Is there any successful control of Covid-19 without a lockdown?

When Covid-19 is spreading in a community, there seem to be 3 ways to break the chain of transmission

• Trace and isolate all those infected so that they do not come into contact those who are not sick

• Isolate every one irrespective of whether they are sick or not.  This is the lockdown strategy

• No need to isolate anyone.  Instead, ask everyone to keep a certain distance from each other and/or wear protective gear if you cannot keep the distance

The first method works if the number of infected is small.

But when the numbers of infected in the community are large, then many countries have resorted to the second method.

Some have even tried the third. 

 

I keep hearing stories about how Sweden tried the third approach and I want to know whether this can be a successful method generally.

To get a sense of whether it is possible, I looked at the countries which have not instituted any lockdown.

Actually, it was not as straight forward as I thought as there are different shades of lockdown. 

According to a VOX article citing Lindsay Wiley, a health law professor at the Washington College of Law "lockdown" isn't a technical term used by public-health officials.

It can refer to anything from mandatory geographic quarantines to non-mandatory recommendations to stay at home, closures of certain types of businesses, or bans on events and gatherings.

Secondly, there is still debate about whether a lockdown works. Wikipedia has the following conclusion:

• Several analyses have concluded that lockdowns did save lives in the aggregate, although admitting that data is insufficient to know how much of the reduction came from voluntary social distancing. 

• Other epidemiologists have asserted that generalized lockdowns were enacted without reliable supporting data. Empirical studies have questioned whether lockdowns actually saved lives since they did not target the most vulnerable and elderly populations yet risked new “deaths of despair” from unemployment and poverty.

To get have a more objective view of the success of controlling the virus without a lockdown, I looked at a number of indicators for those countries that have not had any lockdown based on Wikipedia listing.

  

There were 10 countries that were listed as not having any lockdown.  For these I looked at the following:

• Whether the number of daily cases is increasing or declining

• Where it is ranked in terms of the total number of cases 

• The number of cases per million population 

• The mortality per million population 

• The Malaysian GCI ranking

• The Oxford Stringency Index – a higher score meant more stringent measures were imposed.  So for those without any lockdown, I would expect a relatively lower score

If a country was successful in controlling the virus without any lockdown, I would expect

• A declining number of daily cases

• Low ranking in terms of the total number of cases

• A relatively lower number of cases and mortality per million population

• High GCI rank

• Low Stringency score

The table summarizes the results.  

I have added Brazil – although this was not in the Wikipedia list, I have come across a few news sites that have classified Brazil as one of the countries not having a lockdown.

I have also added Malaysia to serve as a “control”. 

I have classified the countries into 2 groups

• Those with a low or declining number of cases

• Those with an increasing number of cases

Countries  (a)	Covid Trend 16 Jul	Ranking (b)	No of cases per m pop	No of deaths per m pop	Oxford Index 6 Jul	GCI rank 16 Jul
Timor-Leste	Low	197	18	0	19	53
Taiwan	Low	158	19	0.3	19	6
South Korea	decline	65	265	6	57	5
Nicaragua	decline	102	475	15	11	68
Iceland	decline	116	5,599	29	0	11
Belarus	decline	29	6,945	51	11	71
Sweden	decline	27	7,572	552	41	175
Malaysia		77	270	4	51	7
Malawi	increase	108	137	2	57	136
Japan	increase	56	178	8	28	30
Brazil          (c)	increase	2	9,270	355	81	138
USA	Increase	1	10,929	423	69	130

Note

a) Source:  Wikipedia unless stated otherwise

b) Worldodomer at 16 Jul

c) Business Insider 8 Jul

Declining cases

I think it is fair to say that if the number of cases is declining, it must mean that the virus is under control.  Look at their Oxford Stringency Index score - except for South Korea, they are all lower than that for Malaysia.

I think there are 3 sub-groups here

• For Taiwan (with 454 total cases) and Timor-Leste (24 total cases), it does not make sense to lock down the country with such low cases.  If there was a lesson here, it is that a country should go all out (before the lockdown) to have the number of cases low.  

