Nobody denies lockdowns have damaging effects in other areas.
That leaves a discussion about what kinds of lockdowns are worth the benefits they bring. But seems to me the sub isn't geared towards finding that truth?
Just to check in with you - and this is honestly meant as a check-in and not an insult: do you realize how unabashedly privileged you sound? I ask this first because I know that for me, I often don't realize when I make statements that reflect my own privilege, and I find that when that happens, it's almost always a chance to learn something new and important. I hope that is the case here.
Let's look at how lockdowns _actually_ interdict spread:
I'm reasonably affluent. Long-time remote worker in a fairly elite engineering position. I am able to sit in my home and order everything I need delivered to me. I live in a two-generation household, and I'm the oldest. We are all at low risk for adverse outcomes from SARS-CoV-2. In fact, for us, the risk is statistically difficult to distinguish from any other year's circulating pathogens.
Meanwhile, the person delivering things to me (and thus entering and leaving dozens of restaurants and stores every day to obtain the things for me and my affluent neighbors) is far more likely to live with a higher-risk relative and also more likely to live in a three-generation home (which is a fairly dire situation in light of this pathogen).
Let's imagine that my delivery worker lives with his 82-year-old grandmother with untreated high blood pressure. For her, in contrast to me, the risk this year is _nothing_ like that resulting from a typical year's respiratory pathogens. It's perhaps as much as 100x higher. Her risk of hospitalization - which she is also less likely to be able to afford - may be as high as 10%, compared to my small fraction of a percent.
As the months go on, I'm "protected" from infection. Instead of being able to adjoin the cohort of the highest spread acuity and then isolate (which I believe is my civic duty as a low risk person, to protect my higher-risk neighbors), I have to wait a year or more for my inevitable infection.
But that's not the end of the world, right? I had to mostly socially isolate and work remotely for a while, cancel a bunch of trips, etc. But all in all, nothing to cry over.
Now: what about my delivery driver and his grandma? For them, my delay in getting infected comes at an enormous cost. Namely, it increases the overall chance that the high-risk members of their family will be infected. They might possibly be able to interdict infection across their three-generation household for a few weeks, but not for years.
Now perhaps you see the actual first-order impact of lockdowns: they don't simply "slow the spread", they actually break one of the most important tools humans have in our collective ability to fight infectious disease: our social proclivity to facilitate differences in spread acuity _by risk_. We are actually very good at ensuring that young, healthy people share pathogens and develop community immunity quickly.
By preventing that, we protect only those privileged enough among us to isolate more-or-less indefinitely. In other words, lockdowns don't change spread acuity, they just shift its stratification from being by risk (which is great for preventing adverse outcomes) to being by socioeconomic status (which is arguably the worst possible approach if the goal is to prevent adverse outcomes). My friend Jay Bhattacharya at Stanford refers to this situation as "let it drip" (a play on words in the face of "let it rip", a sophomoric slogan used by opponents of traditional vertical risk stratification).
So, what we're saying is that we can observe not only the collateral consequences of lockdowns (which of course are devastating), but also an undesirable impact in first-order effects: lockdowns which are long enough to decrease spread acuity in the low-risk tier also increase first-order death in the high-risk tier.
This is the reason that lockdowns (previously referred to as "quarantine of the healthy") are advised against in the published pandemic plans prior to 2019. By all means, go to Google Scholar (or your search engine of choice for scholarly material) and drive yourself down this memory lane. You'll be astounded and almost certainly come out the other end a lockdown skeptic.
What I'm saying is, is that lockdowns technically work. Keep everyone inside (including the delivery guy) and spreading will be reduced. Let's take this one step further. What if we could (hypothetically) isolate the entire planet for 1 month. We might just completely irradicate a whole bunch of deceases. But of course it would come at a cost.
Lockdowns are just one of the tools we have at our disposal. There's no doubt they work. Viruses don't spread telepathically. This in itself is nothing to be skeptical about. The only question is if the benefits outweigh the costs. A better name for the sub would perhaps have been: /r/lockdownpolicyskepticism
I doubt we'd eradicate any disease which is a significant threat to humankind with a month of isolation, for two reasons:
* In the case of many pathogens, there are extreme outliers who remain contagious for months (and of course with others, such as some retroviruses, it is normal to remain contagious indefinitely).
* There are sufficient animal reservoirs for many pathogens (including SARS-CoV-2 and influenza and many other respiratory pathogens) that, no matter how long humans isolate, they'll be exposed rapidly upon emergence.
> There's no doubt they work.
I'm not sure how you can say this, when a giant chorus of experts from all of the world's foremost institutions of medical research have expressed exactly this doubt.
I appreciate the exercise of your hypothetical, but even in the extreme case you present, it's far from clear that it will have an impact which reduces adverse outcomes. And in the real world, with its imperfections? I see no reason to believe that lockdowns have any positive impact, first- or second-order.
There's no doubt. It's scientific fact that the virus cannot spread when its host doesn't occupy spaces that other people do. Besides it being a "rain is wet" kind of thing, it's also backup up by scientific research.
