emphasising the needs of women, young people, and those with preschool aged children are likely to play an important part in preventing future mental illness.
Journal: International Journal of Social Psychology [March 31, 2020][PSYCHOLOGICAL EFFECTS]
TITLE: The outbreak of COVID-19 coronavirus and its impact on global mental health
METHODS: Published articles concerning mental health related to the COVID-19 outbreak and other previous global infections have been considered and reviewed.
CONCLUSION: “The current focus on the transmission of COVID-19 infection all over the world may probably distract public attention from psychosocial consequences of the outbreak in the affected individuals and in the general population. The emerging mental health issues related to this global event may evolve into long-lasting health problems, isolation and stigma. Global health measures should be employed to address psychosocial stressors, particularly related to the use of isolation/quarantine, fear and vulnerability among the general population. A worldwide inclusive response should include a focus on mental health impact of patients and general population. The information from media and social network should be closely controlled and community supportive psychological interventions globally promoted.”
10. Psychiatry Research [January 2021] [SUICIDES] [DOMESTIC ABUSE]
TITLE: Trends in suicide in Japan by gender during the COVID-19 pandemic, up to September 2020
METHODS: “We obtained monthly mortality data from December 2010 to September 2020 from the National Police Agency, Japan. A quasi-Poisson regression was used to estimate the expected monthly number of deaths from suicide (see Supplement material 1). We used the Farrington algorithm for the estimation of parameters in the quasi-Poisson regression. The Farrington algorithm is used to limit the data for the estimation: the expected number of suicide deaths at a calendar month t is estimated using only the data during t−w to t+w months of years h−b and h−1, where w and b are pre-fixed values and h is the year of t. In this study, we considered b=5 and w=1. We set the point estimate and upper bound of the two-sided 95% prediction interval as the threshold for excess deaths, and the point estimate and lower bound for exiguous deaths. A range for excess/exiguous deaths was then obtained from the differences between the observed deaths and each of these thresholds. The percent excess and deficit were defined as the number of excess and exiguous deaths divided by the threshold, respectively, which can be interpreted as the magnitude of the suicide burden of the COVID-19 pandemic. Note that although we used data during 2010–2020 for the estimation, the results during 2016–2020 were shown in Figures for simplicity.”
CONCLUSION: “The study findings suggest that as of September women were experiencing a greater suicide burden from COVID-19 than men, and it was about 20–30% (i.e. percent excess) larger in number than in previous years. Considering that the percent excess of all-cause deaths over the similar period was less than 1% (National Institute of Infectious Diseases, 2020), the magnitude of the suicide burden during COVID-19 is very significant. There are several possible mechanisms for this gender gap in COVID-19 suicide burden in Japan, and one is violence against women. In China, the United States, Brazil, Australia, and New Zealand, increases in family violence coinciding with COVID-19 related restrictions on movement, such as lockdown orders, were reported (van Gelder, 2020; Every-Palmer, 2020; Usher, 2020), which is known to increase suicidal thoughts and attempts in women (Ellsberg, 2008). The United Nations Development Programme (UNDP) has highlighted a marked increase in violence against women under the COVID-19 pandemic and the need for emergency shelter and protection services for women (United Nations Development Programme, 2020). In fact, consultations on family violence to national and local governments increased in Japan by as much as 60% since the state of emergency was declared (Tokyo Shimbun, 2020). The Cabinet Office strengthened services to protect against violence against women, including the establishment of a Gender Violence Prevention Division in October 2020. The findings of this study support its importance and warn of the need for further efforts to protect women from gendered violence.”
11. Death Studies [SUICIDES][PSYCHOLOGICAL EFFECTS]
TITLE: Suicide risk during the lockdown due to coronavirus disease (COVID-19) in Colombia
METHODS: “A cross-sectional study was designed with the endorsement of the research ethics committee of the University of Magdalena, Santa Marta, Colombia. The proposal considered the ethical aspects of the Declaration of Helsinki and the Colombian standards for health research: the participants gave informed consent.”
