Coronavirus: could China’s lockdowns to contain Covid-19 be the best choice for every country?

China’s unprecedented and, at the time, controversial decision to lockdown the city of Wuhan at the end of January was quickly rolled out across the country, turning cites into ghost towns as businesses not deemed essential to daily life were closed.

The mandatory closures of restaurants, pubs, bookstores, hairdressers, and nail shops across a city at short notice proved successful in curbing the spread of the coronavirus, and last week, the lockdown was removed, with many other cities across China also returning to normal.

But the debate over whether such draconian emergency measures to contain the virus are necessary, or even desirable, in other countries is far from over.

China is citing its mass closures as a key part of its success in bringing the coronavirus under control, and further evidence of the strength of an authoritarian system in handling a crisis.

President Xi Jinping said in a visit to Hangzhou earlier this month that the rapid implementation of such strong measures is a sign of Beijing’s “governance capability” in being able to tighten or relax control over the nation’s social life.

But while China’s one-size-fits-all closure policy has a valid scientific point in reducing social contact, and therefore the spread of the disease, it could also lead to huge social and economic costs, analysts have warned.

On the other hand, not acting rapidly to preserve social freedoms and support the economy, as has happened in the United States and most European countries, can lead to greater infection and more fatalities.

The academic research – some still preliminary – published so far is still exploring the impact of the trade-offs from various forms of interventions.

A report by 15 scholars from around the world published by Science Magazine at the end of March reviewed China’s measures to contain the virus in the first 50 days after the first cases of a mysterious pneumonia were reported on December 31.

They found that there would have been 744,000 confirmed cases outside Wuhan by February 19 if the travel ban or other aggressive interventions, including the suspension of public transport between cities and bans on public gatherings, had not been enacted – 25 times the official count of 29,839.

In two other scenarios, the scholars found that the number of confirmed cases outside Wuhan would have fallen to 202,000 with the Wuhan travel ban alone, or 199,000 if the government had only installed national emergency responses but did not ban travel in and out of Wuhan.

“Neither of these interventions would, on their own, have reversed the rise in incidence by February 19. But together and interactively, these control measures offer an explanation of why the rise in incidences was halted and reversed,” the scholars wrote, adding that it is not yet clear which parts of the interventions were the most effective.

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But the social and economic costs of China’s strict measures have been high. Even in the first week of the nationwide lockdown, which coincided with the Lunar New Year holiday, the revenue losses for the catering and accommodation industries alone were already running into the trillions of yuan.

The mandatory closure of businesses – cinemas across China are still prohibited from opening their doors – is threatening to kill off millions of small Chinese shops and merchants that have no resources to fall back on, sowing the seeds for large-scale unemployment and even the possibility of social unrest.

Some economists have put a US dollar value on social distancing measures, at least for the US. A research paper from the University of Chicago estimated that if the US implemented a mandatory social distancing requirement nationwide over three to four months – meaning seven-day isolation for anyone showing coronavirus symptoms, a 14-day voluntary quarantine for their entire household and reduced social contact for those over 70 – that it could save 1.76 million lives but cost around US$8 trillion.

The figure, which equates to around US$60,000 per household, would equal roughly a third of the US gross domestic product and be bigger than the US federal government’s annual budget.

“Whether in regular times or during a pandemic, it is difficult to think of any intervention with such large potential benefits to American citizens,” wrote Michael Greenstone and Vishan Nigam in their report.

“While we measure benefits of distancing in dollars, they reflect the high value Americans place on small reductions in their chance of death – including consumption, leisure, time with family, and other aspects of life not easily monetised.”

Steps to contain the outbreak have varied across the US, which now has the largest number of confirmed cases and the most deaths from the pandemic.

Most states have imposed some form of lockdowns on business and travel, such as shutting down beaches and parks and restricting bars and restaurants to takeaway service only. The few states reporting a high number of confirmed, like New York, have taken more aggressive approaches to restricting social interactions.

A few exceptions like Nebraska, Iowa and Arkansas, have implemented only mild restrictions and have allowed public venues such as parks to remain open.

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One of the more controversial decisions has been to close schools to curb the spread of the virus. Some 23 states and three US territories have ordered or recommended school closures for the rest of the academic year, potentially affecting at least 124,000 public and private schools and 55.1 million students, according Education Week, an US education publication.

But two US scholars argued in an article published by The Lancet medical journal earlier this month that the benefit from closing schools could be more than offset by the need for those working on the front lines to at stay home to care for their children because of lack of affordable child care.

“Many health care workers must reduce time spent providing patient care, running diagnostic tests, and tracing contacts, and increase time caring for their own children,” said Jude Bayham from Colorado State University and Eli Fenichel from Yale University in the article.

“This trade-off should not be ignored because the capacity to care for infected individuals and trace contacts directly influences the development of an epidemic, the survival of infected patients, and ultimately cumulative mortality from the pathogen.”

They found that this trade-off was particularly an issue in the US, where 29 per cent of households with a health care worker have at least one child aged between three and 12. The burden is also high among households that have a nurse or a medical assistant who works in a nursing home.

Their research suggested that the per infection mortality rate could increase above 2.35 per cent if more than 15 per cent of the health care workforce were no longer able to work normal hours, meaning school closures would lead to a greater number of deaths than they would prevent.

In addition, given the higher mortality rate among the elderly, there are risks that school closures would increase contact at home between children and their grandparents. This is particularly alarming in Britain as around 40 per cent of grandparents provide regular child care for their grandchildren, according to scholars led by Russell Viner from University College London.

They referred to Taiwan as an example that did not introduce a blanket school ban, but has so far has done well in containing the spread of the virus.

“Currently, the evidence to support national closure of schools to combat Covid-19 is very weak and data from influenza outbreaks suggest school closures may have relatively small effects on a virus with Covid-19’s high transmissibility and apparent low impact upon schoolchildren. Yet these same data shows that school closures can have profound economic and social consequences,” Viner wrote.

“These findings is a dilemma for policymakers seeking measures to protect populations. Decisions about closures involve a series of trade-offs between conflicting factors, and a substantial loss of health care staff to child care duties during closures may substantially reduce any benefit to health systems and populations brought by closures of schools.”

But what is even more difficult to measure is the chance of the virus making a comeback once aggressive interventions like those implemented by China are loosened to help increase economic activities.

In a study published by The Lancet in late March, Kiesha Prem from the London School of Hygiene & Tropical Medicine and his team suggested that restrictions on activities in Wuhan could help delay the peak if they are maintained until April, but that a sudden removal could lead to an earlier secondary wave of the virus.