The 2006 Origins of the Lockdown Idea
- Daily Economy
Now begins the grand effort, on display in thousands of articles and news broadcasts daily, somehow to normalize the lockdown and all its destruction of the last two months. We didn’t lock down almost the entire country in 1968/69, 1957 , or 1949-1952 , or even during 1918 . But in a terrifying few days in March 2020, it happened to all of us, causing an avalanche of social, cultural, and economic destruction that will ring through the ages.
There was nothing normal about it all. We’ll be trying to figure out what happened to us for decades hence.
How did a temporary plan to preserve hospital capacity turn into two-to-three months of near-universal house arrest that ended up causing worker furloughs at 256 hospitals , a stoppage of international travel, a 40% job loss among people earning less than $40K per year, devastation of every economic sector, mass confusion and demoralization , a complete ignoring of all fundamental rights and liberties, not to mention the mass confiscation of private property with forced closures of millions of businesses?
Whatever the answer, it’s got to be a bizarre tale. What’s truly surprising is just how recent the theory behind lockdown and forced distancing actually is. So far as anyone can tell, the intellectual machinery that made this mess was invented 14 years ago, and not by epidemiologists but by computer-simulation modelers. It was adopted not by experienced doctors – they warned ferociously against it – but by politicians.
Let’s start with the phrase social distancing, which has mutated into forced human separation. The first I had heard it was in the 2011 movie Contagion. The first time it appeared in the New York Times was February 12, 2006:
If the avian flu goes pandemic while Tamiflu and vaccines are still in short supply, experts say, the only protection most Americans will have is “social distancing,” which is the new politically correct way of saying “quarantine.”
But distancing also encompasses less drastic measures, like wearing face masks, staying out of elevators — and the [elbow] bump. Such stratagems, those experts say, will rewrite the ways we interact, at least during the weeks when the waves of influenza are washing over us.
Maybe you don’t remember that the avian flu of 2006 didn’t amount to much. It’s true, despite all the extreme warnings about its lethality, H5N1 didn’t turn into much at all. What it did do, however, was send the existing president, George W. Bush, to the library to read about the 1918 flu and its catastrophic results. He asked for some experts to submit some plans to him about what to do when the real thing comes along.
The New York Times (April 22, 2020) tells the story from there:
Fourteen years ago, two federal government doctors, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint in suburban Washington for a final review of a proposal they knew would be treated like a piñata: telling Americans to stay home from work and school the next time the country was hit by a deadly pandemic. When they presented their plan not long after, it was met with skepticism and a degree of ridicule by senior officials, who like others in the United States had grown accustomed to relying on the pharmaceutical industry, with its ever-growing array of new treatments, to confront evolving health challenges. Drs. Hatchett and Mecher were proposing instead that Americans in some places might have to turn back to an approach, self-isolation, first widely employed in the Middle Ages. How that idea — born out of a request by President George W. Bush to ensure the nation was better prepared for the next contagious disease outbreak — became the heart of the national playbook for responding to a pandemic is one of the untold stories of the coronavirus crisis. It required the key proponents — Dr. Mecher, a Department of Veterans Affairs physician, and Dr. Hatchett, an oncologist turned White House adviser — to overcome intense initial opposition.
It brought their work together with that of a Defense Department team assigned to a similar task. And it had some unexpected detours, including a deep dive into the history of the 1918 Spanish flu and an important discovery kicked off by a high school research project pursued by the daughter of a scientist at the Sandia National Laboratories. The concept of social distancing is now intimately familiar to almost everyone. But as it first made its way through the federal bureaucracy in 2006 and 2007, it was viewed as impractical, unnecessary and politically infeasible.
Notice that in the course of this planning, neither legal nor economic experts were brought in to consult and advise. Instead it fell to Mecher (formerly of Chicago and an intensive care doctor with no previous expertise in pandemics) and the oncologist Hatchett.
But what is this mention of the high-school daughter of 14? Her name is Laura M. Glass, and she recently declined to be interviewed when the Albuquerque Journal did a deep dive of this history.
Laura, with some guidance from her dad, devised a computer simulation that showed how people – family members, co-workers, students in schools, people in social situations – interact. What she discovered was that school kids come in contact with about 140 people a day, more than any other group. Based on that finding, her program showed that in a hypothetical town of 10,000 people, 5,000 would be infected during a pandemic if no measures were taken, but only 500 would be infected if the schools were closed.
Laura’s name appears on the foundational paper arguing for lockdowns and forced human separation. That paper is Targeted Social Distancing Designs for Pandemic Influenza (2006). It set out a model for forced separation and applied it with good results backwards in time to 1957. They conclude with a chilling call for what amounts to a totalitarian lockdown, all stated very matter-of-factly.
Implementation of social distancing strategies is challenging. They likely must be imposed for the duration of the local epidemic and possibly until a strain-specific vaccine is developed and distributed. If compliance with the strategy is high over this period, an epidemic within a community can be averted. However, if neighboring communities do not also use these interventions, infected neighbors will continue to introduce influenza and prolong the local epidemic, albeit at a depressed level more easily accommodated by healthcare systems.
In other words, it was a high-school science experiment that eventually became law of the land, and through a circuitous route propelled not by science but politics.
The primary author of this paper was Robert J. Glass, a complex-systems analyst with Sandia National Laboratories. He had no medical training, much less an expertise in immunology or epidemiology.
That explains why Dr. D.A. Henderson, “who had been the leader of the international effort to eradicate smallpox,” completely rejected the whole scheme.
Says the NYT:
Dr. Henderson was convinced that it made no sense to force schools to close or public gatherings to stop. Teenagers would escape their homes to hang out at the mall. School lunch programs would close, and impoverished children would not have enough to eat. Hospital staffs would have a hard time going to work if their children were at home. The measures embraced by Drs. Mecher and Hatchett would “result in significant disruption of the social functioning of communities and result in possibly serious economic problems,” Dr. Henderson wrote in his own academic paper responding to their ideas. The answer, he insisted, was to tough it out: Let the pandemic spread, treat people who get sick and work quickly to develop a vaccine to prevent it from coming back.
AIER’s Phil Magness got to work to find the literature responding to the 2006 paper by Robert and Laura M. Glass and discovered the following manifesto: Disease Mitigation Measures in the Control of Pandemic Influenza . The authors included D.A. Henderson, along with three professors from Johns Hopkins: infectious disease specialist Thomas V.Inglesby , epidemiologist Jennifer B. Nuzzo , and physician Tara O’Toole.
Their paper is a remarkably readable refutation of the entire lockdown model.
There are no historical observations or scientific studies that support the confinement by quarantine of groups of possibly infected people for extended periods in order to slow the spread of influenza. … It is difficult to identify circumstances in the past half-century when large-scale quarantine has been effectively used in the control of any disease. The negative consequences of large-scale quarantine are so extreme (forced confinement of sick people with the well; complete restriction of movement of large populations; difficulty in getting critical supplies, medicines, and food to people inside the quarantine zone) that this mitigation measure should be eliminated from serious consideration … Home quarantine also raises ethical questions. Implementation of home quarantine could result in healthy, uninfected people being placed at risk of infection from sick household members. Practices to reduce the chance of transmission (hand-washing, maintaining a distance of 3 feet from infected people, etc.) could be recommended, but a policy imposing home quarantine would preclude, for example, sending healthy children to stay with relatives when a family member becomes ill. Such a policy would also be particularly hard on and dangerous to people living in close quarters, where the risk of infection would be heightened …. Travel restrictions, such as closing airports and screening travelers at borders, have historically been ineffective . The World Health Organization Writing Group concluded that “screening and quarantining entering travelers at international borders did not substantially delay virus introduction in past pandemics . . . and will likely be even less effective in the modern era.”… It is reasonable to assume that the economic costs of shutting down air or train travel would be very high, and the societal costs involved in interrupting all air or train travel would be extreme. … During seasonal influenza epidemics, public events with an expected large attendance have sometimes been cancelled or postponed, the rationale being to decrease the number of contacts with those who might be contagious. There are, however, no certain indications that these actions have had any definitive effect on the severity or duration of an epidemic. Were consideration to be given to doing this on a more extensive scale and for an extended period, questions immediately arise as to how many such events would be affected. There are many social gatherings that involve close contacts among people, and this prohibition might include church services, athletic events, perhaps all meetings of more than 100 people. It might mean closing theaters, restaurants, malls, large stores, and bars. Implementing such measures would have seriously disruptive consequences …
Schools are often closed for 1–2 weeks early in the development of seasonal community outbreaks of influenza primarily because of high absentee rates, especially in elementary schools, and because of illness among teachers. This would seem reasonable on practical grounds. However, to close schools for longer periods is not only impracticable but carries the possibility of a serious adverse outcome …. Thus, cancelling or postponing large meetings would not be likely to have any significant effect on the development of the epidemic. While local concerns may result in the closure of particular events for logical reasons, a policy directing communitywide closure of public events seems inadvisable. Quarantine. As experience shows, there is no basis for recommending quarantine either of groups or individuals. The problems in implementing such measures are formidable, and secondary effects of absenteeism and community disruption as well as possible adverse consequences, such as loss of public trust in government and stigmatization of quarantined people and groups, are likely to be considerable….
Finally, the remarkable conclusion:
Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted . Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen to be less than optimal, a manageable epidemic could move toward catastrophe .
Confronting a manageable epidemic and turning it into a catastrophe: that seems like a good description of everything that has happened in the COVID-19 crisis of 2020.
Thus did some of the most highly trained and experienced experts on epidemics warn with biting rhetoric against everything that the advocates of lockdown proposed. It was not even a real-world idea in the first place and showed no actual knowledge of viruses and disease mitigation. Again, the idea was born of a high-school science experiment using agent-based modelling techniques having nothing at all to do with real life, real science, or real medicine.
So the question becomes: how did the extreme view prevail?
The New York Times has the answer:
The [Bush] administration ultimately sided with the proponents of social distancing and shutdowns — though their victory was little noticed outside of public health circles. Their policy would become the basis for government planning and would be used extensively in simulations used to prepare for pandemics, and in a limited way in 2009 during an outbreak of the influenza called H1N1. Then the coronavirus came, and the plan was put to work across the country for the first time.
[Post-publication note: You can read the 2007 CDC paper here . It is arguable that this paper did not favor full lockdown. I’ve spoken to Rajeev Venkayya, MD, who regards the 2007 plan as more liberal, and assures me that they never envisioned this level of lockdown: “lockdowns and shelter-in-place were not part of the recommendations.” To my mind, fleshing out the full relationship between this 2007 document and current policy requires a separate article.]
The Times called one of the pro-lockdown researchers, Dr. Howard Markel, and asked what he thought of the lockdowns. His answer: he is glad that his work was used to “save lives” but added, “ It is also horrifying .” “We always knew this would be applied in worst-case scenarios,” he said. “Even when you are working on dystopian concepts, you always hope it will never be used.”
Ideas have consequences, as they say. Dream up an idea for a virus-controlling totalitarian society, one without an endgame and eschewing any experienced-based evidence that it would achieve the goal, and you might see it implemented someday. Lockdown might be the new orthodoxy but that doesn’t make it medically sound or morally correct. At least now we know that many great doctors and scholars in 2006 did their best to stop this nightmare from unfolding. Their mighty paper should serve as a blueprint for dealing with the next pandemic.
Correction: A previous version of this article in one instance incorrectly named the coauthor of the 2006 paper by Robert Glass. That is now corrected to Laura M. Glass.
Jeffrey A. Tucker
Jeffrey A. Tucker served as Editorial Director for the American Institute for Economic Research from 2017 to 2021.
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What We’ve Learned About So-Called ‘Lockdowns’ and the COVID-19 Pandemic
By Lori Robertson
Posted on March 8, 2022
Plenty of peer-reviewed studies have found government restrictions early in the pandemic, such as business closures and physical distancing measures, reduced COVID-19 cases and/or mortality, compared with what would have happened without those measures. But conservative news outlets and commentators have seized on a much-criticized, unpublished working paper that concluded “lockdowns” had only a small impact on mortality as definitive evidence the restrictions don’t work.
Multiple lines of evidence back the use of face masks to protect against the coronavirus, although some uncertainty remains as to how effective mask interventions are in preventing spread in the community.
Lab tests, for example, show that certain masks and N95 respirators can partially block exhaled respiratory droplets or aerosols, which are thought to be the primary ways the virus spreads.
Observational studies, while limited, have generally found mask-wearing to be associated with a reduced risk of contracting the virus or fewer COVID-19 cases in a community.
A few randomized controlled trials have found that providing free masks and encouraging people to wear them results in a small to moderate reduction in transmission, although these results have not always been statistically significant.
Masks should not be viewed as foolproof, as no mask is thought to offer complete protection to the wearer or to others. The Centers for Disease Control and Prevention recommends that people wear the most protective mask that fits well and can be worn consistently. Loosely woven cloth masks are the least protective. Layered, tightly woven cloth masks offer more protection, while well-fitting surgical masks and KN95 respirators provide even more protection and N95 respirators are the most protective.
Link to this
In the early months of the COVID-19 pandemic in 2020, as the virus spread around the globe, many countries implemented restrictions on movement and social gatherings in an effort to flatten the curve — or reduce sharp spikes in caseloads to avoid overwhelming health care facilities. Without vaccines or evidence-based treatments, these non-pharmaceutical interventions, or NPIs, were the only public health measures available for months to combat the pandemic.
There have been a lot of studies assessing whether and to what extent so-called “lockdowns” and various NPIs have been effective, and plenty of research that has concluded these measures can limit transmission, or reduce cases and deaths. For instance, a study published in Nature in June 2020 found that “major non-pharmaceutical interventions—and lockdowns in particular—have had a large effect on reducing transmission” in 11 European countries. It estimated what would have happened if the transmission of the virus hadn’t been reduced, finding that 3.1 million deaths “have been averted owing to interventions since the beginning of the epidemic.” The estimate doesn’t account for behavior changes or the impact of overwhelmed health systems.
In May 2020, the same journal published a study that estimated the number of cases in mainland China would have been “67-fold higher” by the end of February 2020 without a combination of non-pharmaceutical interventions.
But one working paper posted online in January — and not peer-reviewed — has gotten a lot of attention in conservative circles for its conclusion that “lockdowns have had little to no effect on COVID-19 mortality.” The paper, which is an analysis of other studies, has been touted as a “Johns Hopkins University study,” but it’s not a product of the university’s Bloomberg School of Public Health, whose vice dean — among other public health experts — has criticized the paper.
“The working paper is not a peer-reviewed scientific study,” Dr. Joshua Sharfstein, vice dean of the Johns Hopkins Bloomberg School of Public Health, said in a Feb. 8 statement sent to us in an email. “To reach their conclusion that ‘lockdowns’ had a small effect on mortality, the authors redefined the term ‘lockdown’ and disregarded many peer-reviewed studies. The working paper did not include new data, and serious questions have already been raised about its methodology.”
Sharfstein said that early on “when so little was known about COVID-19, stay-at-home policies kept the virus from infecting people and saved many lives. Thankfully, these policies are no longer needed, as a result of vaccines, masks, testing, and other tools that protect against life-threatening COVID-19 infections.”
The authors of the working paper are economists: Steve H. Hanke , a senior fellow at the libertarian Cato Institute and founder and co-director of the Johns Hopkins Institute for Applied Economics, Global Health, and the Study of Business Enterprise; Jonas Herby , a special adviser at the Center for Political Studies in Copenhagen, Denmark; and Lars Jonung , a professor emeritus at Sweden’s Lund University.
Fox News published a Feb. 4 story questioning why other mainstream media outlets hadn’t written stories about the working paper, saying there had been “a full-on media blackout,” and “Fox & Friends” co-host Brian Kilmeade asked in a Facebook post , “Will some people get an apology after this?” On Feb. 21, former Republican vice presidential nominee Sarah Palin posted a video to Facebook highlighting the working paper and asking if lockdowns were about “power,” not “safety.”
But the non-peer-reviewed paper isn’t the definitive or final word on lockdowns, and the attention it has received has, in turn, sparked criticism of the paper’s analysis.
Criticisms of the Working Paper
The working paper was a literature review and meta-analysis , meaning it searched the available scientific literature and identified studies that met certain criteria, and then combined similar studies statistically to reach a conclusion. It identified 24 papers, published or posted as of early July 2021, that met its criteria for the meta-analysis — 17 of which were peer-reviewed. Among the criticisms: The paper excluded many relevant studies, broadly defined “lockdown,” and overwhelmingly based one of its headline figures on a study whose conclusions it rejected. That study also didn’t estimate the delayed effect of government restrictions on death rates a few weeks later, according to experts we consulted. Instead, it only assessed the effect of current death rates on current policies.
Excluded research. One of the criticisms is that the working paper excluded a lot of relevant research. The paper said it considered “difference-in-difference” studies, which would compare outcomes in areas or populations that were subject to a restriction with those that were not, and limited its analysis to the impact on mortality. The paper excluded studies that use modeling on mortality, that compare before and after a “lockdown” and that consider the timing of restrictions. Gideon Meyerowitz-Katz , an epidemiologist working on his Ph.D. at the University of Wollongong in Australia, said in a long Twitter thread: “Many of the most robust papers on the impact of lockdowns are, by definition, excluded.”
He called the working paper “a very weak review that doesn’t really show much, if anything.” It excluded “modelled counterfactuals,” which would compare what happened with what would have happened without the intervention. “Because this is the most common method used in infectious disease assessments, this has the practical impact of excluding most epidemiological research from the review,” Meyerowitz-Katz said.
Hanke told us: “Models are fine if they are based on empirical observations,” meaning from experience, “rather than assumptions. In those circumstances, models are able to reliably forecast the real world. But the models used during the pandemic have been inaccurate, as they, for the most part, have not been based on empirical observations but assumptions,” he said in an email. “A prime example of modelers gone astray is the Imperial College London study of March 16, 2020.”
That March 2020 report , early in the pandemic, estimated that 2.2 million lives would be lost in the U.S. in “the (unlikely) absence of any control measures or spontaneous changes in individual behaviour.” As we’ve written before , it wasn’t intended to be a practical estimate, as doing absolutely nothing was, in the author’s words, “unlikely.”
One of the authors of that report has been critical of Hanke’s working paper. Neil Ferguson, director of the MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, said in a statement that the working paper “does not significantly advance our understanding of the relative effectiveness of the plethora of public health measures adopted by different countries to limit COVID-19 transmission.”
Ferguson said that NPIs “are intended to reduce contact rates between individuals in a population, so their primary impact, if effective, is on transmission rates. Impacts on hospitalisation and mortality are delayed, in some cases by several weeks. In addition, such measures were generally introduced (or intensified) during periods where governments saw rapidly growing hospitalisations and deaths. Hence mortality immediately following the introduction of lockdowns is generally substantially higher than before. Neither is lockdown a single event as some of the studies feeding into this meta-analysis assume; the duration of the intervention needs to be accounted for when assessing its impact.”
Ferguson said because NPIs affect transmission rates, “the appropriate outcome measures to consider are growth rates (of cases or deaths) over time, with appropriate time lags – not total cases or deaths.”
Definition of “lockdown.” The working paper also had a very broad definition of “lockdown”: “Lockdowns are defined as the imposition of at least one compulsory, non-pharmaceutical intervention (NPI),” it said. “NPIs are any government mandate that directly restrict peoples’ possibilities, such as policies that limit internal movement, close schools and businesses, and ban international travel.”
The paper did not examine the impact of voluntary behavior or recommendations, as opposed to mandates. “Our definition does not include governmental recommendations, governmental information campaigns, access to mass testing, voluntary social distancing, etc., but do include mandated interventions such as closing schools or businesses, mandated face masks etc.”
The paper then divided the 24 studies it considered into three groups: studies using a stringency index for restrictions, studies on shelter-in-place orders and those looking at specific NPIs. The last category included 11 studies on various measures, including face mask policies and limits on gatherings.
Stringency index studies. The authors examined seven studies on the impact of more severe restrictions, calculating from those studies that, compared with a policy of recommendations, “lockdowns in Europe and the United States only reduced COVID-19 mortality by 0.2% on average” — the figure that conservatives have cited . But six of the seven studies concluded that lockdown policies helped reduce mortality, and the 0.2% figure is overwhelmingly based on one study that mistakenly estimated the wrong effect, according to economists we consulted.
The studies in this group used the Oxford COVID-19 Government Response Tracker , which looked at government responses worldwide to the pandemic and created a stringency index, measuring how strict the measures were over time. The index is from 0 to 100, with 100 being the most stringent restrictions. For instance, the OxCGRT heat map shows that many countries around the world had stringency levels above 70 in April 2020.
The working paper calculates mortality impact estimates for each of the seven studies aiming to show the effect of the average mandated restrictions in Europe and the United States early in the pandemic compared with a policy of only recommendations. The paper then calculates a weighted average, giving more weight to studies that said their findings were more precise. Nearly all of the weight — 91.8% — goes to one study, even though the working paper rejects the conclusions of that study.
That study — coauthored by Carolyn Chisadza , a senior lecturer in economics at the University of Pretoria, and published on March 10, 2021, in the journal Sustainability — looked at a sample of countries between March and September 2020 and concluded: “Less stringent interventions increase the number of deaths, whereas more severe responses to the pandemic can lower fatalities.”
The working paper claims the researchers’ conclusion is incorrect — but it uses the study’s estimates, saying the figures show an increase in mortality due to “lockdowns.”
Chisadza told us in an email that the study showed: “Stricter lockdowns will reduce the rate of deaths than would have occurred without lockdown or too lenient of restrictions.” But Hanke said the data from Chisadza and her colleagues only show that “stricter lockdowns will reduce mortality” relative to “the worst possible lockdown,” meaning a more lenient lockdown that, under the study, was associated with the highest rate of deaths.
We reached out to a third party about this disagreement. Victor Chernozhukov , a professor in the Massachusetts Institute of Technology’s Department of Economics and the Statistics and Data Science Center, along with Professor Hiroyuki Kasahara and Associate Professor Paul Schrimpf , both with the Vancouver School of Economics at the University of British Columbia — the authors of another study that was included in the working paper — looked at the Chisadza study and provided FactCheck.org with a peer review of it . They found the Chisadza study only measured the correlation between current death growth rates and current policies. It did not show the lagged effect of more stringent policies, implemented three weeks prior, on current death growth rates, which is what one would want to look at to evaluate the effectiveness of “lockdowns.”
In an email and in a phone interview, Chernozhukov told us the Chisadza study made an “honest mistake.” He said the working paper is “deeply flawed” partly because it relies heavily on a study that “estimates the wrong effect very precisely.”
In their review, Chernozhukov, Kasahara and Schrimpf write that the Chisadza et al. study “should be interpreted as saying that the countries currently experiencing high death rates (or death growth rates) are more likely to implement more stringent current policy. That is the only conclusion we can draw from [the study], because the current policy can not possibly influence the current deaths,” given the several weeks of delay between new infections and deaths.
The effect that should be examined for the meta-analysis is “the effect of the previous (e.g., 3 week lagged) policy stringency index on the current death growth rates.”
Chernozhukov, Kasahara and Schrimpf conducted a “quick reanalysis of similar data” to the Chisadza study, finding results that “suggest that more stringent policies in the past predict lower death growth rates.” Chernozhukov said much more analysis would be needed to further characterize this effect, but that it is “actually quite substantial.”
If the Chisadza study were removed from the working paper, according to one of the paper’s footnotes, the result would be a weighted average reduction in mortality of 3.5%, which Hanke said doesn’t change the “overall conclusions.” He said it “simply demonstrates the obvious fact that the conclusions contained in our meta-analysis are robust.”
But experts have pointed out other issues with the meta-analysis. Chernozhukov also said the paper “excluded a whole bunch of studies,” including synthetic control method studies, which evaluate treatment effects. He also questioned the utility of looking at a policy index that considers the U.S. as a whole, lumping all the states together. He said the meta-analysis is “not credible at all.”
Among the other six stringency index studies included in the meta-analysis, only one concluded that its findings suggested “lockdowns” had zero effect on mortality. In a review of 24 European countries’ weekly mortality rates for the first six months of 2017-2020, the study, published in CESifo Economic Studies , found “no clear association between lockdown policies and mortality development.” The author and Herby , one of the authors of the working paper, have written for the American Institute for Economic Research , which facilitated the controversial Great Barrington Declaration , an October 2020 statement advocating those at low risk of dying from COVID-19 “live their lives normally to build up immunity to the virus through natural infection,” while those at “highest risk” are protected.
The other studies found lockdown policies helped COVID-19 health outcomes. For instance, a CDC study published in the agency’s Morbidity and Mortality Weekly Report in January 2021, on the experience of 37 European countries from Jan. 23 to June 30, 2020, concluded that “countries that implemented more stringent mitigation policies earlier in their outbreak response tended to report fewer COVID-19 deaths through the end of June 2020. These countries might have saved several thousand lives relative to countries that implemented similar policies, but later.”
A working paper from Harvard University’s Center for International Development , which looked at 152 countries from the beginning of the pandemic until Dec. 31, 2020, found that “lockdowns tend to significantly reduce the spread of the virus and the number of related deaths.” But the effect fades over time, so lengthy (after four months) or second-phase “lockdowns” don’t have the same impact.
A study published in World Medical & Health Policy in November 2020 — that looked at whether 24 European countries responded quickly enough — found that the fluctuating containment measures, from country to country and over time, “prohibited a clear association with the mortality rate.” But it said “the implementation speed of these containment measures in response to the coronavirus had a strong effect on the successful mitigation of fatalities.”
