Editor’s Note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN.
As the clear and present danger of the Covid-19 pandemic begins to fade, discussions and judgments have been swirling as to whether the various battlefield public health decisions to confront the crisis were effective.
Earlier this year, an analysis of the efficacy of wearing a mask caused such an uproar that the estimable Cochrane Review issued a very unusual statement to clarify just what the article said (the study limitations were too great to conclude much) and didn’t say (masks don’t work, full stop).
More recently, a British government inquiry into the country’s day-to-day pandemic management has suggested that decisions (“over-confidence and lack of planning”) and attitude (“misogyny and lack of humanity in the government’s response”) were sorely lacking.
And now, business reporters Bethany McLean and Joe Nocera have published a book, “The Big Fail,” excerpted in a New York Magazine article headlined: “Covid Lockdowns were a Giant Experiment. It was a Failure.” (Full disclosure: I have read only the magazine excerpt, not the full book.) Given this provocative title, it is unsurprising to find a withering assessment of the lockdowns used in the US and many other countries as a means to control Covid-19.
The authors make some good points: The lockdown dislocated students from schools and customers from places of business. Medical care was delayed for some (though needed surgeries continued when hospital beds were available). And, most dramatically, young students lost the educational and social advantage of a physical classroom. (As for the students, by some accounts, the academic impact seems to have been transient.)
They summarize the issue this way: “Did the many social, economic, and medical downsides make [lockdowns], in the aggregate, not worth whatever short-term benefits they might yield?” Their answer is a loud “no.”
To which I, having read the same dozens of primary articles they did, say: You bet it was worth it.
Yes, lockdown was a blunt instrument that caused a great deal of collateral damage. The difference between my view and theirs, I think, is that they consider the lockdown a single activity stretched across the entire pandemic; in contrast, I would distinguish the initial lockdown, which was crucial, from the off-and-on lockdowns as therapies, vaccines and overall care improved. There is an argument to be made that these were not anywhere near as effective.
In other words, I consider the “short-term benefits” to be absolutely critical in allowing the medical world to steady itself and gain a much firmer grasp of the task at hand. One only had to work in health care in New York City to see the difference between early 2020, when the explosion of cases overwhelmed the city, versus later in 2020 when an effective therapy had been identified, supplies and diagnostic testing had been greatly improved (though still completely inadequate) and the makeshift ICUs and emergency rooms had been set in place.
It was still a nightmare to be sure, but it was a vastly more organized nightmare.
The “short-term benefits” at the start of the pandemic are simple to characterize: Every infection that was delayed due to the lockdowns was a day to the good, a day closer to the release of the mRNA vaccines in December 2020, a less-hectic day for the health care workers, a day for clinical trials to mature. Therefore, the authors’ statement that lockdowns “were a mistake that should not be repeated” because they had no “purpose other than keeping hospitals from being overrun in the short-term” is to me a fundamental misunderstanding of the day-to-day work that was being done.
Most disturbing to me about this assessment and the others that have come along are the minimal mention of the death and debility the infection caused. A reminder for those who have forgotten just how brutal the pandemic was: Worldwide there have been 7 million deaths. In the US, there have been more than a million deaths, millions have some post-infection debility and many health care workers remain profoundly demoralized.
In this context, many of the outcomes of concern listed by Nocera and McLean — suicidal thoughts in teens, alcoholism and drug use increases, violence — are as easily explained by this staggering death toll as by the cabin fever brought on by lockdowns. Once again: About 1 out of every 350 Americans died in the Covid-19 pandemic.
Another way to consider the impact of so many deaths is examination of life expectancy. Of note, life expectancy in the US fell in 2020 (1.8 years) and 2021 (0.6 years), the sharpest drop since the 1920s; per the US Centers for Disease Control and Prevention, 74% of the drop was attributed to Covid-19. This perspective makes a simple point for those who consider many deaths among the elderly and very elderly as sad but without larger societal implications. From the society perspective, if only the old and very old die, there should be little if any impact on life expectancy. To fall more than two years so precipitously requires the deaths of many in their 30s and 40s and 50s, as occurred with the first year of the pandemic.
Despite endless studies, the debate about lockdowns will continue. The data is not clean. Real data — not prissy data from a generic randomized placebo controlled double-blind trial run by a pharma company with deep pockets (albeit with a desired outcome as well) — is never clean. Therefore, in its uncertainty there is room for all sorts of interpretations, crazy and not, and the issue will not be settled, though I agree that we must try.
I do think that a practical conclusion that we may send to those caught up in a future pandemic of respiratory virus is this: Lock down hard and quickly until you and the world can get your bearings. Maintaining a functional health care system is crucial.
This of course shifts the hard debate to follow-up decisions. Once started, how quickly can one lift a lockdown? For me, this is the very unclear and very difficult problem and one that can frustrate an already overwhelmed public. The back and forth of the lockdown edicts seemed like more governmental dithering to many and requires a great deal of focused consideration.
But one large caveat to making the decisions that lie ahead: Historians — the tweedy tenured types — understand they stand at a safe remove from the events they are recounting. They acknowledge that being in the middle of total chaos is very different than writing about those who were in the middle of total chaos. The eminent historian Bernard Bailyn warned against the distortion this can impose: “The fact — the inescapable fact — is that we [historians] know how it all came out…and they [those involved in the events] did not.”
True, those of us now giving our own analyses on the effectiveness of lockdowns lived through the pandemic. But still, we should consider context of the Covid reality that we are now somewhat removed from in our assessments. We now know that Covid-19 faded slowly in 2023; the public health experts in the center of the crisis did not. They followed what little science was available and made their best judgments. So let’s perhaps follow the decent path and evaluate but not castigate as we together try to understand just what happened.
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