When the virus first appeared to get out of control in China, the Chinese govt lockdown Wuhan and managed to get it under control.
That track record seemed to overshadow other approaches so that when Italy got into trouble with the virus, it also chose the lockdown option.
Today, we know more about the virus and we also have seen other successful measures that do not involve a lockdown eg social distancing and wearing masks as in Taiwan
No less an authority than Dr. Fauci himself has opined that the US could bring the virus under control with social distancing and wearing masks. Refer to my 30 Jul post about what Dr. Fauci said as well as the Lancet article.
So which is better - lockdown or social distancing with masks?
- Social distancing aims to break the transmission of the pandemic by restricting or closing all public places like cafes and malls.
- Lockdowns are a more stringent strategy entailing the complete stoppage of any sort of public movement except essential services.
I think that this is a very important question as many countries are experiencing a surge and are looking at ways to control them.
- President Rodrigo Duterte on Friday extended restrictions in Manila until mid-August because of the continued high number of coronavirus cases.
- Non-essential businesses such as bars and nightclubs in Hanoi and Ho Chi Minh City have also been closed since July 30 and July 31 respectively until further notice. Gatherings of more than 30 people have also been banned.
- Italy's upper house of parliament has approved a request by Prime Minister Giuseppe Conte to extend a state of emergency until October 15.
Scandinavia
In my 11 July post, I have provided one such analysis when I compared the performance of Sweden with those of its neighbours ie Denmark and Norway
- Sweden did not impose any lockdown
- Denmark and Norway lockdown the country for some time
The conclusion was that Sweden had the worst Covid-19 performance (in terms of the number of cases and mortality) and its economy and unemployment rate was not better than those of its neighbors.
If that was the answer, why are we looking at the question again?
The difference is that what these Scandinavian countries went through was the first wave of Covid-19.
Many countries around the world are now experiencing a resurgence and/or a second wave.
Given that many had already implemented a lockdown initially, should they now look at the social distancing and masks option?
Malaysia
When we went into the MCO in Mac, the rationale was that the virus was widespread and we needed a drastic measure to break the chain of transmission.
Indirectly the message was that
- The number of cases was too large for our contact tracing capability
- We were experiencing exponential growth ie the number of cases was increasing faster than our ability to isolate those infected
Unfortunately at the juncture somehow the govt had no confidence that social distancing with masks would work so we went for the MCO.
The virus is still with us and there have been some noises about another MCO.
So should Malaysia get hit with another wave, should we adopt the social distancing and masks approach rather than another MCO?
The answer should be a yes if there is evidence that it can be more effective than a lockdown - both from the virus control perspective as well as economically.
Unfortunately, Sweden's example has not been positive and Dr. Fauci's position has yet to be proven on a country basis.
We can ignore the results of Taiwan as the number of cases was so low. Taiwan is a case study of how social distancing and masks can prevent exponential growth.
Taiwan is not a very useful reference when a country has a high virus count and or is facing an exponential type of resurgence.
Academic Studies
There have been several academic studies that tried to determine which is better - lockdown or social distancing with masks.
1) A 12 June 2020 VOX article “The cost of staying open: Voluntary social distancing and lockdowns in the US” seems to suggest that a lockdown is better.
“…the lockdowns in the US are in fact efficient in minimizing the costs of the epidemic, once both the economic and medical burden that would arise in the absence of such policies are considered. Estimates from a controlled SIR model, which includes the possibility for changes in behavior, suggest that lockdowns reduce the costs of the pandemic by at least 1.7% of annual GDP compared to a no-lockdown scenario”
2) The April article in the Electronic Journal of General Medicine “The Science of Social Distancing and Total Lock Down: Does it Work? Whom does it Benefit?” concluded that both benefits the country.
“..We expound on these questions and conclude that social distancing and lockdown benefit the local and international community alike.”
3) A 9 June VOX article in Jun 2020 “2 new studies show shutdowns were astonishingly effective” favored lockdown.
“…Lockdowns, stay-at-home orders, closed schools, and canceled public events prevented millions of Covid-19 coronavirus cases and deaths, according to two new peer-reviewed studies in the journal Nature.”
4) A Mac 23 epidemic simulation study published in Lancet "Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study" concluded that a combination of physical distancing measures including quarantine, shutting down schools and workplace distancing is most effective in controlling the coronavirus pandemic.
However, this was not exactly a study to compare a lockdown vs social distancing. And I would like to remind the readers that when the rubber hits the road, Singapore actually had a lockdown.
What is the moral of the story? Academic research alone is not sufficient.
Real-life experiment
Is lockdown or social distancing with masks more effective?
There is no need to theorize as we actually have real-life “experiments” of both approaches going on
- Victoria (of Australia) has gone into lockdown to control the virus
- At the same time, the US is trying to avoid a lockdown. Instead, it is resorting to social distancing and wearing of masks
I think both these countries can provide a good perspective on how effective each measure is.
How can we assess the effectiveness of the approaches? If we ignore the economic issues and focus on the virus impact, we could adopt the following metrics.
- One is to look at the time taken to bring it down to 10% of the peak.
- We could also look at the number of cases and mortality between the peak and the 10% level.
In order to compare apple to apple, we should compare Australia with about 18,000 cases currently with those states in the US with a similar number of cases as well as daily Covid-19 pattern.
The chart below shows the current Australian pattern.
 |
| Source: Worldodometer |
In this context, we are in luck because Worldodometer actually tracks the number of Covid-19 by states for the US.