Many studies found restrictions worked. Meyerowitz-Katz noted that the working paper authors disagreed with the conclusions of other studies included in the review, pointing to one included in the group of shelter-in-place orders. Meyerowitz-Katz said that study “found that significant restrictions were effective, but is included in this review as estimating a 13.1% INCREASE in fatalities.”
That study, by Yale School of Management researchers, published by The Review of Financial Studies in June 2021 , developed “a time-series database” on several types of restrictions for every U.S. county from March to December 2020. The authors concluded: “We find strong evidence consistent with the idea that employee mask policies, mask mandates for the general population, restaurant and bar closures, gym closures, and high-risk business closures reduce future fatality growth. Other business restrictions, such as second-round closures of low- to medium-risk businesses and personal care/spa services, did not generate consistent evidence of lowered fatality growth and may have been counterproductive.” The authors said the study’s “findings lie somewhere in the middle of the existing results on how NPIs influenced the spread of COVID-19.”
In terms of hard figures on fatality reductions, the study said the estimates suggest a county with a mandatory mask policy would see 15.3% fewer new deaths per 10,000 residents on average six weeks later, compared with a county without a mandatory mask policy. The impact for restaurant closures would be a decrease of 36.4%. But the estimates suggest other measures, including limits on gatherings of 100 people or more, appeared to increase deaths. The authors said one possible explanation of such effects could be that the public is substituting other activities that actually increase transmission of the virus — such as hosting weddings with 99 people in attendance, just under the 100-person limitation.
Another study in the shelter-in-place group is the study by Chernozhukov, Kasahara and Schrimpf, published in the Journal of Econometrics in January 2021 . It looked at the policies in U.S. states and found that “nationally mandating face masks for employees early in the pandemic … could have led to as much as 19 to 47 percent less deaths nationally by the end of May, which roughly translates into 19 to 47 thousand saved lives.” It found cases would have been 6% to 63% higher without stay-at-home orders and found “considerable uncertainty” over the impact of closing schools. It also found “substantial declines in growth rates are attributable to private behavioral response, but policies played an important role as well.”
The working paper considered 13 studies that evaluated stay-in-place orders, either alone or in combination with other NPIs. The estimated effect on total fatalities for each study calculated by the authors varied quite widely, from a decrease of 40.8% to an increase of 13.1% (the study above mentioned by Meyerowitz-Katz). The authors then combined the studies into a weighted average showing a 2.9% decrease in mortality from these studies on shelter-in-place orders.
Sizable impact from some NPIs. The working paper actually found a sizable decrease in deaths related to closing nonessential businesses: a 10.6% weighted average reduction in mortality. The authors said this “is likely to be related to the closure of bars.” It also calculated a 21.2% weighted average reduction in deaths due to mask requirements, but notes “this conclusion is based on only two studies.”
As with the shelter-in-place group, the calculated effects in the specific NPIs group varied widely – from a 50% reduction in mortality due to business closures to a 36% increase due to border closures. The paper said “differences in the choice of NPIs and in the number of NPIs make it challenging to create an overview of the results.”
“The review itself does refer to other papers that reported that the lockdowns had a significant impact in preventing deaths,” Dr. Lee Riley , chair of the Division of Infectious Disease and Vaccinology at the University of California, Berkeley School of Public Health, told us when we asked for his thoughts on the working paper. “The pandemic has now been occurring long enough that it’s not surprising to begin to see many more reports that now contradict each other. As we all know, the US and Europe went through several periods when they relaxed their lockdowns, which was followed by a resurgence of the cases.”
Riley said that “many of the studies that this review included may suffer from the classic ‘chicken-or-egg’ bias. Whenever there was an increase in cases of deaths, lockdowns got instituted so it’s not surprising that some of the studies showed no impact of the lockdowns. If there was no surge of cases or deaths, most places in the US did not impose restrictions.”
Meyerowitz-Katz noted on Twitter that “the impact of ‘lockdowns’ is very hard to assess, if for no other reason than we have no good definition of ‘lockdown’ in the first place. … In most cases, it seems the authors have taken estimates for stay-at-home orders as their practical definition of ‘lockdown’ (this is pretty common) And honestly, I’d agree that the evidence for marginal benefit from stay-at-home orders once you’ve already implemented dozens of restrictions is probably quite weak.”
But, “if we consider ‘lockdown’ to be any compulsory restriction at all, the reality is that virtually all research shows a (short-term) mortality benefit from at least some restrictions.”
We’ve already mentioned two studies beyond those in the working paper: the Nature June 2020 study by Imperial College London researchers that estimated interventions in 11 countries in Europe in the first few months of the pandemic reduced transmission and averted 3.1 million deaths; and the Nature May 2020 study that estimated cases in mainland China would have been 67-fold greater without several NPIs by the end of February.
There are many more that aimed to evaluate the effectiveness of various mitigation strategies, not included in the working paper’s analysis.
- A 2020 unpublished observational study — cited in the working paper as the basis for the Oxford stringency index but not included in the analysis — found that more stringent restrictions implemented more quickly led to fewer deaths. “A lower degree of government stringency and slower response times were associated with more deaths from COVID-19. These findings highlight the importance of non-pharmaceutical responses to COVID-19 as more robust testing, treatment, and vaccination measures are developed.” In considering nine NPIs, the authors said the average daily growth rates in deaths were affected by each additional stringency index point and each day that a country delayed reaching an index of 40 on the stringency scale. “These daily differences in growth rates lead to large cumulative differences in total deaths. For example, a week delay in enacting policy measures to [a stringency index of 40] would lead to 1.7 times as many deaths overall,” they wrote.
- A more up-to-date study by many of the same authors, posted July 9, 2021, by the journal Plos One, looked at data for 186 countries from Jan. 1, 2020, to March 11, 2021, a period over which 10 countries experienced three waves of the pandemic. In the first wave in those countries, 10 additional points on the stringency index — in other words more stringent restrictions — “resulted in lower average daily deaths by 21 percentage points” and by 28 percentage points in the third wave. “Moreover, interaction effects show that government policies were effective in reducing deaths in all waves in all groups of countries,” the authors said.
- A Dec. 15, 2020, study in Science used data from 41 countries to model which NPIs were most effective at reducing transmission. “Limiting gatherings to fewer than 10 people, closing high-exposure businesses, and closing schools and universities were each more effective than stay-at-home orders, which were of modest effect in slowing transmission,” the authors said. “When these interventions were already in place, issuing a stay-at-home order had only a small additional effect. These results indicate that, by using effective interventions, some countries could control the epidemic while avoiding stay-at-home orders.” The study, like many others, looked at the impact on the reproduction number of SARS-CoV-2, or the average number of people each person with COVID-19 infects at a given time. It notes that a reduction in this number would affect COVID-19 mortality, and that the impact of NPIs can depend on other factors, including when and for how long they are implemented, and how much the public adhered to them.
- A study in Nature Human Behaviour on Nov. 16, 2020 , considered the impact on the reproduction number of COVID-19 by 6,068 NPIs in 79 territories, finding that a combination of less intrusive measures could be as effective as a national lockdown. “The most effective NPIs include curfews, lockdowns and closing and restricting places where people gather in smaller or large numbers for an extended period of time. This includes small gathering cancellations (closures of shops, restaurants, gatherings of 50 persons or fewer, mandatory home working and so on) and closure of educational institutions.” The authors said this doesn’t mean an early national lockdown isn’t effective in reducing transmission but that “a suitable combination (sequence and time of implementation) of a smaller package of such measures can substitute for a full lockdown in terms of effectiveness, while reducing adverse impacts on society, the economy, the humanitarian response system and the environment.” They found that “risk-communication strategies” were highly effective, meaning government education and communication efforts that would encourage voluntary behavior. “Surprisingly, communicating on the importance of social distancing has been only marginally less effective than imposing distancing measures by law.”
- Another study in Nature in June 2020 looked at 1,700 NPIs in six countries, including the United States. “We estimate that across these 6 countries, interventions prevented or delayed on the order of 61 million confirmed cases, corresponding to averting approximately 495 million total infections,” the authors concluded. “Without these policies employed, we would have lived through a very different April and May” in 2020, Solomon Hsiang, the lead researcher and director of the Global Policy Laboratory at the University of California at Berkeley, told reporters . The study didn’t estimate how many lives were saved, but Hsiang said the benefits of the lockdown are in a sense invisible because they reflect “infections that never occurred and deaths that did not happen.”
- A more recently published study in Nature Communications in October , by U.K. and European researchers, found that closures of businesses and educational institutions, as well as gathering bans, reduced transmission during the second wave of COVID-19 in Europe — but by less than in the first wave. “This difference is likely due to organisational safety measures and individual protective behaviours—such as distancing—which made various areas of public life safer and thereby reduced the effect of closing them,” the authors said. The 17 NPIs considered by the study led to median reductions in the reproduction number of 77% to 82% in the first wave and 66% in the second wave.
- A February 2021 study in Chaos: An Interdisciplinary Journal of Nonlinear Science estimated large reductions in infections (by 72%) and deaths (by 76%) in New York City in 2020, based on numerical experiments in a model. “Among all the NPIs, social distancing for the entire population and protection for the elderly in public facilities is the most effective control measure in reducing severe infections and deceased cases. School closure policy may not work as effectively as one might expect in terms of reducing the number of deceased cases,” the authors said.
Near the end of his lengthy Twitter thread on the working paper, Meyerowitz-Katz said he agrees that “a lot of people originally underestimated the impact of voluntary behaviour change on COVID-19 death rates – it’s probably not wrong to argue that lockdowns weren’t as effective as we initially thought.” He pointed to the Nature Communications study mentioned above, showing less of an impact from NPIs in a second wave of COVID-19 and positing individual safety behaviors were playing more of a role in that second wave.
“HOWEVER, this runs both ways,” Meyerowitz-Katz said. “[I]t is also quite likely that lockdowns did not have the NEGATIVE impact most people propose, because some behaviour changes were voluntary!”
He and others examined whether lockdowns were more harmful than the pandemic itself in a 2021 commentary piece in BMJ Global Health . They concluded that “government interventions, even more restrictive ones such as stay-at-home orders, are beneficial in some circumstances and unlikely to be causing harms more extreme than the pandemic itself.” Analyzing excess mortality suggested that “ lockdowns are not associated with large numbers of deaths in places that avoided large COVID-19 epidemics,” such as Australia and New Zealand, they wrote.
Editor’s note: SciCheck’s COVID-19/Vaccination Project is made possible by a grant from the Robert Wood Johnson Foundation. The foundation has no control over FactCheck.org’s editorial decisions, and the views expressed in our articles do not necessarily reflect the views of the foundation. The goal of the project is to increase exposure to accurate information about COVID-19 and vaccines, while decreasing the impact of misinformation.
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Sorrow and stamina, defiance and despair. It’s been a year.
Weeks before American life ground to a halt, the coronavirus was blazing a mostly silent path across the country, burrowing deep into people’s lungs and launching an attack that would expose nationwide vulnerabilities, scar a generation and reshape the world.
For most people, March 11 was when the covid-19 crisis first became real. It was the day of a high-profile diagnosis, major event cancellations and an official designation: pandemic. Schools closed, streets emptied and commuters stayed home.
We didn’t know it then, but the virus already had infected thousands of Americans. Over the next 12 months, leaders bungled opportunities to quell its spread, case levels rose, fell and rose again, hope endured, and more than 525,000 people lost their lives.
Scientists developed vaccines in record time. Misinformation and lies spread as quickly as the pathogen itself. Racial and economic inequalities compounded. A new president was elected.
This timeline, based on data gathered and analyzed by The Washington Post and hundreds of articles written by its journalists, tells the story of a singular period — the year of covid-19.
(Tim Meko/The Washington Post)
March 11 : The World Health Organization declares the novel coronavirus a pandemic . Director General Tedros Adhanom Ghebreyesus says he is “deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.”
Actor Tom Hanks and his wife, Rita Wilson, say they’ve tested positive for the virus while at work in Australia. Hanks is the first American celebrity to announce a diagnosis.
The NBA suspends its season . Most college and pro leagues follow suit. A dozen states close schools. Many people begin working from home. American life grinds to a halt .
March 12 : Anthony S. Fauci, the nation’s top infectious-disease expert, testifies before Congress that the U.S. testing system is not working. “Yeah, it is a failing,” he says. “Let’s admit it.”
March 13 : President Donald Trump declares a national emergency .
March 15 : The Centers for Disease Control and Prevention says Americans should cancel gatherings of 50 or more people for two months. Several states impose shutdown orders , closing bars and restaurants and banning large groups.
March 16 : Trump tells Americans to avoid gathering in groups of more than 10 and to stop eating in restaurants and taking nonessential trips for the next 15 days. It is the closest the federal government will come to calling for a nationwide shutdown.
March 17 : The official U.S. death toll surpasses 100 — and experts predict it will rise quickly.
March 19 : Trump tells Post associate editor Bob Woodward that he has intentionally misled Americans and minimized the danger : “I wanted to always play it down. I still like playing it down, because I don’t want to create a panic,” as Woodward recounts later in his September book.
But it is everywhere. The virus tears through the Seattle region. It’s taking hold in New York City — and in Detroit, Chicago and New Orleans. More than 16,000 people are infected.
March 21 : Nursing homes are the first hot spots . Residents account for at least a quarter of all deaths, and probably more. Once inside, the virus is “an almost perfect killing machine.”
March 23 : Under pressure from conservatives, Trump says he’s considering nixing the guidelines for social distancing he announced a week earlier, saying: “We cannot let the cure be worse than the problem itself.”
March 26 : The United States records its 1,000th official coronavirus death , fewer than 10 days after the toll passed 100. Behind every reported death, every data point on a curve or chart, is a name and a story.
March 28 : Trouble with the national stockpile of emergency medical equipment emerges. State and hospital leaders are unable to secure enough masks, ventilators and other essential gear.
April 2 : Most Americans are living under stay-at-home orders .
April 3 : In a reversal, the federal government recommends that people wear masks in public . Trump emphasizes that mask-wearing is voluntary and says, “I don’t think I’m going to be doing it.”
April 7 : Emerging demographic data confirms that covid-19 is infecting and killing Black Americans at an alarming rate — a devastation that people in predominantly Black communities know all too well.
The virus is spreading at a head-spinning pace. In just one month, the United States has gone from about 1,000 cases to nearly 400,000. Almost 15,000 people are dead — a toll that won’t be fully revealed for weeks. Urban hospitals are nearing capacity.
April 11 : The U.S. coronavirus death toll is the highest in the world, passing Italy .
‘Too much on humanity’
In the epicenter of the epicenter, the noise never stops. On the streets of Elmhurst, Queens, sirens wail day and night as ambulances transport the sick from their homes to the hospital. In one funeral home , the phone rings again and again.
“Christ have mercy,” says Omar Rodriguez, who does embalming at the Gerard J. Neufeld funeral home. Workers are tallying the covid-19 deaths they handled that day.
“It’s too many,” says Joe Neufeld Sr.
Outside Elmhurst Hospital Center — which is “filled to the brim” — Kamal Hossain lists his symptoms : “We cannot breathe properly, we had diarrhea, vomiting. My entire house has the same problem.”
Hossain’s wife works there, and he thinks she brought the virus home. It’s his third time trying to get care at the facility. The line outside stretches for hours. Local leaders are pleading for help.
Outside an overflowing funeral home in Brooklyn, authorities find dozens of bodies stored in moving trucks. For Tamisha Covington, who lost her mother, it is one indignity too many.
“Already, we’re grieving for our mothers, our family members, our friends,” she says. “This is too disrespectful to the dead. This is too disrespectful to us. This is too much on humanity.”
April 16 : Four weeks after Trump declared a national emergency, 22 million Americans have filed for unemployment aid . It’s the steepest level of job loss since the Great Depression.
April 17 : Trump tweets “LIBERATE MINNESOTA,” “LIBERATE MICHIGAN” and “LIBERATE VIRGINIA,” encouraging protesters who are ignoring social distancing guidance and demanding that their states reopen. Shutdown opposition is spreading , aided by Trump and right-wing groups.
April 24 : Georgia Gov. Brian Kemp, a Republican and one of the last leaders to issue a stay-at-home order, allows business to reopen . Georgia is the first state to do so.
Even as Georgia bucks restrictions, rural counties in the state’s southwest are suffering some of the highest rates of covid-19 deaths per capita in the country. In the hardest-hit places, African Americans make up most of the population, and about 30 percent of residents live in poverty.
April 27 : A Post investigation reveals for the first time the scope of the hidden death toll : The United States recorded an estimated 15,400 “excess deaths” in the pandemic’s first weeks — nearly two times as many as were publicly attributed to the virus at the time.
April 29 : At an event with corporate executives, Trump says the virus will vanish: “It’s going to go. It’s going to leave. It’s going to be gone.”
April 30 : The federal government’s social distancing guidelines expire , and most states push ahead with reopening plans.
But the virus is still spreading. Nearly 30,000 people are infected each day, and nearly 2,000 are dying. Every day.
May 1 : From Michigan to California, gun rights supporters, anti-vaccination activists and business owners protest coronavirus restrictions. Some are heavily armed, some are displaying hate symbols.
‘Not afraid to use them’
They show up armed. One man brings a noose. Another, an ax. Others wear combat gear and carry long guns.
Across the country, people are protesting state-mandated shutdowns and social distancing orders — and their rhetoric is increasingly violent.
From the steps of the Michigan Capitol , Stefan Kril calls the governor “a criminal” and, with a snarl, adds that “she’s fired.” He turns to the crowd below and shouts: “Whoever’s in charge of her, fire her ass!”
Two weeks before, hundreds of protesters forced their way into the building, chanting “Our house!” and “Lock her up!” — a strain of anger that grips the world’s attention months later during the deadly siege at the U.S. Capitol.
Elsewhere, people wave signs calling for leaders to be hanged and crowd into local government meetings to accuse officials of “contributing to the demise of what was once the greatest nation in history” but is now “enslaved to a Communist Party.”
One of the men who brought guns into the Michigan Capitol in late April appears on a live stream from inside. “I don’t carry my guns for show. I am not afraid to use them,” William Null says. In five months, the FBI charges him and a dozen others in a plot to kidnap Whitmer.
May 15 : Trump announces his administration’s vaccine development program. He dubs it Operation Warp Speed.
May 19 : Forty-three states have begun at least some form of reopening, hoping to boost their economies. Seven never had stay-at-home orders.
May 24 : The virus is surging across rural America, where populations are poorer, older and more prone to health issues. Rural counties now have some of the highest rates of covid-19 cases and deaths in the country, topping even the hardest-hit New York City boroughs.
May 25 : Crowded beaches, parties and pools during Memorial Day weekend alarm health officials. One calls the scene an “international example of bad judgment.”
May 27 : U.S. coronavirus deaths surpass 100,000 . The toll goes unmarked by national requiem or collective mourning.
May 31 : Millions flood streets across the country to protest the killing of George Floyd and police violence against Black Americans, sparking fears of a new round of virus outbreaks. Health officials will later say that the protests, which continue for days, probably did not cause a spike in cases.
June 3 : A Post investigation finds that U.S. cities squandered early chances to protect Black residents from the virus. Poor data reporting obscured the disproportionate impact , many of the first testing sites were set up in areas with many White residents, and local governments targeted few education campaigns specifically to African Americans.
June 8 : In the West and across the South, more than a dozen states set records for new infections reported. Many of these places had avoided the brunt of the pandemic through the spring.
June 17 : “The numbers are very minuscule compared to what it was,” Trump says . “It’s dying out.”
In mid-June, new infections begin a sharp, month-long rise. Unemployment also hits a new level: 13 straight weeks in which more than 1 million people have filed for aid for the first time.
‘Like I was trapped in a box’
It feels like the walls are closing in. That’s how Jayden, 12, describes living in his parents’ car in Kissimmee, Fla. The pandemic stripped them of jobs and forced them into homelessness, part of an unprecedented wave of people who found themselves suddenly unemployed.
“It felt like I was trapped in a box,” Jayden says. “Like someone tossed me in a cage where the bars were thick, and it was like you can’t even stick your hand through it, and then they locked the cage and then disposed of the key.”
His parents, Sergine Lucien and Dave Marecheau, are trying to get Jayden and his sister a permanent home.
In Atlantic City, Donnell Johnson thought things were about to get better. Once homeless himself, he had a job lined up — but then the virus came and he never got to start .
“It seems like everything that was starting to look up for me and my family drastically changed within one day with this pandemic,” he says.
He’s not getting help from the government and his debt is growing.
“We are struggling,” he says. “There’s nowhere to turn to. Backed up in rent. Cable bill, phone bill, we’re backed up in everything.”
June 25 : Americans are living through a split-screen pandemic. The country records its highest-ever single-day case count , yet leaders push ahead with reopenings.
June 26 : The governors of Texas and Florida reverse course and shut down bars in their states as infections and hospitalizations soar.
July 8: Trump pressures the CDC to change guidance on school reopening and threatens to cut funding for schools that do not fully open for in-person learning.
July 11 : Trump wears a mask in public for the first time, more than three months after his own public health officials recommended face coverings for all Americans.
July 13 : A study finds that more than 5 million Americans lost their health insurance from February to May, the largest such loss in the country’s history.
The United States sets back-to-back records on July 16 and 17, recording nearly 150,000 new infections in 48 hours. Florida, Texas, California, Georgia and Arizona lead the country in reported cases.
July 27 : Two coronavirus vaccines — one from Pfizer-BioNTech and one from Moderna — mark a major milestone: The beginning of 30,000-person trials, the final phase of testing .
July 31 : The official U.S. death toll passes 150,000 , a mark it was never expected to reach. Latinos and Native Americans represent an increasing proportion of the deaths.
Aug 1 : A superintendent of schools in rural Arizona issues one of many warnings from educators thinking about reopening schools: “I’m sorry, but it’s a fantasy. Kids will get sick, or worse. Family members will die. Teachers will die.”
Aug. 3 : Teachers across the country protest school reopenings , carrying symbolic gravestones and caskets. Meanwhile, hundreds of returning students and staff members test positive or enter quarantine, and Trump continues his pressure campaign to resume in-person learning.
Aug. 7 : Nearly 500,000 people converge on Sturgis, S.D., for a 10-day motorcycle rally . Attendees gather in bars, restaurants and tattoo parlors. The virus spreads, and there are additional outbreaks in the Midwest.
Aug. 9 : The school year is underway, but plans everywhere are in flux. Some schools begin online, some in person. Others try a bit of both but change their minds.
Aug. 13 : Democratic presidential nominee Joe Biden calls for a nationwide mask mandate .
Aug. 17 : Kristin Urquiza, whose father died of covid-19, speaks at the Democratic National Convention, furious with Trump and Republican governors who play down the virus. She is one of many turning her grief into action .
Aug. 25 : Universities sound alarms as infections soar on campuses and in surrounding communities nationwide.
Sept. 5 : Epidemiologists predict a cold-weather virus surge : “There is a wave coming, and it’s not so much whether it’s coming, but how big is it going to be?”
But that warning comes as the summer surge relents. On Sept. 8, the country reports fewer than 25,000 new infections for the first time in three months. The plateau will be short-lived. In another three months, the country will report a daily caseload 10 times that number.
Sept. 10 : Trump says the country has “rounded the final turn.” The next day, Fauci contradicts him: “I’m sorry, but I have to disagree with that.”
Sept. 13 : More than 200 meat plant workers have died and federal regulators have issued only two small fines to companies flouting safety rules. An earlier Post investigation found companies failing to contain outbreaks and encouraging some employees to continue working on site even while sick.
‘Are you trying to kill us?’
Jitu Brown says it three times : “We are scrambling in our communities for our lives. For our lives. For our lives.”
Brown, an organizer on Chicago’s South Side, has battled structural racism for years. Now, in the middle of the pandemic, he’s watching the same pattern play out.
“When we talk about racism, you don’t have to go an hour away to another site. You can go one train stop to the next train stop,” he says.
In Chicago, covid-19 is hitting predominantly Black neighborhoods harder than anywhere else, and the city’s African Americans represent a highly disproportionate share of cases and deaths.
From coast to coast, the virus is infecting and killing people of color at alarmingly high rates — a fact that escaped officials in the pandemic’s early months, when governments were not tracking and reporting data by race and ethnicity.
But local leaders like Demetrius Young knew . A city commissioner in Albany, Ga., Young feels abandoned by the state and federal governments. “For Black folks, it’s like a setup,” he says. “Are you trying to kill us?”
In Texas, where Latinos are more likely to be hospitalized or die of the virus than White people, Oralia Soto is infected but doesn’t have time to see a doctor. When she finally does, her condition is dire and she dies days later — one of 15 members of her family that the virus sickens or kills.
“It is just too much to handle,” says Brenda Benitez, Soto’s niece. “I feel numb inside. I just pray.”
Sept. 18 : Emails surface showing Trump political appointees attempting to silence a top CDC official who issued stark warnings about the coronavirus, contradicting the administration. “She is duplicitous,” one wrote.
Sept. 22 : The official U.S. death toll tops 200,000 , with no end in sight. Trump says : “It’s a shame.”
Sept. 26 : More than 150 people pack into the White House Rose Garden to celebrate the nomination of Amy Coney Barrett to the Supreme Court. Few wear masks.
Oct. 2 : Trump says he and first lady Melania Trump have tested positive for the virus . Less than 24 hours later, he is flown to a hospital for treatment.
