Is a 5-Week Lockdown Necessary to Crush COVID-19?

John Whyte, MD, MPH; Yaneer Bar-Yam, PhD

Disclosures

December 10, 2020

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  • The coronavirus transmits when an infected person breathes it out and another person breathes it in. A 5- to 6-week lockdown would eradicate the virus much faster by drastically slowing down the rate of transmission.

  • New Zealand and Australia have shown that lockdowns are effective in reducing the number of COVID cases. When the virus pops up again in those countries, it's usually a small, localized outbreak that can be extinguished quickly.

  • If 80% of people committed to a lockdown, it could dramatically decrease the number of COVID cases. After about 5 weeks, communities that do it well could go back to normal.

  • The United States did not isolate people with COVID properly. Rather than isolating COVID-positive people in hotels with health care support, leaving them to reside at their homes has infected other household members.

  • We cannot solely rely on vaccination. Until the vast majority of the US population is vaccinated, approximately 2000 people will die each day over the next 6 months or more.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Welcome, everyone. You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD.

We're all tired of the coronavirus — tired of staying in and tired of wearing masks. Yet, cases are still rising, deaths are going up, and hospitalizations are at an all-time high. Some are suggesting that the way that we solve this is not just with vaccines, because that's going to take a while. We need a lockdown.

One of those proponents is Dr Yaneer Bar-Yam, who's an MIT-trained scientist and an expert in quantitative analysis of pandemics at the New England Complex Systems Institute in Cambridge, Massachusetts. Dr Bar-Yam, thanks for joining me.

Yaneer Bar-Yam, PhD: Thank you for having me.

Whyte: You mentioned that the way we can crush COVID is by treating it like a house fire : You've got to put the fire out all at once. In your analysis, that requires a lockdown. Tell me the rationale behind it.

Bar-Yam: It starts with just understanding the transmission. We all know this by now: The virus transmits when somebody breathes out and someone else breathes in. The point is that the virus dies if it doesn't transmit. So, we just have to stop it from transmitting. The way we do that is by making sure that we're not near other people. It's that simple.

Lockdown is the idea that we're going to "go all-out." The advantage of doing this is that the virus goes away very fast. It only takes about 4 to 6 weeks for even a very large outbreak to get down to very small numbers if we do it all-out.

Why would we want to continue to live with this for 3 to 6 months? We've been living with it for a long time already. If you're tired of it, the solution should be to get rid of it. If there isn't a way to do that, then, well, there isn't a way to do that. But, it turns out that there is. It's been shown to work in multiple countries, and the analysis shows it. The experience shows it. That's really what we want to do ─ we want to get rid of it.

Whyte: You mentioned that it's been shown in multiple countries. Let's take New Zealand as an example. They had a true lockdown, where one family member was designated to go out for essentials, and they really defined essential workers. They had no cases in over 100 days, but then they started to have a few outbreaks as well. So, it didn't completely eradicate the virus, is that right?

Bar-Yam: That's right, but it turns out that that's where the idea of the fire really shows up. Just because you can't get rid of all possible future fires doesn't mean you don't put out a fire. If there's a new fire, what you do is you attack it quickly. You get rid of it. Then it's only a small fire in a localized place for a short amount of time. That's the way you fight fires, because you don't want to live in a burning building. If a new fire shows up, you just get rid of it at that time.

Somehow, this idea was confusing to people. People said, "Why should we put out this huge fire if there's going to be another fire in the future?" But when you think about it in terms of fires, it makes it really clear that it's still the right thing to do to get rid of the fire.

Whyte: People say, "You know what? Lockdowns have been tried, and they haven't worked. Several countries have tried them." Is your argument that they haven't done them right?

Bar-Yam: This is one of the problems with the word "lockdown." Everyone thinks a lockdown is a lockdown is a lockdown.

Whyte: Give me a better word.

Bar-Yam: The word "lockdown" was not originally used to mean stay-at-home orders, social distancing, or masks. It was originally used to mean stopping transportation. You didn't want people to go from a place that had the disease to other places that didn't have it and transmit it from community to community and start more fires. You don't want to move it from place to place. You want to stop it where it is.

In order to do that, you create firebreaks. You prevent travel from one place to another, and there are various ways to do that. You can do it voluntarily, or with enforcement and fines ─ all kinds of ways.

One of the most important problems is that we didn't say, "We're going to do this, and we're going to get it right." And you have to know that if you do it right, the number of cases drops really rapidly. If you do it well, you can actually get the numbers down by 100-fold in just a month. The first thing that we need is for people to buy in. It doesn't have to be everybody. There are always crazies, and the press is often really good at focusing on the crazy.

Whyte: Let's be fair — it has to be most people, or it doesn't work.

Bar-Yam: It does have to be most people. In fact, it has to be around 80% of people in order to do it well. But the point is, you have to give people a reason to do it. The most important reason to do it is that after a month, after 5 or 6 weeks, you can go back to normal. That's super important.