The discussion is about what flavor of lockdown offers sufficient benefits that outweigh the costs. And if such flavors can be enforced.
Do I understand correctly that you are saying, for example, that lockdowns will somehow eliminate a virus from animal reservoirs? Or stop spread within a household? Or ameliorate rare but important cases in which a host remains contagious for much longer than is typical?
Horizontally interdiction is sometimes possible with pathogens with spread via the fecal-oral route, or STIs, or arboviruses, or hemorrhagic fevers, etc.
But a highly contagious respiratory pathogen with robust, worldwide animal reservoirs? I do not agree that it is "scientific fact" (whatever that phrase even means) that mere separation of humans can achieve a reduction in adverse outcomes (setting aside, as you rightly acknowledge, the collateral effects).
But you seem to be under the impression that there exists no form of lockdown that works. That's simply not true. We've already seen various real-world examples of successful lockdowns. China did them. New Zealand did so successfully in 2020. Italy did them when they were first hit.
Lockdowns simply work. The virus cannot spread between people that are isolated from each other. That's simple scientific fact. It's scientifically known how the virus transmits itself.
Take a simple experiment. 2 rooms opposing sides of the planet. 1 person in each room. 1 person infected. 1 person uninfected. There's simply no way the infected person can infect the uninfected person. They would need to get into contact with each other to allow the virus to spread.
If you keep the entire population locked up. If you implement a total curfew. Police the streets so that everyone stays inside. There is no doubt spreading will be reduced significantly. But we don't want to live in China.
So the question isn't if lockdowns work. They work perfectly. The question is what form of lockdown outweighs the costs to warrant putting them in place.
> We've already seen various real-world examples of successful lockdowns. China did them. New Zealand did so successfully in 2020. Italy did them when they were first hit.
This is absolute, total nonsense. Neither China nor New Zealand have implemented anything resembling a successful strategy in anything but the very short-term. Both are still dealing with this virus, and are _further_ from endemic equilibrium than Florida and Sweden (which also made terrible mistakes obviously).
> Take a simple experiment. 2 rooms opposing sides of the planet. 1 person in each room. 1 person infected. 1 person uninfected. There's simply no way the infected person can infect the uninfected person. They would need to get into contact with each other to allow the virus to spread.
I don't understand how you can tell this story when it is so obviously empirically false.
There were _zero_ infected people only two years ago. Now there have been billions of cases.
It seems that you don't really fully believe in germ theory? Or something?
In your experiment, I guarantee the uninfected person will eventually become infected, via contact with animal reservoirs if not the normal course of living and making contact for routine purposes such as acquiring food and medical care.
I'll give you an even more strident experiment: take two people, both uninfected with H3N2, no demonstrable cases at all in the entire world in the human population (such as happens some years with influenza near the equinox or during a period of strong viral interference). What do you think will happen? Obviously both of them will become infected because of the enormous and enduring reservoir in the bird population.
Now consider that coronaviruses are even more infectious and have a wider diversity of animal reservoirs.
Seriously: how do you think pandemics emerge? Even though there is an endemic H3N2, pandemic H1N1 (or other influenza A subtypes) still break out, starting with _zero_ cases. Or do you deny that pandemic influenza is still possible?
Horizontal interdiction does not work with respiratory pathogens. Not on small or large scales. Pathogens which are sufficiently deadly can burn themselves out without being transmitted to an available susceptible, but this is a different phenomenon.
> If you keep the entire population locked up. If you implement a total curfew. Police the streets so that everyone stays inside. There is no doubt spreading will be reduced significantly.
In such a scenario, you're correct that spreading in the community will likely be less acute, but spread within households will likely be more acute. And then what? The virus will be no nearer to endemic equilibrium than when you started. So you'll have to facilitate the same acute spread you blocked in the first place.
> So the question isn't if lockdowns work. They work perfectly.
This is just a completely indefensible position in light of the data. No nation on earth has eliminated the virus, nor achieved endemic equilibrium with a lockdown in place. Every place that has done testing has found positive animal reservoirs. Just... stop.
> The question is what form of lockdown outweighs the costs to warrant putting them in place.
This is true, but it's not only the collateral damage that is to be measured. It is also the first-order effects, such as more acute spread in the household, delayed endemic equilibrium, etc. In addition to the collateral damage, lockdowns appear to cause more adverse outcomes _from the pathogen in question_.
I think New Zealand was free from Covid for maybe 1 year? I wouldn't call that short-term. While many countries were locked down, they were enjoying parties and festivals. If they would've kept themselves isolated from the rest of the world, they'd still be Covid-free.
> In such a scenario, you're correct that spreading in the community will likely be less acute
Yes, so that was the point. Lockdowns work to reduce spreading. We are in agreement.
> , but spread within households will likely be more acute.
Spreading within households would only occur for those households containing an infected person. This wouldn't be a very large percentage of the total households. 2 ~ 4 weeks later those households would've been recovered. A significant reduction would've been achieved. But it would come at great costs. And would only delay the inevitable once everything opens up again.