Oct. 5 : Trump returns to the White House , playing down the virus that put him in the hospital, telling Americans: “Don’t be afraid of Covid.” He received cutting-edge treatment unavailable to nearly everyone else.
Oct. 9 : The Rose Garden ceremony was “ a superspreader event, ” Fauci says, after at least 11 attendees test positive.
Oct. 19 : Trump claims that “people are tired of hearing Fauci and all these idiots” and says journalists covering the pandemic are “dumb bastards.”
Two days before the presidential election, the United States records more than 100,000 new cases in 24 hours for the first time. The same day, in a blitz of campaign rallies, Trump declares at least four times that the country is “rounding the turn” on the pandemic. But worse is still to come.
Nov. 3 : It is Election Day, and many Americans already have cast their ballots in a record-setting, pandemic-spurred wave of early voting.
Nov. 7 : Biden wins the presidential election, officially inheriting the public health crisis as the country enters the worst-yet stretch of the pandemic.
‘Like my life depended on it’
Jimmy Wright is the first in line , 5 a.m., with his doughnuts and coffee — and an oxygen tank. It’s time for early voting in Columbus, Ohio, and even though Wright is fresh off a long-haul battle with covid-19, he’s not going to miss the chance to cast his ballot.
“My lungs are damaged, my breathing is damaged,” Wright says. “I’m just glad to be alive.”
Wright is one of about 94 million Americans who vote early in 2020. On Election Day, more than 60 million others cast ballots, the highest percentage to vote in any election since 1900. Many vote by mail. Others, like Wright, risk their lives going to the polls.
In Chattanooga, Tenn., Shajuana Dawson travels there with her kids . The virus has infected all three of them.
“It’s the sickest I’ve seen my children,” Dawson says. “It makes me so angry that people — especially our politicians — aren’t taking it seriously.”
Rosemarie Waldron drops her ballot off with one hand and waves an American flag with the other. The 88-year-old Rutherford, N.J., resident says she wants a government that will control the pandemic, one that “functions for the welfare of all the people instead of one that just looks out for themselves.”
“I voted,” she says, “like my life depended on it.”
Trump refuses to concede and will insist for months that the election was “rigged.” His scores of lawsuits will be rejected, including at the Supreme Court.
Nov. 9 : Pfizer-BioNTech reports that its vaccine is more than 90 percent effective at protecting people from the virus. A week later, Moderna reports that its vaccine is nearly 95 percent effective, a sign that the country could have two vaccines by the end of the year.
Nov. 19 : The day the death toll reaches 250,000, the CDC urges Americans to avoid travel and gatherings during the Thanksgiving holiday, warning that those activities could supercharge virus spread.
Nov. 23 : Americans don’t listen. Air travel reaches an all-time pandemic high. Exactly two weeks later, the country is recording an average of 200,000 new infections every day — precisely the surge experts feared.
Dec. 8 : Biden announces his plan to address the pandemic during his first 100 days in office, including a federal mask mandate, striking a sharp contrast with the Trump administration.
Dec. 11 : The Food and Drug Administration authorizes the Pfizer-BioNTech vaccine for emergency use, a rare glimmer of hope during one of the pandemic’s darkest hours. Two days later, the first doses of that vaccine are distributed nationwide.
Dec. 14 : More than 300,000 have died, with a quickening pace of death and worse still to come.
California emerges as the new U.S. hot spot, posting record-breaking — and unnerving — numbers: more than 50,000 new infections in a single day. More than 100,000 in 48 hours. A soaring positivity rate. If California were a country, it would be among the world leaders in new cases. “Our hospitals are under siege,” Los Angeles County’s public health chief says.
Dec. 18 : The FDA authorizes Moderna’s vaccine , a turning point that gives the country its second tool to fight the virus. Two days later, the first vials of the Moderna vaccine ship across the country.
‘A small beacon of hope’
At last, good news. Vaccines.
Mary Ellen Day exhales and laughs after the shot hits her arm. People applaud. She tears up.
Day, a nurse at Temple Health in Philadelphia, is among the first to receive a dose of coronavirus vaccine — marking a desperately anticipated moment. A signal that the end may be beginning.
“Nobody was prepared for this,” Day says. “Nobody’s prepared for a pandemic of this magnitude.”
The early days were terrifying. She was working with covid-19 patients and watching her colleagues fall ill. They weren’t sure how it spread, weren’t sure how to protect themselves.
“Thank God we have the vaccination now,” she says. “It’s just taking steps to getting back to a little bit of normalcy.”
Daisy Solares, a respiratory therapist at the University of Maryland Medical System in Baltimore, was taking care of coronavirus patients early on. Then, the virus came for her father.
“It means a lot,” she says after getting inoculated . “Basically, in honor of him.”
There are still many tall hurdles to clear: producing enough doses, distributing them equitably, persuading people to be vaccinated.
But for now, says Justin Chazhikatt at Cedars Sinai in Los Angeles, “This is just a small beacon of hope for the future.”
Dec. 21 : Americans once again ignore pleas to stay home for the holidays. Pre-Christmas travel sets a pandemic record, outpacing Thanksgiving.
Dec. 26 : A more contagious variant of the coronavirus, first found in the United Kingdom, spreads across the world. The United States hasn’t yet reported a case, and experts suggest it may be undetected because of the the country’s glacial pace of genetic sequencing.
Dec. 29 : A growing body of evidence suggests that the virus does not spread much in schools — if the right steps are taken, including mask-wearing, social distancing and ample ventilation.
Dec. 30 : The vaccination campaign is off to a chaotic, confused and slower-than-expected start. The country will fall well short of its goal to distribute 20 million doses by the end of the year.
Jan. 6 : A Trump-supporting mob storms the U.S. Capitol in a failed insurrection that turns deadly. Many among the riotous crowd would later say they were motivated in part by restrictions put in place to curb virus spread.
Jan. 8 : The United States records more than 313,000 new cases in a single day , shattering the previous record and revealing the consequences of holiday travel and gatherings.
The country witnesses the deadliest 48 hours of the pandemic. It sets back-to-back fatality records. At least 8,345 people die, more than doubling the body count of America’s worst calamities: the Battle of Antietam, Pearl Harbor and Sept. 11, 2001.
Jan. 14 : Companies scramble to increase vaccine production , and officials estimate that the United States will have enough doses to inoculate 70 percent of the adult population by the end of July.
Jan 15 : Researchers estimate that the U.K. variant is 50 percent more contagious. The CDC predicts that it will be dominant in the United States within two months, the most dire warning yet about mutations.
Jan. 19 : Covid-19 has now killed more than 400,000 Americans , the milestone coming on the final full day of Trump’s presidency, which will be defined by his mismanagement of the crisis.
Biden opens his inaugural activities with a vigil at the Lincoln Memorial, honoring victims of the pandemic. It’s the country’s first real requiem.
Jan. 20 : In his inaugural address, President Biden pauses for a moment of silence to remember the 400,000 felled by the virus. “We must set aside politics and finally face this pandemic as one nation,” he says. He then signs an executive order mandating masks on all federal property. That day, the virus kills 4,440 more Americans. It is a record.
Jan. 22 : The Biden administration announces plans to open as many as 100 federally run vaccination sites across the country, dramatically expanding the government’s direct role in combating the pandemic.
Jan. 25 : Moderna begins work on a vaccine designed to protect against the variants.
Jan. 26 : Biden says he is close to securing an extra 200 million doses of the two approved coronavirus vaccines, increasing U.S. supply by 50 percent.
Jan. 29 : Clinical trials show a single-shot coronavirus vaccine made by Johnson & Johnson to be effective at preventing illness, hospitalization and death, raising the prospect that a third option could be close to authorization.
Jan. 31 : Essential workers , particularly grocery and food workers, are pushed back in the vaccine line as states prioritize people 65 and older, delaying vaccination for people at the highest risk of exposure.
Feb. 1 : The CDC reports that race and ethnicity data was missing for nearly half of all vaccine recipients, repeating a pattern seen in case and death data and stymieing equity efforts.
Feb. 5 : Preliminary data show a virus variant that originated in South Africa may be able to reinfect people who have recovered from covid-19. Meanwhile, the U.K. variant spreads rapidly in the United States. The variants mean the coronavirus is here to stay as a perennial — albeit, lesser — threat.
Feb. 10 : The CDC’s guidance on mask-wearing changes again, as officials urge Americans to double up to better protect themselves from virus variants.
Feb. 13 : A lack of infrastructure — pharmacies, hospitals, transportation — emerges as a major impediment to distributing vaccines in communities of color.
Feb. 14 : The catastrophic winter wave finally ebbs . Stressed hospitals are finding reprieve and the number of new daily cases falls below 100,000 for the first time since early November.
Feb. 19 : Winter storms batter Texas and much of the country, delaying the distribution of 6 million vaccine doses.
Feb. 23 : The U.S. death toll surpasses 500,000 , a number greater than the combined American losses in combat from the Civil War, World War I and World War II. “The people we lost were extraordinary,” Biden says at a sunset vigil for the dead.
Feb. 25 : The Ad Council launches one of the largest public education efforts in U.S. history, telling the tens of millions of Americans still unsure about vaccination: “It’s Up to You.” More than 50 million Americans have now been vaccinated .
Feb. 26 : Experts begin forecasting a summer that looks somewhat normal — as long as vaccinations continue and variants don’t outrace them.
Feb. 27 : The FDA authorizes the easier-to-use, single-shot Johnson & Johnson vaccine , and the country gets a third tool against the mutating virus. Within 48 hours, shots begin shipping to sites across the country.
March 2 : Biden says the country will have enough vaccine doses for every American adult by the end of May, two months earlier than previously projected. Texas and Mississippi rescind their restrictions, ignoring the warnings of health officials. Gov. Greg Abbott (R) boasts in an all-caps tweet: “Texas is OPEN 100%. EVERYTHING.”
March 4: The Penn Relays, the nation’s oldest and largest track-and-field competition, is canceled for the second year in a row.
March 6 : A record number of Americans — nearly 3 million — receive a coronavirus vaccine , and the country is now averaging more than 2 million doses administered every day.
March 8 : The CDC issues guidance for vaccinated people : grandparents who have received the shot can finally hug their grandchildren.
March 10 : Congress passes a $1.9 trillion pandemic relief bill, sending it to Biden’s desk for signing. The legislation will deliver $1,400 checks to many Americans, a boost in unemployment payments and a raft of other programs in an attempt to hoist the country out of a deep economic hole.
After a year, more than 50,000 new infections are still being reported each day. But some people are acting as though the pandemic has ended — gathering in crowds, tossing masks into burning trash cans. Meanwhile, experts repeat familiar warnings: Beware another surge. There is hope and there is division, clarity and confusion. America ends one year living with a pandemic, unsure what the next will bring.
About this story
Kate Harrison Belz, Rhonda Colvin, Drea Cornejo, Jacqueline Dupree, Alyssa Fowers, Arelis R. Hernández, Jasmine Hilton, Greg Jaffe, Stephanie McCrummen, Zoeann Murphy, Alden Nusser, Skyler Reid, Monica Rodman, Robert Ray and Youjin Shin contributed to this report.
Editing by Ann Gerhart. Copy editing by Paula Kelso. Photo editing by Karly Domb Sadof. Video editing by Reem Akkad and Ashleigh Joplin. Additional editing by Matt Callahan and Courtney Kan. Design and development by Junne Alcantara.
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CDC Museum COVID-19 Timeline
This timeline provides information about select moments in the COVID-19 pandemic in the United States and around the world beginning from its known origins to today.
Late 2019 | Early 2020 | Mid 2020 | Late 2020 | Early 2021 | Mid-2021 | Late-2021 | Early 2022 | Mid 2022
December 12, 2019
A cluster of patients in China’s Hubei Province, in the city of Wuhan, begin to experience the symptoms of an atypical pneumonia-like illness that does not respond well to standard treatments.
December 31, 2019
The World Health Organization (WHO) Country Office in China is informed of several cases of a pneumonia of unknown etiology (cause) with symptoms including shortness of breath and fever occurring in Wuhan, China. All initial cases seem connected to the Huanan Seafood Wholesale Market.
The Huanan Seafood Wholesale Market in Wuhan is closed amid worries in China of a reprise of the 2002–2004 SARS (Severe Acute Respiratory Syndrome Coronavirus or SARS-CoV-1) outbreak.
January 2, 2020
WHO activates its Incident Management Support Team (IMST) across all three organizational levels: Country Office, Regional Office, and Headquarters.
January 3, 2020
China informs WHO that they have identified over 40 cases of pneumonia of unknown etiology.
January 5, 2020
CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) activates a center-level response to investigate this novel pneumonia of unknown etiology.
The genetic sequence for the atypical pneumonia virus, Wuhan-Hu-1, is submitted to the Department of Zoonoses, National Institute of Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, in Beijing, China by Yong-Zhen Zhang of Fudan University, Shanghai. The complete genetic sequence of the virus remains unavailable to the rest of the world as the virus spreads.
January 7, 2020
Public health officials in China identify a novel coronavirus as the causative agent of the outbreak.
CDC establishes an incident management structure to guide their response to the novel coronavirus by following the preparedness plan for developing tests and managing cases made for Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
January 10, 2020
WHO begins using the phrase “2019 Novel Coronavirus” or “2019-nCoV” to refer to disease causing the outbreak in Wuhan, China.
CDC publishes information about the 2019 Novel Coronavirus (2019-nCoV) outbreak caused by the SARS CoV-2 virus on its website.
Edward C. Holmes of the University of Sydney, Australia posts online that the viral genome sequence of the unknown pneumonia causing the outbreak in Wuhan has been uploaded to GenBank as “Wuhan-Hu-1” (MN908947) and will be released shortly. He does so on behalf of Yong-Zhen Zhang of Fudan University, Shanghai in collaboration with the Shanghai School of Public Health, the Central Hospital of Wuhan, Huazhong University of Science and Technology, the Wuhan Center for Disease Control and Prevention, the National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control, and the University of Sydney. Hours later, Holmes and Zhang publish the sequence.
January 11, 2020
WHO tweets that it has received the genetic sequences of the novel coronavirus from China and expects that the information will shortly become publicly available.
CDC updates its Travel Health Notice (THN) system for persons traveling to Wuhan, China to Level 1 or “practice usual precautions.”
China reports the first death from the novel coronavirus and publishes a draft genome of the newly discovered coronavirus suspected of causing the outbreak. By January 12, 2020, four other genomes have been uploaded to the viral sequence database curated by the Global Initiative on Sharing All Influenza Data (GISAID).
January 13, 2020
The Thailand Ministry of Public Health confirms the first laboratory-confirmed case of the SARS-CoV-2 virus outside of China.
January 14, 2020
WHO finds evidence of possible human-to-human transmission of the SARS-CoV-2 virus, but WHO scientists say that human-to-human transmission is not surprising given our knowledge of respiratory pathogens.
January 15, 2020
The Japanese Ministry of Health, Labor and Welfare reports an additional laboratory-confirmed case of the SARS-CoV-2 virus outside of China.
January 17, 2020
CDC begins screening passengers for symptoms of the 2019 Novel Coronavirus on direct and connecting flights from Wuhan, China to San Francisco, California, New York City, New York, and Los Angeles, California and plans to expand screenings to other major airports in the U.S.
January 19, 2020
Worldwide, 282 laboratory-confirmed cases of the 2019 Novel Coronavirus have been reported in four countries: China (278 cases), Thailand (2 cases), Japan (1 case) and the Republic of Korea (1 case).
January 20, 2020
CDC reports the first laboratory-confirmed case of the 2019 Novel Coronavirus in the U.S. from samples taken on January 18 in Washington state and on the same day activates its Emergency Operations Center (EOC) to respond to the emerging outbreak.
January 21, 2020
CDC artists Alissa Eckert and Dan Higgins create “an identity” for the SARS-CoV-2 virus by designing the red and white virus image.
Chinese government officials confirm that human-to-human transmission is driving the spread of the SARS-CoV-2 virus in China.
January 22, 2020
WHO’s International Health Regulation Emergency Committee meets and decides to not declare the 2019 Novel Coronavirus a Public Health Emergency of International Concern (PHEIC). Instead, the committee decides to monitor the situation and reconvene in 10 days to re-evaluate.
January 23, 2020
Wuhan, China— a city of 11 million people— is placed under lockdown due to the 2019 Novel Coronavirus outbreak.
January 24, 2020
CDC confirms a travel-related infection of the SARS-CoV-2 virus in Illinois, bringing the total number of cases in the U.S. to two.
January 26, 2020
CDC confirms additional travel-related infections of the SARS-CoV-2 virus in Arizona and California, bringing the total number of cases in the U.S. to five.
January 27, 2020
The U.S. Food and Drug Administration (FDA) announces that it will take “critical actions to advance development of novel coronavirus medical countermeasures” with interagency partners, including CDC.
January 28, 2020
CDC issues a Level 3 Travel Health Notice— advising travelers to avoid all non-essential travel to China due to the 2019 Novel Coronavirus outbreak.
The U.S. government relocates U.S. citizens from Wuhan, China back to the U.S. due to the 2019 Novel Coronavirus (2019-nCoV).
January 29, 2020
A team of CDC medical officers meets the flight carrying the repatriated U.S. citizens from Wuhan, China at the March Air Reserve Base in California to screen the passengers for symptoms of the SARS-CoV-2 virus.
January 30, 2020
CDC confirms that the SARS-CoV-2 virus has now spread between two people in Illinois with no history of recent travel. This is the first recorded instance of person-to-person spread of the 2019 Novel Coronavirus in the U.S and brings the total number of cases up to seven.
January 31, 2020
CDC issues 14-day federal quarantine orders to all 195 U.S. citizens who were repatriated back to the U.S. on January 29, 2020, from Wuhan, China.
WHO’s International Health Regulation Emergency Committee reconvenes early to declare the 2019 Novel Coronavirus outbreak a Public Health Emergency of International Concern (PHEIC).
The Secretary of the Department of Health and Human Services (HHS), Alex Azar, declares the 2019 Novel Coronavirus (2019-nCoV) outbreak a public health emergency.
February 3, 2020
The Department of Homeland Security (DHS) directs all flights from China and all passengers who have traveled to China within the last 14 days to be routed through one of eleven airports in the U.S. for enhanced screening procedures and possible quarantine. U.S. citizens who have been in Hubei province within 14 days of their return are subject to up to 14 days of mandatory quarantine;, U.S. citizens who have been in other areas of mainland China within 14 days of their return are subject to 14 days of self-quarantine with health monitoring;, and foreign nationals (other than immediate family of U.S. citizens, permanent residents, and flight crew) who have traveled in China (excluding Hong Kong and Macau) within 14 days of their arrival, will be denied entry into the U.S.
CDC submits an emergency use authorization (EUA) to FDA to expedite approval for a CDC developed SARS-CoV-2 diagnostic test.
February 4, 2020
FDA approves the EUA for the CDC developed SARS-CoV-2 diagnostic test kit.
February 5, 2020
CDC begins shipping its laboratory test kit to detect the SARS-CoV-2 virus, “CDC 2019-nCoV Real Time RT-PCR,” to select domestic and international laboratories.
CDC medical officer teams meet additional planes carrying passengers from Wuhan, China at Travis Air Force Base in Sacramento, CA, Marine Corps Air Station Miramar in San Diego, CA, Lackland Air Force Base in San Antonio, TX, and Eppley Airfield in Omaha, NE to screen the passengers for the symptoms of the 2019 Novel Coronavirus (2019-nCoV). All passengers are placed under mandatory 14-day quarantine orders.
February 8, 2020
Some of the first CDC test kits for detecting the SARS-CoV-2 virus arrive at a public health laboratory in east Manhattan, New York City, N.Y. The laboratory reports that the tests produce “untrustworthy results.”
February 10, 2020
Worldwide deaths from the 2019 Novel Coronavirus reach 1,013. The SARS-CoV-2 virus has now killed more people than the severe acute respiratory syndrome (SARS-CoV-1) outbreak, which claimed 774 lives globally from November 2002 to July 2003.
February 11, 2020
WHO announces the official name for the disease that is causing the 2019 Novel Coronavirus outbreak: “COVID-19.” The new name of this disease is an abbreviated version of “Coronavirus Disease 2019.”
February 13, 2020
CDC confirms the 15th case of COVID-19 in the U.S.
February 18, 2020
Due to the high case load and numbers of asymptomatic individuals testing positive for COVID-19, all passengers and crew of the Diamond Princess cruise ship are quarantined off the coast of Japan, placed under travel restrictions, and are prevented from returning to the U.S. for at least 14 days after they have left the Diamond Princess.
February 23, 2020
As Italy becomes a global COVID-19 hotspot, the Italian government issues Decree-Law No. 6, containing urgent measures to contain and manage the epidemiological emergency caused by COVID-19, effectively locking down the country.
February 25, 2020
CDC’s Dr. Nancy Messonnier, the incident manager for the COVID-19 response, holds a telebriefing and braces the nation to expect mitigation efforts to contain the SARS-CoV-2 virus in the U.S. that may include school closings, workplace shutdowns, and the canceling of large gatherings and public events, stating that the “disruption to everyday life may be severe.”
February 28, 2020
CDC reports four additional presumptive positive cases of COVID-19 in California, Oregon, and Washington: one case is likely travel-related, but three are likely due to community spread of the SARS-CoV-2 virus in the U.S.
February 29, 2020
CDC updates its Criteria to Guide Evaluation and Testing of Patients Under Investigation (PUI) for COVID-19 to any patients with a severe respiratory illness even in the absence of travel history to affected areas or known exposure to another case to prepare for possible widespread person-to-person transmission.
FDA announces a “new policy…for certain laboratories that develop and begin to use validated COVID-19 diagnostics before FDA has completed review of their emergency use authorization (EUA) requests,” allowing laboratories to create tests to address testing shortages in the U.S.
CDC and the Washington Department of Public Health report the first death in an individual with laboratory-confirmed COVID-19 in the U.S. The patient was a male in his 50s who was hospitalized with a pneumonia of unknown cause and later died of his illness.
March 1, 2020
CDC creates a hospitalization surveillance network for the SARS-CoV-2 virus called “COVID-NET” to track the numbers and rates of COVID-19 hospitalizations by modifying existing respiratory virus surveillance networks that monitor for hospitalizations associated with influenza and Respiratory Syncytial Virus (RSV).
March 3, 2020
CDC reports 60 cases of COVID-19 across Arizona, California, Florida, Georgia, Illinois, Massachusetts, New Hampshire, New York, Oregon, Rhode Island, Washington, and Wisconsin. Of the 60 COVID-19 infections detected, 21 are travel-related, 11 are from person-to-person spread, and 27 are unknown.
March 6, 2020
The Grand Princess cruise ship is stranded off the California coast after officials learn that a California man who had traveled on the ship last month contracted COIVID-19 and died. The California Air National Guard drops off a limited supply of testing kits by helicopter; more than 3,500 people are aboard the ship, but only 46 are able to be tested and 21 (mostly crew members) test positive.
March 11, 2020
After more than 118,000 cases in 114 countries and 4,291 deaths, the WHO declares COVID-19 a pandemic.
March 12, 2020
FDA no longer requires CDC to perform confirmatory testing for a positive COVID-19 diagnosis.
March 13, 2020
The Trump Administration declares a nationwide emergency and issues an additional travel ban on non-U.S. citizens traveling from 26 European countries due to COVID-19.
March 14, 2020
CDC issues a “no sail order” for all cruise ships— calling for them to cease activity in all waters that the U.S. holds jurisdiction over.
March 15, 2020
States begin to implement shutdowns in order to prevent the spread of COVID-19. The New York City public school system— the largest school system in the U.S., with 1.1 million students— shuts down, while Ohio calls for restaurants and bars to close.
March 16, 2020
CDC launches “Clara-Bot,” a COVID-19 symptom checker, on its website.
New and old guidelines begin circulating among state health departments for who gets critical care in the event of ventilator shortages: Massachusetts and Pennsylvania use a point system prioritizing patients by likelihood of benefitting from ICU care, while New York’s 2015 plan relies on “exclusion criteria”— a list of medical conditions that would make a patient ineligible, like traumatic brain injury, severe burns, or cardiac arrest. Alabama’s exclusion criteria list, released in 2010 and since removed from publication, included both “severe or profound mental retardation” and “moderate to severe dementia.”
March 17, 2020
Moderna Therapeutics begin the first human trials of a vaccine to protect against COVID-19 at a research facility in Seattle, Washington.
The University of Minnesota launches a clinical trial testing hydroxychloroquine, an FDA-approved drug for the prevention and treatment of malaria, for the treatment of COVID-19.
The Centers for Medicare & Medicaid (CMS) temporarily expands telehealth benefits, enabling beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility.
March 19, 2020
CDC asks healthy people to donate blood if they are able amid a national shortage of blood during the COVID-19 pandemic.
California governor Gavin Newsom issues a statewide stay-at-home order to slow the spread of COVID-19 instructing residents to only leave their homes when necessary and shutting down all but essential businesses.
March 27, 2020
The Trump Administration signs the Coronavirus Aid, Relief, and Economic Security (CARES) Act into law. The act includes funding for $1,200 per adult (with expanded payments for families with children), expanded unemployment benefits, forgivable small business loans, loans to major industries and corporations, and expanded funding to state and local governments in response to the economic crisis caused by COVID-19.
Apple, in partnership with HHS, CDC, and the White House Coronavirus Task Force, releases an app with a COVID-19 symptom and exposure questionnaire telling people how to isolate and monitor symptoms and giving recommendations on testing and when to contact a medical provider if they believe they have contracted or have been exposed to the SARS-CoV-2 virus.
