Infection Control Today® Editorial Staff

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A team of economists from Johns Hopkins have examined the effects of government-mandated lockdowns in preventing mortality risk from COVID-19 in a new systematic review and meta-analysis.

 series under the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise, cited analysis from 24 previously published studies to express the authors’ contention that lockdowns have had “little to no public health effects” in response to the ongoing pandemic.

Additionally, the study contends that such measures—stratified into categories including shelter-in-place-orders (SIPOs) and non-pharmaceutical interventions (NPIs)— adversely affected economic and social standing in the regions they were mandated. “In consequence, lockdown policies are ill-founded and should be rejected as a pandemic policy instrument,” the authors wrote.

The new analysis was led by authors Jonas Herby, a special advisor at the Center for Political Studies in Copenhagen; Lars Jonung, a professor emeritus in economics at Lung University in Sweden; and Steven H. Hanke, a Professor of Applied Economics and Founder, Co-Director of the aforementioned Johns Hopkins institute.

Hanke is additionally a Senior Fellow and Director of the Troubled Currencies Project at the Cato Institute, a currency and commodity trader.

The authors cited a trio of concepts, including 2 previous studies, spurring their interest in assessing understood associations between lockdowns and COVID-19-based mortality: a 2020 trial submitted to the National Bureau of Economic Research suggesting a decrease in COVID-19 daily death rates within 20-30 days “after each region experience 25 cumulative deaths;” another study suggesting that government policies—including those set in lockdown mandates—are “strongly driven” by those initiated among other countries; and the authors’ argument that there was “no clear negative correlation” between the degree of pandemic-driven lockdowns and COVID-19 deaths in the spring of 2020.

“Today, it remains an open question as to whether lockdowns have had a large, significant effect on COVID-19 mortality,” the authors wrote. “We address this question by evaluating the current academic literature on the relationship between lockdowns and COVID-19 mortality rates.”

NPI was used to describe any government mandate which directly restricted citizens’ “possibilities,” excluding any governmental recommendations, information campaigns, access to mass testing, voluntary social distance, etc. They wrote the NPI definition did indeed include interventions including schools or businesses, mandated face masking, and on. “Lockdowns” were defined as ≥1 NPI as described by the authors

Eligible studies were published by July 1, 2020 and observed the effect of lockdowns on COVID-19 mortality rates. The authors focused on studies examining “actual impact of lockdowns on COVID-19 mortality rates based on registered cross-sectional mortality data and a counterfactual difference in-difference approach.” Of 1048 observed trials, 34 met their eligibility criteria.

Based on the Oxford COVID-19 Government Response Tracker (OxCGRT)—a database from the University of Oxford Blavatnik School of Government collecting global policy responses to the pandemic stratified by 23 indicators including school closures, travel restrictions, and vaccination policy—just Oxford COVID-19 Government Response Tracker (OxCGRT)

1 of 186 observable countries did not impose ≥1 NPI prior to the end of March 2020, during the global wave of COVID-19 cases.

Using a stringency index informed by the OxCGRT data, the authors reported that the average NPI in Europe and the US reduced COVID-19 mortality by 0.2% versus COVID-19 policies based on government recommendations.

“(SIPOs) were also ineffective,” the authors wrote. “They only reduced COVID-19 mortality by 2.9%.”

The team further reported a 10.6% reduced rate of COVID-19 mortality in regions that closed non-essential businesses, as well as potentially supporting—but limited—evidence of masking mandates for the reduction of mortality.

“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,” authors wrote. “Lockdowns (compared to no lockdowns) also do not reduce COVID-19 mortality.”

The team concluded from their research that lockdowns are not effective in reducing mortality rates during a pandemic, citing among their observed rationales that “even if lockdowns are successful in initially reducing the spread of COVID-19, the behavioral response may counteract the effect completely, as people respond to the lower risk by changing behavior.”

“If closing bars and restaurants causes the prevalence of the disease to fall toward zero, the demand for costly disease prevention efforts like social distancing and increased focus on hygiene also falls towards zero, and the disease will return,” they wrote.

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, and since COVID-19 is a fairly recent development—it was labeled a pandemic in March 2020—experts aren’t sure what “long” means exactly. Weeks? Months? Years?

