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COVID-19 Measures : Lockdown or Common Sense?

"It seems like the lockdowns don't add a whole lot after you've done other social distancing measures."
"[On the other hand], the research on isolation and centralized quarantine is extensive and compelling. We know this works."
"As long as your life doesn't require you to be gathered in large groups, life here is pretty normal [where he lives and works, in Hong Kong]."
"Ideas go viral. When something works people imitate it and it appeared that the lockdown in Wuhan worked. If you follow the official guidance you never lose the lawsuit."
"Information is the most powerful tool we have. Getting good information out there is important."

Lyman Stone, researcher, American Enterprise Institute, Hong Kong

"By quickly implementing public health measures, Hong Kong has demonstrated that COVID-19 transmission can be effectively contained without resorting to the highly disruptive complete lockdown adopted by China, the United States, and Western European countries."
Benjamin Cowling, professor, School of Public Health, University of Hong Kong

"Simulations show that the overall burden is expected to be similar across countries, resulting in about 528 to 544 deaths per million."
"Unlike its peers, Sweden is likely to take the hit sooner and over a shorter period, with the majority of deaths occurring within weeks, rather than months."
Paul W.Franks, professor of genetic epidemiology, Lund University, Sweden

A study published on April 17 in The Lancet medical journal surveyed people on how they were adapting to the COVID-19 outbreak and found that 85 per cent were avoiding public places voluntarily and almost 99 per cent were wearing face masks outside.

The world looks toward Sweden for its approach to handling the country's response to the presence of a high contagious, vicious virus represented by COVID-19, ravaging populations in Europe, with Italy and Spain particularly hard hit with the number of cases and subsequent deaths among their populations, despite going into lockdown. Sweden, unlike its close neighbours, Denmark and Norway, decided to opt for a more open approach, closing most schools but otherwise ensuring that life would go on as normal, depending on the good sense and choices of Swedes to observe social distancing.

Sweden's high-risk experiment was a gamble the government decided on to see whether it could succeed in avoiding having its intensive care units overwhelmed. That outcome would serve as vindication of the government's decision-making. If matters turned out otherwise, "health care professionals in Sweden will face the fight of their lives", since it was at their scientific promptings the government was led to make the choice for a continued open society..

Sweden permitted bars and restaurants to remain open as well as schools for younger children. In Hong Kong, all schools were closed and everyone diligently wore face masks, taking personal responsibility for their health outcomes with the virus, but not shutting the city down as China did, and most Western societies as well. Lyman Stone, the American Enterprise researcher who lives in Hong Kong, is convinced that the world's response to the novel coronavirus by shutting down everything is unwarranted, that people should be trusted to observe physical distancing on their own.

"As long as  your life doesn't require you to be gathered in large groups, life here is pretty normal", he explained. Workers have been encouraged to work from home, and schools have closed, but restaurants remain open and shopping malls are full of shoppers. Hong Kong, with its population of 7.5 million, in close proximity to China has seen four people die from COVID-19. By the end of April there were almost 3,000 deaths in firmly locked-down, business-and-school-closed-down Canada.

A protester is interviewed as he demands the removal of the provincial coronavirus disease (COVID-19) restrictions outside the Ontario legislature in Toronto, Ontario, Canada April 25, 2020. Chris Helgren / Reuters

People in Hong Kong remember the 2003 SARS outbreak that hit really hard in Hong Kong. Masks are worn when colds or the flu appear imminent, and physical distancing becomes second nature every time a new outbreak is reported. The medical journal The Lancet published a study which surveyed how people were adapting to the COVID-19 outbreak, with the result that 85 percent avoided public places voluntarily, with close to 99 percent wearing face masks when out in public.

Before school closures and physical distancing in Hong Kong every person with the flu infected 1.28 people while after the automatic return to social distancing the infection number was reduced to 0.73. A similar effect is likely for COVID-19, according to researchers. The Hong Kong government believes the infection rate for COVID is somewhere below 0.5.

What defines a lockdown is people ordered to remain in their homes other than for essential trips. Disallowing people to mingle with others socially, with the exception of their own household and many businesses in a lockdown are ordered to close, with most social activities of any kind banned temporarily. The adoption of stay-at-home measures in most Western countries was based on world Health Organization guidelines, which in turn based its advice on China's reaction to the coronavirus.

Lyman Stone analyzed the imposition of protective measures in Spain, France and Italy, finding that deaths attributable to COVID-19 in Spain plateaued some ten to fifteen days following lockdown. Deaths were declining in Spain before the lockdowns even started, he found, since it takes about 20 days for death from the disease to occur, from the day of infection. People had adjusted their behaviour based on information about the virus even before government forced them to.

Trusted sources giving information appeared to have a large impact on people's behaviour in the United States, when for example celebrity figures confirmed they tested positive for COVID. Such revelations in tandem with a state of public alarm impacted on people's consciousness. One of the best methods to fight an epidemic, according to Mr. Stone, is the closure of schools and keeping children distant from one another, just as school closures are vital for influenza epidemics since children become the biggest spreaders.

Travel restrictions between states represent yet another important tactic in non-lockdown situations, a move readily taken in Asian countries in close proximity to the early coronavirus outbreak in China where Vietnam immediately imposed travel restrictions, giving them time to invest in other measures, the result being that no deaths were experienced in the country. A ban on large gatherings is another important measure, affecting 50 to 100 people. And still leaving restaurants open, where people maintain social distancing.

Centralized quarantine and generalized mask use have been commonplace in many Asian countries since the outbreak, whereas in Western countries a gradual approach was common. A sophisticated system to track, isolate and feed people in a centralized quarantine area in Taiwan, South Korea and Hong Kong could also have contributed hugely to their successful battle against the pandemic. People who tested positive or were in contact with positive-testers would ideally be isolated in a hotel or a custom-arranged space between seven to 21 days in quarantine. This requires widespread testing.

On the other hand, with Sweden's non-lockdown 'experiment' in trusting its population to self-monitor where the borders remain open, people can still gather in groups of up to 50 people and no one wears masks. One Swedish doctor has accused the government of playing "Russian roulette" with its population, with other experts  urging on stricter measures, in response to Sweden's death figures outdistancing those of its Scandinavian neighbours.

Sweden had about 256 deaths per million people in comparison to 38 per million in Norway and 75 per million in Denmark by the end of April. Sweden feels the number of deaths will even out eventually, accomplished with less strain on their economy and on people's mental health. Swedish professor Johan Giesecke's position is that few of the measures used to control COVID-19 in western countries "have a shred of evidence" in support of their choices, in high approval of his own government;'s decision to avoid full lockdown.

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

A person rides a bike with their dog past closed stores on April 29, 2020 in New York City. New York City has been on a lockdown of all non-essential businesses since March 23, 2020. Getty Images