There’s no proof that lockdowns save lives but plenty of evidence that they end them.
John Tierney March 21, 2021 @ City Journal. Published with permission. I recommend subscribing, it's free.
Now that the 2020 figures have been properly tallied, there’s still
no convincing evidence that strict lockdowns reduced the death toll from
Covid-19. But one effect is clear: more deaths from other causes,
especially among the young and middle-aged, minorities, and the less
affluent.
The best gauge of the pandemic’s impact is what statisticians call
“excess mortality,” which compares the overall number of deaths with the
total in previous years. That measure rose among older Americans
because of Covid-19, but it rose at an even sharper rate among people
aged 15 to 54, and most of those excess deaths were not attributed to
the virus.
Some of those deaths could be undetected Covid-19 cases, and some
could be unrelated to the pandemic or the lockdowns. But preliminary
reports point to some obvious lockdown-related factors. There was a
sharp decline in visits to emergency rooms and an increase in fatal heart attacks due to failure to receive prompt treatment. Many fewer people were screened for cancer. Social isolation contributed to excess deaths from dementia and Alzheimer’s.
Researchers predicted that the social and economic upheaval would lead to tens of thousands of “deaths of despair”
from drug overdoses, alcoholism, and suicide. As unemployment surged
and mental-health and substance-abuse treatment programs were
interrupted, the reported levels of anxiety, depression, and suicidal thoughts increased dramatically, as did alcohol sales and fatal drug overdoses. The number of people killed last year in motor-vehicle accidents
in the United States rose to the highest level in more than a decade,
even though Americans did significantly less driving than in 2019. It
was the steepest annual increase in the fatality rate per mile traveled
in nearly a century, apparently due to more substance abuse and more high-speed driving on empty roads.
The number of excess deaths not involving Covid-19 has been especially high in U.S. counties
with more low-income households and minority residents, who were
disproportionately affected by lockdowns. Nearly 40 percent of workers
in low-income households lost their jobs during the spring, triple the rate in high-income households. Minority-owned small businesses suffered more, too. During the spring, when it was estimated
that 22 percent of all small businesses closed, 32 percent of Hispanic
owners and 41 percent of black owners shut down. Martin Kulldorff, a
professor at Harvard Medical School, summarized the impact:
“Lockdowns have protected the laptop class of young low-risk
journalists, scientists, teachers, politicians and lawyers, while
throwing children, the working class and high-risk older people under
the bus.”
The deadly impact of lockdowns will grow in future years, due to the
lasting economic and educational consequences. The United States will
experience more than 1 million excess deaths in the United States during
the next two decades as a result of the massive “unemployment shock”
last year, according to a team of researchers from Johns Hopkins and Duke, who analyzed the effects of past recessions on mortality. Other researchers,
noting how educational levels affect income and life expectancy, have
projected that the “learning loss” from school closures will ultimately
cost this generation of students more years of life than have been lost
by all the victims of the coronavirus.
After the pandemic began in March, the number of excess deaths in the
United States rose for all American adults. During the summer, as the
pandemic eased, the rate of excess mortality declined among older
Americans but remained unusually high among young adults. When statisticians at the Centers for Disease Control
totaled the excess deaths for age groups through the end of September,
they reported that the sharpest change—an increase of 26.5
percent—occurred among Americans aged 25 to 44.
That trend persisted through fall, and most of the excess deaths among younger people were not linked to the coronavirus, as researchers from the University of Illinois
found by analyzing excess deaths from March through the end of
November. Among Americans aged 15 to 54, there were roughly 56,000
excess deaths, of which about 22,000 involved Covid-19, leaving 34,000
from other causes. The Canadian government
also reported especially high mortality among Canadians under 45:
nearly 1,700 excess deaths from May through November, with only 50 of
those deaths attributed to Covid-19.
“We don’t know exactly why, but a lot of adults were dying last year
who would not have ordinarily died, and it wasn’t just because of
Covid,” says Sheldon H. Jacobson, one of the Illinois researchers. “It’s
possible that some of the Covid-19 deaths were undercounted, but there
were many deaths due to other causes. Shutdowns certainly caused mental
health issues, and a lot of preventive medical treatments were delayed.”
