covid lockdown

Was lockdown necessary?
Two years on from the UK’s first covid lockdown, Kit Yates looks at whether it could have been
avoided
Kit Yates senior lecturer
On 23 March 2020 at 8 pm prime minister Boris
Johnson came onto our TV screens to address the
nation about the escalation of the covid situation in
the UK. “From this evening I must give the British
people a very simple instruction,” he said. “You must
stay at home.”1 It was the beginning of the UK’s first
lockdown.
Two years on from that surreal Monday evening, more
than 185 000 people in the UK have died from
covid-19,2 hundreds of thousands of people continue
to struggle with the burden of long covid,3 hospitals
have frequently been unable to provide the expected
quality of care,4 and the NHS has just struggled
through the worst winter on record.5
Despite this long lasting and ongoing impact, some
people’s memories of the early days of the pandemic
seem shorter than others. We are hearing from some
sections of the media that that first lockdown was
unnecessary—that the worst impacts of that first wave
of the pandemic could have been mitigated, while
simultaneously avoiding the damage done by
lockdown.6
Let’s be clear about this upfront, lockdowns are not
without their costs. In the absence of an effective
public health response to covid-19, the lockdowns
experienced by the UKwere economically damaging.7
That damage has not been evenly distributed,
affecting the poorest parts of the UK
disproportionately. That said, the countries that
experienced the worst economic downturns in the
first covid wave were also typically the counties, like
the UK and Spain, with the highest rate of death per
head of population. During the first wave, there was
no evidence of the much discussed tradeoff between
protecting people’s health and protecting the
economy.8 This was always a false dichotomy, as so
clearly demonstrated by New Zealand.
The school closures that came with the first lockdown
were also undoubtedly detrimental to students’
education. This makes it all the more bizarre that the
government has done so little to safeguard our
children’s ongoing education. Despite claiming on
multiple occasions that it was their number one
priority,9 the government has not done enough to
mitigate the impact of lockdowns. Union leaders have
derided the government’s paltry post-pandemic catch
up programme as “pitiful”—the £1.4bn earmarked
for it less than a tenth of the £15bn recommended by
the education recovery commissioner. At £50 per
head, the UK’s spending on post-pandemic catchup
provision was 50 times lower than the £2500 provided
by the Netherlands.10 Even now the government has
not implemented simple measures like providing
adequate ventilation for all classrooms, which have
been shown to be of benefit in reducing cases of
covid.11 Vaccines are still not routinely available for
UK primary pupils as they face yet another wave of
covid ripping through their schools.
Despite the clear downsides, there is still a strong
argument to suggest the first lockdown was necessary
in order to save lives and to prevent the NHS from
becoming even more overstretched than it eventually
was. Modelling from Imperial College London
suggested at the time that, had the government
carried on with their “mitigation” strategy, around
250 000 people in the UK would have died from covid
in the first wave.12 This stark prediction was without
taking into account the fact that the health service
would have been overwhelmed many times over, or
the impact of the more transmissible and more deadly
variants which later emerged, which would
undoubtedly have made the situation worse. Had we
not locked down, this modelling suggests it would
have been an unmitigated disaster. Indeed, in light
of the emerging situation in Italy in early March
2020,13 there is a strong argument to say that we
should have locked down sooner, saving tens of
thousands of lives.14
Here it seems appropriate to say that no one is in
favour of lockdowns. If public health practitioners
have advocated for lockdowns, it has been when the
covid situation has been allowed to get so out of hand
that there is no other solution to protect people’s
lives. But lockdowns are not public health policy. If
anything, they represent a failure of public health
policy.
It could be argued that the first lockdown in the UK
was unavoidable, although better preparedness may
have helped to mitigate against the worst impacts of
it.15 Given the warnings that were illustrated so
graphically by the first wave in 2020, it’s harder to
make the case that the second and third lockdowns
were truly unavoidable. We had time to implement
managed isolation and quarantine for incoming
travellers,16 locally driven contact tracing,17 effective
public health messaging,18 and to improve ventilation
in schools and workplaces, all of which would have
helped to blunt, if not avoid, the alpha wave we
experienced in the winter of 2020, perhaps without
the need for further lockdowns. We largely failed on
all these counts.
Ultimately, there will always be disagreement about
lockdowns. Whether you view them as necessary
depends on your value system. Many people would
place the lives of the most vulnerable high on their
list of priorities. Many people would value a
functioning NHS with equal access for all at the point
of need. Many would place a high worth on the long
the bmj | BMJ 2022;376:o776 | doi: 10.1136/bmj.o776 1
OPINION
Department for Mathematical Sciences,
University of Bath
Twitter: @Kit_yates_maths
Cite this as: BMJ 2022;376:o776
http://dx.doi.org/10.1136/bmj.o776
Published: 23 March 2022
BMJ: first published as 10.1136/bmj.o776 on 23 March 2022. Downloaded from http://www.bmj.com/ on 30 March 2022 by guest. Protected by copyright.
term health of their population. But not everyone. It is worth
remembering that since these values are not universally held, there
will always be small but vocal minorities who decry that first
lockdown two years ago as unnecessary, favouring instead a strategy
of “riding it out.” Faced with the counterfactual though—the
overwhelmed hospitals, the hundreds of thousands of people dead
in a few short months, the long term health burden—I suspect most
of those voices would have fallen quiet.
Competing interests: KY is a member of Independent SAGE.
Provenance and peer review: Not commissioned; not peer reviewed.
1 Prime Minister’s statement on coronavirus (COVID-19): 23 March 2020. Speech. GOV.UK. 23
March 2020. https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23-march-2020
2 Coronavirus (COVID-19) in the UK. Deaths. GOV.UK. https://coronavirus.data.gov.uk/details/deaths
3 Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 3 March
2022. Office for National Statistics. 3 March 2022. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/3march2022
4 Fetzer T, Rauh C. Pandemic Pressures and Public Health Care: Evidence from England. CAGE
working paper no. 607. January 2022. https://warwick.ac.uk/fac/soc/economics/research/centres/cage/manage/publications/wp607.2022.pdf