CONCLUSION: “A total of 714 people completed the questionnaire; however, 14 of them who reported residing outside of Colombia were excluded, resulting in a final sample of 700 people residing in Colombia. The ages of the participants were between 18 and 76 years (M = 37.1, SD = 12.7); 248 (35.4%) were emerging adults and 442 (64.6%) were 30 years or older. Table 1 presents other demographic characteristics and frequencies of variables.
In the present study, a presence of 7.6% of high suicide risk was observed during the period of confinement in Colombia. Studies show that suicide self-injurious behaviors (ideation, plan, and attempts) increase during epidemics (Ammerman et al., 2020; Cheung et al., 2008; Mejía et al., 2020; Yip et al., 2010). However, this presence is less than 13.3% of the high suicide risk observed in Colombian adolescents during 2018. The differences in the age groups may account for the difference in that suicide behaviors are more frequent during adolescence than in other periods of the life course (Turecki & Brent, 2016).
In the present analysis, a statistically significant association was found between perceived stress related to COVID-19 and high suicide risk during confinement. Various investigations observed a significant relationship between perceived stress and suicide behaviors (Anastasiades et al., 2017; Bickford et al., 2020). Perceived stress can increase suicide risk by neurophysiological and psychological mechanisms (Bickford et al., 2020; Turecki & Brent, 2016). Uncertainty about the nature of a highly contagious and life-threatening illness, and problems, social confinement, and economic problems can be sources of stress (Reger et al., 2020; Thakur & Jain, 2020).
12. Psychiatry Research [June 26, 2020]
TITLE: Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor
METHODS: The present study followed to utilize the press media reported suicide cases like the previous retrospective suicide studies conducted in developing South Asian countries (e.g., India, Armstrong et al., 2019; Bangladesh, Mamun and Griffiths, 2020; Mamun et al., 2020a, Mamun et al., 2020b; Pakistan, Mamun & Ullah, 2020). We used a purposive sampling method in selecting the seven popular English Indian online newspapers from March to May 24, 2020. Duplicates identified of same news in multiple reports and suicide reports unrelated to COVID-19 were excluded from the study.
CONCLUSION: A total number of 72 suicide cases from 69 newspaper reports met the inclusion criteria for the study. Most of the suicide cases were males (n=63), and the age of the individuals ranged from 19 to 65 years. The most common causative factors reported were fear of COVID-19 infection (n=21), followed by financial crisis (n=19), loneliness, social boycott and pressure to be quarantine, COVID-19 positive, COVID-19 work-related stress, unable to come back home after lockdown was imposed, unavailability of alcohol etc.
13. Preventing Chronic Disease [October 1, 2020]
TITLE: Social Determinants of Health–Related Needs During COVID-19 Among Low-Income Households With Children
METHODS: We distributed an electronic survey in April 2020 to 16,435 families in 4 geographic areas, and 1,048 responded. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19–related concerns, food insecurity, and diet-related behaviors during the pandemic. An open-ended question asked about their greatest concern. We calculated descriptive statistics stratified by location and race/ethnicity. We used thematic analysis and an inductive approach to examine the open-ended comments.
CONCLUSION: More than 80% of survey respondents were familiar with COVID-19 and were concerned about infection. Overall, 76.3% reported concerns about financial stability, 42.5% about employment, 69.4% about food availability, 31.0% about housing stability, and 35.9% about health care access. Overall, 93.5% of respondents reported being food insecure, a 22-percentage-point increase since fall 2019. Also, 41.4% reported a decrease in fruit and vegetable intake because of COVID-19. Frequency of grocery shopping decreased and food pantry usage increased. Qualitative assessment identified 4 main themes: 1) fear of contracting COVID-19, 2) disruption of employment status, 3) financial hardship, and 4) exacerbated food insecurity.