The lockdowns may also have saved some lives, but there’s still no good evidence. When the 50 states are ranked according to the stringency of their lockdown restrictions,
you can see one obvious pattern: the more restrictive the state, the
higher the unemployment rate. But there’s no pattern in the rate of Covid-19 mortality. International comparisons yield similar results. One shows that countries with more stringent lockdowns tend to have slightly higher levels of Covid-19 mortality. Another suggests that European countries with stricter lockdowns have performed worse economically while also suffering higher rates of excess mortality.
It’s true, as lockdown proponents argue, that many factors could
confound these broad comparisons. Some places are more vulnerable to
Covid-19 because of geographic and demographic variables, and so may be
more likely to impose lockdowns in response to a surge. But other
methods of measuring the effects of lockdowns have also been
inconclusive. Some researchers reported early in the pandemic that
lockdowns slowed viral spread and reduced mortality, but those
conclusions were based on mathematical models with widely varying—and sometimes quite dubious—assumptions about what would have happened without lockdowns.
Meantime, more than two dozen studies
have challenged the effectiveness of lockdowns, relying mainly not on
mathematical models but on trends in Covid-19 cases and deaths. Studies
have repeatedly shown that school closures have little or no impact on
viral spread and mortality. By comparing regions and countries,
researchers have found that trends in infections were similar regardless of whether there were mandated business closures or stay-at-home-orders.
It seems intuitively obvious that lockdowns would save lives by
reducing social interactions and therefore the spread of the virus, but
there are other consequences. Lockdowns force people to spend more time
indoors, where viruses spread more easily. By preventing younger people
from socializing and being exposed to the virus, a lengthy lockdown
slows the build-up of herd immunity in this low-risk population, so
eventually the virus may infect and kill more vulnerable older people.
Last spring and summer, public-health officials attributed
California’s low rate of Covid-19 mortality to its stringent lockdown
policies, and they predicted disaster for Florida, which reopened early
and has remained one of the least-restrictive states. But California’s
lockdowns didn’t prevent a severe outbreak in the winter. While the
state’s Covid-19 mortality rate remains slightly below the national
average, its overall rate of excess mortality since the pandemic began
is well above the national average.
In Florida, by contrast, the rate of excess mortality is below the
national average and significantly below California’s, especially among
younger adults.
Public-health officials widely denounced
Sweden for refusing to lock down and mandate masks last spring, when its
Covid-19 mortality was high. A computer model projected nearly 100,000 Swedish deaths
from the virus last year. But that prediction turned out to be ten
times too high, and other countries have since caught up with Sweden.
While it suffered another outbreak this winter, mainly in regions that
were not hit hard in the spring, Sweden’s cumulative death toll per capita from Covid-19 is now slightly below the European Union’s average and about 20 percent lower than America’s.
When it comes to preventing excess deaths, Sweden has done at least
as well as the rest of Europe or better, depending how one calculates.
To determine excess mortality, statisticians first define the baseline
for a “normal” number of deaths in each country. This can be done by
extending the mortality trend of the previous years or by taking an
average of past mortality rates, with adjustments for the changing age
structure of the population. The CDC’s method, for instance, shows 18 percent more deaths than normal last year in America, while other methods put the figure at 13 percent.
It’s debatable which measure is better, but as long as any single
method is applied consistently everywhere, it can gauge how one place
has fared relative to another.
A group of researchers in Israel and Germany
calculates that there have been 11 percent more deaths than normal in
Sweden since the pandemic began, which is slightly lower than the median
among European countries. Statisticians at the Economist also rank Sweden’s excess mortality slightly lower than the European median since the pandemic began. A team at Oxford University,
which counted deaths for all of 2020, calculates that Sweden’s rate of
excess mortality last year was just 1.5 percent, which was lower than
two-thirds of the countries in Europe.
By any measure of excess mortality, Sweden has fared much better than
countries with especially strict lockdowns and mask mandates, like the
United Kingdom, Spain, and Portugal. It hasn’t done as well as Norway
and Finland, where mortality has been no higher than normal (and below
normal, by some calculations). Critics have often noted this disparity
as an argument against Sweden’s approach. But the problem with this
“Neighbor Argument,” as Oxford’s Paul Yowell calls it, is that the neighbors have followed policies like Sweden’s for most of the pandemic.
Norway and Finland were stricter than Sweden in the spring, when they
quickly imposed border controls and closed schools and some businesses.
