A Literature Review and Meta Analysis of the Effects of Lockdowns on COVID 19 Mortality

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1. Study (Author & title) 2. Measure 3. Description 4. Results 5. Comments Fuller et al. (2021); "Mitigation Policies <strong>and</strong> COVID-19–Associated Mortality — 37 European Countries, January 23– June 30, 2020" Gibson (2020); "Government m<strong>and</strong>ated lockdowns do not reduce Covid-19 deaths: implications for evaluating <strong>the</strong> stringent New Zeal<strong>and</strong> response" Goldstein et al. (2021); "Lockdown Fatigue: The Diminishing <strong>Effects</strong> <strong>of</strong> Quarantines on <strong>the</strong> Spread <strong>of</strong> COVID-19 " Guo et al. (2021); "Mitigation Interventions in <strong>the</strong> United States: An Exploratory Investigation <strong>of</strong> Determinants <strong>and</strong> Impacts" COVID- 19 mortality COVID- 19 mortality COVID- 19 mortality COVID- 19 mortality Uses COVID-19-deaths <strong>and</strong> OxCGRT stringency in 37 European countries to estimate <strong>the</strong> effect <strong>of</strong> lockdown on <strong>the</strong> number <strong>of</strong> COVID-19-deaths. Find a significant negative (fewer deaths) effect <strong>of</strong> stricter lockdowns after mortality threshold is reached (<strong>the</strong> threshold is a daily rate <strong>of</strong> 0.02 new COVID-19 deaths per 100,000 population (based on a 7-day moving average)) Uses data for every county in <strong>the</strong> United States from March through June 1, 2020, to estimate <strong>the</strong> effect <strong>of</strong> SIPO (called "lockdown") on COVID-19 mortality. Policy data are acquired from American Red Cross reporting on emergency regulations. His control variables include county population <strong>and</strong> density, <strong>the</strong> elder share, <strong>the</strong> share in nursing homes, nine o<strong>the</strong>r demographic <strong>and</strong> economic characteristics <strong>and</strong> a set <strong>of</strong> regional fixed effects. H<strong>and</strong>les causality problems using instrument variables (IV). Uses panel data from 152 countries with data from <strong>the</strong> onset <strong>of</strong> <strong>the</strong> p<strong>and</strong>emic until December 31, 2020. Finds that lockdowns tend to reduce <strong>the</strong> number <strong>of</strong> COVID-19 related deaths, but also that this benign impact declines over time: after four months <strong>of</strong> strict lockdown, NPIs have a significantly weaker contribution in terms <strong>of</strong> <strong>the</strong>ir effect in reducing COVID-19 related fatalities. Uses policy data from 1,470 executive orders from <strong>the</strong> state–government websites for all 50 states <strong>and</strong> Washington DC <strong>and</strong> COVID-19-deaths from Johns Hopkins University in a r<strong>and</strong>om-effect spatial error panel model to estimate <strong>the</strong> effect <strong>of</strong> nine NPIs (SIPO, streng<strong>the</strong>ned SIPO, public school closure, all school closure, large-ga<strong>the</strong>ring ban <strong>of</strong> more than 10 people, any ga<strong>the</strong>ring ban, restaurant/bar limit to dining out only, nonessential business closure, <strong>and</strong> m<strong>and</strong>atory self-quarantine <strong>of</strong> travelers) on COVID-19 deaths. might have reduced confirmed cases by 390,000 (170,000 to 680,000) <strong>and</strong> fatalities by 41,000 (27,000 to 59,000) within <strong>the</strong> first three weeks in localities that implemented stayat-home orders. For each 1-unit increase in OxCGRT stringency index, <strong>the</strong> cumulative mortality decreases by 0.55 deaths per 100,000. Find no statistically significant effect <strong>of</strong> SIPO. Stricter lockdowns reduce deaths for <strong>the</strong> first 60 days, whereafter <strong>the</strong> cumulative effect begins to decrease. If reintroduced after 120, <strong>the</strong> effect <strong>of</strong> lockdowns is smaller in <strong>the</strong> short run, but after 90 days <strong>the</strong> effect is almost <strong>the</strong> same as during first lockdown (only app. 10% lower). Two mitigation strategies (all school closure <strong>and</strong> m<strong>and</strong>atory