A small but vocal movement calling for the end of lockdown restrictions is gaining steam globally. Dr Siouxsie Wiles explains why such an approach would be a bad idea.

As life in Aotearoa gets back to some kind of normal after our latest Covid-19 outbreak, cases in the northern hemisphere are on the rise again and that puts us all at risk. Because no one is safe until we are all safe.

This is a tricky virus. We now know that it spreads well through droplets and aerosols and that people are infectious before they realise they have symptoms. And while most people will only infect one or two others, in the right conditions, one case can result in tens, hundreds or even thousands of infections. These super-spreader events have happened indoors and outdoors, though especially indoors at weddings, funerals, church services, choirs, bars, and workplaces. Super-spreader events have even happened at the White House.

There’s now an abundance of evidence that this virus is more deadly than the flu, leaves many who survived it experiencing debilitating symptoms for months, and has the potential to cause serious long-term health problems. We’re now approaching 40 million confirmed cases and over a million deaths, and we know both of those numbers are an underestimate. We’ve gone from 100,000 cases a day worldwide back in April to approaching 400,000 a day just six months later.

Earlier in the year, many countries were forced to take drastic action to stop the spread of Covid-19 after finding their pandemic preparedness plans weren’t actually suitable for the pandemic we were experiencing. Here in New Zealand, we went into a country-wide “lockdown” in late March with the aim of eliminating the virus. Our alert level four restrictions backed by financial support from the government enabled the country to press pause on transmission while providing the space to ramp up capacity to test and contact trace.  New Zealand’s experience has just been published in The Lancet and shows how Covid-19 can be controlled using a range of measures, including border closures, managed isolation and quarantine for travellers, financially-supported “lockdowns”, rapid testing of people with symptoms, extensive contact tracing, and isolation of close contacts.   

When is a lockdown not a lockdown? 

Lockdowns have been getting a lot of bad press recently. And no wonder: they’re a blunt disruptive tool that have been wielded really badly in many places. That’s had a negative impact on people’s mental and physical health, as well as the economy. But the same is true for uncontrolled community transmission of Covid-19. The WHO has been very clear that lockdowns should be used sparingly. But one problem is the very definition of the word lockdown itself. If you take a look at the Covid-19 Government Response Stringency Index which compares restrictions in different countries, it becomes quite clear that one country’s idea of “lockdown” is another’s “only a little bit restricted”. 

New Zealand had one of the strictest lockdowns during which many people were financially supported with a government wage subsidy. The time that bought was then used to ramp up our testing and contact tracing systems. Other countries did something a lot less restrictive, with little or no financial support put in place for people and businesses to cope. And rather than getting their testing and contact tracing up to scratch, they just tinkered around the edges or gave vast sums of public money to private companies and management consultants who know nothing about public health and haven’t delivered anything fit for purpose. The heartbreaking reality is that those countries have experienced plenty of the pain of a lockdown but have squandered its benefits. And now, for those in the northern hemisphere, winter is coming and cases are surging. It was all so utterly predictable. 

Plan B and the Great Barrington Declaration

Enter the contrarians. In New Zealand, they take the form of Covid Plan B. Their premise is simple: the cost of “lockdowns” is too high so we should protect the vulnerable and learn to “live with the virus”. It’s an unethical, eugenicist, have-your-Swedish-cake-and-eat-it-too sort of model. It also entirely minimises the huge toll Sweden has already paid for what appears to be surprisingly little benefit. Plan B academics have been pushing their agenda since April. I’ve already written about how they cherry-pick their evidence and how unworkable their herd immunity plan to protect the vulnerable actually is. 

Now the movement has gone global with the release of the Great Barrington Declaration. It’s the same unethical, eugenicist crap only they call it “Focused Protection”. What the Great Barrington Declaration and Covid Plan B have in common are a small number of contrarian or fringe academics, some from very prestigious universities, backed by slick PR companies and libertarians in positions of power and influence. It’s a tried and tested formula taken right out of the anti-tobacco control and anti-climate change mitigation playbook that pushes the false idea that experts are divided on a particular issue. The Great Barrington Declaration does seem to have the support of the current occupants of the White House. It also has thousands of signatories, though they apparently include the likes of Dr Johnny Bananas.

In other words, don’t be fooled into thinking any of that means “Focused Protection” is the way to deal with Covid-19. 

The John Snow Memorandum   

Using uncontrolled infection to bring about herd immunity is a dangerous, unethical, and inhumane way to deal with the Covid-19 pandemic. Instead, the goal has to be controlling community spread of the virus. We have tools that work and plenty of examples of countries showing how to use those tools well, New Zealand being just one of them. There’s also Japan, Vietnam, Singapore, and Australia. It’s also clear that the more community transmission there is, the harder it will be to bring cases under control. But it’s not impossible. What’s needed is leadership, compassion, a clear plan, and clear communication. 

To counter the Covid contrarians, a group of international researchers with expertise spanning from infectious diseases, mathematical modelling, public health, and epidemiology, to sociology, psychology, psychiatry, and medicine, have created the John Snow Memorandum. Yes, winter is coming in the northern hemisphere, but it’s not named after that Jon Snow – it’s named after the physician considered one of the founders of epidemiology and anaesthesia. In 1854, London was experiencing an outbreak of cholera. Suspecting the bacterium responsible was spreading through contaminated water, Dr John Snow famously removed the handle of a water pump in Soho he thought was the culprit. He later used a dot map to show how the cholera cases clustered around the pump.

The signatories of the John Snow Memorandum firmly believe countries can bring the Covid-19 pandemic under control without going down the herd immunity-by-uncontrolled infection route. I am one of those signatories. If you are a scientist, medic, researcher, modeller, healthcare or public health professional and would like to support the memorandum, head to the website, enter your details, and hit the “Sign The Memo” button. Your signature will be checked and added to their website. 

We’re entering a new and alarming phase of the pandemic. What concerns me now is less the virus and more the disinformation campaign being waged against the public health responses we know work. Its everyone’s responsibility to help stop the spread of disinformation. 

Because no one is safe until we are all safe.