March 28, 2020
To prevent the spread of COVID-19, the White House extends all social distancing measures until through the end of April 2020.
FDA issues an EUA to allow hydroxychloroquine sulfate and chloroquine phosphate products to be added the Strategic National Stockpile for the treatment of COVID-19.
CDC distributes a Health Alert Network (HAN) warning against using chloroquine phosphate without the recommendation of a doctor or pharmacy after one person is made seriously ill and a second dies from ingesting non-pharmaceutical chloroquine phosphate (a chemical aquariums use that is commercially available for purchase at stores or online) to prevent or treat COVID-19.
CDC issues a domestic travel advisory for New York, New Jersey, and Connecticut due to high community transmission of COVID-19 in those states, urging residents to refrain from all non-essential domestic travel for at least 14 days, effective immediately.
March 31, 2020
At a White House Press Briefing, Dr. Anthony Fauci and Dr. Deborah Brix announce that between 100,000 and 240,000 deaths in the U.S. are expected— even if social distancing and public health measures are perfectly enacted.
The Journal of the American Medical Association Ophthalmology reports that COVID-19 can be transmitted through the eye. One of the first warnings of the emergence of the SARS-CoV-2 virus came late in 2019 from a Chinese ophthalmologist treating patients in Wuhan, Li Wenliang, MD, who died at age 34 from COVID-19.
April 3, 2020
At a White House press briefing, CDC announces new mask wearing guidelines and recommends that all people wear a mask when outside of the home.
CDC warns the public about phone scams and phishing attacks that appear to originate from CDC and ask for donations from individuals. This is government impersonation fraud— federal agencies do not request donations from the public.
April 23, 2020
Using funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CDC announces $631 million to fund and expand the existing Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC), allowing state health departments to expand their capacity for the testing, contact tracing, and containment of COVID-19.
April 4, 2020
CDC launches a new weekly SARS-CoV-2 virus surveillance report called “COVIDView” summarizing weekly data on COVID-19 hospitalizations, deaths, and testing.
More than 1 million cases of COVID-19 had been confirmed worldwide, a more than ten-fold increase in less than a month.
April 6, 2020
Hundreds of doctors and civil rights groups urge CDC and the U.S. government to release race and ethnicity data on COVID-19 case-numbers in order to reveal the true impact of the virus on communities of color.
April 7, 2020
Data from the Chicago Department of Public Health reported by the Chicago Tribune shows that despite being about 30% of the total population, Black people account for 68% of the COVID-19 related deaths in Chicago and are dying of COVID-19 at a rate nearly six-times greater than that of White Chicagoans, who account about 33% of the population and approximately 14% of deaths. These numbers illuminate for many the racial disparities of the COVID-19 pandemic in the U.S.
HHS announces $186 million in additional funding to state and local jurisdictions for the COVID-19 response.
April 8, 2020
HHS announces first contract for ventilator production under the Defense Production Act with General Motors.
April 9, 2020
CDC modifies and extends the no sail order for all cruise ships.
April 10, 2020
With over 18,600 confirmed deaths and more than 500,000 confirmed cases in under four months, the U.S. is the country with the most reported COVID-19 cases and deaths, surpassing Italy and Spain as a global hot-spot for the virus.
With 159,937 confirmed cases, New York State now has more reported cases of COVID-19 than Spain (153,000), Italy (143,000), or China (82,000). Amid critical hospital bed and ventilator shortages, aerial images emerge of workers in hazmat suits burying coffins in mass graves at Hart Island off the Bronx, an area used for over 150 years by New York City officials as a mass burial site for those with no next-of-kin or who cannot afford funerals.
April 13, 2020
Most states in the U.S. report widespread cases of COVID-19.
At a White House press briefing, President Trump announces that the U.S. will cease contributing funding to the WHO, shaking the global public health community.
April 16, 2020
The Trump Administration releases a plan outlining how states should reopen, calling for states or metropolitan areas to meet benchmarks like reducing COVID-19 cases or deaths before reopening or stopping mitigation strategies (like required masking), also known as “gating
April 20, 2020
As the COVID-19 pandemic grows, shortages of personal protective equipment (PPE) like gowns, eye shields, masks, and even body bags, become dire– particularly in New York
April 22, 2020
After two pet cats in separate areas of New York state test positive for the SARS-CoV-2 virus, CDC recommends that people restrict their pets’ interactions with other people or animals outside their household to prevent the spread of COVID-19.
April 24, 2020
Georgia, Alaska, and Oklahoma begin to partially reopen their states despite concerns from health experts saying it was too early to reopen.
April 26, 2020
Clinicians in the U.S. and U.K. report clusters of children and adolescents requiring admission to intensive care units (ICUs) with a multisystem inflammatory condition that can lead to multiorgan failure— similar to Kawasaki disease and toxic shock syndrome. This condition will become known as Multisystem Inflammatory Syndrome in Children (MIS-C), a serious inflammatory condition that affects children with current or recent COVID-19 infections.
April 28, 2020
Polls show that many people in the U.S., particularly those ages under 30 years or making less than $40,000 per year, plan to defer medical care because of the cost of treatment due to the lack of insurance or being under-insured, potentially leading to the further spread of COVID-19, the under-reporting of case numbers, and excess deaths from COVID-19 and other preventable diseases.
April 30, 2020
The Trump Administration launches Operation Warp Speed, an initiative to produce a vaccine against the SARS-CoV-2 virus as quickly as possible. The operation funds the development of six promising vaccine candidates while they are still in the clinical trial phase, including the Pfizer-BioNTech and Moderna mRNA vaccines.
Since mid-March 2020, more than 26.5 million people in the U.S. have filed for unemployment, increasing the number of people without health insurance amid a pandemic.
May 1, 2020
FDA issues an emergency use authorization (EUA) for the use of the antiviral drug Remdesivir for the treatment of suspected or confirmed COVID-19 in people who are hospitalized with severe disease.
CDC develops the “PPE Burn Rate Calculator,” a spreadsheet-based model made to help healthcare facilities plan and optimize the use of personal protective equipment or PPE for the COVID-19 response and publishes it on the Apple and Android App stores.
CDC launches the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES), a national network to provide real-time genomic sequencing data to public health response teams investigating COVID-19 cases, allowing them to track the SARS-CoV-2 virus as it evolves.
As some countries discuss re-opening, WHO convenes the International Health Regulation Emergency Committee for a third time and declares that the global COVID-19 pandemic remains a Public Health Emergency of International Concern (PHEIC).
May 8, 2020
The Associated Press reports that top White House officials blocked a CDC document “Guidance for Implementing the Opening Up America Again Framework” that included detailed advice on how to safely reopen the country.
FDA authorizes the first COVID-19 test with the option of using home-collected saliva samples.
May 9, 2020
The unemployment rate in the U.S. is 14.7%— the highest since the Great Depression. With 20.5 million people out of work, the hospitality, leisure, and healthcare industries take the greatest hits overall, affecting essential workers, people with lower incomes, and racial and ethnic minority workers disproportionally.
May 11, 2020
President Trump holds a briefing in the White House Rose Garden to claim that anyone who wants to get a coronavirus test can get one and encourages businesses around the country to reopen. He does not wear a mask.
May 12, 2020
Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases (NIAID), testifies before the U.S. Senate that experts believe more people have died from COVID-19 than have been officially reported and warns against “re-opening” too quickly.
May 15, 2020
New estimates from a University of Michigan study revise the survival rate for people with COVID-19 who are put on a ventilator from as low as 10% – 12% to between 25% – 50%.
CDC’s Chief Health Equity Officer officially joins CDC’s COVID-19 response. This is the first time in the agency’s history that a senior leader within the incident management structure has the sole purpose of advocating for greater health equity across an entire emergency response.
CDC distributes a warning for clinicians through the Health Alert Network describing Multisystem Inflammatory Syndrome in Children (MIS-C), a serious inflammatory condition that affects children with current or recent COVID-19 infections.
May 18, 2020
HHS awards states, territories, and local jurisdictions $11 billion in new funding to support testing for COVID-19: CDC will provide $10.25 billion to states, territories, and local jurisdictions through CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) and the Indian Health Service (IHS) will provide $750 million to IHS, tribal, and urban Indian Health programs to expand testing capacity.
Navajo Nation now has the highest COVID-19 infection rate per capita in the U.S.
May 21, 2020
AstraZeneca receives more than $1 billion from the U.S. government in funding for the development of the AstraZeneca/Oxford University COVID-19 vaccine, with the first doses due to arrive in September 2020.
May 22, 2020
The Lancet publishes a large study showing that COVID-19 patients who received the anti-malaria drug hydroxychloroquine die at higher rates and experience more cardiac complications than COVID-19 patients who do not receive the drug. This study will shortly be retracted due to data misuse, but multiple other studies have since shown that hydroxychloroquine is neither harmful nor beneficial in the treatment of COVID-19.
May 26, 2020
Navajo officials implement a series of mitigation efforts including extended weekend lockdowns, curfews, stay-at-home orders, masking, and checkpoints, as younger generations of Navajo begin to launch grassroots social media campaigns like “Protect the Sacred” to provide health information and help defend their people and cultural heritage from COVID-19— the Navajo become a model for implementing a unified pandemic response.
May 28, 2020
The recorded death toll from COVID-19 in the U.S. surpasses 100,000.
June 4, 2020
HHS announces new laboratory date reporting guidance for COVID-19 testing to include demographic data on race, ethnicity, age, and sex.
The Lancet and the New England Journal of Medicine retract the two publications that halted global trials of the antimalarial drug hydroxychloroquine for the treatment of COVID-19 after investigations found inconsistencies in the data.
June 8, 2020
The World Bank states that the COVID-19 pandemic will plunge the global economy into the worst recession since World War II.
June 10, 2020
The number of confirmed COVID-19 cases in the U.S. surpasses 2 million.
June 13, 2020
CDC releases consolidated guidelines for COVID-19 testing— including for nursing homes, long-term care facilities, and high-density critical infrastructure workplaces, like food production facilities.
June 15, 2020
FDA rescinds the EUA that allowed hydroxychloroquine sulfate and chloroquine phosphate products to be donated to the Strategic National Stockpile for the treatment of COVID-19.
June 16, 2020
HHS announces that COVID-19 vaccines will be provided free of charge to older adults and other groups experiencing disproportionate impacts from the COVID-19 pandemic.
June 18, 2020
WHO halts its trial of hydroxychloroquine after a large, randomized study conducted in the U.K. found that the drug had no apparent effect on mortality when treating COVID-19.
June 22, 2020
The journal Science Translational Medicine releases a study suggesting that as many as 80% of the Americans who sought care for flu-like illnesses in March 2020 were likely infected with undetected COVID-19.
June 24, 2020
Three weeks after Black Lives Matter protests broke out across the country in the wake of the deaths of George Floyd and Breonna Taylor, data from 300 of the largest U.S. cities found no evidence of a COVID-19 spike in the weeks following the beginning of the protests— researchers determined that social distancing behaviors went up as people tried to avoid the protests.
June 25, 2020
CDC expands the list of people at increased risk for severe COVID-19 illness by removing the specific age threshold, instead noting that risk increases with age. CDC also includes people experiencing chronic kidney disease, COPD, obesity, serious heart conditions, sickle cell disease, and type 2 diabetes, and those who are immunocompromised from solid organ transplants.
June 29, 2020
Despite its development and clinical trials being supported by as much as $6.5 billion in public funds, Gilead Sciences sets the price of Remdesivir, an anti-viral used to treat COVID-19 that can shorten hospital stays and reduce the need for mechanical ventilation, at $3,120 for one typical treatment course ($520 per vial) for insured patients in the U.S.
June 30, 2020
Dr. Anthony Fauci warns a Senate committee that the number of new COVID-19 cases in the U.S. could soon rise from 40,000 to 100,000 new infections every day, likely overwhelming an already burdened healthcare system.
July 6, 2020
More than 200 scientists sign an open letter asking WHO to update its COVID-19 guidelines to include warnings about airborne transmission.
July 7, 2020
The number of confirmed COVID-19 cases in the U.S. surpasses 3 million.
The U.S. begins the process of withdrawing from WHO.
July 9, 2020
WHO announces that the SARS-CoV-2 virus that causes COVID-19 can be transmitted through the air and is likely being spread by asymptomatic individuals.
July 14, 2020
CDC again calls on all people to wear cloth face masks when leaving their homes to prevent the spread of COVID-19, calling masks “a critical tool in the fight against COVID-19.”
Florida, Texas, Oklahoma, Mississippi, North Carolina, South Carolina, and Georgia have both the greatest percentage of adults who are currently uninsured and the highest numbers of new COVID-19 cases.
July 15, 2020
A mandate from the Trump Administration directs hospitals nationwide to stop sending critical information about COVID-19 hospitalization rates and equipment availability to CDC and instead report this data to a new system set up by HHS using a private contractor, raising concerns over the politicization of public health, data, and privacy.
July 16, 2020
Many states, including California, Michigan, and Indiana postpone re-opening plans as COVID-19 case numbers rise.
The U.S. reports a record number of COVID-19 infections in a single day, with 75,600 new cases reported.
CDC extends the no sail order for all cruise ships through September 30, 2020.
July 22, 2020
The Department of Defense (DOD) and HHS reach a deal with Pfizer BioNTech for the delivery and distribution of 100 million doses of the Pfizer BioNTech COVID-19 vaccine candidate in December 2020, upon confirmation that the vaccine is safe and effective.
Antibody data examined by CDC shows that there were about 10 times more SARS-CoV-2 infections than first reported in March 2020 – May 2020 (depending on the region, there were 6 to 24 times more cases than were initially reported).
July 23, 2020
CDC releases resources for school administrators, teachers, parents, guardians, and caregivers to help build appropriate public health strategies to slow the spread of COVID-19 in a school environment.
August 4, 2020
A study finds that more than 50% of all people living in rural areas in the U.S. have no intensive care unit (ICU) beds available (only 3% of the communities with higher incomes had no ICU beds). High rates of COVID-19 infections, chronic health conditions, limited testing, and inadequate access to healthcare could all lead to significant COVID-19 mortality among people living in rural communities.
August 11, 2020
The Trump Administration agrees to pay $1.5 billion, or $15 per-dose, to Moderna for 100 million doses of COVID-19 vaccine.
August 12, 2020
Obesity is found to increase the risk of mortality from COVID-19 disease, especially among men and younger people– even when isolated from racial, ethnic, or socioeconomic disparities.
August 14, 2020
CDC reports results from a representative panel survey on mental health conducted among adults across the U.S. in June of 2020: 41% of responders reported struggling with mental health and 11% had seriously considered suicide recently. Essential workers, unpaid caregivers, young adults, and racial and ethnic minority groups were found to be at higher risk for experiencing mental health struggles, with 31% of unpaid caregivers reporting considering suicide.
CDC releases data indicating that most COVID-19 positive people are infectious to others for up to 10 days after symptoms first appear, but that individuals with severe illness or who are immunocompromised may be infectious for up to 20 days.
August 15, 2020
FDA issues an EUA to the Yale School of Public Health for its rapid diagnostic test for COVID-19 SalivaDirect. The test uses a new and more flexible method of containing and processing saliva samples when testing for COVID-19, allowing laboratories to increase capacity and efficiency in testing.
August 17, 2020
COVID-19 becomes the 3rd leading cause of death in the U.S. Deaths from COVID-19 now exceed 1,000 per day and nationwide cases exceed 5.4 million.
August 19, 2020
After CDC studies show that American Indians and Alaska Natives are among the racial and ethnic minority group at higher risk for severe COVID-19 outcomes, CDC provides more that $200 million in COVID-19 funding to Indian Country.
August 22, 2020
A study published by the Journal of the American Medical Association calls into question the clinical benefits of the anti-viral drug Remdesivir being used to treat patients hospitalized with COVID-19.
August 23, 2020
FDA issues an EUA for use of convalescent plasma (the liquid component of blood that, when taken from someone who has recently recovered from an infection, can contain antibodies to that illness) to treat people hospitalized with severe COVID-19.
August 24, 2020
The first documented case of COVID-19 reinfection is confirmed by the University of Hong Kong.
August 26, 2020
FDA issues an EUA for Abbott’s BinaxNOW Covid-19 Test Kit— a rapid antigen test that can detect a COVID-19 infection in 15 minutes using the same technology as a flu test.
August 28, 2020
The first documented case of COVID-19 reinfection in the U.S. is confirmed by the Nevada State Public Health Laboratory.
September 1, 2020
The U.S. and China decline to join the COVID-19 Vaccine Global Access Facility, or COVAX, a global program spearheaded by WHO that aims to develop and distribute COVID-19 vaccines worldwide— more than 170 other nations sign on.
September 3, 2020
The Journal of the American Medical Association and WHO now recommend the use of steroids for the treatment of severe COVID-19 disease after multiple studies find that steroids like dexamethasone, hydrocortisone, and methylprednisolone— a group of cheap and widely available drugs that reduce inflammation and immune response— can reduce mortality in severe cases of COVID-19 by up to 36%.
September 11, 2020
CDC releases data in a Morbidity and Mortality Weekly Report (MMWR) showing that because of concerns about COVID-19, an estimated 41% of U.S. adults had delayed or avoided seeking medical care, including urgent or emergency care. Unpaid caregivers for adults, people with underlying medical conditions, Black adults, non-White Hispanic adults, young adults, and people with disabilities are the most affected.
September 14, 2020
CDC ends the symptom-based COVID-19 screenings of air travelers from China (including Hong Kong and Macau), Iran, the Schengen area of Europe (26 European countries that have officially abolished all passport and all other types of border control at their mutual borders), and the U.K., citing limited effectiveness due to asymptomatic spread.
Pfizer BioNTech expands phase 3 clinical trials of its COVID-19 vaccine to 44,000 participants— increasing the trial population diversity to include adolescents as young as 16 years and people with chronic, stable HIV, hepatitis C, or hepatitis B infections. The Pfizer/BioNTech vaccine is a 2-shot series given 3 weeks apart and must be stored at a temperature of –70 degrees Celsius (or –94 degrees Fahrenheit).
September 15, 2020
CDC releases data in MMWR from a study showing that people who recently tested positive for the SAR-CoV-2 virus were more than twice as likely to have recently dined out and more than four times as likely to have recently visited a bar or café.
CDC releases an infographic guide to help schools mitigate COVID-19 transmission in schools.
September 16, 2020
HHS announces a plan to make COVID-19 vaccines free in the U.S.
September 21, 2020
Johnson & Johnson begins phase 3 clinical trials of its COVID-19 vaccine with 60,000 participants. The J&J vaccine does not need to be frozen and may require just one shot.
September 22, 2020
The reported death toll in the U.S from COVID-19 surpasses 200,000.
September 23, 2020
HHS and CDC awards states, territories, and local jurisdictions $200 million from the Coronavirus Aid, Relief, and Economic Security (CARES) Act in new funding to support vaccine distribution for COVID-19.
September 28, 2020
The reported death toll from COVID-19 reaches more than 1 million worldwide— in just 10 months.
September 30, 2020
CDC extends the no sail order for all cruise ships through October 31, 2020.
October 2, 2020
President Trump tests positive for the SARS CoV-2 virus and is treated at Walter Reed National Military Medical Center with antiviral drugs, including Remdesivir.
October 5, 2020
More staff at the White House, including the press secretary, test positive for COVID-19.
CDC updates its “How COVID-19 is Spread” guidelines to acknowledge the potential for the airborne spread of the COVID-19 virus— even when 6 feet of social distance is maintained if the area is poorly ventilated or enclosed and activities occur that require heavy breathing, like singing or exercise.
October 6, 2020
Food insecurity in the U.S. reaches 52 million people due to the COVID-19 pandemic— 17 million more people than pre-pandemic numbers.
October 7, 2020
New Zealand lifts restrictions and declares COVID-19 “beaten” after a cluster of 179 cases in Auckland (the country’s largest outbreak yet) is fully contained.
October 30, 2020
CDC announces the end of the no sail order for cruise ship companies, replacing it with a conditional sail order that requires companies to meet testing and safety requirements and to test those rules on simulated voyages before cruises resume.
November 4, 2020
One day after the presidential election, the U.S. reports 100,000 new cases of COVID-19 in 24 hours.
November 9, 2020
FDA issues an EUA for Eli Lilly’s drug Bamlanivimab, a monoclonal antibody treatment that mimics the immune system’s response to infection with SARS-CoV-2 and appears to protect patients at increased risk from a COVID-19 infection progressing to more severe forms of disease.
November 11, 2020
The journal Nature releases a study showing that most COVID-19 cases originate at indoor gathering spaces— places of worship, restaurants, gyms, and grocery stores. Areas of lower socioeconomic status were found to be at much greater risk: many residents are essential workers or cannot work from home and public spaces in these areas tend to be scarcer and more densely populated. The study’s model suggested that a trip to a grocery store would be about twice as risky in a neighborhood of lower incomes as in one of higher incomes.
November 13, 2020
Two weeks after large groups gathered for Halloween celebrations, COVID-19 case numbers spike across the U.S.
November 16, 2020
Moderna’s COVID-19 vaccine is found to be 95.4% effective in its clinical trial.
November 17, 2020
Dr. Anthony Fauci discusses the need to understand the “long COVID” symptoms like persistent fatigue, shortness of breath, muscle aches, sporadic fevers, and concentration issues, that as many as one-third of patients experience for weeks or months after contracting COVID-19.
November 18, 2020
Pfizer-BioNTech’s COVID-19 vaccine is found to be 95% effective in their 44,000-person trial.
November 20, 2020
As COVID-19 case numbers in the U.S. surge past 11 million, CDC recommends that Americans stay home for Thanksgiving and avoid contact with all people not living in their household for the last 14 days.
November 21, 2020
CDC revises the Travel Health Notice system for COVID-19; adding a fourth alert level (low, moderate, high, and very high) and recommending that all travelers test 1-3 days before and 3-5 days after all international air travel in addition to staying home for 7-14 days after travel to avoid transmitting the SARS-CoV-2 virus.
November 23, 2020
FDA grants an EUA for a COVID-19 antibody treatment manufactured by Regeneron. In a clinical trial of 800 people, the drug significantly reduced virus levels within days.
December 3, 2020
ACIP recommends that healthcare professionals and older people living in long-term care facilities be offered a vaccine first in the initial phases of the COVID-19 vaccination program. CDC also notes that people ages 70 years and older who live in multi-generational households should be given priority as soon as more vaccine doses are available
December 11, 2020
FDA issues an EUA for the Pfizer-BioNTech COVID-19 vaccine.
ACIP recommends the Pfizer-BioNTech COVID-19 vaccine for all people ages 16 years or older for the prevention of COVID-19
December 14, 2020
The recorded death toll from COVID-19 in the U.S surpasses 300,000.
Sandra Lindsay, a nurse in New York, becomes the first American outside of clinical trials to receive a COVID-19 vaccine.
The U.K. announces the detection of a new and more contagious COVID-19 variant, B.1.1.7.
December 17, 2020
CDC records the highest number of drug overdose deaths ever in a 12-month period ending in May 2020 in the U.S.—more than 81,000. Overdose deaths involving synthetic opioids (primarily illicitly manufactured fentanyl) increased by 38%, methamphetamines by 35%, and cocaine (likely linked to co-use or contamination of cocaine with illicitly manufactured fentanyl or heroin) by 27%.
December 18, 2020
FDA issues an EUA for the Moderna COVID-19 vaccine.
December 19, 2020
ACIP recommends the Moderna COVID-19 vaccine in persons ages 18 years or older for the prevention of COVID-19.
December 22, 2020
CDC releases a report in MMWR outlining the ACIP’s recommendations for the “phases” of COVID-19 vaccination allocation while supply is still limited in the U.S. The suggested model for efficient and equitable vaccination distribution: phase 1a – healthcare personnel and residents of long-term care facilities; phase 1b – essential workers and all persons ages 75 years and older; phase 1c – all persons ages 65–74 and all persons ages 16–64 with a medical condition that increases their risk of severe disease from COVID-19; phase 2 – all persons ages 16 years and older not already recommended in phase 1.
December 23, 2020
The Trump Administration announces the purchase of 100 million additional doses of the Pfizer-BioNTech COVID-19 vaccine.
December 24, 2020
More than 1 million COVID-19 vaccine doses have been administered in the U.S. in just 10 days: healthcare workers and older adults living in long-term care facilities are the first to be vaccinated with the goal of vaccinating every person as soon as enough vaccine doses are available
December 27, 2020
The Trump Administration signs the second COVID Relief Act into law. The bill includes $900 billion in funding for enhanced unemployment benefits, business loans, the purchase and distribution of COVID-19 vaccines and testing kits, and direct cash payments of $600.
December 28, 2020
Proof of a negative COVID-19 test taken within 72 hours of departure is mandated for all foreign national travelers entering the U.S. from the U.K. due to the highly transmissible COVID-19 B.1.1.7 / “Alpha” variant circulating in the U.K.
December 29, 2020
The first case of the COVID-19 B.1.1.7 / “Alpha” variant is detected in the U.S. by the Colorado Department of Health.
December 30, 2020
The Oxford University / AstraZeneca COVID-19 vaccine is authorized for emergency use in the U.K. Within a week, 530,000 doses are available for care-home residents, adults ages 80 years and older, and healthcare workers.
December 31, 2020
One year anniversary of the first reported case of COVID-19 to WHO.
2.8 million people in the U.S. have received a COVID-19 vaccine dose— far short of the nation’s goal of 20 million.