So I looked for similar patterns for those states with 15,000 to 30,000 total cases. I actually found 5 states in the US with the following pattern
- Kentucky
- Kansas
- Idaho
- New Mexico
- Oregon
 |
| Source: Worldodmeter |
 |
| Source: Worldodometer |
 |
| Source: Worldodometer |
 |
| Source: Worldodometer |
 |
| Source: Worldodometer |
The current Covid-19 status for the countries/states are as per the table below. You can see that in terms of no of cases per million population or mortality rates, Australia has much fewer cases by a factor of about 10.
I am now going to monitor the performance of these regions over the course of the next month or so to see how long it would take these places to get the virus down to 10 % of the moving average peak.
|
Countries/States |
Current
cases per m population |
Current
deaths per m population |
No of
daily cases based on 7 day MA at peak |
Peak
date based on 7 days MA |
|
Australia |
734 |
9 |
503 (a) |
2 Aug |
|
Kentucky |
7,052 |
167 |
655 |
25 Jul |
|
Kansas |
9,993 |
125 |
485 |
17 Jul |
|
Idaho |
12,129 |
115 |
587 |
21 Jul |
|
New
Mexico |
10,077 |
312 |
330 |
29 Jul |
|
Oregon |
4,592 |
78 |
388 |
1 Aug |
|
Control
|
||||
|
Belarus (b) |
7,412 |
60 |
954 |
17 May |
|
Sweden (b) |
8,017 |
568 |
1129 |
19 Jun |
Note
a) May not be the peak
b) I found that there were 2 countries that did not institute any lockdown and where the number of cases (while still declining) has not reached 10%. They are Belarus and Sweden. I am using these as control
In addition to comparing Australia and these 5 US states, I also wanted some other reference points. In this context
- This is not the first time that I tried to compare the difference between a lockdown and other measures. In my post of 18 July, I have identified a number of countries without any lockdown and where the number of cases has been declining. I have selected Belarus and Sweden from them to be the control group for this Australia vs the US real-life experiment.
- In my 14 July post, I have looked at the time to bring the virus under control. The general conclusion was that took an average of 82 days. It ranged from 61 days for China to 117 days for Italy. So I would say that on average expect at least a 3-months period.
So let's wait and see what the results will be.
A growing number of countries with the second wave
In Mac when I first started to analyses what was happening in the context of Covid-19, I had thought that it was a short-lived thing as the virus would be brought under control soon.
I guess this was influenced very much by what had happened in China, Taiwan, and Hong Kong.
Today, we have learned that it is not so simple to control the virus. Partly this has to do with politics as well as the different behavior of the people around the world.
So Covid-19 is not going to go away. It will continue to dominate news headlines for many more months to come as cases are spreading.
- There are currently countries which have yet to flatten the curve
- There are currently those who have got some control initially only to see another wave
In my 21st July post, I identified 25 countries among the world's top 100 (in terms of the total number of cases) which had experienced a second wave.
How is the world doing today?
I identified 33 countries with a second wave pattern (based on visual observation of the number of daily cases in each country as per John Hopkins Coronavirus Tracking)
The additional countries that came onto the list are:
- Belgium
- Bosnia and Herzegovina
- Madagascar
- Nepal
- Netherlands
- Peru
- Poland
- West Bank and Gaza
But there is some good news as some countries which looked as if a second wave was forming the last time, manage to control it. For some, it plateaued while others declined. These were
- Kuwait
- Portugal
- Turkey
- UAE
So while waiting for the vaccine, the world has to grapple with having a lockdown or more stringent social distancing and mask measures.
Let's hope my Australia vs the US states analysis can provide some practical pointers.
I think that for Malaysia if social distancing and masks can be as effective as a lockdown, this is a better option as it can help to avoid the economic impact that comes with a lockdown.
I would argue that our export environment is challenging whether we have another lockdown or not.
But a lockdown would affect the domestic economy and make a difficult situation even worse. So economically, it would be better to have social distancing and masks so that the domestic economy can continue to contribute.
Appendix - list of top 100 with 2nd wave
1. Algeria - No 57
2. Australia - No 69
3. Belgium - No 36
4. Bosnia and Herzegovina - No 77
5. Bulgaria - No 78
6. Canada - No 22
7. Cote d'Ivoire
8. Croatia - No 97
9. Czechia - No 72
10. Djibouti - No 98
11. Iran - No 10
12. Israel - No 33
13. Japan - No 54
14. Luxembourg - No 92
15. Madagascar - No 80
16. Morocco - No 62
17. Nepal - No 65
18. The Netherlands - No 41
19. North Macedonia - No 81
20. Panama - No 39
21. Peru - No 7
22. Poland - No 46
23. Paraguay - No 195
24. Philippines – No 25
25. Romania - No 42
26. Saudi Arabia - No 14
27. Serbia - No 58
28. Singapore - No 43
29. Spain - No 9
30. Switzerland - No 55
31. Ukraine – No 34
32. USA - No 1
33. West Bank and Gaza
Note: The "No" refers to the ranking as per Worldodometer in terms of the total number of Covid-19 cases.
Change of schedule and direction
For those who have been following my blog regularly, I wish to announce that I will now publish once a week - every Wed from this post onwards.
Each post will be more in-depth and longer as exemplified by this post
More importantly, instead of just focussing on Covid-19, I am going to cover "quality of life" issues affected the general public. Currently, it is Covid-19 but later it could be some other national crisis.
But I will leave out politics.
The goal is to make sense of the various public announcements based on some data-driven analysis.
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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.