But they also reopened quickly and during the rest of the year ranked
among the least restrictive countries in Europe. All three Nordic
countries have imposed on-and-off restrictions in some areas during
outbreaks this winter, but they have avoided extended national lockdowns
and other strict measures. Finland recently mandated masks on public
transportation, but Norway and Sweden still merely recommend it for
commuters; otherwise, they remain among the few countries in Europe
without mask mandates. In all three countries, businesses and schools
have remained open most of the past year, and relatively few people have
worn masks on the streets or in stores, offices, or classrooms.
Sweden’s higher rate of mortality among the Nordics may be related to
the greater number of international travelers arriving there last year,
due partly to its looser border-control policies and partly to its
larger population of immigrants. Another explanation for last year’s
high mortality rate is what researchers call the “dry tinder”
factor: the previous flu seasons in Sweden had been exceptionally mild,
leaving an unusually large number of frail elderly people who were
especially vulnerable to Covid-19. (This same factor contributed to the
high death toll last year in the United States, where flu mortality had
also been low the previous two winters.) If you compensate for this factor
by averaging mortality in Sweden over 2019 and 2020, the age-adjusted
mortality rate is about the same as during the previous few years.
The three Nordic countries have all done much better than the United
States in preventing excess deaths, and there’s one especially troubling
difference: the rate of excess mortality among younger people. That
rate soared last year among Americans in lockdown, but not among the
Swedes, Norwegians, and Finns, who kept going to school, working, and
socializing without masks during the pandemic. In fact, among people aged 15 to 64 in each of the Nordic countries, there have been fewer deaths than normal since the pandemic began.
The lockdowns in America exacted a toll on
people of all ages because excess deaths not attributed to Covid-19 also
occurred among the elderly. Some were doubtless due to undetected
Covid-19 infections—particularly early in the pandemic, when tests were
not widely available. However, there was probably also some overcounting
(the CDC permitted states to count a death as Covid-related without a
test if it was deemed the “probable cause”). Whatever the direction of
the errors, there were clearly many excess deaths not caused by the
virus. The CDC counted about 345,000 deaths last year in which Covid-19
was the “underlying cause.” Even if you add the deaths in which the
virus was a “contributing cause,” bringing the total to nearly 380,000,
that accounts for only three-quarters of the excess mortality. Given
that the total number of excess deaths, by the CDC’s calculation, was
about 510,000 last year, that leaves more than 130,000 excess deaths
from other causes.
How many of those 130,000 people in America were killed by lockdowns?
No one knows, but the number is surely large, and the toll will keep
growing this year and beyond. Those deaths won’t make many headlines,
and the media won’t feature them in charts like the ones comparing the
coronavirus death toll to past wars. But these needless deaths are the
greatest scandal of the pandemic. “Lockdowns are the single worst public
health mistake in the last 100 years,” says Dr. Jay Bhattacharya,
a professor at Stanford Medical School. “We will be counting the
catastrophic health and psychological harms, imposed on nearly every
poor person on the face of the earth, for a generation.” He describes
the lockdowns as “trickle-down epidemiology.”
Public-health officials are supposed to consider the overall impact
of their policies, not just the immediate effect on one disease. They’re
supposed to weigh costs and benefits, promoting policies that save the
most total years of life, which means taking special care to protect
younger people and not divert vast resources to treatments for those
near the end of life. They are not supposed to test unproven and
dangerous treatments by conducting experiments on entire populations.
Sweden and Florida followed these principles when they rejected
lockdowns and trusted their citizens to take sensible precautions. That
trust has been vindicated. The lockdown enforcers made no effort to
weigh the costs and benefits—and ignored analyses showing that, even if
the lockdowns worked as advertised, they would still cost more years of life
than they saved. During the spring, panicked officials claimed the
lockdowns were a temporary measure justified by projections that
hospitals would be overwhelmed. But then the lockdowns continued long
after it became clear that the projections were wildly wrong.
If a corporation behaved this way, continuing knowingly to sell an
unproven drug or medical treatment with fatal side effects, its
executives would be facing lawsuits, bankruptcy, and criminal charges.
But the lockdown proponents are recklessly staying the course, still
insisting that lockdowns work. The burden of proof rests with those
imposing such a dangerous policy, and they haven’t met it. There’s still
no proof that lockdowns save any lives—let alone enough to compensate
for the lives they end.
John Tierney is a contributing editor of City Journal, a contributing science columnist for the New York Times, and coauthor of The Power of Bad: How the Negativity Effect Rules Us and How We Can Rule It.
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