January 6, 2021
HHS and CDC announce plans to provide $22 billion in funding for states, localities, and territories to support expanded COVID-19 testing and vaccine distribution from the Coronavirus Response and Relief Supplemental Appropriations Act.
January 8, 2021
Amid vaccine shortages, scientists at Pfizer-BioNTech, Moderna, and the National Institutes of Health (NIH), look for ways to double the supply to prevent future shortages.
January 12, 2021
CDC expands the COVID-19 negative test requirement to include all air passengers entering the U.S. CDC continues to recommend that people test again 3-5 days after arrival and stay home for 7 days after traveling to help slow the spread of COVID-19.
January 18, 2021
The reported death toll from COVID-19 in the U.S. surpasses 400,000.
January 20, 2021
Dr. Rochelle Walensky begins her term as the director of the CDC with the goal of rapidly accelerating COVID-19 testing, surveillance, and vaccination, while confronting the public health challenges posed by suicide, substance use disorder and overdose, chronic diseases and the tolls caused by social and racial injustice and inequity.
First anniversary of the first laboratory-confirmed case of COVID-19 in the U.S. from samples taken in Snohomish County, Washington and of CDC activating its Emergency Response Center (EOC) to respond to the novel coronavirus.
January 21, 2021
The Biden Administration announces the National Strategy for the COVID-19 Response, an outline of 7 goals to restore trust, vaccinate, test, and treat COVID-19 while protecting schools, businesses, and workers in addition to advancing health equity and building the nation’s preparedness for future pandemics, calling it “a wartime undertaking.”
The Biden Administration reverses the Trump Administration’s attempt to withdraw from WHO and joins the COVID-19 Vaccine Global Access Facility “COVAX”, a program aimed at vaccinating people in low- and middle-income countries against COVID-19.
January 22, 2021
CDC releases data in MMWR on the emerging and more transmissible COVID-19 B.1.1.7 / “Alpha” variant— now detected in more than 30 countries and in 12 U.S. states. CDC recommends universal and increased compliance with mitigation strategies, like social distancing and masking, and higher vaccination coverage to protect the public.
January 25, 2021
The first case of the COVID-19 P.1 / “Gamma” variant, first identified by scientists in Brazil, is detected in Minnesota.
January 26, 2021
More than 23 million COVID-19 vaccine doses have been administered in the U.S.
The number of recorded COVID-19 cases worldwide surpasses 100 million.
January 28, 2021
The first case of the COVID-19 B 1.351 / “Beta” variant, first identified by scientists in South Africa, is detected in South Carolina.
January 29, 2021
CDC Director Dr. Rochelle Walensky signs an extension of the eviction moratorium through March 31, 2021, in an effort to help slow the spread of COVID-19.
January 30, 2021
As part of the Biden Administration’s Executive Order on Promoting COVID-19 Safety in Domestic and International Travel, CDC requires face masks to be worn by all travelers while on public transportation and inside transportation hubs to prevent the spread of COVID-19 effective February 2, 2021.
February 1, 2021
The Biden Administration, with the U.S. Department of Defense (DOD), HHS, and CDC, reach a $231.8 million deal with the Australian company Ellume to supply rapid at-home COVID-19 tests in the U.S., committing to ship 100,000 test kits per month February through July.
February 16, 2021
Vaccine distribution is disrupted in several states, including Texas, Missouri, Alabama, and New Hampshire, due to severe winter storms.
February 18, 2021
An estimated 2.5 million women and 1.8 million men have left the workforce since the start of the pandemic in the U.S.
February 21, 2021
The recorded COVID-19 death toll in the U.S. surpasses 500,000.
February 27, 2021
FDA approves an emergency use authorization (EUA) for Johnson & Johnson’s one-shot COVID-19 vaccine for all people ages 18 years and older.
February 28, 2021
ACIP recommends Johnson & Johnson’s COVID-19 vaccine for all people ages 18 years and older.
March 2, 2021
The Biden Administration directs all states to make pre-K-12 teachers, school staff, and childcare workers eligible for COVID-19 vaccinations and to prioritize this group during the month of March within the Federal Retail Pharmacy Program. After this directive, the number of states where these essential workers are eligible to be vaccinated increases by more than 50%.
March 8, 2021
CDC recommends that people who are fully vaccinated against COVID-19 can safely gather with other fully vaccinated people indoors without masks and without socially distancing.
March 11, 2021
First anniversary of WHO declaring COVID-19 a global pandemic.
The Biden Administration announces plans for all adult Americans to be eligible and able to receive a COVID-19 vaccine by May 1, 2021. They plan to make COVID-19 vaccines accessible by delivering vaccines to 700 community health centers in under-resourced communities, doubling the number of pharmacies providing COVID-19 vaccines and the number of federally run mass vaccination centers, deploying more than 4,000 active-duty troops to support these efforts, and by launching the “Find a Vaccination Website” and a 1-800 Number.
The Biden Administration signs the $1.9 trillion American Rescue Plan into law. The stimulus bill includes funding for expanded unemployment benefits, rental assistance, and COVID-19 vaccinations, as well as extending the child tax credit for one year and providing direct cash payments of up to $1,400 per person.
The Biden Administration announces a $1.75 billion investment in expanding genomic sequencing to identity and track new variants and $50 billion to expand the nation’s testing capabilities.
March 13, 2021
More than 100 million COVID-19 vaccine doses have been administered in the U.S.
March 14, 2021
Ireland, Iceland, Denmark, and Norway suspend distribution of AstaZeneca’s COVID-19 vaccine as the European Union (EU) investigates if the shot may be linked to reports of blood clots.
March 17, 2021
CDC announces $2.25 billion in spending over two years to address COVID-19 related health disparities for people living in rural areas and racial and ethnic minority groups.
March 18, 2021
The U.S. announces it will send 4 million unused doses of AstraZeneca’s COVID-19 vaccine from its stockpile to Mexico and Canada.
After 13 European countries halt distribution of the AstraZeneca COVID-19 vaccine pending review, the European Medicines Agency (EMA) announces that they did not find any evidence that the vaccine causes blood clots, and while they were unable to definitively rule out a link between rare blood clots events and the vaccine, the AstraZeneca COVID-19 vaccine is still considered safe, is effective, and the benefits of this vaccine still outweigh its risks.
March 19, 2021
CDC updates its guidance on social distancing in K-12 schools: most elementary students can safely socially distance from at least 3 feet instead of 6 feet inside the classroom with universal masking, but middle and high school students should still maintain at least 6 feet apart in communities where the transmission level is high.
March 25, 2021
CDC announces $300 million in funding for states, localities, territories, tribes, and tribal organizations for community health worker (CHW) services to address: 1) disparities in access to COVID-19 related services, such as testing, contact tracing, and immunization; 2) factors that increase risk of severe COVID-19 illness, such as chronic diseases, smoking, and pregnancy; and 3) community public health needs that have been exacerbated by COVID-19, such as health and mental health care access and food insecurity.
CDC announces a plan to provide the patients and staff of dialysis clinics easy access to COVID-19 vaccinations on-site. People with chronic kidney disease on dialysis who contract COVID-19 are at higher risk of severe adverse health outcomes— half require hospitalization and 20% – 30% die. Additionally, advanced stage chronic kidney disease disproportionately affects African Americans, Non-White Hispanics, and American Indians and Alaska Natives. To date, only 35% of healthcare workers in U.S. dialysis centers have been vaccinated.
March 29, 2021
A CDC study finds that mRNA COVID-19 vaccines, Pfizer-BioNTech and Moderna, are highly effective at preventing infection with the SARS-CoV-2 virus in real-world conditions among healthcare personnel, first responders, and other essential workers (groups that are more likely than the general population to be exposed to the virus because of their occupations), reducing their risk of infection by 90%.
CDC Director Dr. Rochelle Walensky extends the eviction moratorium through June 30, 2021, in an effort to help slow the spread of COVID-19.
March 31, 2021
CDC, in collaboration with the National Institutes of Health (NIH), launches the community health testing program called “Say Yes! COVID Test” in Pitt County, North Carolina and Chattanooga/Hamilton County, Tennessee, providing 160,000 residents with access to free, at-home COVID-19 tests to use up to three times a week for one month in an effort determine if frequent self-testing can reduce community spread of COVID-19.
April 2, 2021
CDC recommends that people who are fully vaccinated against COVID-19 can safely travel at lower-risk to themselves.
April 3, 2021
CDC announces $3 billion in additional funding for expanded COVID-19 vaccination programs.
April 6, 2021
CDC estimates that nearly 80% of pre-K-12 teachers, school staff, and childcare workers in the U.S. have received at least their first shot of COVID-19 vaccine.
April 8, 2021
CDC Director Dr. Rochelle Walensky releases a statement on racism and health amid the COVID-19 pandemic, writing: “Yet, the disparities seen over the past year were not a result of COVID-19. Instead, the pandemic illuminated inequities that have existed for generations and revealed for all of America a known, but often unaddressed, epidemic impacting public health: racism.”
April 13, 2021
CDC and FDA issue a joint statement recommending pausing the use of the Johnson & Johnson’s COVID-19 vaccine while six cases of a rare and serious blood clot in people who received the J&J COVID-19 vaccine are investigated.
April 21, 2021
More than 200 million COVID-19 vaccine doses have been administered in the U.S.
April 23, 2021
ACIP and FDA recommend the continued use of Johnson & Johnson’s COVID-19 vaccine for all people ages 18 years and older in the U.S., following a thorough safety review after the use of the vaccine was paused when 6 cases of rare and severe type of blood clots were reported.
April 27, 2021
In March 2021, according to data from the Census Bureau, 18 million adults (16% of Black adults, 16% of Latino adults, and 6% of White adults) and up to 8.8 million children, over one-fifth of Black and Latino children, lived in a household without enough food sometime in the last seven days.
April 28, 2021
CDC finds that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines reduce the risk of hospitalization with SARS-CoV-2 in people ages 65 years and older by 94%.
May 10, 2021
FDA expands the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to include all adolescents ages 12–15 years.
May 12, 2021
ACIP recommends the Pfizer-BioNTech COVID-19 vaccine for all adolescents ages 12–15 years.
May 14, 2021
CDC finds that mRNA COVID-19 vaccines, Pfizer-BioNTech and Moderna, reduce the risk of infection with the SARS-CoV-2 virus by approximately 94%.
May 17, 2021
An estimated 5.1 million women left the workforce when COVID-19 closed schools and child-care centers in 2020. Today, 1.3 million remain out of the workforce and only 56% of women in the U.S. are working for a salary– the lowest percentage since 1986.
June 1, 2021
The COVID-19 B.1.617.2 / “Delta” variant, first identified in India, becomes the dominant variant in the U.S. The variant begins a third wave of infections during the summer of 2021.
June 7, 2021
CDC finds that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines reduce the risk of infection with the SARS-CoV-2 virus by 91% and protect against severe illness and hospitalization if a breakthrough infection does occur.
June 11, 2021
CDC releases data in MMWR showing that while most COVID-19–associated hospitalizations occur in older adults, severe disease requiring hospitalization can occur in all age groups – including adolescents ages 12–17 years.
June 24, 2021
CDC Director Dr. Rochelle Walensky extends the eviction moratorium through July 31, 2021, in an effort to help slow the spread of COVID-19.
June 30, 2021
CDC’s National Breast and Cervical Cancer Early Detection Program reports that the total number of cancer screenings decreased by an average of 87% for breast cancer and 84% for cervical cancer during early 2020 due to the COVID-19 pandemic, putting individuals at risk for delayed diagnoses and poorer health outcomes. Access to medical care among racial and ethnic minority groups and people with lower incomes declined the most during this period: breast cancer screenings declined 98% among American Indian and Alaskan Native women.
July 6, 2021
American Indian and Alaska Natives had some of the highest rates of hospitalization and death in the U.S. early in the pandemic, but American Indian and Alaskan Native vaccination campaigns are succeeding: CDC’s COVID-19 data tracker shows that American Indians and Alaskan Natives have the highest COVID-19 vaccination rate of any racial or ethnic group in the U.S.
July 9, 2021
CDC and FDA release a joint statement assuring the public that Americans who have been fully vaccinated do not need a booster shot at this time.
July 16, 2021
CDC issues an exception for unaccompanied non-citizen children under Title 42, the order suspending the right to introduce non-citizen persons into the U.S. due to the increased risk from COVID-19.
July 20, 2021
The Lancet reports that more than 1.5 million children worldwide have lost their primary or secondary caregiver due to the COVID-19 pandemic.
July 27, 2021
Amid a Delta variant surge, CDC releases updated masking guidance recommending that everyone in areas with substantial or high transmission wear a mask indoors.
July 30, 2021
CDC releases data in MMWR showing an increase in breakthrough infections of COVID-19 in Barnstable County, Massachusetts in July of 2021. The early data showing high viral loads in people infected with the Delta variant of COVID-19 suggest a concern that, unlike with other variants, vaccinated people infected with Delta can transmit the virus to others. This MMWR becomes the most wildly circulated report in the agency’s history.
August 2, 2021
CDC extends Title 42, the order suspending the right to introduce non-citizen persons into the U.S. at the nation’s southern and northern land borders, except for the unaccompanied non-citizen children covered under the July 16, 2021, order, due to the increased risk from COVID-19.
CDC reports that the Indian Health Service (IHIS) has administered 1,497,047 COVID-19 vaccine doses— more than 70,000 shots given daily.
August 3, 2021
Amid a growing surge of the Delta variant, CDC Director Dr. Rochelle Walensky signs an eviction moratorium in areas of substantial and high COVID-19 transmission in recognition that eviction moratoria, like quarantine, isolation, and social distancing, can be effective public health measures taken to prevent the spread of a communicable disease like COVID-19.
August 6, 2021
CDC releases data in MMWR showing that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus – in other words, COVID-19 vaccines offer stronger protection than natural immunity alone
August 11, 2021
CDC releases a statement assuring the public that COVID-19 vaccination is safe for pregnant and breastfeeding people. CDC studies have found that an infection with COVID-19 during pregnancy increases the risk of developing severe illness from COVID-19 and that there is no evidence that any vaccines, including the COVID-19 vaccines, cause fertility problems in women or men.
August 13, 2021
ACIP recommends an additional dose of COVID-19 vaccine after the two-dose vaccine series for all people with moderately to severely compromised immune systems.
August 18, 2021
CDC announces a new center, the Center for Forecasting and Outbreak Analytics (CFA), which aims to improve the nation’s ability to forecast and model emerging health threats, including pandemics like COVID-19, using data analytics.
HHS, CDC, and FDA release a statement concluding that booster shots of the Pfizer-BioNTech, Moderna, and Johnson & Johnson COVID-19 vaccines will be needed to protect against severe disease, hospitalization, and death in the coming months.
August 23, 2021
FDA fully approves the Pfizer-BioNTech COVID-19 vaccine for all people ages 18 years and older. Full FDA approval further reinforces that the Pfizer-BioNTech COVID-19 vaccine has been shown to meet the agency’s high standards for safety, effectiveness, and consistent quality in manufacturing.
August 30, 2021
ACIP recommends Pfizer-BioNTech’s COVID-19 vaccine for all people ages 16 years and older.
September 1, 2021
CDC releases a digital toolkit for individuals with Intellectual and Developmental Disabilities (IDD) and their caregivers to navigate the COVID-19 pandemic, with communication resources like videos, stories, posters, and interactive activities about getting tested, vaccinated, masking, and social distancing. To date, CDC has also released more than 40 videos and 25 web resources in American Sign Language (ASL) on COVID-19.
September 3, 2021
CDC announces an additional $300 million in funding for community health worker services to support COVID-19 prevention and control.
September 17, 2021
The Biden Administration, working through CDC, invests $2.1 billion in funding for state, local, and territorial public health departments to give them the resources needed to prevent infections in healthcare settings, detect and contain infectious organisms, enhance laboratory capacity, and combat infectious disease threats, including COVID-19.
September 24, 2021
ACIP recommends Pfizer-BioNTech’s COVID-19 vaccine boosters for all people ages 65 years and older, residents of long-term care settings, people ages 50–64 years with underlying medical conditions, and people ages 18–49 years with underlying medical conditions and / or who live or work in high-risk settings to be given at least 6 months after their primary vaccination series.
CDC releases three studies in MMWR looking at the COVID-19 pandemic’s effect on education. Despite school closures in some areas, around 96% of K-12 schools have remained open for in-person learning and schools without universal indoor mask mandates were more than three times more likely to have COVID-19 outbreaks than the K-12 schools that required universal masking from day one.
September 29, 2021
CDC issues an urgent health advisory to increase COVID-19 vaccination rates among people who are pregnant, breastfeeding, or who are trying to become pregnant. More than 22,000 pregnant people have been hospitalized with COVID-19 and 161 have died. COVID-19 in pregnant people carries a two-fold risk of admission to intensive care, a 70% increased risk of death, and adverse pregnancy outcomes that can include preterm birth, stillbirth, and the admission of a newborn into the ICU with COVID-19
October 6, 2021
WHO publishes a clinical case definition of “post COVID-19 condition” or long COVID. The symptoms of long COVID include, but are not limited to, fatigue, shortness of breath, and / or cognitive dysfunction that persists for at least two months and impacts everyday life, three months from the onset of an initial COVID-19 infection.
October 7, 2021
More than 140,000 children in the U.S. have lost their primary or secondary caregiver to the COVID-19 pandemic. One of every 168 American Indian and Alaska Native children, 1 of every 310 Black children, 1 of every 412 non-White Hispanic children, 1 of every 612 Asian children, and 1 of every 753 White children have now experienced orphanhood or the death of caregivers.
CDC adds mental health conditions to the list of risk factors associated with severe illness from COVID-19.
October 21, 2021
ACIP recommends Moderna or Pfizer-BioNTech’s COVID-19 vaccine boosters for all people ages 65 years and older and all people ages 18 years and older who are residents of long-term care settings, have underlying medical conditions, and who live or work high-risk settings to be given least 6 months after their primary vaccination series. ACIP also recommends booster shots for everyone who received Johnson & Johnson’s COVID-19 vaccine more than two months ago.
October 26, 2021
CDC announces $26 million in funding for CDC’s new Center for Forecasting and Outbreak Analytics (CFA).
October 29, 2021
CDC releases data in MMWR showing that unvaccinated individuals who had been recently infected with COVID-19 were about 5 times more likely to be re-infected with the SARS-CoV-2 virus than fully vaccinated individuals with no prior COVID-19 infections.
November 2, 2021
ACIP recommends the Pfizer-BioNTech pediatric COVID-19 vaccine for all children ages 5–11 years.
November 3, 2021
On the sixth annual One Health Day, a global campaign that highlights the interconnected relationship between people, animals, and their environment, CDC releases a statement on the COVID-19 pandemic, noting that more than 400 different animals have been found to be infected with COVID-19 and, as a zoonotic virus, SARS-CoV-2 can spread between people and animals.
November 8, 2021
All non-citizens who are traveling to the U.S. will now be required to be fully vaccinated and provide proof of their vaccination status to fly to the U.S. All travelers will continue to be required to show a negative pre-departure COVID-19 test taken no more than three days before they board their flights.
November 10, 2021
CDC and WHO report that more than 22 million infants missed their first dose of the measles vaccine in 2020. This is the largest global increase of unvaccinated children in two decades and is due in-part to the disruptions the COVID-19 pandemic has had on health care and immunization
November 19, 2021
Amid worries of an upcoming Omicron surge, CDC strengthens its recommendation urging that everyone ages 18 years and older who received a Johnson & Johnson, Pfizer-BioNTech, or Moderna COVID-19 vaccine should receive a booster after they are fully vaccinated.
November 26, 2021
WHO designates the COVID-19 “Omicron” variant, first identified by scientists in South Africa, as a “variant of concern.” Changes in the spike protein of the Omicron variant of the SARS-CoV-2 virus, concern scientists around the world due to the potential for increased transmissibility and decreased vaccine protection.
November 29, 2021
CDC recommends that everyone ages 18 years and older who received a Johnson & Johnson COVID-19 vaccine should receive a booster shot 2 months after their initial J&J vaccine.
December 1, 2021
The first case of the Omicron variant in the U.S. is detected by the California and San Francisco Departments of Public Health.
December 2, 2021
A second case of the Omicron variant in the U.S. is detected by the Minnesota and the New York City Departments of Health.
December 3, 2021
FDA revises the emergency use authorization (EUA) for Eli Lilly’s two monoclonal antibodies, Bamlanivimab and Etesevimab, to allow the drugs to be used together for the treatment of mild to moderate COVID-19 in all pediatric patients, including newborns, who have a positive COVID-19 test and are at high risk for progression to severe COVID-19.
December 6, 2021
CDC introduces a new one-day testing policy requiring international travelers to show a negative pre-departure COVID-19 test taken 24 hours before they board their flights to the U.S.
December 8, 2021
FDA issues an EUA for AstraZeneca’s Evusheld, a treatment of two monoclonal antibodies for the pre-exposure prevention of COVID-19 in adults and children ages 12 years and older who weigh at least 88 pounds and have moderate to severely compromised immune function or a history of severe adverse reactions to COVID-19 vaccines.
December 9, 2021
CDC and FDA expand COVID-19 booster recommendations to include everyone ages 16 years and older.
December 15, 2021
The recorded death toll from COVID-19 surpasses 800,000 in the U.S. One in every 100 people ages 65 years and older in the U.S. has died.
December 16, 2021
ACIP updates its recommendations to express a clinical preference for individuals to receive, when possible, an mRNA COVID-19 vaccine, Pfizer-BioNTech or Moderna, over Johnson & Johnson’s COVID-19 vaccine.
December 17, 2021
CDC releases two reports in MMWR highlighting the use of test-to-stay practices to help keep students in school during the COVID-19 pandemic.
December 20, 2021
CDC releases data estimating that the Omicron variant is around 1.6 times more transmissible than the Delta variant.
December 22, 2021
FDA authorizes Pfizer’s anti-viral pill Paxlovid to treat COVID-19 under an EUA for adults and children ages 12 years and older who weigh at least 88 pounds who test positive and are at high risk for progression to severe disease. It is the first treatment for COVID-19 that is taken orally and can be used at home.
December 23, 2021
FDA authorizes Merck’s anti-viral pill Molnupiravir to treat COVID-19 under an EUA for all adults and children ages 18 years and older who test positive and are at high risk for progression to severe disease. It is the second treatment for COVID-19 that is taken orally and can be used at home but, despite supply concerns, Paxlovid remains the preferred oral anti-viral treatment for COVID-19.
CDC updates its recommendations for the isolation and quarantine periods for healthcare workers, decreasing their isolation time after infection with COVID-19. Asymptomatic healthcare workers can now return to work after 7 days with a negative test and healthcare workers who have received all recommended COVID-19 vaccines doses, including a booster, do not need to quarantine after a high-risk exposure.
December 27, 2021
CDC shortens the recommended isolation period for people with COVID-19 to 5 days, followed by 5 days of wearing a mask around others if they are asymptomatic or if their symptoms are resolving (resolving is defined as without a fever for 24 hours).
CDC updates the recommended quarantine period for people exposed to someone with COVID-19 to wear a mask around others for 10 days and get tested on day 5 if you have been boosted or vaccinated within the last 6 months. If the exposed individual is unvaccinated, CDC now recommends a quarantine period of 5 days, followed by strict mask use for an additional 5 days.
January 1, 2022
As Delta and Omicron spread, New York state records its highest number of new COVID-19 cases in a single day since the pandemic began – with 114,082 new confirmed cases.
January 3, 2022
The U.S. reports nearly 1 million new COVID-19 infections– the highest daily total of any country in the world. The number of hospitalized COVID-19 patients has risen nearly 50% in just one week.
FDA amends the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to allow a single booster dose for all individuals ages 12–15 years; shortens the time-period between the completion of primary vaccination series of the Pfizer-BioNTech COVID-19 vaccine and a booster dose to at least five months; and allows for a third primary series dose for certain immunocompromised children ages 5–11 years.
January 4, 2022
ACIP shortens the recommended time between the primary vaccination series and a booster shot for the Pfizer-BioNTech COVID-19 vaccine from 6 months to 5 months.
ACIP recommends that moderately or severely immunocompromised children ages 5–11 years receive an additional primary dose of the Pfizer-BioNTech COVID-19 vaccine 28 days after their second shot.
January 5, 2022
ACIP recommends that all adolescents ages 12–17 years receive a booster shot 5 months after their initial Pfizer-BioNTech vaccination series.
January 7, 2022
FDA amends the EUA for the Moderna COVID-19 vaccine to shorten the time between the primary series of the vaccine and a booster dose from at least 5 months to 6 months for individuals ages 18 years and older. The same day, CDC endorses the FDA’s recommendation.
January 11, 2022
The Biden Administration purchases 600,000 doses of GSK and Vir Biotechnology’s antibody treatment Sotrovimab, after the drug was found to be effective against both the Delta and Omicron variants.
January 14, 2022
CDC updates guidelines on masks to emphasize fit, comfort, and consistent wear.
In one month, the daily average of new COVID-19 infections reported in the U.S. spikes from 119,215 to 805,062.
January 17, 2022
The American Civil Liberties Union (ACLU) sues an Arkansas jail on behalf of detainees who reported COVID-19 like symptoms and say they were unknowingly given ivermectin and hydroxychloroquine, two drugs that CDC does not recommend for the treatment of COVID-19.
January 19, 2022
To help meet the demand for testing during the Omicron surge, the Biden Administration purchases 1 billion COVID-19 tests and creates an online portal where people can order free at-home rapid antigen COVID-19 tests through the U.S. Postal Service (USPS).