AssignmentTutorOnline

6 Orange R. Covid lockdowns weren’t needed, finds inquiry in the country that stayed open. The
Telegraph. 25 February 2022. https://www.telegraph.co.uk/world-news/2022/02/25/lockdownsnot-necessary-defensible-says-head-inquiry-swedens/
7 Elliott L. A year of Covid lockdowns has cost the UK economy £251bn, study says. The Guardian.
22 March 2021. https://www.theguardian.com/business/2021/mar/22/a-year-of-covid-lockdownshas-cost-the-uk-economy-251bn-study-says
8 Hasell J. Which countries have protected both health and the economy in the pandemic? Our
World in Data. 1 September 2020. https://ourworldindata.org/covid-health-economy
9 Quinn B. Covid-19 forcing schools in England ‘to juggle pupil and financial safety.’ The Guardian.
30 August 2020. https://www.theguardian.com/world/2020/aug/30/covid-19-forcing-schoolsin-england-to-juggle-pupil-and-financial-safety
10 Siddique H. Covid catch-up plan for England pupils ‘pitiful compared with other countries.’ The
Guardian. 2 June 2021. https://www.theguardian.com/education/2021/jun/02/union-criticisespitiful-covid-catch-up-plan-england-pupils
11 Jones G, Parodi E. Italian study shows ventilation can cut school COVID cases by 82%. Reuters.
22 March 2022. https://www.reuters.com/world/europe/italian-study-shows-ventilation-can-cutschool-covid-cases-by-82-2022-03-22/
12 Ferguson NM, Laydon D, Nedjati-Gilani G, et al. Report 9 – Impact of non-pharmaceutical
interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College
London.16 March 2020. https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-
19/report-9-impact-of-npis-on-covid-19/
13 Tondo L. Italian hospitals short of beds as coronavirus death toll jumps. The Guardian. 9 March
2020. https://www.theguardian.com/world/2020/mar/09/italian-hospitals-short-beds-coronavirusdeath-toll-jumps

15 Report EC. Tier One Command Post Exercise: Pandemic Influenza, 18 to 20 0ctober 2016. Public
Health England. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/927770/exercise-cygnus-report.pdf
16 Yates K. Covid Won’t Go Away Until We Take Control Of Our Borders. Huffington Post. 1 January
2021. https://www.huffingtonpost.co.uk/entry/border-control-uk-coronaviruscovid_uk_5ff6d8ddc5b6ef6b1583c504?8sr
17 Statement on the Management of NHS Test and Trace.The Independent Scientific Advisory Group
for Emergencies (SAGE). 30 0ctober 2020. https://www.independentsage.org/statement-onthe-management-of-nhs-test-and-trace/
18 UK government messaging and its association with public understanding and adherence to
COVID-19 mitigations: Five principles and recommendations for a COVID communication reset.
The Independent SAGE Report 22. The Independent Scientific Advisory Group for Emergencies
(SAGE). 13 November 2020. https://www.independentsage.org/uk-government-messaging-andits-association-with-public-understanding-and-adherence-to-covid-19-mitigations-five-principlesand-recommendations-for-a-covid-communication-reset/
2 the bmj | BMJ 2022;376:o776 | doi: 10.1136/bmj.o776
OPINION
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