There have been published numerous papers on various aspects of the COVID-19 crisis: for example, PubMed®
) collection alone lists 93,478 papers published in 2020 and 138,429 in 2021. Due to the vast amount of relevant literature, we found it unfeasible to perform a systematic review of the existing literature. Instead, we performed a narrative review following an iterative procedure discussed below.
First, an initial list (described in the next paragraph) of a limited number of sources (entries) was produced. Then, papers cited in the latter entries were reviewed, as well as subsequent works citing the entries. Since we did not perform a systematic review, no rigorous inclusion or exclusion criteria were defined. Instead, we performed a subjective assessment whether the new entry either provided considerable new information or cited important sources related to the research questions. Regarding previous pandemics and the connection between health and wealth, works conducted after 9/11 (when the topic of emergency management became extensively funded) were subjected to additional scrutiny to exclude possible bias. The suitability of references was double-checked by a two-stage screening process: first screening by the first author (MY) with random control by the second author (YS), followed by a final assessment by both authors. Entries that passed the screening were added to the list. The above process was iterated several times, until no new sources providing considerable information were found. The process is illustrated in Figure 1
. Since the search converged, we believe that the choice of initial sources was not crucial.
The initial list for the iterative search was compiled from two sub-lists. The first sub-list contained all COVID-19 papers published in 2020 in the highest-impact journals in the fields of medicine (Nature, Science, The Lancet, The New England Journal of Medicine) and economics (Journal of Economic Literature, Journal of Political Economy). The second contained selected papers of authors of important (often pioneering) works, published before 2020 but directly related to the COVID-19 crisis management: Gary Becker, Daron Acemoglu—health and economic growth; Kip Viscusi—value of statistical life (VLS) indicator to measure policy effectiveness; John Ioannidis—epidemiology and population health; Christian Bjørnskov—economic history.
Modern economic growth, observed at least since the Industrial Revolution, has been accompanied by impressive growth in trade, travel, and population density. At the same time, in recent centuries there have been no examples of pandemics that killed a large part of the population in many countries.
The focus of this small study is on established democracies because in the rest of the world there are significant statistical reliability problems encountered. Also, in authoritarian countries, the motivation for decision-making is noticeably different.
As a result of the described survey, a collection of about two hundred works (referred to as “the Collection” below) was compiled [4
]. Then, we performed an evidence-based risk-benefit evaluation of the lockdowns’ effectiveness. Analyzing decision-making, we exploited one of the basic assumptions of the Public Choice theory stating the absence of an ideal omniscient interest-free government [5
It is correct that our understanding of viral transmission mechanisms leads to the assumption that lockdowns should be an effective pandemic management tool if long-term collateral damage is neglected. However, the post factum
analysis yields the opposite result. Many factors could contribute to the lack of lockdowns’ effectiveness; consideration of these factors lies far beyond the scope of this paper. We just mention the mechanism of aerosol transmission [46
] and the low percolation threshold for contagion in the modern densely interconnected society [47
The extreme measures that deprived billions of their basic human rights followed (without any reasonable discussion) the abandonment of well-prepared crisis management plans. The extent of human life lost due to lockdowns themselves has never been quantitatively reported and therefore never been taken into consideration in the decision-making process. Moreover, governments continuously stuck to these measures despite the absence of proof that such measures were effective in controlling the pandemic. Nor the Italian government, the first among democratic countries to impose a nationwide lockdown, neither the authorities in other countries published materials showing how the known negative consequences of lockdowns were taken into account when making a decision (which could prove a posteriori to be correct or erroneous) that the expected gains outweigh the losses. Publication of the results of the scientific analysis would certainly strengthen public support of the authorities and their decisions. The absence of such publications probably means that such analysis was not performed.
We should stress here that the burden of proof is with the lockdown proponents. Lockdown opponents do not have to prove that lockdowns cause damage, the proponents must prove that lockdowns are beneficial. The latter statement follows from the two basic principles, which are outlined below.
