Arguments against blockages: can we fight the COVID-19 epidemic without confining people to their homes?

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As anti-lockdown protests invaded Capitol buildings in the United States last month, protesters demonstrated their patriotism in the uniform of the Continental Army that fought the American Revolution, including a man carrying which, on closer inspection, was in fact the coat worn by the Beast in Disney’s Beauty and the Beast.

When similar protests against the foreclosure took place in Toronto, Ontario Premier Doug Ford called the rebels a “group of yahoos” and dismissed their calls to lift his government’s home stay orders .

So far, the blockage file has not been well articulated and it has been poorly received. An Angus Reid poll earlier this month found that only 9% of Canadians believed that public health officials should be more concerned about the negative effects on the economy than public health and safety.

In the background, however, and with fewer flamboyant costumes, some academics, public health officials and politicians around the world argued that these strict bans were unnecessary. The case is not only to avoid economic suffering either. Many of them are concerned about the mental health blockages and others are simply trying to find the best way to fight a resilient and deadly virus.

Most importantly, Sweden has taken a relaxed stance on the government’s response to the COVID-19 epidemic, allowing bars and restaurants to remain open, as well as schools for young children. Hong Kong residents took the virus seriously and reacted diligently, wearing masks and closing schools, but the city is not closed like most western countries.

Lyman Stone, researcher at the American Enterprise Institute, lives in Hong Kong and wonders if most of the world deploys a hammer to defeat COVID-19 when a few well placed hammer strikes would do the job, with much less damage guarantees .

“It seems blockages don’t add up much after taking other social distancing measures,” Stone said in an interview with the National Post. On the other hand, “the research on isolation and central quarantine is extensive and compelling. We know it works. ”

Stone’s argument is that, apart from a few yahoos, people are good enough to take physical distance even without the government requiring them to do so.

The situation in Hong Kong

Stone, a former international economist with the United States Department of Agriculture, spoke to the National Post from his home in Hong Kong while his wife was out for a stroll late on the beach with a friend.

“As long as your life doesn’t require you to be gathered in large groups, life here is pretty normal,” he said. Schools have closed and workers have been encouraged to work from home, but restaurants are still open and shopping centers are busy.

Canadians, on the other hand, have been at home for more than six weeks, with only essential trips to grocery stores and pharmacies.

Locked-in Canadians may be surprised to learn that in Hong Kong, with a population of 7.5 million and close to the source of the epidemic in China, only four people died from COVID-19. Canada killed nearly 3,000 people at the end of April in a context of strict foreclosure.

During the 2003 SARS epidemic, nearly two-fifths of the deaths occurred in Hong Kong, and the crisis was remembered by the people of the region. People wear masks at the slightest suspicion of a cold or flu and quickly adopt physical distance measures when a new epidemic is reported.

A study published on April 17 in the medical journal The Lancet asked people how they were coping with the COVID-19 epidemic and found that 85% voluntarily avoided public places and almost 99% wore masks outside.

Government measures and changes in the behavior of Hong Kong residents have had a significant effect on the transmission of the new coronavirus and the flu. Before the schools closed and the physical distance, each person with influenza infected 1.28 people and after the measurements, that number was 0.73. Researchers believe a similar effect is likely for COVID-19 and the Hong Kong government estimates that the infection rate is somewhere below 0.5.

“By rapidly implementing public health measures, Hong Kong has demonstrated that the transmission of COVID-19 can be effectively contained without resorting to the very disruptive full lockdown adopted by China, the United States and the countries of Western Europe Said Benjamin Cowling, professor at the University of Hong Kong, in a press release announcing the study.

What is a lock?

Although some protesters are calling for a full reopening of the economy and a return to normalcy, few experts argue that we must do nothing to fight COVID-19.

Sweden’s response has sometimes been mistakenly labeled as no response, and Sweden’s public health officials have rejected the idea that they are letting the virus invade society to gain “collective immunity”.

Stone defines confinement as a situation in which people are required to stay at home, except essential travel, and people are not allowed to mix with anyone outside their own home. Many businesses are forced to close during the shutdown period and most activities are temporarily banned.

A person bikes with his dog in front of stores closed on April 29, 2020 in New York. New York City has been blocked for all non-core businesses since March 23, 2020.


Getty Images

Western countries may have quickly adopted home support measures based on guidance from the World Health Organization, which based its advice on the initial situation in China.

“Ideas go viral. When something works, people imitate it and it seems that the Wuhan lockout has worked, “said Stone, although he points out that success in China followed a series of measures that were deployed at the same time . Basically, however, politicians and public health officials have a risk aversion.

“If you follow official advice, you never lose the lawsuit,” said Stone.

Do the locks work?

After analyzing the measures imposed in Spain, France and Italy, Stone found that deaths from COVID-19 in Spain had plateaued around 10 to 15 days after the bans were imposed. Because it takes about 20 days to die from the disease from the day of infection, this means that deaths were declining in Spain even before the closures began.

