COVID restrictions are winding down, and in many places all over the world, people are steadily going back to their normal lives (well, at least anywhere that’s not Shanghai). After governments spent years placing restrictions on their citizens in order to control the spread of the contagion, it seemed like many got the disease anyways, plus the collateral damage. Despite this, many people still believe that lockdowns were the right call in March of 2020.
Different studies using all sorts of fancy statistical analysis are going to yield different results. Whether someone is for or against lockdowns, there always seems to be some new study to back up a person’s claims. We can look at the data all we want to try to extract the truth, but statisticians can massage the numbers to obfuscate what is actually happening. Besides, even if we wanted to prove our point with data, the average person doesn’t know how to interpret these kinds of studies anyways.
If we don’t want to go through lockdowns ever again, we need to cut at the heart of the issue. Lockdowns are an illogical strategy for combating disease. We can argue whether they are ethical, or whether the data backs up lockdown proponents’ claims. But ultimately, lockdowns were rejected prior to 2020 as a disease mitigation strategy because they are an illogical disease mitigation strategy. The average person (and the highbrow academic for that matter) needs to understand why this is the case.
We can start by helping people understand some basic concepts about how their immune system works and how diseases spread. Then we can look at how lockdowns theoretically affect the spread of disease and finally expose the fallacy in a lockdown strategy.
Basics of the Immune System
Our immune systems are fascinating but also incredibly complex. My purpose here is not to delve into a long, detailed explanation about immunology, but rather highlight some basic concepts.
Immune systems are anti-fragile, which means that they become stronger by being exposed to and overcoming pathogens. There needs to be constant exposure to pathogens so that the immune system can stay strong and keep up to date. Severe disease can develop when we encounter a new pathogen that our immune defenses do not know how to handle.
Severe disease can also develop when our bodies are under stress, when they are deprived of sleep or nutrition, or when they encounter too many dangerous pathogens at one time. This is because immune systems have limited resources. Since resources are limited, there are different layers that take effect and retain memory against pathogens of different severity. Weak pathogens are handled for instance at the mucosal level and are not easily remembered. Dangerous pathogens are handled by immunity cells whose memory is retained for years. This helps the immune system efficiently devote limited resources to fighting all different kinds of pathogens in the body. It is therefore important to get plenty of exercise, sleep, and nourishment to give our bodies the resources it needs to fight off invaders.
Genetic Drift
Viruses attack cells through a sort of lock and key mechanism. When the virus unlocks the cell, it enters so that it can infect the cell and replicate. The replication process is not always perfect, thus resulting in mutations. If a mutated virus can still successfully unlock a cell, the mutated virus can continue to replicate. Otherwise, the virus fails to replicate.
The change in the frequency of an existing variant is called genetic drift. Viruses with a complex lock and key combination, such as measles, leave little room for mutations to successfully replicate, and have a slow genetic drift. Viruses with simpler lock and key combinations, such as influenza or coronaviruses, can regularly mutate and evolve into new variants or strains. These types of viruses have rapid genetic drift.
Disease Spread: Evolution
If a virus causes severe disease, people tend to stay at home away from others and rest while their body heals. If the disease is too severe, the host dies along with the virus. Both results are an evolutionary dead end for the virus. Thus, as viruses with rapid genetic drift evolve, the mutations that lead to less severe disease are more likely to survive in the host population.
Successful mutations are also likely to become more contagious. The pathogens that spread easier will infect more hosts and outcompete the pathogens that are not as contagious. As long as people are able to stay home when sick, viruses with rapid genetic drift tend to progress along two highly correlated tracks: the disease will get more contagious, and the disease will become less dangerous.
Though disease spread is probably less understood than we think, we can quite confidently say that many diseases spread through close contact. If potential hosts are in close contact for long periods of time, the virus can easily spread, regardless of how dangerous or contagious it is. Since severe disease would be just as likely to spread as mild disease, it would have an avenue to outcompete the mild variant. As a result, there is no evolutionary pressure on the virus to become milder, and dangerous variants can wreak havoc on a population that is consistently in close contact.
This can happen during wartime with soldiers who are in close quarters. World War I is one of the most famous examples, when the influenza of 1918 spread rapidly in army hospitals among wounded soldiers in cramped conditions. The virus quickly evolved to become most dangerous for young men. This would be expected, since young men were precisely the demographic forced to maintain close contact with each other during wartime.
Herd Immunity
When hosts get infected, they build an immune response and either clear the pathogen or die. Regardless, that person becomes a dead end for any future encounters with the virus. As more people become immune, the pathogen is less likely to spread. The point at which the rate of infection does not increase in a population is called herd immunity. Herd immunity is reached either through natural infection or an effective vaccination.
If a virus mutates enough to reinfect hosts, then herd immunity to a previous strain or variant cannot prevent the rapid spread of a new one. Thus, during a pandemic where the disease in question has rapid genetic drift, herd immunity is not the only desirable result. Evolution toward milder variants is also desirable. Both can be reached by allowing healthy, low risk people to spread milder variants while taking reasonable precautions.
