We are learning the wrong lessons from lockdown

And unless we learn the right ones, we risk making the same mistakes in a new pandemic

England started its first of three lockdowns exactly five years ago. The immediate impacts of lockdown were devastating for many, and the longer term harmful impacts are becoming increasingly clear and still emerging. Lockdown was a massive society wide intervention – it is right and proper that its impacts be studied in detail and lessons learned from its implementation and extent. But the tenor of reporting and public opinion seems to be that “lockdowns were terrible and so we must not have lockdowns again”. This is the wrong lesson. Lockdowns are terrible but so are unchecked deadly pandemics. The question should be “lockdowns were terrible, so how can we prevent the spread of a new pandemic so we never need one again?”.

Was lockdown, despite its harms, better than the alternative?

First let’s revisit the actual choice that faced the government in March 2020. Lockdown was not instituted on a whim. It was a drastic response to a drastic situation. No one had any immunity and we had barely any treatments. We knew it was infectious and serious, with a mortality rate 4-20 times higher than seasonal flu, depending on age. We had no idea what the medium to long impacts of Covid infection were. We knew older adults were most vulnerable, but we didn’t know how it would affect children or if there were other differences such as by sex or other health conditions.

By the time the first lockdown was called on 23 March 2020, there were over 1,000 daily hospital Covid admissions in England and that number had been doubling every four days. We had no idea how many people were infected, no population level testing, no contact tracing, little PPE (including masks), and did not understand well how it spread (how it transmitted, how common asymptomatic spread was). Essentially, we had very few ways to stop the spread and any chance we did have to stop it gaining a foothold was over weeks before.

Lockdown worked – it brought Covid under control. Hospitalisations peaked at 3,000 per day at the beginning of April and deaths at 1,000 a day about a week later. By the end of June hospital admissions were in the low hundreds and falling. Nonetheless, by the end of June 2020 7% of people had been infected and 53,000 people had died of Covid. Hospitals did not cope, but they did not collapse completely.

Without lockdown, the number of people infected and the number of people dying would have been far higher, and hospitals would have collapsed. Even delaying lockdown by a week from 16^th to 23^rd March likely resulted in 20,000 extra deaths. The illness and death from the first wave was not felt equally. Health care workers and other key workers (disproportionately from Black and South Asian minorities) were two- to three- times more likely to have been infected than non-essential workers. Chances of Long Covid from that original Covid variant (in the context of no vaccine or previous infection) were much higher than now – the Imperial REACT study estimated that about 20% of infected people developed Long Covid in 2020. They also reported that only 31% of people with Long Covid had recovered within a year.

Without lockdown, both the absolute size and the inequality of impact would have been more extreme. Those able to stay home voluntarily would have been far better off than those who worked in public facing settings, or those in overcrowded accommodation. Businesses that relied on footfall would have been severely damaged but this time possibly without furlough or as generous government support.

Had that original variant of Covid infected millions more people, the impact on people’s lives (the tens of thousands more dead, the hundreds of thousands more bereaved, the millions more newly long-term sick) – and our economy – would have been even more devastating. There was never a choice between lockdown and carrying on as normal. It was a choice between the devastation of lockdown and an even worse devastation.

Other choices should have been possible – especially by the end of 2020

Had we been better prepared, it could have gone differently. The Covid-19 Inquiry Module 1 report laid out all the ways in which we weren’t prepared and I’ve written about how the very aims of the government’s preparation were flawed.

But by the autumn of 2020, we knew so much more. We knew it was airborne and we knew that testing and contact tracing was key – and we could have learned how to do it better from other countries such as South Korea, Japan and Germany. We knew that a vaccine was on its way sooner than we thought. Covid levels in England were very low in the summer of 2020 – we should have been able to keep them low for long enough to allow our population to be vaccinated. But we didn’t. Twice more the government faced the consequences too late of its hodge-podge of policies not working, despite ample warning from SAGE and others, and was forced into further lockdowns as a last resort. The second large wave (at a time when about 90% of the population were still uninfected and susceptible) and the final lockdown are particularly unforgivable – over 70,000 people died when they were weeks away from being vaccinated.

The real lessons from lockdown

So - these are my lessons from lockdown. Firstly, lockdowns are devastating in their impacts, both in the short and long term, particularly on younger people and on more deprived communities. Secondly, lockdowns can and should be avoided – but by tackling the spread of an infectious disease not by doing nothing! Preventing future lockdowns requires planning, preparation, investment in public health infrastructure, and investment in testing, virology and medical research - and the fundamental acceptance that you can’t wing a pandemic.

Finally, it’s possible that a future pandemic will be severe enough – just reaching our shores too quickly, or being too infectious or too deadly - that our preparation still fails and a lockdown is needed as a last resort. This too needs to be planned for, with economic, educational and day-to-day support measures ready to go. There needs to be a recovery plan for after – and rapid learning to prevent the need for further lockdowns if at all possible. The best way to avoid future lockdowns is to learn the right lessons from the last ones.