Better Safe than Sorry? The Lockdown Debate at The Cambridge Union

Darren Wong 11 May 2020
Image Credits: Wikimedia Commons

This House backs global governments’ lockdowns.

Political leaders around the world have declared war on the coronavirus, imposing increasingly strict restrictions on mobility — travel bans, social distancing and eventually, the closure of non-essential businesses — in a bid to suppress the spread of the coronavirus. By the end of March, one-third of the world’s population has been placed under lockdown, with varying levels of state enforcement. Amid signs of lockdown fatigue, should governments press on with their lockdown strategies? More fundamentally, were lockdowns appropriate and necessary from the outset?

For the first time in its 205 years of history, The Cambridge Union debuted its first online debate on Youtube, bringing together an ensemble of speakers to evaluate the oft value-laden justifications behind the lockdown strategy. Side proposition comprised a lineup of healthcare and medical experts — Dr John Edmunds, Professor in the Department of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine; Dr Christl Donnelly, Professor of Statistical Epidemiology at Imperial College London and a Fellow at St Peters, Oxford; Dr Karol Sikora, an oncologist and Dean of Medicine at the University of Buckingham; and Dr Paul Hunter, Professor in Medicine at the University of East Anglia.

Side opposition, on the other hand, comprised speakers from a more diverse background — Dr Anders Tegnell, State Epidemiologist of the Swedish Public Health Agency; Peter Hitchens, journalist for The Mail; Dr Leonid Eidelman, Chair of the Division of Anaesthesia and Intensive Care at Tel Aviv University; and Dr Mushfiq Mobarak, Professor in Economics at Yale University. Their different sets of experiences and knowledge set up a nice contrast from side proposition in considering the effectiveness and ethics of imposing a lockdown.

While both sides proposed extremely valid arguments, there was understandably, and unsurprisingly, no clear conclusion, with several speakers taking a more nuanced stance. The lockdown strategy can be examined from multiple perspectives, be it the medical, political, economic or social, and each foregrounds certain values and priorities. Coupled with the lack of concrete information about the epidemiology of the coronavirus, there is consensus that the more pertinent questions to consider should be: How do we get out of this? What should we do after the lockdown?

Below, I highlight several key questions discussed in the debate.

1. Do lockdowns actually help?

The reproduction number of the virus — the “magic number” — was frequently raised as a barometer of the effectiveness of government strategy in curbing the virus. “It started from 2.6 and dropped to less than 1 after social distancing and lockdown”, Dr Sikora argued that this “prevented a surge in healthcare demand.” An oncologist, he highlighted the need to consider the larger healthcare system. “Cancer patients have disappeared in April, there is no system for them to get diagnosed” and he warns that without a lockdown, there could have been more deaths from non-coronavirus causes due to an overburdened healthcare system.

Reminding viewers that “there are currently no drugs to effectively treat this disease nor a vaccine to prevent infection”, Dr Donnelly remarked that the difference between Covid-19 and the SARS pandemic is due to “transmission during the pre-symptomatic stage and by asymptomatic individuals.” Large-scale lockdowns are required to buy time for governments to “determine which elements of normal life could be reinstated while keeping transmission rates low and know who will be mildly affected and who will struggle with [the virus].” While China has set an important precedent in containment, a non-pharmaceutical intervention, the dual-pronged approach of case isolation and contact tracing had not prevented sustained transmission. Dr Edmunds harshly pointed out that “other methods in February and March failed frankly”, which necessitated “radical measures”.

2. Are lockdowns appropriate for every country?

Professor Mobarak emphasised the term “global”, asserting that lockdowns should not be pursued with similar stringency like high-income countries due to their different demographics and healthcare capacities. Not only do low-income countries have a smaller elderly population to protect from the virus, the economic cost of imposing a lockdown is also significantly higher due to the larger proportion of manual labour. “It does not matter whether you are ill early or late, you still will not have access to healthcare.” Instead, he suggests that social transfers are more important — putting cash into the hands of families — thereby decentralising some responsibility to families by giving them the power to decide how to protect themselves from the virus. Nonetheless, certain restrictions should continue to be adopted, including bans on social gatherings of certain sizes.

3. Are the costs worth it?

How should we conduct cost-benefit analyses of government lockdowns? Which approach should be adopted — a utilitarian one of saving the most lives, or a libertarian one of respecting individual rights and liberties?

Dr Leonid questioned the costs we “should be ready to pay for lockdowns”. “The economic consequences are obvious: 8 weeks of confinement to stop the spread of coronavirus in France will cause 120 billion euros in lost revenue”, and he pointed out the sobering reality that the economic crisis will result in austerity in healthcare, which could be worse in the long run. Peter Hitchens agreed, citing that 2.4 billion pounds are lost each day. “All the money saved by austerity has been lost. The lowering of wages, the crashing of small businesses… This has erased years of effort. Is the lockdown a wise and proportionate response?” A softer approach of locking down harder hit areas might thus be more cost-efficient than an escalating lockdown.

“We are citizens of a free society. We are entitled to a great deal, which we are not getting.” Noting that “social distancing is unnatural for human beings”, there may be other psychological and physical conditions that surface as a result of an extended lockdown. Bringing to mind the issues of lockdown fatigue and scepticism towards state policies, Professor Mubarak also warned that the public may not adhere to restrictions “if [the government] sets up systems that are too stringent”. Policies implemented have to be both feasible and sensible.

Dr Tegnell shared his opinion on Sweden, a prime example of a country that has bucked the trend of adopting a lockdown strategy. Stressing the “need to find a way to live with the coronavirus” as unlike SARS, he maintained that there is “trust between the public and state agencies”. While some “binding regulations” have been put in place, such as online teaching, reductions in travel and a ban on mass gatherings of more than 50 people, Sweden is not considering a change in tack. “The alternative [to the lockdown] is not to stop transmission, but to ensure the healthcare system can cope.” Dr Tegnell said that at least 20% of intensive care units in Sweden are still empty and the peak of infection would be over soon.  However, the country has recorded deaths many times higher than its Nordic neighbours.

4. Better safe than sorry? Moving on?

“Are we in fact safer because of the lockdown?” Hitchens mentioned “highly dubious figures about projected deaths” and the lack of an “obvious exit from this after engaging the enthusiasm and sympathy of the British public”. He also criticised the lack of transparency and open debate before implementing the lockdown in the UK, with no “organs of civil society providing the brakes to foolish actions.” I believe Hitchens is right in calling for a degree of scepticism, albeit not to denounce the efforts of the governments, but to properly examine the role and impacts of a lockdown, such that if and when pandemics happen again, governments are not forced into the burdensome and difficult decisions made for the current one.

Dr Hunter emphasised “the need to work more closely with European colleagues to see how they have been relaxing measures and their impact on the trajectory of the disease. Whether or not ultimately it proves to be an appropriate intervention, we may never be able to fully answer because we cannot with absolute certainty know what would have happened had we not done anything.” For instance, Germany has begun relaxing restrictions, reopening certain commercial spaces, to the disagreement of scientists who fear this may send the wrong message that a return to normal life is in sight.

Indeed, as Hitchens put into perspective, “we all have good motives, and [the goal is] to reduce the number of deaths and losses and pain in society only.” The debate proved that it is difficult to weigh the pros and cons of the lockdown strategy, given their far-reaching and hard-hitting impacts that we have yet to fully decipher. Years from now, perhaps hindsight might reveal that the global lockdown was unnecessary after all, but this would just be a lesson in history.