14. CESifo Eonomic Studies [MORTALITY] [March 29, 2021]
TITLE: Did Lockdown Work? An Economist’s Cross-Country Comparison
METHODS: In this paper, I instead approach the question using a standard approach and standard econometric tools used in economics and political science instead of epidemiological modelling or single-case studies. I compare weekly general mortality rates in the first half of the year in 2017, 2018, 2019, and 2020 in 24 European countries that took very different policy measures against the virus at different points in time. Estimating the effects of these policy measures as captured by the Blavatnik Centre’s COVID-19 policy indices and taking the endogeneity of policy responses into account, the results suggest that stricter lockdown policies have not been associated with lower mortality.
CONCLUSION: “The lockdowns in most Western countries have thrown the world into the most severe recession since World War II and the most rapidly developing recession ever seen in mature market economies. They have also caused an erosion of fundamental rights and the separation of powers in large part of the world as both democratic and autocratic regimes have misused their emergency powers and ignored constitutional limits to policy making. It is therefore important to evaluate whether and to which extent the lockdowns have worked as officially intended: to suppress the spread of the Sars-CoV-2 virus and prevent deaths associated with it.
“Comparing weekly mortality in 24 European countries, the findings in this paper suggest that more severe lockdown policies have not been associated with lower mortality. In other words, the lockdowns have not worked as intended. Further tests also show that early interventions offered no additional benefits or effectiveness and even indicate that the lockdowns of the spring of 2020 were associated with significantly more deaths in the particular age group between 60 and 79 years.“
15. JAMA [LOCKDOWN SIDE EFFECTS, OBESITY]
TITLE: Changes in Body Mass Index Among Children and Adolescents During the COVID-19 Pandemic
METHODS: “We conducted a retrospective cohort study using Kaiser Permanente Southern California (KPSC) electronic health record data. Youth between 5 and 17 years with continuous health care coverage were included if they had an in-person visit with at least 1 BMI measure before the pandemic (March 2019-January 2020) and another BMI measure during the pandemic (March 2020-January 2021 with at least 1 BMI after June 16, 2020, ie, about 3 months into the pandemic). Youth with complex chronic conditions were excluded.2,3 Race and ethnicity based on caregiver report or birth certificates were used to compare with the underlying population. Outcomes were the absolute distance of a youth’s BMI from the median BMI for sex and age,4 weight adjusted for height, and overweight or obesity (≥85th or ≥95th percentile of BMI for age, respectively).5,6 We fit mixed-effect and Poisson regression models accounting for repeated measures within each individual, using an autoregressive correlation structure and maximum likelihood estimation of covariance parameters to assess each outcome. Similar to an interrupted time-series design, we included a binary indicator representing the periods before or during the pandemic plus a calendar month by period interaction term. We divided youths into 3 age strata (5.0-<12, 12-<16, 16-<18 years) based on age at the start of the pandemic.
Models were adjusted for sex, race and ethnicity, state-subsidized health insurance, neighborhood education, neighborhood income, and number of parks in the census tract. Mixed-effects models also included BMI-for-age class at baseline. All analyses were performed with α = .05 for 2-sided tests using SAS version 9.4 (SAS Institute Inc). The KPSC institutional review board approved the study and granted a waiver for informed consent.”
CONCLUSION: “Significant weight gain occurred during the COVID-19 pandemic among youths in KPSC, especially among the youngest children. These findings, if generalizable to the US suggest an increase in pediatric obesity due to the pandemic.“
Study limitations include the observational design and inclusion of only those with in-person appointments. However, the analyses benefited from longitudinal data with prepandemic BMI and in-person well-child visits resuming at 84% of prepandemic levels by June 2020. Furthermore, the sample was comparable in all relevant characteristics with the overall KPSC pediatric membership.
Research should monitor whether the observed weight gain persists and what long-term health consequences may emerge. Intervention efforts to address COVID-19 related weight gain may be needed.”