January 20, 2022
CDC releases data in MMWR showing that during the Delta surge, both COVID-19 vaccination and surviving a prior infection provided protection against infection and hospitalization from COVID-19.
A study published in the American Journal of Epidemiology finds that COVID-19 vaccination has no impact on male or female fertility, but that a COVID-19 infection may be associated with a short-term decline in male fertility.
January 24, 2022
FDA further revises the EUA for Eli Lilly’s two monoclonal antibodies, Bamlanivimab and Etesevimab, to limit their use after the treatment is shown to be ineffective against the Omicron variant.
FDA revises the EUA for Regeneron’s monoclonal antibody, Regen-cov, to limit its use after the treatment is shown to be ineffective against the Omicron variant.
The Omicron variant now accounts for approximately 99% of all current COVID-19 cases in the U.S.
January 31, 2022
FDA fully approves the Moderna COVID-19 vaccine for all people ages 18 years and older. Full FDA approval further reinforces that the Moderna COVID-19 vaccine has been shown to meet the agency’s high standards for safety, effectiveness, and consistent quality in manufacturing. To date, COVID-19 vaccines are estimated to have saved at least a quarter of a million lives and prevented more than 1 million hospitalizations.
February 4, 2022
ACIP recommends the use of Moderna’s vaccine for all people ages 18 years and older.
The death rate from COVID-19 climbs 30% in two weeks amid an Omicron surge, with more than 2,600 people dying from COVID-19 each day.
The number of recorded deaths in the U.S. due to COVID-19 surpasses 900,000.
February 7, 2022
A study is published in Nature showing that even a mild case of COVID-19 appears to increase the risk of heart problems for one year after infection. The study’s authors suggest that COVID-19 might be as much of a risk factor for heart disease as high blood pressure, diabetes, or smoking.
February 11, 2022
CDC releases data showing that COVID-19 vaccine boosters remain safe and were highly effective against severe disease during the Omicron and Delta variant surges for everyone ages 5 years and older.
CDC releases data in MMWR showing that the Omicron variant rose from 1% of all infections in the U.S. to 99% of all infections in just 6 weeks (compared to 18 weeks for Delta).
February 15, 2022
CDC releases data in MMWR showing that maternal COVID-19 vaccination during pregnancy with an mRNA vaccine, Pfizer-BioNTech or Moderna, reduces the risk of COVID-19 hospitalization in infants (babies under 6 months) by around 60%.
February 18, 2022
CDC releases two reports in MMWR on pediatric emergency department visits during the COVID-19 pandemic and recommends increased awareness of the health concerns among children and adolescents that could arise due to delayed medical care and heightened emotional distress, especially for adolescent girls (ages 12–17 years).
The Wisconsin Department of Health Services confirms that a child in Wisconsin has died from multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition associated with COVID-19 infection in children.
March 2, 2022
WHO releases data showing that the COVID-19 pandemic triggered a 25% increase in anxiety and depression worldwide, with young people and women at the highest risk.
March 3, 2022
CDC updates the “COVID-19 Community Level,” showing that more than 90% of the U.S. population is in a location with either low or medium COVID-19 community transmission level.
The U.S. has now donated more than 480 million COVID-19 vaccine doses to 110 countries.
March 4, 2022
While access to COVID-19 vaccines has expanded, the gap in COVID-19 vaccination rates between urban and rural areas in the U.S. has more than doubled since April 2021.
March 5, 2022
More than 10 billion people have received a COVID-19 vaccine, with WHO reporting that 10,704,043,684 COVID-19 vaccine doses have been administered worldwide. About 56% of the world is now fully vaccinated, but many regions still lack access, especially on the African continent where less than 20% of the total population is currently vaccinated.
March 8, 2022
Hawaii becomes the last state to announce an end to its universal indoor mask mandate, scheduled for March 26, 2022.
March 10, 2022
On CDC’s recommendation, the Transportation Security Administration (TSA) extends the mask requirement for all public transportation and transportation hubs through April 18, 2022.
The number of recorded deaths due to COVID-19 surpasses 6 million worldwide, with WHO reporting 6,019,085 confirmed deaths. The true number is likely much higher.
The number of recorded COVID-19 cases surpasses 450 million worldwide, with WHO reporting 450,229,635 confirmed infections. The true number is likely much higher.
March 11, 2022
Two-year anniversary of WHO declaring COVID-19 a global pandemic.
CDC updates the “COVID-19 Community Level,” showing that more than 98% of the U.S. population is in a location with either a low or medium COVID-19 community transmission levels.
In the U.S., 92% of all children ages 5–11 years now live within 5 miles of a vaccine provider.
CDC releases data in MMWR showing that school districts in Arkansas with universal mask requirements had a 23% lower incidence of COVID-19 among staff and students compared to districts without mask requirements during August – October 2021.
March 12, 2022
CDC estimates that 23% of all current COVID-19 infections in the U.S. are caused by the Omicron BA.2 subvariant, with initial data suggesting that BA.2 appears to be more transmissible than the Omicron BA.1 variant.
March 14, 2022
Several regions in China face new lockdowns under the “COVID Zero” policy when cases of the Omicron variant are found. Tens of millions of people are required to stay inside their homes, key technology manufacturers like Foxconn and Unimicron close factories, and the production and distribution of goods is disrupted throughout the world.
March 15, 2022
CDC releases data in MMWR showing that the COVID-19 hospitalization rate among infants and children ages 4 years and younger was 5 times higher during the peak of the Omicron variant surge when compared to the Delta variant– 63% of those children hospitalized had no underlying medical conditions.
After officially recording more than 43 million COVID-19 cases, India begins vaccinating adolescents ages 12–14 years with the COVID-19 vaccine Corbevax and schools reopen after two years of closures.
CDC outlines its goals for the third year of a global COVID-19 response: to increase vaccination levels around the world, reduce spread of COVID-19 and its impact, expand scientific knowledge of the SARS-CoV-2 virus, and strengthen public health leadership while improving long-term health security worldwide.
March 16, 2022
At the World Trade Organization (WTO) meeting the U.S., the European Union, India, and South Africa forge a preliminary agreement on a COVID-19 vaccine intellectual property (IP) waiver, hoping to expand access to vaccines around the world.
March 18, 2022
CDC releases data in two MMWRs showing that adults who received 3 doses of a COVID-19 mRNA vaccine were 94% less likely to be put on a ventilator or die from COVID-19 during the Omicron surge compared to non-vaccinated adults in the U.S. and that Black adults are currently 4 times more likely to be hospitalized than White adults.
March 24, 2022
Data from the Census Bureau shows that deaths in the U.S. between 2019 – 2020 increased by approximately 19% after the onset of the COVID-19 pandemic in March 2020. That is the largest spike in mortality in the U.S. in 100 years.
March 26, 2022
CDC estimates that about 55% of all current COVID-19 cases in the U.S. are caused by the Omicron BA.2 subvariant.
March 29, 2022
CDC and FDA both recommend a second mRNA COVID-19 vaccine booster for immunocompromised individuals and all adults ages 50 and older 4 months after their last booster dose.
CDC recommends that all adults who received a primary vaccine series and booster dose of Johnson & Johnson’s COVID-19 vaccine receive a second booster dose with an mRNA COVID-19 vaccine.
March 30, 2022
The number of recorded deaths due to COVID-19 reaches 976,229, with more than 79,853,683 total reported cases of the virus in the U.S.
March 31, 2022
CDC releases data from the Adolescent Behaviors and Experiences Survey (ABES) showing that from January 2021 – June 2021 among high-school aged adolescents: 44% report feeling persistently sad or hopeless; 55% report emotional abuse in the home; 11% report physical abuse in the home; and 29% report job loss by an adult in the home. Lesbian, gay, bisexual, and female youth reported the poorest overall mental health, the most emotional abuse by a parent or caregiver, and attempted suicide more their peers during the COVID-19 pandemic.
April 1, 2022
CDC announces the termination of Title 42, an Order that suspended the right to introduce migrants into the U.S. due to the public health risk of COVID-19, effective May 23, 2022.
April 8, 2022
CDC releases data in MMWR showing that the risk for cardiac complications in all age groups was significantly higher after COVID-19 infection when compared to after mRNA COVID-19 vaccination.
April 13, 2022
The Omicron subvariant BA.2 now makes up more than 85% of all new COVID-19 infections in the U.S.
April 18, 2022
CDC’s mask mandate for indoor public transportation is struck down by a judge in Florida.
April 19, 2022
CDC releases data in MMWR showing that of the children ages 5–11 years who were hospitalized with COVID-19 during the first few months of the Omicron surge, 3 in 10 had no underlying medical conditions, 9 in 10 were unvaccinated, and 2 in 10 required ICU care.
April 21, 2022
The Department of Homeland Security (DHS) extends the COVID-19 vaccine requirement for all non-citizens entering the U.S.– in addition to the requirement that all travelers show a negative antigen test taken within one day of departure.
April 22, 2022
For the second year in a row, COVID-19 was the third leading cause of death in the U.S.– after heart disease and cancer.
April 26, 2022
The Biden Administration purchases 20 million doses of Pfizer’s oral anti-viral drug Paxlovid as part of the Test-to-Treat initiative– 2,200 locations where Americans can receive free COVID-19 testing and, if needed, treatment. These doses will also be used to double the number of pharmacies with Paxlovid stocked from 20,000 to 40,000.
April 27, 2022
It is estimated that during 2000–2018, measles vaccines prevented 23.2 million deaths, but delays in routine vaccinations caused by the COVID-19 pandemic and crises in Ukraine, Ethiopia, Somalia, and Afghanistan have led to a nearly 80% worldwide rise in measles cases in 2022.
April 29, 2022
Data from CDC’s National Commercial Laboratory Seroprevalence Study estimates that, as of February 2022, approximately 75% of children and adolescents showed infection-induced antibodies to SARS-CoV-2 (evidence of a previous infection with SARS-CoV-2 – also called seroprevalence) and that, since December 2021, approximately one third have become newly seropositive.
April 30, 2022
The current proportion of the U.S. population fully vaccinated against COVID-19 broken down by age group is: 5–11, 28%; 12–17, 59%; 18–49, 69%; 50–64, 80%; and ≥65 years, 90%.
May 3, 2022
CDC recommends that everyone continue to wear a mask while in indoor transportation hubs to prevent the spread of COVID-19 – but this is no longer legally enforceable.
May 5, 2022
WHO estimates that there have been approximately 15 million direct or indirect deaths (also called “excess mortality”) globally from January 2020 – December 2021 that were caused by the COVID-19 pandemic. South-East Asia, Europe, and the Americas accounted for 84% of the excess deaths.
May 10, 2022
During the COVID-19 pandemic, there has been a 35% increase in the firearm homicide rate, resulting in the highest firearm homicide rate in more than 25 years. Firearm homicide rates are the highest among males, adolescents, young adults, and non-Hispanic Black and non-Hispanic American Indian and Alaska Native people. Rates of firearm suicide remained high, increasing most notably among American Indian and Alaska Native males ages 10–44, and are highest in rural areas.
May 12, 2022
The number of recorded deaths due to COVID-19 in the U.S. reaches 1 million (1,000,000).
Initial research suggests that between 4% and 36% of all people infected with COVID-19 will experience symptoms lasting at least six-months, potentially leading to between 5 and 25 million people in the U.S. experiencing a long-term disability (approximately 200 million people worldwide). Experts and disability advocates worry that the long-term consequences of this virus are underappreciated.
May 16, 2022
Researchers from Brown University School of Public Health, Brigham and Women’s Hospital, and Harvard T.H. Chan School of Public Health, estimate that approximately 50% of COVID-19 deaths in the U.S. were vaccine-preventable deaths.
May 19, 2022
ACIP recommends Pfizer-BioNTech’s COVID-19 vaccine boosters for everyone ages 5–11 years to be given at least 5 months after their primary vaccination series. ACIP also recommends everyone ages 12 years and older who is immunocompromised and those ages 50 years and older should receive a second booster dose at least 4 months after their first to prevent severe disease, hospitalization, and death.
May 25, 2022
CDC releases data in MMWR showing that COVID-19 survivors are twice as likely to develop a pulmonary embolism or respiratory condition and that approximately 1 in 5 adults now have at least one health condition that may be attributable to a previous COVID-19 infection.
May 26, 2022
CDC updates the “COVID-19 Community Level,” showing that 71.52% of the U.S. population is in a location with low COVID-19 community transmission levels; 20.73% have medium levels and 7.76% have high COVID-19 community levels.
May 27, 2022
North Korea reports a total of 3.27 million “fever patients.”
May 28, 2022
The weekly average of new COVID-19 infections in the U.S. is now six times higher than it was in 2021. Currently, there are 119,725 new cases reported each week– a number that is “grossly underreported” according to experts– compared to May 28, 2021, when there were 17,887.
May 31, 2022
The U.S. Department of Justice (DOJ) asks a federal appeals court to overturn the order that declared CDC’s mandate requiring individuals to wear masks on public transportation unlawful.
Authorities in Shanghai announce that they are partially reopening China’s largest city after two months of a COVID-19 lockdown that has kept millions of people strictly in their homes and employed both mass testing and isolation of anyone infected with COVID-19 in centralized facilities.
June 1, 2022
The U.S. has recorded a total of 84,145,569 COVID-19 infections and 1,003,571 (more than 1 million) deaths from COVID-19.
June 2, 2022
A Kaiser Foundation study tested three widespread false statements about COVID-19 vaccines: “pregnant women should not get the COVID-19 vaccine; it is unsafe for women who are breastfeeding to get a COVID-19 vaccine; and the COVID-19 vaccines have been shown to cause infertility.” Vaccine misinformation is so pervasive that about six in ten U.S. adults and seven in ten women who are pregnant or planning to become pregnant either believed or were unsure about at least one of these false statements.
June 10, 2022
The global market for N95 masks is predicted to reach $11.8 billion by 2026.
June 18, 2022
ACIP recommends Moderna and Pfizer-BioNTech’s COVID-19 vaccines for everyone ages 6 months – 5 years, expanding vaccine eligibility to over 20 million additional children in the U.S. All people ages 6 months and older are now eligible for COVID-19 vaccination in the U.S.
June 24, 2022
ACIP recommends Moderna’s COVID-19 vaccine for everyone ages 6–17 years.
June 30, 2022
As COVID-19 case numbers rise across the U.S. due to the highly transmissible omicron subvariants BA.4 and BA.5., FDA calls for Omicron-specific updates to COVID-19 vaccine boosters from Pfizer-BioNTech and Moderna in fall 2022.
July 6, 2022
CDC data shows that Omicron subvariants BA.4 and BA.5 are now dominant in the U.S., making up over 70% of new COVID-19 infections.
July 8, 2022
New York Department of Health recommends that all people should wear N95, KN95, or KF94 masks in all public indoor settings and when in crowded outdoor areas due to high community transmission of COVID-19.
FDA fully approves Pfizer-BioNTech’s COVID-19 vaccine for everyone ages 12–15 years. Full FDA approval further reinforces that Pfizer-BioNTech’s COVID-19 vaccine has been shown to meet the agency’s high standards for safety, effectiveness, and consistent quality in manufacturing.
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Discover Thomson Reuters
Fact check: Studies show COVID-19 lockdowns have saved lives
By Reuters Staff
12 Min Read
As many states enter a new wave of more stringent measures to limit the spread of COVID-19, users on social media have been sharing posts that question the purpose of so called “lockdowns”. Some posts falsely claim that these measures “don’t save lives”. This article examines some of the reasons why lockdowns have been called, and how effective they have been.
An example of a lockdown-sceptic post circulating on social media ( here ) features the screenshot of an entry in the Merriam-Webster Dictionary on the word “lockdown”, which includes a definition that reads: “the confinement of prisoners to their cells for all or most of the day as a temporary security measure”. The image has an overlaid text that reads: “Never forget where the word LOCKDOWN comes from… A loving government isn’t trying to save you from COVID…it is using COVID to justify MARTIAL LAW”
While this definition is indeed included in the Merriam-Webster Dictionary entry here , the screenshot fails to show two further definitions. According to Merriam Webster, the term also stands for a “temporary condition” imposed by authorities, for example, during the outbreak of an epidemic disease, “in which people are require to stay in their homes and refrain from limit activities outside the home involving public contact (such as dining out or attending large gatherings)”.
An article by The Guardian delves into the evolution of the meaning of the word lockdown here .
In April, Reuters debunked a similar claim that the U.S. coronavirus response was “slowly introducing” martial law and found it to be false ( here ) .
Reuters has reported on international studies that have determined that lockdowns potentially have saved millions of lives here .
However, it is also true that some lockdown measures may have a direct impact on a person’s income and mental health. Further reading about short, mid and long-term effects of lockdowns are visible here .
The World Health Organization (WHO) explains here that such measures can have “a profound negative impact on individuals, communities and societies by bringing social and economic life to a near stop”, something that according to the organization, disproportionately affect vulnerable groups.
But evidence also suggest that stringent but temporary restrictions, could actually benefit the economic recovery because they reduce the spread of the disease. The International Monetary Fund, for example, determined here that while lockdowns “impose short-term costs” they may lead to “a faster economic recovery. The organization states that “by bringing infections under control, lockdowns may thus pave the way to a faster economic recovery as people feel more comfortable about resuming normal activities” ( bit.ly/2UXoIUy page 74).
Reuters contacted two experts, Dr. Elizabeth Stuart, Associate Dean for Education at the Johns Hopkins Bloomberg School of Public Health ( here ) and Dr. Stuart Ray, infectious disease expert with the Johns Hopkins University School of Medicine ( here ) . Both confirmed that lockdowns do reduce transmission of the SARS-Cov-2 and highlighted that a more “targeted” or “proportional” approach of restrictions can mitigate the risk of infection, while balancing other concerns about the economy and mental health.
Without a treatment or vaccine available, Stuart said, the world had to rely on “really core behavioral factors”, such as physical distancing, hands washing, wearing masks, that have been used as “effective ways” of preventing transmission of infectious diseases in the past. “They do help”, she said.
Ray pointed to evidence ( here and here ) that has suggested that the spread of SARS-CoV-2, the virus that causes COVID-19, is mitigated by “progressively stringent measures”, such as stay-at-home orders.
A MORE TARGETED APPROACH
“In March we had all had to lockdown because so little was known”, Stuart said. But she added that as experts have learnt more about the disease and how it spreads, it has appeared there are ways to implement a more targeted approach to this measure.
“I wouldn’t even call them lockdowns, but more ‘targeted interventions’, that restrict the higher risk activities but allow lower risk activities to precede”, Stuart said.
Stuart referred to Michigan as an example. On Nov. 15, in response to a surge in COVID-19 cases, Gov. Gretchen Whitmer announced new restrictions for the state and asked people to be cautious, to avoid a stay-at-home order ( youtu.be/WQi001dquQo?t=751 ) . As reported here by CBS Detroit, the new order states that “high schools and colleges must halt-in person classes, restaurants must stop indoor dining” as well as limitation of gathering sizes and a temporary closure of entertainment businesses. See new emergency order bit.ly/39eb0oS .
Ray dismissed the need for a national stay-at-home order but rather referred to “staged or proportional” measures depending on the risk, in which “things are more restrictive when the prevalence of new infections is higher”. He highlighted the need for “really clear national messaging” and said that not all places needed the same measures at the same time. To limit the impact of this pandemic, he said, “we have to have everyone understand the status where they are and where transmissions are happening nearby”.
Some posts that attempt to dismiss the role of stricter measures to reduce the spread of the new coronavirus argue that COVID-19 has a survival rate of over 99% ( here ).
While the exact mortality rate of COVID-19 is still not known, a hypothetical rate of 1% would still result in a massive number of deaths if left to spread unchecked.
When asked about this claim, Stuart told Reuters that one out of a hundred was still a “high mortality”, adding that there was a “ripple effect of consequences” for a lot of people, not just the deceased individual. “If there are reasonable preventive strategies that we can take in order to reduce that even further we should do that”, she said.
While it appears that a high percentage of people recover from the disease, Ray noted that “there are also non- lethal complications of COVID-19 that are important, so it is challenging to relax control measures when the spread is high”. Further reading about the lingering known effects of COVID-19 is visible here , here and here .
Other posts also argue that these restrictions “don’t save lives”, citing an alleged increase in suicides here .
Earlier this year, experts warned here that COVID-19 might increase suicide rates, citing adverse effects on people with mental illness and the population in general “might be exacerbated by fear, self-isolation, and physical distancing” and “well-recognised risk factors for suicide” like loss of employment and financial stressors.
Richard Dunn, associate Professor of Agricultural and Resource Economics at the University of Connecticut ( here ), who has studied the relation between mental health and the economy, told Reuters by email that arguments for why lockdowns may increase suicide risk present valid arguments, but that “they are selective” and that some of these arguments “ignore important countervailing effects”.
According to Dunn, such countervailing effects include technology that facilitates social contact ( here ), and a “locus of control” ( here ) through which individuals can take proactive steps to help prevent the spread of COVID-19. “Suicide risk increases as individuals feel they lack control over their life and what control they do have is without worth,” said Dunn.
In addition, Dunn said, is the concept of “social connectedness”, which tends to increase in the face of a communal threat, such as a pandemic. “During wars and natural disasters, despite their great economic upheaval, suicide rates tend to drop because people rally to a common cause,” he said. To exemplify this, Dunn referred to the numerous scenes from around the world of people cheering health workers from their balconies ( here , here ).
Some posts on the issue of lockdowns are missing context, and some present information that is contradicted by international studies. While it is true that more restrictive measures that aim to control the spread of SARS-CoV-2 can have an impact in income and mental health, multiple studies suggest that stay-at-home orders and other nonpharmaceutical interventions have a determining role in reducing the transmission of the virus. Experts highlight that a more “targeted” approach rather than a “nationwide” lockdown, can limit the impact of the pandemic while balancing other economic, mental health and social concerns.
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Are Lockdowns Effective in Managing Pandemics?
The present coronavirus crisis caused a major worldwide disruption which has not been experienced for decades. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside the studies questioning it. In this work, we performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics and risk-benefit analysis based on the connection of health and wealth. Our aim was to learn lessons and analyze ways to improve the management of similar events in the future. The comparative analysis of different countries showed that the assumption of lockdowns’ effectiveness cannot be supported by evidence—neither regarding the present COVID-19 pandemic, nor regarding the 1918–1920 Spanish Flu and other less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: by using the known connection between health and wealth, we estimate that lockdowns may claim 20 times more life years than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown for either COVID-19 or any future pandemic.
The present coronavirus crisis caused major worldwide disruption which has not been experienced for decades. The word ‘lockdown’, originally meaning “ the confinement of prisoners to their cells for all or most of the day as a temporary security measure ” according to Webster’s dictionary [ 1 ] emerged with a new meaning: Schools and workplaces closed, closure or restrictions on dining, sports, and cultural events, extraordinary travel restrictions, canceled medical and dental visits, curfews, quarantine regulations and more [ 2 , 3 ]. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside with the studies questioning it.
Our aim in this work was to learn lessons and analyze ways to improve the management of similar events in the future. To achieve this, we have performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics. Moreover, we aimed to perform a cost-benefit analysis to compare lockdowns’ benefits (lives saved) with cost (lives lost). The following research questions have been formulated: What has been known about lockdowns’ effectiveness in saving/prolonging life in previous pandemics; what is the COVID-19 evidence regarding lockdowns’ effectiveness in saving/prolonging life; which factors determine the human cost of lockdowns—side-effects that shorten life; how can the human cost of lockdowns be estimated based on economical parameters; what is the quantitative estimation for lockdowns’ human cost? Finally, we tried to understand how decision-making was actually performed. The research questions are listed in Table 1 .
Research questions of the present study.
There have been published numerous papers on various aspects of the COVID-19 crisis: for example, PubMed ® (pubmed.gov) 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.
Block diagram of the performed search. Sub-list 1: all COVID-19 papers published in 2020 in the highest-impact journals in the fields of medicine and economics. Sub-list 2: pre-2020 publications of selected authors directly related to the COVID-19 crisis management. Screening: initial screening performed by the first author (MY). Assessment: final assessment performed by both authors. New sources: cited sources and citing papers leftover after the two-stage screening.
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 ].
3.1. Lockdowns’ Effectiveness in Controlling Pandemics
3.1.1. previous pandemics.
Influenza-like pandemics are a natural consequence of human development [ 6 ]. Therefore, they should not be considered a global threat. The history of the 1918 H1N1 influenza type-A pandemic (the Spanish Flu) and numerous less-severe pandemics is well documented—see references in sect. II of the Collection [ 1 ]. Analysis of this well-documented history shows that the COVID-19 problems are not new, unlike round-the-globe governmental reactions that are unprecedented and definitely not based on any successful policy in the past.
The quite reasonable idea (from the point of view of contagion mechanisms) of the effectiveness of social distancing during epidemics is not supported by vast evidence. Somewhat, on the contrary, modern economic growth is associated with an unprecedented increase in travel (partly related to trade) and a significant increase in population density as most of the population becomes urban rather than rural. That is, the average social distance has become much less. At the same time, in recent centuries there were no examples of epidemics that killed a quarter to a half of the population in dozens of countries, such as with the Justinian Plague [ 7 ] or Black Death [ 8 ].
