The purpose of this systematic review and meta-analysis is to determine the effect of lockdowns, also referred to as ‘Covid restrictions’, ‘social distancing measures’ etc., on COVID-19 mortality based on available empirical evidence. We define lockdowns as the imposition of at least one compulsory, non-pharmaceutical intervention (NPI). We employ a systematic search and screening procedure in which 19,646 studies are identified that could potentially address the purpose of our study. After three levels of screening, 32 studies qualified. Of those, estimates from 22 studies could be converted to standardised measures for inclusion in the metaanalysis.
But whatever the reason, mask mandates were a fool’s errand from the start. They may have created a false sense of safety — and thus permission to resume semi-normal life. They did almost nothing to advance safety itself. The Cochrane report ought to be the final nail in this particular coffin.
There’s a final lesson. The last justification for masks is that, even if they proved to be ineffective, they seemed like a relatively low-cost, intuitively effective way of doing something against the virus in the early days of the pandemic. But “do something” is not science, and it shouldn’t have been public policy. And the people who had the courage to say as much deserved to be listened to, not treated with contempt. They may not ever get the apology they deserve, but vindication ought to be enough.
Jefferson and his colleagues also looked at the evidence for social distancing, hand washing, and sanitising/sterilising surfaces — in total, 78 randomised trials with over 610,000 participants.
Jefferson doesn’t grant many interviews with journalists — he doesn’t trust the media. But since we worked together at Cochrane a few years ago, he decided to let his guard down with me.
Interestingly, 12 trials in the review, ten in the community and two among healthcare workers, found that wearing masks in the community probably makes little or no difference to influenza-like or Covid-19-like illness transmission. Equally, the review found that masks had no effect on laboratory-confirmed influenza or SARS-CoV-2 outcomes. Five other trials showed no difference between one type of mask over another.
There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory‐confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under‐investigated.
…It also brings the recommendations for unvaccinated people in line with people who are fully vaccinated – an acknowledgment of the high levels of population immunity in the U.S., due to vaccination, past COVID-19 infections or both. “Based on the latest … data, it’s around 95% of the population,” Massetti said, “And so it really makes the most sense to not differentiate,” since many people have some protection against severe disease.
To prevent medically significant COVID-19 illness and death, persons must understand their risk, take steps to protect themselves and others with vaccines, therapeutics, and nonpharmaceutical interventions when needed, receive testing and wear masks when exposed, receive testing if symptomatic, and isolate for ≥5 days if infected.
The present coronavirus crisis caused a major worldwide disruption which has not been experienced for decades. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside the studies questioning it. In this work, we performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics and risk-benefit analysis based on the connection of health and wealth. Our aim was to learn lessons and analyze ways to improve the management of similar events in the future. The comparative analysis of different countries showed that the assumption of lockdowns’ effectiveness cannot be supported by evidence—neither regarding the present COVID-19 pandemic, nor regarding the 1918–1920 Spanish Flu and other less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: by using the known connection between health and wealth, we estimate that lockdowns may claim 20 times more life years than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown for either COVID-19 or any future pandemic.
While our understanding of viral transmission mechanisms leads to the assumption that lockdowns may be an effective pandemic management tool, this assumption cannot be supported by the evidence-based analysis of the present COVID-19 pandemic, as well as of the 1918–1920 H1N1 influenza type-A pandemic (the Spanish Flu) and numerous less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: we estimate that, even if somewhat effective in preventing death caused by infection, lockdowns may claim 20 times more life than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown in the future.
Two years into the pandemic, the experts are now the last to acknowledge the accuracy of their earlier predictions. This raises the question of why they changed course and sacrificed their own credibility in the process. Miller confines himself to the data, and if there’s a limitation to his book, it’s that he does not offer any compelling explanation of why the expert class threw itself a policy it once regarded as worse than useless.
It is not difficult to see why mask mandates proved irresistible to politicians. Masks are the perfect form of hygiene theatre, conveying an intuitive sense of safety regardless of demonstrable efficacy at scale. They also offload responsibility for controlling the pandemic to ordinary people. The overcrowding of ICUs can be blamed on the bad behavior of “anti-maskers”, rather than on the allocation of resources by governments and hospital CEOs. When cases and deaths spike, it is the fault of the citizenry, not the leadership.
The scientific and medical establishment’s uncritical support of masks and other dubious policies is just the latest manifestation of its lack of independence from political imperatives. After several years of finding themselves at the receiving end of rhetorical assaults from rising Right-wing populists, the experts seized on the pandemic as an opportunity to reassert their own status and authority — and that of the liberal-technocratic politicians with whom they are largely aligned.
Results While model 1 found that lockdown was the most effective measure in the original 11 countries, model 2 showed that lockdown had little or no benefit as it was typically introduced at a point when the time-varying reproductive number was already very low. Model 3 found that the simple banning of public events was beneficial, while lockdown had no consistent impact. Based on Bayesian metrics, model 2 was better supported by the data than either model 1 or model 3 for both time horizons.
Conclusions Inferences on effects of NPIs are non-robust and highly sensitive to model specification. Claimed benefits of lockdown appear grossly exaggerated.
Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.
There is no evidence to support the wearing of surgical masks by healthcare workers for close patient encounters and staff meetings, according to new official guidance.
The guidance was issued by Health Service Executive clinical lead on infection control Prof Martin Cormican in response to moves towards routine wearing of face masks by a number of hospitals.
One Dublin hospital last week advised staff they should wear surgical masks for all patient encounters and meetings between staff where social distancing of at two metres cannot be maintained.
…While acknowledging many staff are fearful for their own health and the wearing of masks provides “a sense of security for many people” Prof Cormican said the recommendation to use three, or two, masks during a shift is “likely to be counterproductive”.