The Term:
The term ‘lockdown’ was used by media and the WHO to describe the actions taken by Chinese authorities towards their citizens during the COVID-19 (2019-2020) outbreak. It is not an official term used by the public health sector. Later, Italy too imposed a strict quarantine order. Since then, most media outlets across the world have only been using this term but the definition has kept shifting, depending on the countries which used it. The term itself has been associated with martial law wherein no person is allowed to come out of their homes, doors must be locked and distance kept from windows. In order to avoid confusion, some governing authorities have tried using the term ‘stay-at-home’ or ‘shelter in place’.
In terms of emergency situations such as virus outbreaks, a lockdown is an emergency step taken by governments or organisations to prevent people from leaving designated areas and effectively quarantine them. Exceptions are made, depending on the country. For example, getting groceries or going for essential work. However, non-essential services and businesses need to close down, gatherings and events are banned and schools may (or may not) close too.
As the novel coronavirus, COVID-19, continues spreading, many governing bodies have placed their citizens under lockdown. The goal of a lockdown is to stop the spread of infection by limiting people’s social contact with others.
See how many countries are currently affected, the number of cases and lives lost.
Why are certain countries doing a lockdown?
Lockdowns really depend on the context. Each country faces different social, cultural, economic, medical challenges. The decisions are made based on multiple factors: the country’s medical system’s ability to cope with the number of COVID-19 positive cases (equipment, trained medical personnel, isolation wards, regular cleaning etc.), public opinion, public’s level of awareness of the issues, affected regions, current number of cases, availability of test kits and many others.
In Peru and Panama, for example, men can leave their house only on certain days while women can leave on others. Neither gender can go outdoors on Sundays. While, Thailand is expected to have a 10pm to 4am curfew implemented soon. The exception to that time are those people seeking medical attention or essential transportation of goods.
On the other hand, India, China, France, Italy, Spain, Ireland, Denmark, Germany, New Zealand, Poland, South Africa and the UK have implemented the strictest restrictions.
India started an almost complete nationwide lockdown on 24th March. Indian Prime Minister Narendra Modi said, “To save India and every Indian, there will be a total ban on venturing out of your homes.” A daunting and difficult task to ask a nation of 1.3 billion people to stay indoors till further instructions are given. Thankfully, many state governments in India displayed foresight by curbing social activities, working from offices, public gatherings, transports and such, far earlier than the nationwide lockdown announced by the central government – some, such as Telangana, Uttarakhand and Rajasthan imposed a state lockdown. Interstate travel too was suspended. The capital city, New Delhi, started an early curfew. Public transportation (metro, rickshaw) was suspended, factories, shops, offices and temples shut down. Essential services, news, grocery stores, hospitals and such were exempt.
Many people would question why such a drastic measure is effective in fighting COVID-19? (See our complete guide – what is COVID-19?)
Why are lockdowns effective?
Early scientific studies have estimated the reproduction number (R0) for SARS-CoV-2 as 2.2 (this one and this one). This means that, on average, each infected individual spreads the infection to at least 2 more individuals. Seeing the worldwide strong transmission of COVID-19, a R0 of 3.0 is agreed upon in scientific circles. The aim is to bring this number below 1.0.
Professor Hugh Montgomery, director of the Institute for Human Health and Performance at University College London, said on Channel 4’s TV show, “Dispatches”, “Normal flu, if I get that, I’m going to infect on average 1.3, 1.4 people … by the time it’s happened 10 times, I’ve been responsible for about 14 cases of flu”
“If you are irresponsible enough to think that you don’t mind if you get the flu, remember it’s not about you – it’s about everybody else.”
PROF. mONTGOMERY
“This coronavirus is very, very infectious, so every person passes to it three, now that doesn’t sound like much of a difference, but if each of those three pass it to three and that happens in 10 layers, I have been responsible for infecting 59,000 people.”
The Solution:
A lockdown where people isolate themselves within their homes (as seen in the illustration above). Thus, whether people are infected or not, the only people they can infect are the people within their vicinity – other people within the same house.
Additionally, there are three benefits for this:
- It prevents health care services from being overwhelmed by a huge surge of patients. [Most health services are stretched in terms of funding, medical staff, equipment and other resources. Moreover, they are already handling people with diseases like cancer, patients in need of surgery, transplants, taking care of to be mothers in labor and many more. A sudden surge in COVID-19 patients will mean that we will not get the basic treatment or care we need. ]
- It gives governments the ability to control the infection in areas where positive cases have been reported. They can send a sufficient number of medical personnel. India, for example, only has 5 medical staff per 10000 people. So it is key to distribute them in areas wisely.
- It allows for controlled testing of the SARS-CoV-2 virus in areas that are affected or may potentially be affected.
What happens after a lockdown? How should it be handled?
How effective a lockdown is in nature will depend on how it is handled by governing bodies. This is a time for rigorous testing, isolation and treatment.
The lifting of the lockdown should only take place based on strong evidence based research in order to avoid a second wave of infections.
One of WHO’s top emergencies expert, Dr. Mike Ryan, said governments would have to look at specific parameters: availability of hospital beds, infection rate and the proportion of positive results compared to all tested samples, to determine whether they can start slowly loosening the lockdown.
A study was published in the Lancet that simulated extension or relaxation on workplace and school closure using mathematical modeling in Wuhan, China – a city of 11 million people. The study suggested that by lifting the lockdown at the end of March, a second wave may occur by end of August. Keeping the city in lockdown till April helps delay the second wave till October that could help healthcare workers regroup.
The co-author of the study, Dr. Kiesha Prem, from the London School of Hygiene & Tropical Medicine (LSHTM), said that, “The city now needs to be really careful to avoid prematurely lifting physical distancing measures because that could lead to an earlier secondary peak in cases. If they relax the restrictions gradually, this is likely to both delay and flatten the peak.”
The WHO director-general, Tedros Adhanom Ghebreyesus, has also mentioned that lockdowns were the best way to curb transmission. He added that, “the last thing any country needs is to open schools and businesses only to be forced to close them again because of a resurgence,” he said.
In a country like India, despite a lockdown, it has been difficult policing people in keeping social distancing measures. In spite of this, under the lockdown, there is hope that the Indian policing and medical services will prevail, that common sense will get through to individuals who are seen flouting emergency rules – congregating in markets and streets.