In Spain, a tighter adjustment to the decline in mortality is the “alarm state” declared on March 13 and the school closings which occurred on March 12. The week before, the government had banned large assemblies.

People were adjusting their behavior based on new information about the disease long before the government forced them to. Similar patterns can be found in the United States after the NBA season was canceled and Tom Hanks confirmed he was positive with COVID-19.

Information from reliable sources seems to have a huge effect on people’s behavior, especially if it is combined with the shaking effect of an alarmed or beloved celebrity victim of the disease.

“Information is the most powerful tool we have,” said Stone. “It is important to spread good information.”

If not, then what?

Stone says one of the best ways to fight an epidemic is to close schools. In addition to keeping the inherently evil children away from each other, it sends a strong signal to the entire population.

School closings are extremely important for flu epidemics, as children are among the biggest spreaders. We don’t yet know exactly how children are participating in the COVID-19 epidemic, but Stone says there is no better way to shock the parents’ system than to send their children home.

Travel restrictions, even between provinces and states, are another important non-locking tactic. It was a decision made early in Asian countries that were near the start of the epidemic in China. Vietnam, for example, immediately imposed travel restrictions, which allowed them to deploy other measures, and the country recorded no deaths.

Another slight drawback in non-closed countries is the ban on large gatherings, usually from 50 to 100 people, although Hong Kong residents can still eat at restaurants as long as there is a healthy distance between tables.

A protester is interviewed as he requests the removal of provincial restrictions on coronaviruses (COVID-19) outside the Ontario Legislature in Toronto, Ontario, Canada, April 25, 2020.


Chris Helgren /

Reuters

In Canada, these measures are already in effect at the same time as our broader home support measures.

The main difference is that centralized quarantine and the widespread use of masks have been in effect in many Asian countries since the epidemic, while in Canada they seemed to be an afterthought. In Taiwan, South Korea and Hong Kong, a sophisticated system for tracking, isolating and feeding people in a centralized quarantine area could be the main reason they fought the pandemic so successfully.

Centralized quarantine means that people who have tested positive or who have been in contact with a person who tested positive would be isolated in a custom-built hotel or space for a period of seven to 21 days. It is a measure that requires extensive testing and some confidence in government, as it severely limits the freedom of a small number of people.

In general, non-closed countries are also enthusiastic mask wearers.

In Canada, there were conflicting messages from public health officials at the start of the crisis, but most jurisdictions are now recommending people to wear masks. There is no confusion in Asian countries.

The Swedish experience

Sweden has become the poster for non-closed countries. And while it’s not quite the COVID slacker in which it has been described, Sweden has looser measures than even the anti-lock promoter Stone recommends.

The country kept its borders open and allowed schools for young children to remain open. Bars and restaurants are open and people can still meet in groups of up to 50 people. New York Times reporter found people drinking beer on patios and picnicking in public parks and noticed Swedes looking at people wearing masks as if they had “landed from Mars “

In essence, the government’s strategy is to trust its people to behave appropriately.

Some people are concerned, however. A doctor accused the government of playing “Russian roulette” with the public, and other experts called for tougher measures. Deaths in Sweden were also higher than in neighboring Scandinavian countries.

People order food from food trucks in Stockholm, Sweden, April 26, 2020, amid the new COVID-19 coronavirus pandemic.


AFP

At the end of April, Sweden had around 256 deaths per million citizens, compared to 38 per million in Norway and 76 per million in Denmark. The Swedes argue that the death toll will eventually spread, but with less pain inflicted on their economy and on people’s mental health.

Stone’s own research suggests that Sweden will kill more people than its neighbors, but mainly due to the fact that they had an earlier and more serious epidemic.

“The simulations show that the global burden is expected to be similar across countries, causing an estimated 528 to 544 deaths per million,” wrote Paul W. Franks, professor of genetic epidemiology at Lund University. “Unlike its counterparts, Sweden is likely to suffer the blow earlier and over a shorter period, with the majority of deaths occurring within weeks, rather than months. “

Franks stresses, however, that Sweden is embarking on a high-risk experiment. If Sweden can avoid leaving its intensive care units submerged, the country will be justified. Otherwise, “health professionals in Sweden will face the struggle of their lives.”

In an interview with British news site unHerd, Swedish professor Johan Giesecke argued that few of the measures taken to combat COVID-19 in western countries “have any evidence” to support them and praised the his government’s plan to avoid full containment.

Giesecke said Sweden’s higher death rate was due to the country’s largest nursing homes and said he agreed with simulations which showed that the total number of deaths per capita would be very similar at the end.

The bottlenecks are simply not sustainable in the long run, he said.

“How long in a democracy do you think you can maintain a lockdown? Said Giesecke. “After three or four weeks, people will say that I want to go out. I want to go to the pub. “

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