The first is the classical medical principle ‘primum non nocere’—first, do not harm. The meaning of this principle is that the fear of ultimately harming by intervention should clearly prevail over the fear of not helping (while nearly every medical procedure, surely every surgery, is associated with some harm). This principle is valid no matter how serious the medical problem is; it should be valid for public health as well. The harm caused by lockdowns was obvious a priori and confirmed a posteriori—unlike the benefits of these interventions, as discussed above.
The second foundation is the classical juridical principle ‘semper necessitas probandi incumbit ei qui agit’—in any dispute, the burden of proof lies with those who lay charges. A citizen does not lay charges against the government; the government lays charges against citizens—to wear masks, to close their business, to stay at home.
The precautionary principle (PP) is sometimes cited to defend costly governmental interventions without solid scientific justification. However, even some PP supporters agree that in the case of governmental responses to COVID-19 pandemics (lockdowns and mandatory vaccination) even lowered standards of scientific justification, required by PP, were not met [48
Such behavior—shifting the burden of proof to the opponents—provides ground for speculations that the decisions were not made exclusively on a professional and interest-free basis. Special interests of the decision-making groups provide partial explanations of the unprecedented policy.
Even in democratic countries with limited and accountable governments, decisions are made not by angels but by humans (even if they are elected representatives of government officials) with their own characters, biases and interests [50
]. The special interests could well be altruistic if decision-makers were sincerely sure that their activity was in the best interest of the society; in addition, the experience of the PRC in controlling the epidemic by emergency measures—impressive in real time though questionable a posteriori
—undoubtedly biased the early decisions made all over the world.
However, decisions on lockdowns may have also been politically motivated—see sect. V.5 of the Collection [4
]. During the COVID-19 crisis, governments in general and public healthcare officials, in particular, enjoyed unprecedented expansion of power—to close schools and universities, send people to self-isolation, issue stay-at-home orders (de facto
—house arrest without a court order), and more [2
]. The expansion of funding was also unprecedented: the US Coronavirus Aid, Relief and Economy Security Act (“CARES Act”) alone was estimated to cost taxpayers $
2.3 trillion (around 11% of GDP) [53
] to be re-distributed by the government. The latter aspect of power and funding expansion could have contributed to the decisions to stick to the PRC pattern (ignoring the experience of countries such as South Korea, Taiwan, etc.) while abandoning the prepared plans and the evidence-based approach.
Moreover, even if decision-makers are interest-free, they cannot be ideal error-proof decision-making machines. One should not wonder that practical implementation of lockdowns often resulted in probably unexpected and surely undesired effects such as panic, increase in social tension and hostility, artificial crowding caused by document checks, etc.
One should not overlook the expansion of the limits of governmental power with a simultaneous decrease in accountability during the pandemic—see sect. IV.1, V.4, V.5, VI.1 of the Collection [4
]. Abandonment of “wider social and economic costs” consideration de facto means disregarding the harm inflicted on personal liberties and democratic institutions by lockdown policies [54
The questions of to what extent, why, and how the dissenting (disapproved by healthcare officials) scientific opinions were suppressed during COVID-19 [55
] deserve a special and urgent analysis. Suppression of “misleading” opinions causes not only grave consequences for scientists’ moral compass; it prevents the scientific community from correcting mistakes and jeopardizes (with a good reason) public trust in science. At least, publicly funded research should be scrutinized for conflict of interest to avoid artificial scientific consensus [56
Finally, it should be mentioned that even if hypothetically rigorous cost-benefit analysis in terms of the human cost would favor lockdowns, the very idea of saving the lives of people on account of the lives of others raises serious philosophical and ethical questions [26
Our study is not free from limitations. The main limitation probably is that our resources did not enable performing a systematic literature review. Another important limitation stems from the probable bias in publications [56
] mentioned above. Moreover, our study was based mainly on democratic countries with higher transparency. We anticipate that these issues will be addressed in detail by many future researchers. In addition, as time elapses, we anticipate long-term (hopefully lifespan) studies of the effects of both COVID-19 disease and lockdowns.