A recent study illustrated that long COVID’s physical, mental, and cognitive symptoms can cling to some patients for at least a year. The patients in the study initially had to go to intensive care units (ICUs) because of the severity of infection. The exploratory prospective multicenter cohort study was conducted in the ICUs of 11 Dutch hospitals and was 

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). Investigators included 452 patients 16 years and older who survived ICU admission during the first COVID-19 surge (March 1-July 1, 2020). The patients were followed up for 1 year following their release from the ICU, and the final follow-up date was June 16, 2021. The main outcomes were physical symptoms (including frailty, fatigue, and other physical problems), mental symptoms (including anxiety, depression, and posttraumatic stress disorder), and cognitive symptoms self-reported 1 year after ICU treatment.

According to the Centers for Disease Control and Prevention (CDC), long COVID “is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if their illness was mild or if they 

Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of 

®’s) Editorial Advisory Board (EAB), said she’s “seen athletes in their 20s on the wait list for double lung transplants because of long COVID.” Infection preventionists (IPs) and other health care professionals on the frontlines are also in danger of contracting long COVID. “If health care workers have to give up their careers, then what comes next?” Spaulding asked, adding that the financial consequences of long COVID on the health care system could last “forever.”

As noted by Kevin Kavanagh, MD, another member of 

’s EAB, a core difficulty in society’s attempt to guide COVID-19 from pandemic to endemic is that COVID-19 is not just a respiratory virus. Kavanagh wrote in 

®’s October 2021 issue that SARS-CoV-2 is similar to HIV because it can “silently spread throughout the host’s body and attack 

 study, of the initial patient cohort, 301 (66.8%) were included in the study. The average age was 61.2 years, the average duration of ICU stay was 18 days, and 71.5% were men. A year after their release from the ICU, 74.3% of patients reported physical symptoms, 26.2% reported mental symptoms, and 16.2% reported cognitive symptoms.

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®’s January issue, Kavanagh wrote that “much of the abandonment of public health measures has been spurred by a massive disinformation campaign, which has successfully convinced a relatively large portion of our population that, as long as one lives through COVID-19, all will be well. The young and healthy have especially embraced 

It is a false narrative, Kavanagh warns, because “the premise that mild infections do not carry significant risks is false. In part, this belief is driven by those who have not died from COVID-19 being counted as ‘recovered’ as opposed to ‘survived.’ SARS-CoV-2 causes a system infection and is commonly detected in the heart and brain, exemplified by the loss of smell from brain tissue destruction and loss of cardiac function from myocarditis. Even those who develop mild COVID-19 can develop long COVID, which, in many cases, lasts for a year or longer.”

Of course, the best way to avoid long COVID is to avoid infection by COVID-19 in the first place. IPs and other health care professionals must continue to utilize nonpharmaceutical COVID-19 mitigation efforts, such as hand hygiene, social distancing, and masking, both inside and outside the hospital. That’s one of the takeaways of a 

That study involved monitoring 2425 fully vaccinated staff at 2 referral hospitals in Tokyo and comparing their data with that of a control group. Investigators with Japan’s National Center for Global Health and Medicine (NCGM) stated that “vaccination programs alone cannot eliminate the risk of infection…. Still, we could reasonably infer that the program has contributed to the sizable reduction in the number of COVID-19 patients among the staff during the largest epidemic [up until that point].” NCGM comprises 2 hospitals that also serve as research centers that focus on infectious disease.

Despite the effectiveness of the COVID-19 vaccines, the findings bolster the argument that we cannot vaccinate our way out of the COVID-19 pandemic. “NCGM has adopted comprehensive measures against nosocomial infection since the early phase of the epidemic,” the study stated. “The current data confirm the significant role of these measures to protect health care workers against…variant infection.”

The comprehensive nonpharmaceutical anti–COVID-19 measures adopted by NCGM include avoiding what the institution refers to as the 3 Cs: crowded places, close-contact settings, and confined and enclosed spaces without wearing a mask. They also include social distancing; cough etiquette; not touching the eyes, nose, and mouth; and hand hygiene.

The health care workers did a good job of following mitigation efforts inside the hospital but not so much outside of it. The study stated “infection among the staff had occurred mainly outside the hospital [household, community, etc].” Saskia Popescu, PhD, MPH, MA, CIC, another 

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