The Spanish Flu was one of the deadliest pandemics in centuries, and for sure the most lethal of well-documented pandemics [ 9 ]. The highest mortality was detected among the 20–40 years age group [ 10 ] and so caused sizable demographic damage—unlike COVID-19. This being said, there was no panic then and the response was mainly based on common sense—see references in sect. II.2 of the Collection [ 4 ]. The leaders generally presumed reasonable and rational behavior of the citizens: e.g., quarantine practices were almost exclusively voluntary. Closure of the non-entertainment business was out of discussion [ 11 ]. School closure was discussed but often rejected due to the obvious outcome: children’s bands roaming in dirty streets could boost the infection spread more than gathering in supervised and relatively clean schools [ 12 ].
The effectiveness of various closures has not been proven. For example, mortality rates were similar in New York (535 per 100,000) [ 12 ] and Los Angeles (494 per 100,000) [ 11 ], even though in Los Angeles schools, churches, and places of entertainment were closed for up to 6 weeks [ 11 ], and in New York, everything remained open [ 12 ]. It should be noted that New York was a port city with a mass return of troops—infected by the flu—from Europe.
Two extensively cited papers [ 13 , 14 ] argue that government intervention and coercion are justified by the Spanish flu pandemic’s experience of suppressing mortality. The work claims that in cities that imposed earlier and harsher restrictions, both the mortality was lower, and the after-flu economic recovery was faster.
The benefits of coercive social distancing are justified using the indicator of authorities’ coercion (Non-pharmaceutical Interventions—NPI) in the 42 largest cities in the United States from 1918–1919. The “NPI intensity” is defined as the duration of the imposed restrictions, completely ignoring their nature and extent. Essentially, the authors assume that the restrictions in all 42 cities of the sample were the same. Therefore, New York falls into a subsample of cities with strong intervention (total NPI days—73 days, above the median)—despite the fact that schools and theaters were not closed there.
The principal “intervention” in New York was staggered business hours to avoid rush hour in the public transit system, agreed with big business and approved by city authorities [ 12 ]. This intervention caused minimal compliance costs for businesses and was insignificant even compared with pretty moderate NPI in the rest of American big cities during the Spanish Flu.
On the opposite, Pittsburgh (the most severely-affected city of the sample) is classified by the cited authors as unacceptably “liberal” with 52 NPI days (below median)—though during these 52 days theaters and schools were closed.
The Pittsburgh case is a clear example of the authors’ failure to include a significant local factor in the model. Namely, the high mortality rate in Pittsburgh has a good explanation not connected to the alleged oversight and ‘liberalism’ of the authorities. Even before the Spanish flu, many more people (compared to the US average) died in Pittsburgh from respiratory diseases due to severe air contamination by metallurgical plants’ emissions [ 15 ].
3.1.2. Preparedness Plans
It should be mentioned that the same conclusions—no clear benefit of lockdowns in case of pandemic—were made by national and international bodies before COVID-19 emerged. Namely, several governments prepared detailed plans of response to influenza-like pandemics years ago—see the programs of the U.S. Occupational Safety and Health Administration (2007) [ 16 ], Israeli Ministry of Health (2007) [ 17 ] and more references in sect. II.4 of the Collection [ 4 ]. Israel probably had the most elaborate plan which relied on the unique experience of civil-military partnership (ref. II.4.4 in the Collection [ 4 ]). Noteworthy, the World Health Organization (WHO) published its comprehensive 91-page preparedness plan [ 6 ] in October 2019!
All these response plans mentioned lockdowns, if at all, as a means of last resort only. The WHO document, for example, explicitly mentioned that:
- social distancing measures “can be highly disruptive” and should be carefully weighted
- travel-related measures are “unlikely to be successful”; “border closures may be considered only by small island nations in severe pandemics”
- contact tracing and quarantine of exposed individuals are not recommended in any circumstances.
All the above plans were abandoned without any serious discussion at the very beginning of the COVID-19 crisis: The authors failed to find a single mention of these plans in publications of national health ministries in either country. Lockdowns, border closures, contact tracing, and quarantines became the main instruments.
We saw that pre-COVID-19 evidence was against lockdowns that were nevertheless imposed in nearly every country. A posteriori, the pro-lockdown evidence, while extensively cited, was based largely on comparing real-world outcomes against computer-generated forecasts derived from models that were not tested empirically, such as that of Flaxman et al. [ 18 ] or Brauner et al. [ 19 ]. A recent review analyzed the 1st lockdown (Spring 2020) in 130 countries and, after making multiple adjustments, concluded that early school and workplace closures saved around 1.5 daily deaths per million [ 20 ] (we shall discuss later the implications of this number).
On the other hand, comparative studies of different countries showed no connection between the stringency of response measures (non-pharmaceutical interventions) and actual outcomes. For example, the American Institute for Economic Research prepared in December 2020 a digest [ 21 ] of 35 works showing no such connection; see also refs. [ 22 , 23 ] and more references in sect. III.3 of the Collection [ 4 ]. Later research (January 2022) performed at Johns Hopkins University [ 24 ] also concluded that “lockdowns have had little to no effect on COVID-19 mortality”.
On the contrary, the lockdown policies had a direct side effect of increasing mortality. Hospitals in Europe and USA were prepared to manage pretty small groups of highly contagious patients, while unprepared for a much more probable challenge—large-scale contagion. As a result, public health care facilities and nursing homes often became vehicles of contamination themselves—to a large extent because of the lockdown-based emergency policy implementation, e.g., New York’s policy of forcing nursing homes to admit recently discharged COVID-19 patients; see references in sect. IV.1 of the Collection [ 4 ].
3.2. Human Cost of Lockdowns
3.2.1. factors of life loss due to lockdowns.
Numerous deaths can be attributed to the interruption of normal social life and routine regular social interactions. The direct factors are [ 25 , 26 ]:
- increased mortality due to postponement of diagnoses and routine treatments
- increase in mortality due to non-arrival at hospitals
- increase in mortality due to a decrease in the level of income and as a result—use of less safe cars, reduction in the scope of physical activity, etc.
- “deaths of despair” caused by drugs, alcohol, and suicide following loss of social-economic status
- increase in violence, including domestic violence; dismantling of families
- severe health damage to the elderly in particular—physical and mental deterioration (usually irreversible) due to loneliness, lack of movement, and routine supportive care.
More information can be found in sect. IV.2 of the Collection [ 4 ] and on the Collateral Global charity website (CollateralGlobal.org).
While it is very difficult to quantify lockdowns’ negative effects on public health with precision, one can make rough estimations based on economic losses and the connection of health and wealth. This is conducted in the following subsections.
3.2.2. Health and Wealth
Irrefutable historical facts are the following: modern progress in life expectancy, health status, and sharp decrease in infant mortality—all followed the economic progress and were clearly explainable by economic progress. ‘Modern economic growth’ manifests in per capita growth, rather than just population growth, which is the only reliable indicator of economic progress during the pre-capitalist epochs. Modern economic growth caused drastic improvements in housing conditions, food, clean water, and sanitation [ 27 , 28 ]. In turn, a drastic decrease in morbidity and early death encouraged more investment in human capital [ 29 ]. The rise in education and income prompted demand for healthcare services, and eventually also for medical research. Advanced healthcare and vaccination contributed back in stronger incentives to invest in health and education, producing a virtuous cycle [ 30 ].
Since increased income led to life extension, it is logical to conclude that lost income means lost lives. Corresponding references can be found in sect. I.3 of the Collection [ 4 ]. Therefore, any decision potentially harmful to personal income should be scrutinized, and decision-makers should not ignore the loss of life caused by loss of income and corresponding loss of socioeconomic status and self-respect [ 31 , 32 ].
Some authors argue on the above connection between health and wealth. Some of them point out that the positive trend of mortality decrease was not altered during the Great Depression, therefore questioning the negative health effects of the economic factors—see refs. [ 33 , 34 ] and more in section I.4. of the Collection [ 4 ].
All these authors generally ignore long-term trends. Since the beginning of the 20th century (at least), the overall mortality decreased and life expectancy increased, mainly due to the decrease in infectious diseases’ mortality. The overall mortality decrease was accompanied, however, by the increase in cardiovascular and cancer mortality: Roughly speaking, more and more people die of heart attack or cancer being 50–60 years old because they did not die of diphtheria or tuberculosis at age 30–40. However, during the Great Depression, the cardiovascular and cancer mortality growth rate slightly increased compared to both pre-Depression (1909–1929) and post-Depression (1940–1960) periods. Cardiovascular diseases and cancer are linked to psychosomatic consequences of job loss etc. (while any psychosomatic factors in carcinogenesis are a matter of debate, there is no doubt that psychosomatic factors affect a person’s resistance to illness and reaction to treatment). While the overall mortality continued to decrease during the Depression, the slope of this decrease certainly did not grow despite extensive government health programs which were a part of the New Deal.
In summary, it can be said: Though the evidence of the Great Depression’s negative effect on health is inconclusive, the opposite claims—of the overall positive effect of the massive government involvement in health during that period—are certainly not backed by the existing data.
Some researchers have even made a bold claim that the lockdowns coupled with economic recession could cause improvements in public health. We suggest the reader to compare this claim made for the broad audience via a popular resource [ 35 ] with the in-depth study by the same authors providing evidence for just the opposite [ 32 ]: All-cause mortality among the industrial workers who lost their jobs in the 1970s–1980s and never regained their socio-economic status, demonstrates an increase in the 2000s–2010s in stark contrast to the general trend of declining mortality in the developed countries.
Among the key sources that should be cited here is judicial commentary on an expensive regulation of Occupational Safety and Health Administration, in which Judge Williams of the D.C. Circuit stated that excessive regulatory expenditures would make society poorer, potentially worsening individual health. This opinion probably urged the Office of Management and Budget to raise the issue of the potentially counterproductive effects of excessive regulation [ 36 ].
3.2.3. Cost-Effectiveness Threshold
Cost-effectiveness analysis is routinely performed in health policy. It is widely assumed (though far not unanimously) that the state should not provide citizens with services (including life-extension services) that are less cost-effective than the citizens themselves are willing to pay for such services [ 37 ]. Very different values for the cost-effectiveness threshold (CET) can be found in the literature. In our opinion, the proper approach to calculate CET is to use ‘willingness to pay’ (WTP)—that is, how people themselves value their lives in monetary terms [ 38 ]; the term WTP itself describes most exactly the mechanism behind the assumption that the state should not provide citizens with services costing above CET. We are going to discuss this mechanism now.
Accepting certain or very probable death for money is morally unacceptable. However, taking small risks for monetary compensation is routine. Each occupation is associated with some risk. Some occupations are riskier than others (firefighters, police, and even actors). If on average people are ready to take risk of death with a probability, e.g., of 0.001 (one of a thousand) for $1500, then WTP should be estimated as $1.5 million. Namely, to obtain $1.5 million in total wealth, a thousand people on average will take the risk 0.001 to die, and one on average will die. Though people take their risks voluntarily, the net effect is that public expenditure of one WTP statistically claims one human life. The above method of valuing life was proposed by Adam Smith more than two centuries ago and has been used since then in economic analysis as well as in legal practice [ 39 ]. Therefore, CET is not about the monetary value of life. It is about extending the life of the entire population.
3.2.4. Human Cost of Lockdowns—Quantitatively
In the case of the COVID-19 crisis management, the extent of human life lost due to lockdowns can be roughly estimated based on the value of about 150% GDP per capita per quality-adjusted life-year (QALY) as the upper limit of prudent expenditure on healthcare and safety [ 40 ]. Yanovskiy et al. [ 41 ] quantified the human life loss in Israel: The total cost of lockdowns during the year 01.04.2020–31.03.2021 was estimated as about US$ 30 billion based on (a) the data of Bank of Israel and (b) the Oxford COVID-19 Government Response Tracker; while the Israeli population was about 9.2 million, and GDP per capita—about US $45,000. By dividing 30 billion by 1.5 × 45,000, the estimation of 500,000 QALY lost to lockdowns was obtained.
Another comparison can be made if we remember that the average age of people dying of COVID-19 was around 80, with 3–6 QALY per death lost. Therefore, 500,000 QALY are equivalent to roughly 100,000 COVID-19 deaths. Even if we assume that lockdowns saved 1.5 daily deaths per million [ 20 ] for a whole year (365 days), after multiplying by 9.2 million (population of Israel) we arrive at about 5000 lives saved—just about 5% of the lockdowns’ human cost. In other words, it can be estimated that even if the lockdowns saved some lives, in the long term they killed 20 times more.
To put the above number of 500,000 QALY into proportion, such life loss was found to be the equivalent of life years lost in Israel to cancer for 4 years [ 41 ]. Probably, in other developed countries, the human cost of lockdowns was also comparable with several years of life lost to cancer. The latter hypothesis is based on the fact that lockdowns imposed in Israel were of medium strictness according to the Oxford COVID-19 Government Response Tracker (OxCGRT) prepared by the Blavatnik School of Government [ 2 ]. In addition, Israel’s population density and national wealth are also rather typical for developed countries.
3.3. Decision Making
A thorough analysis of the lockdown decision-making is beyond the scope of this paper. However, it seems to us important to raise several questions.
- As mentioned above, the prepared response plans, both national and international, were abandoned without any serious discussion at the very beginning of the COVID-19 crisis. The actual response consisted of instruments that had been considered ineffective and counter-productive.
- The extent of human life loss has probably never been calculated and has never been taken into consideration in the decision-making process. One of the first reports recommending strict lockdowns (26 March 2020) explicitly stated [ 42 ]: “we do not consider the wider social and economic costs of suppression, which will be high”. Anyhow, societies have never been informed about these considerations and calculations.
- The implemented policy relied on compulsion instead of compassion and private initiative (with very few exemptions). The governments ignored alternative ways to protect groups at risk—see Sect. V.3 of the Collection [ 4 ].
- The forecasts which were chosen for political decision-making systematically overestimated the COVID-19 threat, supporting excessive measures—see references in sect. III.1. of the Collection [ 4 ]. Political leaders and government officials systematically “instilled fear in the population, thereby contributing to the making of mass hysteria” [ 43 ].
“Whilst it is always helpful to have more data and more evidence, we caution that in this complex and fast-moving pandemic, certainty is likely to remain elusive. ‘Facts’ will be differently valued and differently interpreted by different experts and different interest groups. A research finding that is declared ‘best evidence’ or ‘robust evidence’ by one expert will be considered marginal or flawed by another expert.”
- Lockdowns were still imposed during the subsequent waves (autumn/winter 2020/21 and 2021/22, to say nothing about the 2022 spring lockdowns in PRC [ 45 ]) as if they had been proven effective—despite the above-mentioned evidence.
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 , 49 ].
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 , 51 , 52 ]. 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 , 3 ]. 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 , 57 ].
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.
While our understanding of viral transmission mechanisms leads to the assumption that lockdowns may be an effective pandemic management tool, this assumption cannot be supported by the evidence-based analysis of the present COVID-19 pandemic, as well as of the 1918–1920 H1N1 influenza type-A pandemic (the Spanish Flu) and numerous less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: we estimate that, even if somewhat effective in preventing death caused by infection, lockdowns may claim 20 times more life than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown in the future. Our conclusions are summarized in Table 2 .
The authors wish to thank Yair Y. Shaki (Jerusalem College of Technology) for his constant interest in this work and numerous stimulating discussions. We would also like to thank the late Ludwik Dobrzynski (NCBJ, Poland), Alexei Kassian (RANEPA, Moscow), Retsef Levi (MIT), Semyon Levitsky (Shamoon College of Engineering), Ori N. Levy (Ariel University), Eugene Medovoy (Israel), Udi Qimron (Tel Aviv University), (MD) Marilyn Singleton (USA), Eli Sloutskin (Bar-Ilan University) and the late Alexander Vaiserman (Inst. of Gerontology, Kiev) for stimulating discussions and constructive criticism. We wish also to thank Sunetra Gupta (University of Oxford) and the PANDA (Pandemics Data & Analytics) group (pandata.org) for their interest in this work. Last but not least, we would like to thank the anonymous reviewers for their constructive criticism that enabled considerable improvement of the paper.
This research received no external funding.
Conceptualization, M.Y.; Methodology, M.Y. and Y.S.; Writing—original draft, M.Y.; Writing—review & editing, Y.S. All authors have read and agreed to the published version of the manuscript.
Institutional Review Board Statement
Informed consent statement, data availability statement, conflicts of interest.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Life lessons from the history of lockdowns
They have been successfully used against pandemics, terror, and technological disasters. What are the costs? Thanks to tools like lockdowns confinement and isolation, lives have been saved in recent history. Self-isolation is now part of our everyday philosophy of life
NEW DELHI : Prime Minister Narendra Modi’s announcement of a national lockdown for 21 days is an unprecedented decision in Indian history. While this is an emergency measure in response to an imminent health security risk, this is not the first time that a government facing a huge threat decides to take an exceptional measure.
Lockdowns have existed throughout human history in different forms and for different reasons: either to stop a pandemic, or to fight against terrorism or technological disasters.
Learning about the history of lockdowns is not merely an intellectual exercise. For instance, it has been a great help to doctors, nurses, pharmacists and state institutions in order to respond actively and positively to the dangers of a pandemic like Covid-19. Let us not forget that isolation, quarantine, and total lockdown are recognized public health measures that have been used for a long time.
Pandemics have always been profoundly unpredictable events in history, due to the immense complexity of the interactions between viruses and humans. It is by using the language of health and purity that modern rationality has approved and administered the creation of boundaries, gated communities and quarantines—distancing healthy society from the impure or unhealthy Other.
The image of the diseased person has often served as an isolation-reinforcing argument, signalling the moral and political imperatives of defending the integrity of a “healthy nation" against all those who are afflicted by the disease. The interventions may vary from behavioural changes like social distancing; quarantining infected patients; regional or national lockdowns. However, it is important to understand that modernity coupled with globalization has created its own dark side: pandemics like SARS and coronavirus, global terrorism and modern technological disasters like Chernobyl and Fukushima can have a worldwide impact.
Isolation and quarantine
The advent of pandemics in the history of humankind has always been accompanied by a series of social, political and economic measures. In 412 BC, Greek physician Hippocrates reported an epidemic that modem doctors believe was the first recorded reference of influenza. Subsequently, there were two major plague pandemics in Europe—the Plague of Justinian (from 600 AD) and the Black Death (from 1340s onward)—followed by socio-political and economic consequences.
As such, each outbreak in the West was accompanied by the implementation of health regulations for its confinement. Isolating the plague patients was one of the measures practised in early modern Europe. A number of Italian city-states established quarantines as early as the 15th century to isolate those sick with plague.
The practice of confinement of those stricken by the plague was adopted by the European maritime powers like England and France during the 16th to the 18th centuries. London’s great plague of 1665 and the Marseilles outbreak in 1720 convinced the French and British administrations to enforce isolation measures in order to protect people from exposure to deadly diseases from overseas.
However, most historians go back to the outbreak of 1347-48. This reactive psychology against the patients of the Black Death was underlined by the Italian author Giovanni Boccaccio in his famous book The Decameron. According to him, “What gave more virulence to this plague was that by being communicated from the sick to the hale, it spread daily, like fire, when it comes in contact with large masses of combustibles. Nor was it caught only by conversing with, or coming near the sick, but even by touching their clothes, or anything that they had touched before."
What was described by Boccaccio at the micro-level of individual psychology in relation to plague patients produced great economic and political changes at the level of state policies and commercial relation in modern Europe. The European maritime states adopted quarantine measures as part of their general mercantilist policies, establishing monopolistic trading companies.
Quarantine measures in early modern Europe not only helped to promote overseas commercial trade, but also served as an ideological function for the European states to stress on public welfare over private lives of the citizens. Also the English public became more aware of the dangers of the plague epidemic at the end of the 18th century. Quarantine regulations were relaxed in the mid-19th century.
The end of the plague pandemic in Europe did not mean necessarily that the world was free from all infectious diseases. The modern magnitude and gravity of some widespread diseases conferred upon them a social, economic, and political significance outweighing those of the two world wars in the 20th century. The influenza pandemic of 1918 caused 50 million deaths worldwide.
Since 1957, influenza pandemics have killed a million people. With the new infectious diseases such as SARS and Avian flu having a disastrous influence on the global economy and international politics, many developed states around the world had to take severe measures.
The outbreak of SARS in November 2002 in China infected more than 5,300 people and killed 349 nationwide. However, the SARS crisis led the Chinese government to take draconian measures to strengthen its authority while sealing off villages, apartment complexes, and university campuses and putting hundreds of thousands of people in confinement. The anti-SARS lockdown policy in China in 2003, followed by a comprehensive epidemic control plan, taught China how to contain the coronavirus outbreak in 2020.
The fact that China’s aggressive measures have slowed the coronavirus does not mean that a global surveillance system for pandemic prevention has become a reality. Containing pandemics is not an easy task for governments and civil societies around the globe. Successful containment would depend on many factors, including tracing exposed individuals, vaccinating the threatened population and decontaminating places and things. Individual isolation and national lockdowns have not been replaced thus far.
The nuclear lockdowns
Some of the more recent examples of lockdowns have taken place thanks to nuclear accidents, like those in Chernobyl and Fukushima.
The nuclear accident on 26 April 1986, at the Chernobyl Nuclear Power Plant, near the city of Pripyat in the north of Ukraine, is considered as the worst nuclear disaster in history. Today, nearly 35 years after the accident, it is still difficult to quantify the impacts of the accident, either in terms of public health or in terms of economic and social costs.
The numbers of victims were staggering: 650,000 workers were directly involved in fighting the fire, assisting evacuees, and cleaning up. About 90,000 people had been evacuated from the 30km-radius, which included the thriving city of Pripyat and more than 70 other settlements. Additionally, 77 administrative districts in 12 regions of Ukraine, including more than 1,500 villages, residential areas, and towns, were heavily contaminated with radioactive material.
Soon after the accident, the Soviet army locked down an area of 30km-radius from the Chernobyl Nuclear Power Plant. Later the radius was changed to cover a much larger area of Ukraine. Known by the name of “The Exclusion Zone", the locked down area was initially divided into three subzones: the area immediately adjacent to the reactor where the incident happened; an area of approximately 10km-radius from the reactor; and the remaining 30km-zone.
Considered as the radioactive contaminated area, “The Exclusion Zone" was totally closed to public access and it was under full military control. For more than two decades, Soviet and Ukrainian authorities maintained the zone around the reactor, including the city of Pripyat, once home to 50,000 people.
It is interesting to note that in the memory of Ukrainians and Russians the horrific disaster of Chernobyl was compared to an act of war. As if the lockdown was a victory against a foreign enemy which has invaded the country. No one better than Svetlana Alexievich, the winner of the Nobel Prize of Literature in 2015, has analysed this muddling of the two concepts of “war" and “disaster" in her book Voices From Chernobyl: The Oral History Of A Nuclear Disaster.
In this book, she argues: “In Chernobyl, we see all the hallmarks of war: hordes of soldiers, evacuation, abandoned houses. The course of life disrupted. Reports on Chernobyl in the newspapers are thick with the language of war: ‘nuclear’, ‘explosion’, ‘heroes’. And this makes it harder to appreciate that we now find ourselves on a new page of history. The history of disasters has begun."
Consequently, even pandemics, emergencies and lockdowns have their own heroes. Let us not forget that today, nine years after Fukushima Daiichi nuclear disaster, the Japanese continue to consider the courageous group of firefighters, employees of the nuclear plant, and members of the Japanese Self Defense Forces as their heroes. But even if disasters and lockdowns do not last forever, sometimes heroism and tragedy are put together and turn into a subject of tourist attraction. It is ironic that Chernobyl, that is the site of the worst nuclear disaster in modern times, which resulted in thousands of deaths, is today an official tourist attraction in Ukraine.
According to Greenpeace, the final death toll of Chernobyl, mostly related to cancer deaths, is estimated up to 200,000 fatalities. Chernobyl has become one of the most blatant examples of what we can call “dark lockdown", a term that can be associated with death and suffering of innocent people such as the 9/11 tragedy in New York.
The terrorist lockdowns
Not surprisingly, most of the famous examples of national lockdowns in the past two decades around the world have been related to terrorist attacks. Like pandemics, global terrorism is a side effect of a globalized world as ours. 11 September 2001 will be forever remembered as one of the most horrific terrorist attacks in modern times.
The attacks caught America and its leaders completely off guard, but it was immediately followed by a three-day lockdown of American civilian airspace. All incoming international flights were diverted to Canada. Washington airspace restrictions were severely tightened after the 9/11 attacks, but the most severe lockdown happened in New York. Bridges and tunnels to Manhattan were closed to non-emergency traffic in both directions. As a result, there was interruption of food deliveries to restaurants and groceries.
All public schools, colleges, daycares and universities in New York and in the Washington, D.C., were also closed. The 9/11 lockdown might have been short term, but it had a long-term effect on the social and political behaviour of the American institutions and citizens. It increased anti-Muslim feelings and segregation in certain American cities, limited American democracy with an anti-terrorist laws, extended privatization of the public sector and restricted the use of public spaces.
These are modes of behaviour and governmental decisions which have usually accompanied nationwide lockdowns around the world.
In the wake of a series of coordinated terrorist attacks in Paris by the Islamic State organization on 13 November 2015, the Belgian government imposed a security lockdown of four days. A terror alert across the Brussels metropolitan area led to the closure of shops, schools, public transportation and the prohibition of any gatherings for a period of four days. This is similar to the Boston lockdown, after the Boston Marathon bombing on 15 April 2013. Thanks to the shutdown, one of the bombers, Tamerlan Tsarnaev, died after the shootout.
