Lockdown is a public-health strategy that many countries have used to prevent the spread of Covid-19. Some governments imposed national or regional lockdowns. Others restricted movement at night, weekends or alternating weeks.
With the pandemic well into its second wave, and some countries like Australia already imposing lockdowns on certain cities or regions, nations are debating the wisdom of lockdowns. Policymakers must decide which is worse: the rapid spread of disease or the emotional and economic fallout of quarantining everyone but essential workers.
It’s a complex question, and the Israeli experts we talked to do not agree on an answer. Here’s what they told ISRAEL21c.
Dr. Hagai Levine: No lockdown
Epidemiologist Dr. Hagai Levine is chairman of the Israeli Association of Public Health Physicians and is on the faculty of the Hebrew University School of Public Health.
“A lockdown is an extreme measure. This should be saved as a last resort for very unusual situations of very contagious and deadly diseases. This is not the situation with Covid,” Levine tells ISRAEL21c.
In April, Levine and two Hebrew University finance and banking experts issued a report, “Managing the Covid-19 Pandemic without Destructing the Economy,” claiming that prolonged quarantining is a “medieval” approach and not necessary for controlling Covid-19.
“At the beginning, we didn’t know enough about how the [SARS-CoV-2] virus spread and even then, public-health professionals thought the response should be more proportional to the specific risk,” says Levine.
“Now we know much more about the virus. The risk of transmission in open air is very low. It therefore does not make any sense, from an efficiency or a public-health point of view, to force people to stay at home,” he continues.
“What we need to do is proportional measures to reduce transmission so we will get slowly to a reduction of the disease.”
The measures he advocates are things people have been asked to do throughout the pandemic: mask-wearing, handwashing and social distancing. He says that without those, even an extreme lockdown won’t help because people still go out for food, medicine and short walks.
But as we all know, many people ignore these directives.
“Behavior is not changed only by restrictions but also by engaging people and getting them involved in preventing transmission,” Levine says.
“You don’t tell people, ‘You are bad for not following instructions.’ You show them that you are working for the same goal. You explain that gathering in closed spaces is risky and in open spaces much less risky. You give solutions for people to be educated in how they socialize, work and consume entertainment.
“We need to get people to understand how important it is to avoid any unnecessary contact. If we don’t have this internal motivation, nothing will work,” concludes Levine.
Yaneer Bar-Yam: Lockdown will put the fire out
Yaneer Bar-Yam has a doctorate in physics from MIT and heads the New England Complex Systems Institute, an independent research and educational institution in Massachusetts.
For the past 15 years, he has used mathematical tools to help governments and organizations tackle problems including pandemics such as Ebola. Bar-Yam long ago warned that the rise in international travel would trigger pandemics.
In February, he launched EndCoronavirus, an international coalition that develops and promotes community-based solutions for policymakers, businesses and individuals.
Bar-Yam notes that Israel initially responded to the Covid-19 outbreak strongly by closing its borders and ordering a lockdown. But relaxing these measures when new cases fell to 20 per day led to a second spike.
“If you fought a fire in your house and got it down to a small fire and then walked away, the fire will grow again,” is how he puts it.
“This is not a natural disease that circulates in the population. It is driven by a simple dynamic. It grows exponentially in a normally behaving population until the population takes clear actions such as social distancing from people who might be sick and isolating people who are sick as determined by symptoms or testing.”
Bar-Yam sees three options: “Either you relax restrictions and infections will continue to grow; keep the current situation [of limiting gatherings and mandating mask-wearing], where you’ll have a constant but high number of nearly 2,000 new cases per day; or choose stronger actions and the number of cases per day will decline.”
Decision-makers must consider how long each method will take to stop transmission, he says.
“The shortest amount of time requires the strongest action. Within four to six weeks, anyplace in the world can be at zero transmission. It will take longer the more lax you are.”
Bar-Yam says he understands that people want to get back to normal, but he cannot understand resistance to lockdowns.
“The way to do all the things everyone wants to do, and the way to save lives, prevent disease and make the economy recover, all result from getting transmission to zero,” he says.
“Some countries have gotten to zero and others to near zero. There’s a real difference. Only when you get to zero does normal become possible. It’s a very straightforward mathematical fact,” Bar-Yam says.
“You still may have to put out an occasional fire after you get to zero, but you can manage those outbreaks and a normal economy can still thrive. If we keep going through partial lockdowns, it won’t help.”
