This phenomenological study assesses the impacts of full lockdown strategies applied in Italy, France, Spain and United Kingdom, on the slowdown of the 2020 COVID-19 outbreak. Comparing the trajectory of the epidemic before and after the lockdown, we find no evidence of any discontinuity in the growth rate, doubling time, and reproduction number trends. Extrapolating pre-lockdown growth rate trends, we provide estimates of the death toll in the absence of any lockdown policies, and show that these strategies might not have saved any life in western Europe. We also show that neighboring countries applying less restrictive social distancing measures (as opposed to police-enforced home containment) experience a very similar time evolution of the epidemic.

Introduction

The recent COVID-19 outbreak in Europe has challenged the governments responsiveness in front of an unpredictable and unprecedented situation. Since most countries were unprepared to face such an unexpected epidemic, lack of testing capacities yielded most policies to shift towards social distancing measures rather than modern laboratory-based quarantine [10]. A broad range of public actions were taken in response to the epidemic, from no action at all (Sweden) to full lockdown (Italy, France, Spain and United Kingdom), including police-enforced home containment. Other countries, such as the Netherlands and Germany, opted for a measured response, encouraging social distancing without locking their population down.

While new medical treatments proposed to cure COVID-19 cases are required to be validated through controlled double blind studies, the benefits and risks of social distancing strategies are not subject to any comparative tests. However, full lockdown measures, such as those decided in Italy, France, Spain and United Kingdom have not been experienced in Western Europe countries for centuries, and their effects in contemporary population’s mental and physical health is largely unknown. The COVID-19 epidemic episode was shown to, by itself, affect mental health, including anxiety syndromes and depression [21] and the consequences of isolation could enhance these conditions. In the absence of any control group, the impacts on western Europe’s population will not be measurable until months. Nevertheless, increased mortality due to difficulties of access to basic health care, increased mental conditions linked to isolation, as well as social consequences of economic recession, despite being unquantifiable so far, is to be expected. Such measures are thus only appropriate if their impacts on limiting the epidemic spreading save more lives than their inherent death toll. Attempting a real-time assessment of full lockdown policies efficiency thus seems crucial to help public action decisions in the forthcoming weeks.

Recent modeling results suggestes that China’s full lockdown policy was successful in containing the epidemic [9]. In an attempt to predict the efficiency of similar policies in Western Europe countries (Italy, France, Spain and United Kingdom), Picchioti el al. (2020) [16] implemented a SEIR model, testing different lockdown parameterizations, and suggested that early public containment measures could be efficient. However, as acknowledged by the authors, real-time parameterization of a model for an un-known disease is a difficult and uncertain task, and the effects of lockdown may vary from one country to another. Although modeling studies offer valuable insights and possible scenarii for forthcoming events, and might provide a deep understanding of the epidemic’s dynamics a posteriori, they require validation, which can only be provided by thorough data analysis. In that regard, the observational efforts of Tobias (2020) [20] represent an interesting approach. The latter recently claimed that the full lockdown policies in Spain and Italy have had positive results in slowing the epidemic. However, their methods, based on fitting linear trends to the logarithm of the daily new cases and daily death numbers, and comparing them before, and after the lockdown policies, might not be appropriate. As will be shown below, to assess the trajectory of the epidemic, one should look for trends in the time derivative of the logarithm of daily numbers, rather than trends in the logarithm of the daily numbers itself.

Here, we show that the available data exhibit no evidence for any effects of the full lockdown policies applied in Italy, Spain, France and United Kingdom in the time evolution of the COVID-19 epidemic. Using a phenomenological approach, we compare the evolution of the epidemic before and after the full lockdown measures are expected to produce visible results. Our approach have similarities with Tobias (2020)’s [20]: it is focused on incident rather than cumulative data, and it compares pre-lockdown and post-lockdown trends. However, here, no positive changes are noticed in the trend of the daily death growth rate, doubling time, or reproduction number, weeks after lockdown policies should have impacts.

in https://www.medrxiv.org/content/10.1101/2020.04.24.20078717v1.full-text