Was lockdown necessary?BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o776 (Published 23 March 2022) Cite this as: BMJ 2022;376:o776
- Kit Yates, senior lecturer
- Twitter: @Kit_yates_maths
On 23 March 2020 at 8 pm prime minister Boris Johnson came onto our TV screens to address the nation about the escalation of the covid situation in the UK. “From this evening I must give the British people a very simple instruction,” he said. “You must stay at home.”1 It was the beginning of the UK’s first lockdown.
Two years on from that surreal Monday evening, more than 185 000 people in the UK have died from covid-19,2 hundreds of thousands of people continue to struggle with the burden of long covid,3 hospitals have frequently been unable to provide the expected quality of care,4 and the NHS has just struggled through the worst winter on record.5
Despite this long lasting and ongoing impact, some people’s memories of the early days of the pandemic seem shorter than others. We are hearing from some sections of the media that that first lockdown was unnecessary—that the worst impacts of that first wave of the pandemic could have been mitigated, while simultaneously avoiding the damage done by lockdown.6
Let’s be clear about this upfront, lockdowns are not without their costs. In the absence of an effective public health response to covid-19, the lockdowns experienced by the UK were economically damaging.7 That damage has not been evenly distributed, affecting the poorest parts of the UK disproportionately. That said, the countries that experienced the worst economic downturns in the first covid wave were also typically the counties, like the UK and Spain, with the highest rate of death per head of population. During the first wave, there was no evidence of the much discussed tradeoff between protecting people’s health and protecting the economy.8 This was always a false dichotomy, as so clearly demonstrated by New Zealand.
The school closures that came with the first lockdown were also undoubtedly detrimental to students’ education. This makes it all the more bizarre that the government has done so little to safeguard our children’s ongoing education. Despite claiming on multiple occasions that it was their number one priority,9 the government has not done enough to mitigate the impact of lockdowns. Union leaders have derided the government’s paltry post-pandemic catch up programme as “pitiful”—the £1.4bn earmarked for it less than a tenth of the £15bn recommended by the education recovery commissioner. At £50 per head, the UK’s spending on post-pandemic catchup provision was 50 times lower than the £2500 provided by the Netherlands.10 Even now the government has not implemented simple measures like providing adequate ventilation for all classrooms, which have been shown to be of benefit in reducing cases of covid.11 Vaccines are still not routinely available for UK primary pupils as they face yet another wave of covid ripping through their schools.
Despite the clear downsides, there is still a strong argument to suggest the first lockdown was necessary in order to save lives and to prevent the NHS from becoming even more overstretched than it eventually was. Modelling from Imperial College London suggested at the time that, had the government carried on with their “mitigation” strategy, around 250 000 people in the UK would have died from covid in the first wave.12 This stark prediction was without taking into account the fact that the health service would have been overwhelmed many times over, or the impact of the more transmissible and more deadly variants which later emerged, which would undoubtedly have made the situation worse. Had we not locked down, this modelling suggests it would have been an unmitigated disaster. Indeed, in light of the emerging situation in Italy in early March 2020,13 there is a strong argument to say that we should have locked down sooner, saving tens of thousands of lives.14
Here it seems appropriate to say that no one is in favour of lockdowns. If public health practitioners have advocated for lockdowns, it has been when the covid situation has been allowed to get so out of hand that there is no other solution to protect people’s lives. But lockdowns are not public health policy. If anything, they represent a failure of public health policy.
It could be argued that the first lockdown in the UK was unavoidable, although better preparedness may have helped to mitigate against the worst impacts of it.15 Given the warnings that were illustrated so graphically by the first wave in 2020, it’s harder to make the case that the second and third lockdowns were truly unavoidable. We had time to implement managed isolation and quarantine for incoming travellers,16 locally driven contact tracing,17 effective public health messaging,18 and to improve ventilation in schools and workplaces, all of which would have helped to blunt, if not avoid, the alpha wave we experienced in the winter of 2020, perhaps without the need for further lockdowns. We largely failed on all these counts.
Ultimately, there will always be disagreement about lockdowns. Whether you view them as necessary depends on your value system. Many people would place the lives of the most vulnerable high on their list of priorities. Many people would value a functioning NHS with equal access for all at the point of need. Many would place a high worth on the long term health of their population. But not everyone. It is worth remembering that since these values are not universally held, there will always be small but vocal minorities who decry that first lockdown two years ago as unnecessary, favouring instead a strategy of “riding it out.” Faced with the counterfactual though—the overwhelmed hospitals, the hundreds of thousands of people dead in a few short months, the long term health burden—I suspect most of those voices would have fallen quiet.
Competing interests: KY is a member of Independent SAGE.
Provenance and peer review: Not commissioned; not peer reviewed.