• The other sub-group is Nicaragua (3,147 total cases) and South Korea (13,672 total cases) showing that it is possible to bring it under control without a nationwide lockdown even if the total numbers a bit high.  Note that technically, Korea did “lockdown” the area where the virus first surged. 

• The final sub-group is Belarus, Iceland and Sweden. For these, the question becomes whether the “no lockdown” has come at a significant cost as measured in terms of the number of cases, mortality and economic performance. 

In my 11 July post, I have a comparison between Sweden and its 2 Scandinavian neighbors to show that Sweden did not have any economic advantage for bearing the high number of cases and mortality. 

The economic indicators for Belarus and Iceland relative to Sweden as per the table below suggest that they seem to have the same economic performance as Sweden meaning that they are not necessarily better off without the lockdown.  To be fair, Belarus' unemployment is much better than for Sweden. 

Economic indicators	Belarus (a)	Iceland (b)	Sweden
GDP growth in 2020	(6.0)	(7.2)	(6.8)
Unemployment rate %	2.3	8	10.1

Source: Nordeatrade.com from IMF

Note

a) As a small, open, commodity-exporting economy, Belarus is heavily exposed to the deep ongoing contractions in its main trading partners (Russia and the EU), the collapse of global oil prices and global financial volatility caused by the COVID-19 pandemic 

b) As a small and highly open economy with a sizeable concentration in tourism and commodity exports, Iceland is exposed to the economic shock with a severe recession, widening budget deficits, and a significant rise in government debt. 

Increasing cases

For the increasing cases, the jury is still out whether they can bring it under control without any lockdown in the coming future. 

• Brazil and the US already have high Oxford index scores.  So if they have lockdown it will mean higher scores in the future. But have you noticed that their Oxford index scores are higher than that for Malaysia?   More stringent measures but poorer results c/w Malaysia.  

• Japan with the low Oxford score meant that there are other measures it could still try before the lockdown

• Malawi got its 50th case around mid-May so it is currently in the second odd month of the virus with 2,700 odd total number of cases.  I don know enough about what is happening there but it does not look as if the virus is under control. 

For the US and Brazil, the number of cases in both countries is such that they cannot point to Taiwan, Timor-Leste, Nicaragua and South Korea as examples of controlling the virus without a lockdown.

The best is for them to point to Belarus, Iceland and Sweden (which has a 4 digit number of cases per million population) as their role model.  

But if Belarus, Iceland and Sweden are not likely to get any economic gain for the “no lockdown” why would the US and Brazil be different economically?

All I can say is that I am glad I am not in Brazil or the US – you suffer both the virus and a longer economic disruption.

Conclusion - Can you successfully control Covid-19 without a lockdown.  

• YES by nipping in the bud early

• Even if the country fails to nip it early, there is still hope provided it is not so widely spread as shown by South Korea

• But if it is widely spread, like Belarus, Iceland and Sweden, it is still possible to control the virus without a lockdown but I think you need disciplined citizens.  But while you can control it, the cost both in terms of cases and mortality as well as economic may not be attractive

But I think that if the cases have gone into really exponential growth ie very widely spread, I am not sure whether it can be controlled without a lockdown.  

So especially for the US and Brazil where there is no clear cut strategy of lockdown or self-control, I suspect the virus will just run wild.  

I am looking at the US and Brazil with interest as the only hope for them is the vaccine. OR there is a change in leadership.   

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PS: This blog is for me to better understand COVID 19 as this will impact my investments. If you are also into equities, follow me at i4value.asia.

Disclaimer:  I am not an epidemiologist, healthcare worker, pharmacist, or staff in the Ministry of Health, but rather is someone with a strong interest in numerical analysis.  The content is an attempt to understand what is happening in the battle against COVID 19 from a data-based perspective. The opinions expressed here are based on information extracted from readily available public sources but I do not warrant its completeness or accuracy and should not be relied on as such.