Certain types of diseases with slow genetic drift can only be fully eradicated through a strategic immunization of the population, such as with the smallpox eradication headed by Donald Henderson. Others have been eliminated from certain areas with immunizations, improved sanitation, and (whether you like it or not) pesticides. Otherwise, the disease will spread no matter what. The time to herd immunity or milder variants depends primarily on the number of infections. The faster a disease spreads among low risk or healthy individuals, the sooner herd immunity or mild variants are reached.
Mitigation through Well-Being
The ability of a population to combat a disease is through a combination of healthy immune systems and limited means of spread. Improvements in sanitation, pest control, and nutrition as well as growing growth domestic product (GDP) in a country have correlated with lower prevalence of disease and increased life expectancy. GDP is not a perfect measure of well being, but it is perhaps the statistic that best encapsulates health, sanitation, nutrition, and financial stability into one number. GDP is increased through economic growth, which is achieved by allowing people to freely exchange products and services.
A healthy population is also physically fit and sociable. Loneliness has been shown to be a significant contributor to mortality. A well traveled population is exposed to a wider variety of pathogens, and thus develops broader immunity, making it harder for dangerous pathogens to spread.
The Intricacies of Civilization
As people become wealthier, they also tend to become healthier and more competent in resisting severe disease. We tend to attribute improved health to modern medicine, but it is also linked to various other factors such as improved nutrition, sanitation, reduced stress, and perhaps dozens if not hundreds of other factors. Even if we did attribute improved health solely to modern medicine, we can only have doctors and inventors if labor and capital are diversified enough to free up time and resources that can then be devoted to medical developments. Again, this is accomplished through economic growth.
It may not seem like the success of the restaurant owner down the street contributes to your health, but in a very indirect way, her economic success and the economic successes of millions of other people allow for a diverse range of products and services to be offered to benefit your health. In order for you to acquire those products and services, you need to have economic success so that you can purchase those things that are beneficial to your health. It may seem that forcing the restaurant owner to shut her doors during a pandemic will help make the disease go away, but in a very small and indirect way you are affecting your own well-being and consequently your health.
Lockdown Logic
A typical lockdown strategy consists of restricting travel, closing businesses, schools, and certain shops as well as preventing indoor gatherings. Extreme measures include forcing people to stay home. Lockdowns are appealing because they offer the benefits of isolation. If people do not interact, disease does not spread, and the virus reaches a dead end.
In theory, if a disease was only found in humans, and every single human completely isolated from every other human for a few weeks, so that there was no chance the virus could spread, then a society can eliminate a disease. In practice, of course, this is impossible, and I don’t think I need to explain why. That’s why the reasoning behind a lockdown strategy is to “flatten the curve” so that hospitals will not be overwhelmed. An imperfect lockdown during the peak of a wave would not eliminate disease but would reduce the peak number of infections over any given time, thus keeping medical resources from being exhausted.
Lockdowns can be an effective method to accomplish one form of disease mitigation, namely isolation to slow the spread of disease so as not to overwhelm healthcare systems. But how do they do in other areas?
Remember, the only way to reach herd immunity in the absence of a highly effective vaccine is through infection. Additionally, the fastest way way to reach milder variants is for low risk healthy people to spread the virus among themselves. Lockdown of an entire population slows the spread, but it also prolongs the time to milder disease and herd immunity. Vulnerable members of the population are thus at high risk for a longer period of time.
Lockdowns, even for just two weeks, also negatively affect the economy and overall well-being. If businesses cannot succeed economically, those business owners and employees take a hit economically, which indirectly affects their ability to combat disease. Loneliness, which again is a significant health risk, increases with lockdowns. We tend to think these factors affect overall health, but one could argue that these affect an individuals’s ability to fight the disease in question! Loneliness, stress, worry, and fear affect one’s abilities to combat any disease. Travel restrictions limit the ability of people to become exposed to a variety of pathogens and to develop broader immune responses that could assist them in combating new, dangerous diseases. Thus, lockdowns have a direct disadvantage in hurting a population in the fight against the disease in question, and are not just a disadvantage to overall health.
One argument for lockdowns is that negative consequences would occur anyways in the absence of lockdowns because people would isolate voluntarily. But this is an argument against lockdowns. Individuals are best suited with local information to make the health decisions that are best for them. They don’t need a central authority to tell them what is best for their health. A lockdown guarantees severe economic downturn as long as the lockdown lasts. Voluntary isolation may cause economic downturn, but it is dependent on the degree of isolation in a given area, which will vary due to the variance of individual choice.
There is no perfect way to combat disease, but lockdowns are not the best method. Before 2020, widespread lockdown as a mitigation strategy was not recommended. They follow “caveman logic” and appeal to the instinct of individuals to avoid physical contact with unknown vectors of disease. However, they fail multiple tests of “liberal logic”, ignoring the unseen and the unintended consequences that arise in a complex social system.
A better tactic, and one that was widely accepted before 2020, is to protect vulnerable members of a population while allowing low-risk individuals to go about life normally while taking precautions such as proper hygiene and staying home when sick. This would allow low-risk populations to quickly build immunity and arrive at a low-risk variant.