Bar-Yam is a proponent of zoned lockdowns in problem areas for two disease cycles – four to six weeks in total. “This ‘red zone/green zone’ strategy can eradicate transmission if it is implemented with intention and kept going long enough to be effective.”
Dov Shvarts: Partial lockdown
Ben-Gurion University Prof. Dov Shvarts, former chief scientist and current adviser for the Israel Atomic Energy Commission, advocates nighttime curfews, weekend lockdowns and voluntary quarantine for people over age 67 and other at-risk groups.
The partial lockdown plan Shvarts has been promoting would last three to four weeks and would allow people to go to work and school.
“Every weekend, from Friday morning to Sunday morning, there would be a complete closure. In addition, every evening there would be a lockdown after 8pm and all places of entertainment and leisure would be closed,” he said.
That includes gyms, pools, restaurants and theaters, as well as houses of worship. Only essential businesses and medical establishments would be permitted to stay open.
Everyone in high-risk groups, including the elderly, would be asked – not forced – to observe a full lockdown for those three to four weeks according to Shvarts’s plan.
If Israel’s chief spiritual leaders, prime minister and president, all over age 70, would announce that they are the first to self-isolate, he says, “at least 50 percent of the older population will voluntarily obey restrictions.”
Shvarts says that without a lockdown, Israel will not emerge from the second wave.
“Lockdown is the right mathematical option. It has been proven an effective method to minimize the number of people contracting the virus and patients in serious condition.”
Baruch Barzel: Alternating lockdown
The population would be split into two groups – red and blue – and each group would alternate between a week of lockdown and a week of regular activity.
“It takes about a week, on average, to get to the peak infectious stage and that is when you must be isolated. If you work a week and stay home for a week, the average person will be home at peak infection time. This model synchronizes with the disease cycle and makes the experience much easier,” Barzel tells ISRAEL21c.
“A general quarantine is non-egalitarian — for instance, terrible for restaurant owners but not bad for university professors. The 50-50 idea not only flattens the epidemic curve but also the socioeconomic curve. Everyone can keep operating and the burden is split evenly.”
Barzel’s idea generated interest from about 15 world governments, including Israel’s. Although it was not implemented, he believes this option should be fully planned out and ready if needed.
“Currently, most of the experts agree there is no need for quarantine,” Barzel says. “As much as the numbers are high and troubling, we don’t see a pattern of exponential growth. We’ve seen linear growth for a few weeks, a constant level of about 1,500 new cases per day. Linear growth is manageable.”
He says with better incentives for responsible behavior, and better contact tracing, “we can live this way for a year if need be.”
But in case contagion grows exponentially, he wants the government prepared for an alternating lockdown so that “quarantine won’t be a doomsday scenario; it will be a reasonable option over the course of five or six weeks.”
He envisions each local authority assigning residents to the blue or red group by address. The authority would handle requests for switching from one group to another – for example, to facilitate a work situation or caring for someone in a different group.
“I don’t need exactly equal cohorts, so all reasonable requests will be granted,” Barzel says.
An app would inform each person which group they’re in and when they need to be in lockdown. Gatekeepers at public buildings would check the app to ensure that nobody in the currently quarantined group enters.
Enforcement wouldn’t be done by police but through creating motivation (not getting sick) and a framework for cooperation (workplaces, shops, restaurants and schools won’t admit people from the quarantined group).
Barzel likens the motivation to “I want to lose weight, so I won’t eat chocolate” and the framework to “There’s no chocolate available so there’s no reason to leave home.”
Barzel says other details can be worked out, for example how to handle emergencies by matching the person in need with a service provider in his or her group.
The Bar-Ilan simulation suggests that if the proportion of “defectors” – people who continue to be active during their lockdown phase or who hold essential positions and cannot be quarantined – is kept at under 30%, viral spread could still be overcome.
On August 5, newly appointed Israeli coronavirus project manager Dr. Ronni Gamzu said Israel’s goal is to significantly lower morbidity by September 1 without a lockdown.
However, Gamzu added, “No country with as high a morbidity level as Israel has dealt with morbidity without a lockdown. It seems that this is the last opportunity for a moderate line. Should morbidity not decline within two weeks, we will be obliged to consider restrictions including the possibility of a local or nationwide lockdown.”