The other thing, which really helps, is to set it up in the best way. We talked about the limitations on travel ─ this is the best way, because you set it up community by community. The communities that do it well, they go back to normal. The communities that don't do well, they take longer.

Whyte: Do we have to combine it with an incentive package? Because the argument could be that businesses can't survive for a 5-week lockdown right now. They just can't. Small businesses will not be around.

Bar-Yam: Here is the thing. It always becomes harder the longer you wait. If we had done 5 - 6 weeks half a year ago, how many businesses would have been in trouble? So, this is the point: It is harder now. You want to support people who are vulnerable, people with financial needs, all kinds of other things.

Whyte: You say we're limping along instead of being decisive. Is that a fair characterization?

Bar-Yam: That's right. Imagine you're fighting a fire and you say, "Okay, I got it down a little bit."

Whyte: I know, it's a great analogy.

Bar-Yam: Or you say, "Hey, it's all right. There's just this little fire left in the den. It'll be all right." And you walk away.

Whyte: So, why isn't there a will to do it? How do we get to that point?

Bar-Yam: The answer is people really have to understand, and part of that is the communication. There's just a lot of miscommunication.

Whyte: Do you feel there is a political appetite to do a lockdown? People say, that's a sledgehammer approach; we need a scalpel.

Bar-Yam: There is no scalpel. If there was some other way to do this that made everyone feel comfortable, and they're all okay with what you're doing, and so on, you think people wouldn't have found it already? Don't forget that this was also done in Australia. Australia is COVID-free, and it's a big country with lots of states. One state, Victoria, had an outbreak and they got rid of it. Other states were free of the disease during that time.

Whyte: Does testing play a role in this? Some people argue it's not lockdowns that we need to do, but we need to test people every few days for 2 weeks.

Bar-Yam: Here's the idea: When you're in a fight, you have legs and arms and hopefully a head on your shoulders. So, if you have an incredible left hook, you use your left hook. If we had massive testing that we could do every day, that would be the left hook. But we have all of these things. You don't want to tie your legs together. You want to use all the tools that you have, because this is a tough fight.

Another thing that we really have to focus on is that we didn't isolate people well. If you leave people in their homes, you infect a lot of family members and housemates. What some do is have people stay at hotels or dorms. In New York, they had the fanciest hotels set up as places for COVID-positive people to go to.

If you go to such a place, you get supported isolation, which means people are going to take care of you. In particular, if you have COVID, you want to make sure that if your case turns worse, you immediately get care.

Whyte: What if we gave financial incentives for people to go?

Bar-Yam: That's okay, but the point is making sure people understand that the huge incentive is that we get out of this.

Whyte: What about people who say, "Dr Bar-Yam, vaccination is around the corner. We don't need to do this lockdown."

Bar-Yam: You figure out how many people will die at 2000 deaths per day over 6 months. When we dial back to individual consequences and people say, "I don't care. I'm going to take the risk. I don't mind," one of the things they don't know about is long COVID, or long haulers. This is affecting young, healthy people and athletes of all ages. There's heart damage, brain damage, and lung damage. It also looks like there's damage to male fertility.

Whyte: You're really trying to reach people. You're grabbing at anything to encourage people.

Bar-Yam: The consequences of this disease are scary. If you're not paying attention, then you don't know it. My role in this context is not to say this or that, but to communicate about what are the consequences of people's actions. That's something that I take very seriously.

If people are going to trust you, it's because you tell them straight what is going on. The biggest challenge that we've had is that many of the people that we want to trust have not been telling us what is really happening. What is really happening is that we have a terrible disease that grows rapidly.

The most important third statement is that we can stop it. All we have to do is to make a decision that we care about getting back to normal and we care about the people we love.

Whyte: What about the fact that people say they care, but they just disagree with your strategy? They have a different philosophy.

Bar-Yam: Here's the thing. The strategy in terms of the consequences is obvious. It's been shown mathematically; that's my specialty. It's been shown in the real world by many different countries, small and large, rich and poor, island and mainland.

The main thing is it also doesn't have to be everybody. What's happened over and over again is that the polls have shown that a vast majority of people want more restrictions. This whole idea that there are massive numbers of people that don't want to do this, it's not supported by the information we have.

Whyte: You have given us a lot to think about. We certainly need to take another look at this concept of a multi-week lockdown and use every tool that we have, which are limited in terms of crushing COVID-19. Dr Yaneer Bar-Yam, I want to thank you for taking the time today.

Bar-Yam: Thank you.

Whyte: And I want to thank our viewers for watching. If you have more questions about lockdown, other questions about COVID, send them our way. Email questions to drjohn@webmd.net, or post them on Twitter at Dr John Whyte and WebMD, as well as Medscape. Thanks for watching.

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