What methods are there to protect the vulnerable? With COVID-19, elderly people in nursing homes were at highest risk. Caretakers could potentially bring in the disease, thus allowing it to spread in a close contact population. A lockdown only slows the spread, so it does not keep residents from eventually catching the disease. Limiting rotations and contacts, extreme vigilance with symptoms, PPE, early treatment, and utilizing employees with immunity while the virus spreads in the low risk population protects the elderly and shortens the time to a lower risk variant. This strategy is not perfect, but parts of it would need to be implemented anyways even with a lockdown since lockdowns do not eliminate disease.
Short term lockdowns in particular settings for a couple weeks during the peak of an infectious wave, such as temporarily closing an elementary school during a flu pandemic that is particularly dangerous for small children, might be reasonable. Such decisions should remain local or individual. Diseases spread differently in different geographic regions. A nationwide or region wide decision does not take into account the various differences in locales with regard to disease spread.
Rooting out the Fallacy
The argument made in favor of lockdowns is that they are an effective way to slow the spread of disease so that healthcare systems are not overloaded, and this in turn saves lives during a pandemic. This claim relies on certain assumptions:
Lockdowns ease the burden on healthcare systems. (A causes B)
In order to to save lives we need healthcare systems that are not overwhelmed. (C dependent on B)
Therefore, lockdowns save lives (A causes C)
Even if 1 is true, 2 is certainly incomplete. Functioning healthcare systems are one part in the equation to save lives, but as mentioned earlier, there are many innumerable other factors involved in saving and sustaining human life, such as economic prosperity, herd immunity, and time to milder variants. Lockdowns can adversely affect these other factors, and can thus thwart the desired goal of saving as many lives as possible during a pandemic.
Therein lies the faulty logic. It is the assumption that ignores multiple seen and unseen factors on the way to a conclusion.
Let’s look to an analogy to further expose the fallacy. Suppose that we were on the 10th floor of a burning building and we wanted to get as many people out as safely as possible. You would probably disagree with the following logic:
Jumping out of a window gets us out of the building. (A causes B)
In order to save ourselves we need to get out of the building. (C dependent on B)
Therefore, we should jump out the window to save ourselves. (A causes C)
This logic is of course incomplete. Getting out of the building is requisite to save ourselves, and jumping out the window may be an option if the situation becomes dire. But we would also take other factors into account, such as our desire to get out in one piece. If we ignore all the other factors that go into saving ourselves from a burning building, we may fail in achieving our ultimate goal.
A successful disease mitigation strategy needs to have a reasonable goal that takes many different societal factors into account. The goal of most pre-2020 pandemic plans was to minimize the damage of a disease as much as possible while simultaneously interrupting people’s lives as little as possible. Any strategy based primarily on “slow the spread” falls short on both counts. While it is clear that restricting people’s movements and social interactions disrupts our everyday lives, it may not be immediately clear why such restrictions won’t help minimize damage caused by the disease itself.
This becomes clearer when we understand that disease is primarily defeated by healthy immune systems with robust immune responses, and that there is a strong correlation between increasing prosperity and decreasing disease prevalence. Widespread restrictions on social interactions contribute neither to healthy immune systems nor to increasing prosperity. That is not to say that such localized, voluntary restrictions are not useful in certain situations. But they should not be relied on as the primary method for disease mitigation.
The focus of disease mitigation during a pandemic should instead be to promote healthy immune systems and sanitation, as well as to not interrupt increasing economic prosperity. Allowing low-risk individuals to go about their normal lives while taking proper precautions reduces the time to herd immunity and milder variants. Extra care should be taken to protect high-risk individuals from infection. Doctors should have room to innovate using available treatments for off-label use. Communities should be able to innovate ways to protect their vulnerable populations.
While disease prevention is a worthy goal, we need to remember that there is no disease prevention without health promotion. Rather than just worry about quick fixes to our health, we ought to focus on how to properly treat our bodies on a regular basis. Maybe because we are so used to getting a quick prescription from our doctors that when they prescribed shutting everyone up in their homes, we dutifully took the doctors’ orders and ignored the fact that this would ruin so many people’s lives.
How did we get to this point? The scientific community realized by the 20th century that top-down restrictions on movement and social interaction were not an effective strategy against a pandemic. And yet, it took a couple mere weeks for the Chicken Littles of the world to convince people in power that they ought to toss their countries’ pandemic plans out the window. There were multiple factors that led to this, one of which I believe is our instinct to sacrifice when faced with a looming threat. But if we want to persuade people that lockdowns are detrimental during a pandemic, we need to convince them not only with data or with ethical arguments. We also need to show them that lockdowns are illogical strategies built upon a fallacy.
Some helpful links:
Despite what some physicists-turned-epidemiologists might tell you, lockdowns didn’t help during the Ebola crisis.
Take a look at Julius Reuchel’s long read, Your Booster Life: How Big Pharma Adopted the Subscription Model of Profitability
A brief overview of immunology and appropriate pandemic responses is provided by Sunetra Gupta in Pandemics: Our Fears and the Facts.