New Thinking on Covid Lockdowns: They’re Overly Blunt and Costly

Blanket business shutdowns—which the U.S. never tried before this pandemic—led to a deep recession. Economists and health experts say there may be a better way. 

By Greg Ip of The WSJ. Excerpts:

"Five months later, the evidence suggests lockdowns were an overly blunt and economically costly tool. They are politically difficult to keep in place for long enough to stamp out the virus. The evidence also points to alternative strategies that could slow the spread of the epidemic at much less cost. As cases flare up throughout the U.S., some experts are urging policy makers to pursue these more targeted restrictions and interventions rather than another crippling round of lockdowns.

“We’re on the cusp of an economic catastrophe,” said James Stock, a Harvard University economist who, with Harvard epidemiologist Michael Mina and others, is modeling how to avoid a surge in deaths without a deeply damaging lockdown. “We can avoid the worst of that catastrophe by being disciplined,” Mr. Stock said."

"Prior to Covid-19, lockdowns weren’t part of the standard epidemic tool kit, which was primarily designed with flu in mind.

During the 1918-1919 flu pandemic, some American cities closed schools, churches and theaters, banned large gatherings and funerals and restricted store hours. But none imposed stay-at-home orders or closed all nonessential businesses. No such measures were imposed during the 1957 flu pandemic, the next-deadliest one; even schools stayed open.'

"Taiwan, South Korea and Hong Kong set early examples of how to stop Covid-19 without lockdowns. Their reflexes trained by SARS in 2003, MERS and avian flu, they quickly cut travel to China, introduced widespread testing to isolate the infected and traced contacts. Their populations quickly donned face masks. 

Sweden took a different approach. Instead of lockdowns, it imposed only modest restrictions to keep cases at levels its hospitals could handle.

Sweden has suffered more deaths per capita than neighboring Denmark but fewer than Britain, and it has paid less of an economic price than either, according to JPMorgan Chase & Co.

Sweden’s current infection and death rates are as low as the rest of Europe’s."

"By March, it was too late for the U.S. to emulate the test-and-trace strategy of east Asia. The CDC had botched the initial development and distribution of tests, and limited testing capacity meant countless infections went undetected for months."

" Some experts think it takes less than 81% of a population to reach herd immunity. Nonetheless, such predictions helped persuade leaders in Britain and the U.S. to lock down.

Yet at the outset, their goals were unclear, a confusion aggravated by the multitude of terms used. Officials sometimes said their goal was “bending” or “flattening the curve,” which originally meant spreading infections over time so the daily peak never overwhelmed hospitals. At other times they described their aims as “mitigation” or “containment” or “suppression,” often interchangeably.

“There have been few attempts to truly define the goal, and partly it’s because policy makers and epidemiologists haven’t thought well enough about the vocabulary to define what they mean or want,” said Dr. Mina, the Harvard epidemiologist."

"R value”: how many people each infected person goes on to infect."

"mitigation generally aims for an R of just above one, while suppression aims for an R of below one.

The U.S. never resolved “whether we were going for mitigation or suppression,” said Paul Romer, a Nobel laureate economist. Mitigation, he said, meant accepting hundreds of thousands of additional deaths to achieve herd immunity, which no leaders were willing to embrace. But total suppression of the disease “doesn’t make sense unless you’re going to stick with it as long as it takes.”"

"Dr. Mina of Harvard said the U.S. at the outset could have chosen to prioritize the economy, as Sweden did, and accept the deaths, or it could have chosen to fully prioritize health by staying locked down until new infections were so low that testing and tracing could control new outbreaks, as some northeastern states such as Rhode Island did.

Most of the U.S. did neither. The result was “a complete disaster. We’re harming the economy, waffling back and forth between what is right, what is wrong with a slow drift of companies closing their doors for good,” Dr. Mina said."

"“Emphasize the reopening of the highest economic benefit, lowest risk endeavors,” said Dr. Mina.

Social distancing policies, for instance, can take into account widely varying risks by age. The virus is especially deadly for the elderly. Nursing homes account for 0.6% of the population but 45% of Covid fatalities, says the Foundation for Research on Equal Opportunity, a free market think tank. Better isolating those residents would have saved many lives at little economic cost, it says.

By contrast, fewer children have died this year from Covid-19 than from flu. And studies in Sweden, where most schools stayed open, and the Netherlands, where they reopened in May, found teachers at no greater risk than the overall population. This suggests reopening schools outside of hot spots, with protective measures, shouldn’t worsen the epidemic, while alleviating the toll on working parents and on children.

If schools don’t reopen until next January, McKinsey & Co. estimates, low-income children will have lost a year of education, which it says translates into 4% lower lifetime earnings.

Research by Dr. Mina and others has shown that “super-spreader” events contribute disproportionately to infections, in particular dense indoor gatherings with talking, singing and shouting, such as at weddings, sporting events, religious services, nightclubs and bars.

Bars and restaurants accounted for 16% of Covid-19 clusters (five or more cases) in Japan; workplaces, just 11%. Bars, restaurants and casinos accounted for 32% of infections traced to multiple-case outbreaks in Louisiana."

"The German city of Jena in early April ordered residents to wear masks in public places, public transit and at work. Soon afterward, infections came to a halt. Comparing it to similar cities, a study for the IZA Institute of Labor Economics estimated masks reduced the growth of infections by 40% to 60%."

"a universal mask mandate in the U.S. could now save 5% of gross domestic product by substituting for more onerous lockdowns. 

Some epidemiologists and economists argue ramped-up testing could enable the economy to reopen safely without a vaccine. Mr. Romer estimates the U.S. could restore $1,000 in economic activity for every $10 spent on tests.

Dr. Mina pointed to a paper-strip test anyone can use to detect the virus in a sample of saliva in minutes. It is less accurate but far faster and cheaper than sending samples to labs, he said. If 50% to 60% of the population in hot spots took such a test every other day, the disease could be suppressed, he said.

Dr. Mina’s and Mr. Stock’s team has designed a “smart” reopening plan based on contact frequency and vulnerability of five demographic groups and 66 economic sectors. It assumes most businesses reopen using industry guidelines on physical distancing, hygiene and working from home; schools reopen; masks are required; and churches, indoor sports venues and bars stay closed.

They estimated in June that this would result in 335,000 fewer U.S. deaths by the end of this year than if all restrictions were immediately lifted. But they say the plan also would leave economic output 10% higher than if a second round of lockdowns were imposed.'

"When cases soared, Republican Gov. Douglas Ducey (Arizona) resisted reimposing restrictions or requiring masks. He then eventually allowed cities to require masks, ordered bars, gyms, movie theaters and water parks to close and told restaurants to operate at no more than 50% capacity. Gatherings of more than 50 people were prohibited and masks strongly encouraged. But he didn’t lock down the entire state. Cases and hospitalizations have since fallen sharply to early May levels, or lower."