The Impact of Non-Pharmaceutical Interventions on the Spread of COVID-19 - A Lesson from South Korea and Sweden

One of the most severe and unprecedented government responses to the COVID-19 pandemic has been the use of stay-at-home orders and government-forced business and school closures among others.  While governments would have us believe that these measures have been successful at reducing the spread of COVID-19, until now, there has been little research into the effectiveness of these two most restrictive non-pharmaceutical interventions or NPIs.  Thanks to research by Eran Bendavid, Christopher Oh, Jay Bhattacharya and John Ioannidis at Stanford University, we now have an evaluation which compares the use of less restrictive NPIs or lrNPIs and more restrictive NPIs or mrNPIs on the spread of COVID-19.

 

The use of non-pharmaceutical interventions was justified by governments around the world to reduce the transmission of COVID-19 in the absence of pharmaceutical options (i.e. vaccines etcetera) thereby reducing death, disease and health system overloading.  The early adoption of the most restrictive NPI policies (also known as lockdowns) was justified at the beginning of the COVID-19 pandemic as the disease spread rapidly and overwhelmed national and local health systems.  That said, it has become apparent that the most restrictive NPIs had a series of unintended but related health consequences including hunger, increase in non-COVID-19 diseases from missed health appointments, higher rates of opioid overdose deaths, mental health issues including suicide and higher rates of domestic abuse.  Some of these health consequences are related to the significant negative economic impacts of the lockdown measures.  To better weigh the real world benefits of non-pharmaceutical interventions, one must balance the positives and the negatives. 

 

For the purposes of the study, the authors used data from ten nations as follows: England, France, Germany, Iran, Italy, Netherlands, Spain, South Korea, Sweden and the United States.  The authors used South Korea and Sweden as examples of nations with less restrictive policies (lrNPIs) and compares the impact of their modest responses on the spread of COVID-19 to nations with more restrictive policies (mrNPIs).  South Korea's strategy relied on isolation of infected cases and their contacts and intensive investments in both testing and contact tracing.  In the case of Sweden, the government implemented only social distancing guidelines, discouragement of domestic and international travel and a ban on large gatherings.  The results obtained by Sweden and South Korea are then compared to the nations with more restrictive NPIs. 

 

In their research, the authors note that the average growth rate in new cases of COVID-19 prior to the imposition of any NPIs was positive in all ten nations with an average of 32 percent.  Here is a list of each nations' daily case growth rate prior to the imposition of any non-pharmaceutical measures:

 

England: 23 percent

 

France: 35 percent

 

Germany: 32 percent

 

Iran: 42 percent

 

Italy: 36 percent

 

Netherlands: 47 percent

 

Spain: 23 percent

 

USA: 28 percent

 

South Korea: 25 percent

 

Sweden: 33 percent

 

Among the ten nations in the study, government-imposed non-pharmaceutical responses to the pandemic, government measures included national lockdowns, social distancing, school closures, religious closures, paid sick leave, quarantining of positive cases, working from home, no public gatherings, no private gatherings, home isolation, domestic and international travel bans, transit suspensions, 

 

Now, let's look at the effect of more restrictive NPIs (mrNPIs) on daily growth case rates after accounting for the effects of less restrictive (lrNPIs) in South Korea and Sweden (i.e. comparing the effectiveness of the lockdowns in the eight nations when compared to South Korea and Sweden): 

  

England: 

+16 percent compared to South Korea

+23 percent compared to Sweden

 

France: 

+7 percent compared to South Korea

+13 percent compared to Sweden

 

Germany:

-1 percent compared to South Korea

+5 percent compared to Sweden

 

Iran: 

-7 percent compared to South Korea

-2 percent compared to Sweden

 

Italy:

+3 percent compared to South Korea

+8 percent compared to Sweden

 

Netherlands:

-3 percent compared to South Korea

+1 percent compared to Sweden

 

Spain: 

+24 percent compared to South Korea

+30 percent compared to Sweden

 

USA:

+8 percent compared to South Korea

+14 percent compared to Sweden

  

As you can see, the only nation with a decrease in the growth rate of COVID-19 cases when compared to both South Korea and Sweden is Iran and even that is minimal with a 7 percent decrease when compared to Sweden and a 2 percent decrease when compared to South Korea.  In 12 out of 16 of the comparisons, the point estimates are positive, that is, the imposition of more restrictive non-pharmaceutical measures resulted in increased daily growth rate in cases. 

  

It has become increasingly apparent that, as the pandemic grinds into its 14th month, some governments are imposing even stricter measures in a desperate attempt to force down the growth rate of new COVID-19 cases, doubling down on measures that obviously have failed to prevent the growth in the number of COVID-19 cases over the past year.  This research clearly shows that the imposition of stricter measures like lockdowns, shuttering of schools, churches and businesses and restrictions in the number of individuals that can meet each other has been a colossal failure and that the examples of both South Korea and Sweden show clearly that the imposition of minimal non-pharmaceutical measures has worked quite well at controlling the rate of spread of the 2019 edition of the novel coronavirus when compared to the randomly issued mandatory edicts of governments.  While governments seem oblivious to reality, their mandatory lockdowns and shutterings have had a massive negative impact on the economy and the physical and mental health of their citizens that may have been worse than if they had imposed no non-pharmaceutical interventions whatsoever.