self-quarantine <strong>of</strong> travelers) showed positive (more deaths) impact on COVID-19- deaths per 10,000. Six mitigation strategies (SIPO, public school closure, large ga<strong>the</strong>ring bans (>10), any ga<strong>the</strong>ring ban, restaurant/bar limit to dining out only, <strong>and</strong> nonessential business Gibson use <strong>the</strong> word "lockdown" as synonym for SIPO (writes "technically, governmentordered community quarantine") There is little documentation in <strong>the</strong> study (e.g. no tables with estimates). Only conclude on NPIs which reduce mortality. However, <strong>the</strong> conclusion is based on one-tailed tests, which means that all positive estimates (more deaths) are deemed insignificant. Thus, in <strong>the</strong>ir mortality-specification (Table 3, Proportion <strong>of</strong> Cumulative Deaths Over <strong>the</strong> Population), <strong>the</strong> estimate <strong>of</strong> all school closures (.204) <strong>and</strong> m<strong>and</strong>atory self-quarantine <strong>of</strong> travelers (0.363) is deemed insignificant based on schools CI [.029, .379] <strong>and</strong> quarantine CI [.193, .532]. We believe, <strong>the</strong>se results should be interpreted as a significant increase in mortality, <strong>and</strong> that <strong>the</strong>se results should have been part <strong>of</strong> <strong>the</strong>ir conclusion. 19
1. Study (Author & title) 2. Measure 3. Description 4. Results 5. Comments Hale et al. (2020); "Global assessment <strong>of</strong> <strong>the</strong> relationship between government response measures <strong>and</strong> COVID-19 deaths" Hunter et al. (2021); "Impact <strong>of</strong> nonpharmaceutical interventions against COVID-19 in Europe: A quasi-experimental nonequivalent group <strong>and</strong> time-series" Langel<strong>and</strong> et al. (2021); "The Effect <strong>of</strong> State Level COVID-19 Stay-at-Home Orders on Death Rates" Leffler et al. (2020); "Association <strong>of</strong> countrywide coronavirus mortality with demographics, testing, lockdowns, <strong>and</strong> public wearing <strong>of</strong> masks" Mccafferty <strong>and</strong> Ashley (2021); "Covid-19 Social Distancing Interventions by Statutory M<strong>and</strong>ate <strong>and</strong> Their Observational COVID- 19 mortality COVID- 19 mortality COVID- 19 mortality COVID- 19 mortality Uses <strong>the</strong> OxCGRT stringency <strong>and</strong> COVID- 19-deaths from <strong>the</strong> European Centre for Disease Prevention <strong>and</strong> Control for 170 countries. Estimates both cross-sectional models in which countries are <strong>the</strong> unit <strong>of</strong> analysis, as well as longitudinal models on time-series panel data with country-day as <strong>the</strong> unit <strong>of</strong> analysis (including models that use both time <strong>and</strong> country fixed effects). Uses death data from <strong>the</strong> European Centre for Disease Prevention <strong>and</strong> Control (ECDC) <strong>and</strong> NPI-data from <strong>the</strong> Institute <strong>of</strong> Health Metrics <strong>and</strong> Evaluation. Argues that <strong>the</strong>y use a quasi-experimental approach to identify <strong>the</strong> effect <strong>of</strong> NPIs because no analyzed intervention was imposed by all European countries <strong>and</strong> interventions were put in place at different points in <strong>the</strong> development <strong>of</strong> <strong>the</strong> epidemics. Estimates <strong>the</strong> effect <strong>of</strong> state-level lockdowns on COVID-19 deaths using multiple quasi-Poisson regressions with lockdown time length as <strong>the</strong> explanatory variable. Does not specify how lockdown is defined <strong>and</strong> what <strong>the</strong>ir data sources are. Use COVID-19 deaths from Worldometer <strong>and</strong> info about NPIs (mask/mask recommendations, international travel restrictions <strong>and</strong> lockdowns (defined as any closure <strong>of</strong> schools or workplaces, limits on public ga<strong>the</strong>rings or internal movement, or stay-at-home orders) from Hale et al. (2020) for 200 countries to estimate <strong>the</strong> effect <strong>of</strong> <strong>the</strong> duration <strong>of</strong> NPIs on <strong>the</strong> number <strong>of</strong> deaths. O<strong>the</strong>r Use data from 27 U.S. states <strong>and</strong> 12 European countries to analyze <strong>the</strong> effect <strong>of</strong> NPIs on peak morality rate using general linear mixed effects modelling. closure) did not show any impact (Table 3, "Proportion <strong>of</strong> Cumulative Deaths Over <strong>the</strong> Population). Finds that higher stringency in <strong>the</strong> past leads to a lower growth rate in <strong>the</strong> present, with each additional point <strong>of</strong> stringency corresponding to a 0.039%-point reduction in daily deaths growth rates six weeks later. Finds that mass ga<strong>the</strong>ring restrictions <strong>and</strong> initial business closures (businesses such as entertainment venues, bars <strong>and</strong> restaurants) reduces <strong>the</strong> number <strong>of</strong> deaths, whereas closing educational facilities <strong>and</strong> issuing SIPO increases <strong>the</strong> number <strong>of</strong> deaths. Finds no effect <strong>of</strong> closing non-essential services <strong>and</strong> m<strong>and</strong>ating/recommendi ng masks (Table 3) Finds no significant effect <strong>of</strong> SIPO on <strong>the</strong> number <strong>of</strong> deaths after 2-4, 4-6 <strong>and</strong> 6+ weeks. Finds that masking (mask recommendations) reduces mortality. For each week that masks were recommended <strong>the</strong> increase in per-capita mortality was 8.1% (compared to 55.7% increase when masks were not recommended). Finds no significant effect <strong>of</strong> <strong>the</strong> number <strong>of</strong> weeks with internal lockdowns <strong>and</strong> international travel restrictions (Table 2). Finds that no m<strong>and</strong>ate (school closures, prohibition on mass ga<strong>the</strong>rings, business closures, stay at home Finds an effect <strong>of</strong> closing educational facilities <strong>and</strong> non-essential services after 1-7 days before lockdown could possibly have an effect on <strong>the</strong> number <strong>of</strong> deaths. This may indicate that o<strong>the</strong>r factors are driving <strong>the</strong>ir results. They write that "6+ weeks <strong>of</strong> lockdown is <strong>the</strong> only setting where <strong>the</strong> odds <strong>of</strong> dying are statistically higher than in <strong>the</strong> no lockdown case.” However, all estimates are insignificant in Table C. Looks as if lockdown duration may cause a causality problem, because politicians may be less likely to ease restrictions when <strong>the</strong>re are many cases/deaths. Their "mask recommendation" category includes some countries, where masks were m<strong>and</strong>ated (see Supplemental Table A1) <strong>and</strong> may (partially) capture <strong>the</strong> effect <strong>of</strong> mask m<strong>and</strong>ates. Looks at duration which may cause a causality problem, because politicians may be less likely to ease restrictions when <strong>the</strong>re are many cases/deaths. 20
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Page 3 and 4: Abstract This systematic review <st
Page 5 and 6: suppression strategy based on a loc
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Page 11 and 12: approximately 500 fewer deaths <str
Page 13 and 14: 1st wave deaths pr. million 1st wav
Page 15 and 16: which alters the b
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Page 33 and 34: Weight (1/SE) Figure 5: Funnel plot
Page 35 and 36: meet all quality dimensions but fin
Page 37 and 38: espiratory pathogen, quarantine may
Page 39 and 40: Only business closure consistently
Page 41 and 42: 5 Concluding observations Public he
Page 43 and 44: Third, even if lockdowns are succes
Page 45 and 46: 6 Appendix A. The role of</
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Page 55 and 56: Berry, Christopher R., Anthony Fowl
Page 57 and 58: Frey, Carl Benedikt, Chinchih Chen,
Page 59 and 60: Kapoor, Mudit, and
Page 61 and 62: Robinson, Oliver. 2021. “COVID-19

A Literature Review and Meta Analysis of the Effects of Lockdowns on COVID 19 Mortality

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