Did shelter-in-place and stay-at-home orders across the country work? That is, did they reduce the spread of COVID-19 and the number of deaths associated with the pandemic, relative to what would have happened otherwise? Whether or not they worked in this sense, were they a good idea?
My short answer: Lockdowns probably did reduce deaths somewhat relative to lesser restrictions, but not by nearly as much as many people assume. More importantly, government could have taken other proactive measures that would have reduced deaths even more while softening the blow to the economy.
Not even Governor Jared Polis seemed totally sold on the efficacy of Colorado’s stay-at-home order, although he routinely said it was needed. On April 22, Polis said, “The primary goal . . . of the stay-at-home order was to reduce the spread of the virus, to knock down that exponential curve.” Yet he said then and at other times that the order would not and could not be rigorously enforced. For the most part, insofar as the order worked, it was because people bought into it.
Polis added, “Maintaining the stay-at-home order for an additional two weeks or even four weeks [beyond April 26] delays the peak [of the disease], but it doesn’t really have anything more than a negligible impact in severity of the peak. The peak is essentially the same, it’s just a little bit later.”
So here’s my question: If extending the order by two to four weeks would have made almost no difference, then why should we think the order made much difference when it was in effect? Was there something magical about April 26, such that the order worked up until that date but would not have worked after that?
There are several reasons to be skeptical that lockdowns had the dramatic effects that their supporters claim. For starters, people voluntarily reduced their social interactions even before the government restrictions, and they would have done so even more as the disease worsened. For example, my family started isolating on March 13, well before Polis’s stay-at-home order went into effect on March 26.
“Lockdowns don’t work,” argues Lyman Stone, an American economist working in Hong Kong. Stone is not against all government restrictions. He favors school cancellations, travel restrictions, and limits on large assemblies. He also favors masks and, importantly, central quarantines to isolate the infected and their contacts. But, he argues, the evidence for lockdowns is surprisingly weak.
In a follow-up piece, Stone argues that fear of the disease, not government mandates, better explains why people socially distance. Governments can play a critical role in disseminating relevant information, he says. “Americans have been fairly diligent about social distancing, even in places and times where they were under no government order to do so,” he writes. Stone does concede, however, that “some evidence” suggests that “while lockdowns do not influence the timing of social distancing, they do influence its scale.”
A paper from Health Affairs estimates that without lockdowns the number of cases in the U.S. would have skyrocketed by April 27 by 35 times the observed numbers. But these results depend on “holding the amount of voluntary social distancing constant,” which the paper grants is unrealistic. Garbage in, garbage out, as they say. (For more commentary on this and many other sources, see my COVID-19 Updates.)
Anyway, not all social interactions are equally dangerous. Modeling assumptions that everyone is equally likely to get the disease if exposed and equally likely to spread it if infected are nonsense.
Some people are more likely to get and spread the disease because of their social behaviors. Some people come into contact with more people, spend more time socially indoors, shake hands and hug a lot, speak loudly and closely, and touch a lot of shared surfaces.
And some people physically are more likely to pick up the disease. Although COVID-19 can be extremely dangerous for some children, for the most part children are less likely to get and spread it (other things equal). At the same time, the elderly are much more likely to get it, spread it, and die from it.
Elderly people living in shared spaces at senior care centers are especially vulnerable and account for nearly two-thirds of Colorado’s COVID-related deaths, the Colorado Sun reported. As of May 17, Colorado reported 1,192 deaths among people with the virus. (A lower number, 878, died “due to COVID-19.”) Of that larger number, a full 647 (54%) were of people 80 years and older, and 927 (78%) were of people 70 years and older. The problem is a combination of more exposure, greater likelihood of infection, and greater likelihood of death once infected.
A major problem is superspreading events, which can be addressed with more modest restrictions than a full lockdown. Faye Flam summarizes, “most people transmit the disease to nobody, or one person, and a minority infect many others in so-called super-spreading events. . . . Nine percent of infected people are responsible for 80% of the transmissions.” Someone can infect more people at a crowded rock concert or church service than at an uncrowded store or park.
So, realizing that we’re playing Monday-morning quarterback here, what might government have done instead of imposing a lockdown? Virtually every plan that people have put forward involves some combination of six basic strategies:
1. Improve social hygiene by getting people to wear masks in public, wash their hands frequently, sanitize shared surfaces, and do more things outside. Of course most of this can happen without government mandates.
2. Cocoon the vulnerable. Here government failed catastrophically. New York’s government literally forced nursing homes to take in patients with COVID-19. A serious effort here would have quickly expanded testing for residents and workers at these facilities.
3. Restrict some social interactions especially involving large gatherings. (Beyond that details of different proposals vary greatly.) Meat packing plants and the like pose a tough challenge, but obviously sanitation, health checks, and testing help. Even here we have reason to doubt that government mandates are needed or appropriate; recall that many sporting events and the like were called off prior to the lockdown orders. Government directly controls most of the schools, so of course government must decide whether to shut those down.
4. Test more people, preferably mostly asymptomatic people, to track the spread of the disease and get the sick into isolation. Shockingly, the federal government actively suppressed testing at the outset and continues to throw up regulatory hurdles.
5. Trace the contacts of the sick to see who else is infected.
6. Require the sick to go into isolation so that they don’t infect others. Although we can argue about the details of when a quarantine is and is not appropriate, there is no rational basis to oppose quarantines as such. As the Queen of Capitalism, Ayn Rand, said, “To quarantine people who are ill is not a violation of their rights; it merely prevents them from doing physical damage to others.”
Even relative to government doing nothing, lockdowns would have had limited effect simply because most people otherwise would have responded to increased disease threat by voluntarily increasing their social distancing. But that too would have devastated the economy.
What I think government should have done is robustly pursue a test-trace-isolate strategy from the outset while encouraging individuals to make responsible choices. That would have mitigated the ravages of the disease as well as the economic destruction. Still the government’s efforts along these lines are grossly inadequate. Now, as we face the future, we can encourage government to do what it should have been doing all along.