16. Studies in Applied Economics [INEFFICACY, DEATHS][Published January 2022]
TITLE: A Literature Review and Meta-Analysis of the Effects of Lockdowns on COVID-19 Mortality
METHODS: “The studies we reviewed were identified by scanning Google Scholar and SCOPUS for Englishlanguage studies. We used a wide range of search terms which are combinations of three search
strings: a disease search string (“covid,” “corona,” “coronavirus,” “sars-cov-2”), a government response search string and a methodology search string. We identified papers based on 1,360 search terms. We also required mentions of “deaths,” “death,” and/or “mortality.” The search terms were continuously updated (by adding relevant terms) to fit this criterion. We also included all papers published in Covid Economics. Our search was performed between July 1 and July 5, 2021 and resulted in 18,590 unique studies. All studies identified using SCOPUS and Covid Economics were also found using Google Scholar. This made us comfortable that including other sources such as VOXeu and SSRN would not change the result. Indeed, many papers found using Google Scholar were from these sources.
All 18,590 studies were first screened based on the title. Studies clearly not related to our
research question were deemed irrelevant. After screening based on the title, 1,048 papers remained. These papers were manually screened by answering two questions:
- Does the study measure the effect of lockdowns on mortality?
- Does the study use an empirical ex post difference-in-difference approach (see eligibility
Studies to which we could not answer “yes” to both questions were excluded. When in doubt, we
made the assessment based on reading the full paper, and in some cases, we consulted with
colleagues. After the manual screening, 117 studies were retrieved for a full, detailed review. These studies were carefully examined, and metadata and empirical results were stored in an Excel spreadsheet.”
“In the meta-analysis, we include 24 studies in which we can derive the relative effect of
lockdowns on COVID-19 mortality, where mortality is measured as COVID-19-related deaths
per million. In practice, this means that the studies we included estimate the effect of lockdowns
on mortality or the effect of lockdowns on mortality growth rates, while using a counterfactual
estimate. Our focus is on the effect of compulsory non-pharmaceutical interventions (NPI), policies that
restrict internal movement, close schools and businesses, and ban international travel, among
others. We do not look at the effect of voluntary behavioral changes (e.g. voluntary mask
wearing), the effect of recommendations (e.g. recommended mask wearing), or governmental
services (voluntary mass testing and public information campaigns), but only on mandated NPIs.”
“Overall, our meta-analysis fails to confirm that lockdowns have had a large, significant effect on
mortality rates. Studies examining the relationship between lockdown strictness (based on the
OxCGRT stringency index) find that the average lockdown in Europe and the United States only
reduced COVID-19 mortality by 0.2% compared to a COVID-19 policy based solely on
recommendations. Shelter-in-place orders (SIPOs) were also ineffective. They only reduced
COVID-19 mortality by 2.9%.
Studies looking at specific NPIs (lockdown vs. no lockdown, facemasks, closing non-essential
businesses, border closures, school closures, and limiting gatherings) also find no broad-based
evidence of noticeable effects on COVID-19 mortality. However, closing non-essential
businesses seems to have had some effect (reducing COVID-19 mortality by 10.6%), which is
likely to be related to the closure of bars. Also, masks may reduce COVID-19 mortality, but
there is only one study that examines universal mask mandates. The effect of border closures,
school closures and limiting gatherings on COVID-19 mortality yields precision-weighted
estimates of -0.1%, -4.4%, and 1.6%, respectively. Lockdowns (compared to no lockdowns) also
do not reduce COVID-19 mortality.
Overall, we conclude that lockdowns are not an effective way of reducing mortality rates during
a pandemic, at least not during the first wave of the COVID-19 pandemic. Our results are in line
with the World Health Organization Writing Group (2006), who state, “Reports from the 1918
influenza pandemic indicate that social-distancing measures did not stop or appear to
dramatically reduce transmission […] In Edmonton, Canada, isolation and quarantine were
instituted; public meetings were banned; schools, churches, colleges, theaters, and other public
gathering places were closed; and business hours were restricted without obvious impact on the
epidemic.” Our findings are also in line with Allen’s (2021) conclusion: “The most recent
research has shown that lockdowns have had, at best, a marginal effect on the number of Covid19 deaths.” Poeschl and Larsen (2021) conclude that “interventions are generally effective in mitigating COVID-19 spread”. But, 9 of the 43 (21%) results they review find “no or uncertain association” between lockdowns and the spread of COVID-19, suggesting that evidence from that own study contradicts their conclusion.”
Feature image: michael_swan
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