So, it goes without saying that recent lockdowns, as a response to pandemics, terrorism or natural or technological disasters, have saved lives. Lockdown, confinement and isolation are words which are used today positively in the battle against the coronavirus around the world.
As they say in French, isolation is nothing but a bad solitude. But today, isolation can save lives. Self-isolation is now part of our everyday philosophy of life.
Ramin Jahanbegloo is professor, vice dean and executive director of the Mahatma Gandhi Centre for Peace Studies at O.P. Jindal Global University
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Is a huge NHS tax rise the only way to make lockdowns history?
Without a debate about paying for extra capacity in hospitals, pandemic chaos will continue to threaten the economy.
By Tim Ross
For a second Christmas in a row, Boris Johnson is weighing up imposing lockdown measures to prevent the NHS becoming overwhelmed by a surge in Covid-19 patients admitted to hospital.
That this is a repeat scenario – despite the widespread and successful roll-out of coronavirus vaccines earlier in the year – graphically demonstrates the danger of new variants. And it shows, again, the vulnerability of the National Health Service to unexpected pressures.
With the pandemic continuing to dominate political and economic debate, is it time policymakers and health service leaders revised their view of what the NHS should be expected to handle?
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If we are living in an age of Covid, in which new variants threaten to evade vaccines and overwhelm hospitals once or twice a year, does the government simply need to increase the capacity of the NHS so it can cope with surging demand, without the need for economically ruinous lockdowns?
At first sight, the numbers are clear. To date, the Chancellor Rishi Sunak has committed more than £400bn in emergency pandemic funding, including loan and grant schemes to support businesses and workers through a succession of lockdowns. That’s more than twice the annual budget of the NHS in England.
In theory, such huge spending on mitigating the worst economic damage of lockdowns (financed by vast borrowing) would be unnecessary if it had been redirected to the health service so there were enough doctors, nurses and intensive care beds (as well as drugs and vaccines) to meet pandemic demand. Pubs, restaurants and shops would be able to remain open and operate as normal.
Protecting loved ones from infection would still be an important consideration but families perhaps could meet more freely for Christmas without worrying that they would risk compromising state healthcare.
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One reason why the UK is currently at risk of requiring further lockdowns is the fact the hospital system always runs “hot” – close to maximum capacity – especially in winter.
According to Siva Anandaciva, chief analyst at the King’s Fund, a health think tank, this has been a problem every winter for years. Safe bed occupancy rates are regarded as below 85 per cent, he said. But the NHS routinely sees 92 per cent or more hospital beds occupied, he continued, at which point accident and emergency departments can become gridlocked, with ambulances backed up outside hospitals.
“We are not in the state at the moment where we have a resilient service,” Anandaciva said. Overseas visitors who look at the UK rates invariably ask: “Why on earth are you running your health system so close to the red zone so systemically?”
[See also: Exclusive: NHS faces third wave of Omicron mid-January in London ]
One reason is that traditionally there has been no political appetite for building in much spare capacity to the health service (the number of NHS beds in England has halved over the last 30 years ).
Another fragility is that it remains a struggle to recruit the doctors and nurses the system needs already. “The NHS went into the pandemic with 100,000 vacancies – those are posts we had funding for rather than how many posts we need to deliver the service you’d want,” Anandaciva said.
The government has announced increases in funding for the NHS – including a 1.25-point rise in National Insurance contributions from next April. The aim is to help the service cope with a growing backlog of procedures and to prepare for future increases in demand, as well as to address the pressure on care homes that leaves frail people stuck in hospital beds. “We would want to do everything possible to ensure the NHS does not become overwhelmed,” the Prime Minister’s spokesperson said on 20 December.
Officials in Whitehall are beginning to think about how to increase resilience in a system that has been creaking for years but which in the past decade has suffered a squeeze on resources, combined with rising demand from an ageing population.
According to Simon Stevens, who was chief executive of the NHS from 2014 to 2021, building more capacity into the system, rather than aiming for “the optimum just-in-time efficiency”, is a vital lesson to take from the UK’s experience of the pandemic. “Resilience requires buffer, and buffer can look wasteful until the moment when it is not,” he told the Commons Health and Social Care Select Committee earlier this year.
In a report published in September, the health committee called on the government to make a “more explicit, and monitored, surge capacity” part of “long-term” NHS funding and organisation in future. “Comprehensive analysis should be carried out to assess the safety of running the NHS with the limited latent capacity that it currently has, particularly in Intensive Care Units, critical care units and high dependency units,” the committee said.
How much could such spare capacity cost? “You’d be looking at an enormous increase in spending,” according to Ben Zaranko, from the Institute for Fiscal Studies think tank. “Would it actually be desirable to operate with the degree of spare capacity necessary to fully absorb the shock of a pandemic? That would involve huge amounts of idle resources in normal times. If you did something more modest – say, a 10-15 per cent increase in bed numbers – that would be more affordable, but you may not do much to reduce the chances of a lockdown,” he said. “You might just buy yourself a week or two.”
The Institute for Fiscal Studies’s website published a calculator tool to estimate the level of tax rises that would be needed (or public spending cuts) to fund NHS requirements over the next ten to 15 years.
By the early 2030s, keeping pace with growing demand while making modest improvements in NHS performance and capacity would require spending around an extra 2.5 per cent of national income on health, according to the tool, which was first published in 2018. Paying for that through higher taxes would mean raising an extra £56bn, equivalent to roughly £2,000 extra in tax for the average household each year.
Eyewatering though that amount is, it would still be too small to cope with a surge in Covid hospital admissions of perhaps 10,000 a day, which modelling by Sage has warned is a possible worst-case scenario in the current Omicron variant wave.
“It’s hard to imagine running the NHS with so much spare capacity in normal times,” said Paul Johnson, director of the Institute for Fiscal Studies. But this calculation would have to change if scientists concluded that highly disruptive pandemics were to become a far more regular feature of life, he said.
“If the epidemiologists were saying Covid is such that we are going to get a wave twice a year which is going to overwhelm the NHS in its current state then it would make sense to invest enormously in additional capacity,” said Johnson.
So what do the pandemic experts predict? There have been four influenza pandemics in the past 100 years. According to the government’s most recent National Risk Register , published a year ago, this means there is “a high probability of another flu pandemic occurring, but it is impossible to predict when it might happen, or exactly what it would be like”.
In the past 30 years, more than 30 new or newly recognised diseases have been identified, the document said. Most have been naturally transmissible from animals to humans, such as Covid-19, HIV, Ebola, Sars and the Zika virus.
Even if forecasters could predict with any accuracy when the next pandemic will strike, as the current debate over lockdown restrictions shows, the science may point one way but the politics will ultimately be the decisive factor. Johnson’s traditionally low-tax, low-spend Conservative backbenchers are no more likely to embrace a radical expansion of state healthcare provision than they are tighter lockdown measures.
Many Conservatives instinctively still see the value in a bigger role for the private sector in the NHS. The government recently blocked attempts to change the Health and Care Bill currently passing through parliament to limit the role of private healthcare representatives on regional boards, a move that alarmed some campaigners who fear privatisation.
[See also: Is the Conservative government privatising the NHS by stealth? ]
Yet structural reforms have been drawn up in Whitehall without much public debate about the proper role and purpose of the NHS. Since the health service was iconised as a core part of British identity at the opening ceremony of the London Olympics in 2012, neither of the main political parties has wanted to open a fundamental discussion about what some describe as the closest thing the country has to a national religion.
Eventually, if a new mutation of coronavirus – or another devastating disease – changes the environment in which humans seek to thrive, societies and their political leaders will have to adapt too.
“Either you’re limiting your horizon to just getting through the next year or two, or at some point you have to say we need to have a discussion with the public and all the political parties over what type of health service we want,” said Anandaciva. “Unless you do that, you’re always only going to be, at best, just ahead of the curve.”
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Covid-19 Didn't Introduce Lockdown to the World: A Look Back at The History
Curated By : Buzz Staff
Last Updated: November 12, 2020, 21:11 IST
Stacked chairs and tables are pictured on a street during a lockdown in Germany during coronavirus pandemic.
The concept of a lockdown and quarantine has existed since ages to curb down various emergency situations, such as during the bubonic plague, Spanish flu to the recent SARS virus.
Collins Dictionary has declared “lockdown” as the word of the year. The dictionary has defined ‘lockdown’ as “a security measure in which those inside a building or area are required to remain confined in it for a time” and “the imposition of stringent restrictions on travel, social interaction, and access to public spaces”.
While 2020 is the year we witnessed lockdown with the Coronavirus pandemic, this isn’t the first lockdown in the history of the world.
The concept has existed for ages to curb down various natural and man-made situations. Let’s take a look through the pages of history to look back at various lockdowns that the world saw over the centuries.
Seeds of a Shutdown
The Plague of Justinian , which was named for the emperor Justinian (AD 527-565) of the Byzantine empire was what sparked off the end to the great civilisation. The King was sick with the bubonic plague and the disease wreaked havoc on the empire. Some researchers believe that the disease managed to killed up to 5,000 people per day in Constantinople. The devastation it caused to the empire and the population made the experts come up with the idea of separating the diseased people from the general population. However, there wasn’t a formally laid out plan for the same back then.
First Markers of Lockdown, Quarantine
The measures taken to alleviate the effects of the bubonic plague that hit Europe in the 14th century was what is termed as the first ever attempt at a lockdown by the government or those in power. Nicknamed as ‘Black Death’ which attacked parts of Europe and others through 1346 to 1353. Italy’s response to the plague has been deemed the best , the officials were entrusted to lower down movement of people and means of transport in the public space. Sea ports refused to take in ships coming from other countries for fear of fresh plague attacks and in 1348, a formal health policy was initiated thus making Venice one of the first cities to do so. Also, the ships that were allowed to moor at the ports, sailors from them were told to isolate for a month, which led to the beginning of the concept and term of ‘quarantine’. The Italian word for it was originally ‘trentino’, and the English word “quarantine” is directly inspired from the Italian ‘quarantino’, meaning 40-day period. The plague managed to kill about 25 million people across the world eventually.
Spanish Flu Flattening Measures
The virus, which spread in the 20th century and claimed its first recorded death in Britain in 1918, spread even more due to the ongoing First World war and the inaction by the government then which placed more importance on the war rather than the public safety.
The virus spread easily among soldiers, factory workers and in people who used public modes of transport. Even though a policy of safe measures to be undertaken was prepared by authorities, it never saw the daylight because the government kept it under wraps to not alarm the public. It reportedly spoke of avoiding large gatherings and staying indoors. The widely propagated misinformation about the virus is that it originated in Spain but the fact was it was the first country that reported deaths from it.
Similar Lockdown Measures, 100 Years on
Even though there were no actually formalised forms of lockdown imposed on the public, curbs existed in several forms where many public areas of congregation were told to down shutters for fear of the virus spread. Theatres, dance halls, cinemas and churches were closed and in many cases the shutdown lasted for months. Authorities sprayed disinfectants and use of anti-pollution and face covers also saw a rise. The government also initiated drives to warn against spread of the disease through touch and other physical contacts.
Lockdowns in Recent Past
Around 20 years ago, a deadly disease that came to be termed as the Severe Acute Respiratory Syndrome (SARS) virus was detected in China, and later spread to many parts of the world. Although the disease was curbed quickly, efforts to eradicate it begun with a form of lockdown by the Chinese government. Districts were locked down, people were instructed not to venture out and limit social interactions.
Apart from the lockdowns which were necessitated due to such health emergencies, lockdowns have also been implemented due to several many-made concerns. Terror attacks in the US in 2001 also had initiated a short period of locking down in parts of the country. Jammu and Kashmir has also been in a state of absolute civilian lockdown after the Abrogation of Article 370 in 2019.
Within the past 24 hours, India saw 47,905 new Covid-19 cases and 550 deaths, taking the total tally in the country to 8,683,916. The total fatalities are at 1,28,121 after the latest update of the Health Ministry.
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On April 8, 2020, the Chinese government lifted its lockdown of Wuhan. It had lasted 76 days — two and a half months during which no one was allowed to leave this industrial city of 11 million people, or even leave their homes. Until the Chinese government deployed this tactic, a strict batten-down-the-hatches approach had never been used before to combat a pandemic. Yes, for centuries infected people had been quarantined in their homes, where they would either recover or die. But that was very different from locking down an entire city; the World Health Organization called it “unprecedented in public health history.”
The word the citizens of Wuhan used to describe their situation was fengcheng — “sealed city.” But the English-language media was soon using the word lockdown instead — and reacting with horror. “That the Chinese government can lock millions of people into cities with almost no advance notice should not be considered anything other than terrifying,” a China human rights expert told The Guardian . Lawrence O. Gostin, a professor of global health law at Georgetown University, told the Washington Post that “these kinds of lockdowns are very rare and never effective.”
The Chinese government, however, was committed to this “zero-COVID” strategy, as it was called. In mid-March 2020, by which time some 50 million people had been forced into lockdowns, China recorded its first day since January with no domestic transmissions — which it offered as proof that its approach was working. For their part, Chinese citizens viewed being confined to their homes as their patriotic duty.
For the next two years, harsh lockdowns remained China’s default response whenever there was an outbreak anywhere in the country. But by March 2022, when the government decided to lock down much of Shanghai after a rise in cases in that city, there was no more talk of patriotism. People reacted with fury, screaming from their balconies, writing bitter denunciations on social media, and, in some cases, committing suicide. When a fire broke out in an apartment building, residents died because the police had locked their doors from the outside. And when the Chinese government finally abandoned lockdowns — an implicit admission that they had not been successful in eliminating the pandemic — there was a wave of COVID-19 cases as bad as anywhere in the world. (To be fair, this was partly because China did such a poor job of vaccinating its citizens.)
One of the great mysteries of the pandemic is why so many countries followed China’s example. In the U.S. and the U.K. especially, lockdowns went from being regarded as something that only an authoritarian government would attempt to an example of “following the science.” But there was never any science behind lockdowns — not a single study had ever been undertaken to measure their efficacy in stopping a pandemic. When you got right down to it, lockdowns were little more than a giant experiment.
Despite the lack of scientific evidence, lockdowns didn’t come out of nowhere, at least not in the U.S. They had been discussed — and argued over — by scientists since 2005, when (as the story goes) President George W. Bush read John M. Barry’s book The Great Influenza, about the 1918 pandemic. “This happens every hundred years,” Bush is supposed to have said after finishing the book. “We need a national strategy.”
In fact, there were people thinking about pandemic mitigation long before Bush read Barry’s book. The leader of this ad hoc group was D.A. Henderson, perhaps the most renowned epidemiologist of the 20th century — the man who, decades earlier, had led the team that eradicated smallpox. Richard Preston, the author of The Hot Zone, would later describe this feat as “arguably the greatest life-saving achievement in the history of medicine.”
By the time Bush began pushing his administration to come up with a pandemic plan, Henderson was 78 years old. Ten years earlier, he had sat in on a series of top-secret briefings where he listened to a Russian defector describe how he had led a team that was trying to adapt the smallpox virus for bioweapons. Henderson became so concerned that he started a small center focused on biodefense — which meant, in effect, defending against a pandemic. He and his colleagues at the center had spent years trying to persuade government officials to take pandemics seriously — without much success. When the Bush administration began debating what its pandemic strategy should include, it was only natural that Henderson be involved.
The men Bush chose to lead the effort believed that lockdowns could be an important component of a mitigation plan. They were heavily influenced by a model developed by Laura Glass, a 14-year-old high-school student from Albuquerque (aided by her scientist father), that purported to show that keeping people away from one another was as effective as a vaccine. (This story is told, overexcitedly, in Michael Lewis’s book The Premonition. )
Henderson vehemently disagreed. For one thing, he didn’t trust computer models, which churned out estimates based on hypotheticals. Just as important, they couldn’t possibly anticipate the complexity of human behavior. “There is simply too little experience to predict how a 21st-century population would respond, for example, to the closure of all schools for periods of many weeks to months, or the cancellation of all gatherings of more than 1,000 people,” he said.
In addition, he felt that the worst thing officials could do was overreact, which could create a panic. In 2006, as the debate inside the Bush administration was nearing its conclusion, he co-authored a paper in a final effort to change the minds of those devising the strategy. The paper concluded: “Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen as less than optimal, a manageable epidemic could move towards catastrophe.”
The Bush team’s final document, published by the CDC in February 2007, stopped short of mandating lockdowns but came as close as its authors dared, calling for the use of “social distancing measures to reduce contact between adults in the community and workplace.” One of the leaders of the effort, a government scientist named Richard Hatchett, would later tell Lewis what he really believed: “One thing that’s inarguably true is that if you got everyone and locked each of them in their own room and didn’t let them talk to anyone, you would not have any disease.”
Which is true as far as it goes. There were other questions, though, that were at least as relevant. Could the kinds of lockdowns that are achievable in the real world, where hundreds of millions of people can’t live in isolation chambers, be an effective tool against a pandemic? Did the virus truly go away during a lockdown or simply hide, waiting to reemerge when it ended? And finally, did the many social, economic, and medical downsides make them, in the aggregate, not worth whatever short-term benefits they might yield?
Henderson, who died in 2016, never stopped making the latter case. “D.A. kept saying, ‘Look, you have to be practical about this,’” says his former deputy, Tara O’Toole. “‘And you have to be humble about what public health can actually do, especially over sustained periods. Society is complicated, and you don’t get to control it.’”
As the United States gains more and more distance from the COVID pandemic, the perspective on what worked, and what did not, becomes not only more clear, but more stark. Operation Warp Speed stands out as a remarkable policy success. And once the vaccines became available, most states did a good job of quickly getting them to the most vulnerable, especially elderly nursing-home residents.
Unfortunately, there is no shortage of policy failures of which to take stock. We do an accounting of many of them in our new book, The Big Fail . But one that looms as large as any, and remains in need of a full reckoning in the public conversation, is the decision to embrace lockdowns. While it is reasonable to think of that policy (in all its many forms, across different sectors of society and the 50 states) as an on-the-fly experiment, doing so demands that we come to a conclusion about the results. For all kinds of reasons, including the country’s deep political divisions, the complexity of the problem, and COVID’s dire human toll, that has been slow to happen. But it’s time to be clear about the fact that lockdowns for any purpose other than keeping hospitals from being overrun in the short-term were a mistake that should not be repeated. While this is not a definitive accounting of how the damage from lockdowns outweighed the benefits, it is at least an attempt to nudge that conversation forward as the U.S. hopefully begins to recenter public-health best practices on something closer to the vision put forward by Henderson.
After China came Italy, the second country to be hit hard by the coronavirus. The Italian government responded with a lockdown almost as tough as China’s. By the time it was lifted, in early June, 34,000 Italians had died of COVID-19, up from 630 when the lockdown was first imposed.
Those were frightening numbers. But when Neil Ferguson saw what had transpired in Italy, he saw an opportunity. For Ferguson, the head of the infectious disease department at Imperial College London, the Italian government’s decision to follow China’s example meant that lockdowns were suddenly a real-world policy option in Western democratic societies, not just in an authoritarian country like China. As a disease modeler, he believed the same thing Richard Hatchett believed: that if he could lock everyone in a room, the virus would go away. But he had long assumed attempting to do so was politically impossible.
Ferguson is an important epidemiologist, renowned for his estimates, derived from computer models, of possible deaths from a newly emerged virus. As soon as he learned of the outbreak in Wuhan, he and several colleagues began modeling the coronavirus. On March 17, Ferguson laid out the team’s findings at a press conference. Their model predicted that, without serious countermeasures, a staggering 81 percent of the population in the U.S. and Britain would become infected, and that 510,000 people in Britain and 2.2 million Americans would die of COVID by late 2020. In addition, the authors wrote, “We predict critical care bed capacity would be exceeded as early as the second week in April, with an eventual peak in ICU or critical bed care demand that is over 30 times greater than the maximum supply in both countries.”
For Ferguson, the purpose of the report wasn’t just to release their shocking estimates; it was also to push the American and British governments to commit to lockdowns for the long haul. “[T]his type of intensive intervention package,” the authors wrote, “will need to be maintained until a vaccine becomes available (potentially 18 months or more) — given that we predict that transmission will quickly rebound if interventions are relaxed.” It worked. In the U.K., Prime Minister Boris Johnson had initially planned to keep the country open. Instead, he ordered a lockdown within a week of Ferguson’s press conference. (Shortly after Johnson imposed the lockdown, Ferguson was visited twice by his mistress. For obvious reasons, this caused a furor when it was discovered. Ferguson was the first, though hardly the last, Establishment bigwig to ignore the COVID-19 rules they demanded of everyone else.)
As for President Donald Trump, he never used the word lockdown , but he was worried enough to call for the country to adopt social distancing as a mitigation strategy. Schools, restaurants, businesses — they all closed. White-collar employees who were able to work from home did so. More than once, Trump mentioned that 2.2 million lives were at stake, referring to Ferguson’s estimate. Trump’s order wound up lasting six weeks.
Most governors issued their own “stay-at-home” orders, usually stricter than Trump’s. Even Governor Ron DeSantis in Florida — who would soon become an outspoken opponent of mainstream mitigation measures — reluctantly went along for a brief period. But there were important questions that no one advocating for lockdowns addressed, maybe because in the urgency of the moment the questions didn’t occur to them. How long would they last? And even if lockdowns did slow the virus’s progression, what would happen when they were lifted?
Regardless, in the space of two months, lockdowns had gone from being unthinkable to being an unquestioned tool in the pandemic toolkit.
When state public health officials explained to the country’s governors why lockdowns were necessary, they talked primarily about “bending” or “flattening the curve.” And when governors then explained the strategy to their constituents, they used the same rationale. “If we change our behaviors,” said California governor Gavin Newsom in announcing his state’s lockdown on March 19, “we can truly bend the curve to reduce the need to surge.” The day after Newsom, then-Governor Andrew Cuomo announced a lockdown plan for New York. He called it his PAUSE program — Policies Assure Uniform Safety for Everyone — but really, it was the same thing.
What did flattening the curve mean? Here’s what it didn’t mean: It did not mean that if people stayed in their homes, COVID-19 would fade away (even if that idea was often suggested in non-expert contexts). Rather, flattening the curve meant delaying the virus spread to prevent hospitals from becoming overwhelmed with COVID patients. During their early press conferences, many governors would display a chart showing a sharp increase in the estimated rate of COVID-19 infections. That’s what would happen without lockdowns, they explained. Then they would display a second chart showing a more gradual upturn once lockdowns and other mitigation measures took effect. Simply put, flattening the curve was about helping hospitals manage the crisis rather than ending the crisis. Even those who later criticized lockdowns largely agreed on this point. As David Nabarro, the World Health Organization’s COVID-19 envoy (and an eventual lockdown critic), put it, “The only time we believe a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted, but by and large we’d rather not do it.”
In many blue states, however, that rationale was forgotten over time, and many people remained confined to their homes or apartments not just for a few weeks but for a year or more — even after the vaccine became available. And many of the country’s biggest cities continually reimposed lockdowns whenever there was an uptick in COVID cases — not just telling people to shelter in place, but also closing small businesses and restaurants, outlawing sports events and social gatherings, and shutting down in-school learning.
Which naturally leads to the obvious question: Did lockdowns help keep Americans alive? Studies were mixed — in their findings, their methodology, even their definition of lockdown . For instance, in August 2020, eClinicalMedicine, an offshoot of the prestigious British medical journal The Lancet, printed a study that concluded that “full lockdowns and wide-spread COVID-19 testing were not associated with reductions in the number of critical cases or overall mortality.” In March 2021, Christian Bjørnskov, an economist at Aarhus University in Denmark, compared weekly mortality rates in 24 European countries that used mitigation measures with varying degrees of severity. “[T]he findings in this paper suggest that more severe lockdown policies have not been associated with lower mortality,” the economist wrote. “In other words,” he added, “the lockdowns have not worked as intended.”
Michael Osterholm, the prominent epidemiologist at the University of Minnesota, also doesn’t think lockdowns did any good. “There is actually no role for lockdowns,” he says. “Look at what happened in China. They locked down for years, and when they finally relaxed that effort, they had a million deaths in two weeks.” As for flattening the curve, “that’s not a real lockdown,” Osterholm says. “You’re just reducing contact for a few weeks to help the hospitals.”
Dr. Anthony Fauci was probably the best-known defender of lockdowns as a life-saving measure. But the policy continues to have many defenders within the public health establishment. Howard Markel, a doctor and medical historian at the University of Michigan, believes they succeeded. “The amount of lives saved was just incredible,” he says. Markel pointed to an August 2023 study by the Royal Society of London that concluded that “stay-at-home orders, physical distancing, and restrictions on gathering size were repeatedly found to be associated with significant reduction in SARS-CoV-2 transmission, with more stringent measures having greater effects.”
Still, the weight of the evidence seems to be with those who say that lockdowns did not save many lives. By our count, there are at least 50 studies that come to the same conclusion. After The Big Fail went to press, The Lancet published a study comparing the COVID infection rate and death rate in the 50 states. It concluded that “SARS-CoV-2 infections and COVID-19 deaths disproportionately clustered in U.S. states with lower mean years of education, higher poverty rates, limited access to quality health care, and less interpersonal trust — the trust that people report having in one another.” These sociological factors appear to have made a bigger difference than lockdowns (which were “associated with a statistically significant and meaningfully large reduction in the cumulative infection rate, but not the cumulative death rate”).
In all of this discussion, however, there is a crucial fact that tends to be forgotten: COVID wasn’t the only thing people died from in 2020 and 2021. Cancer victims went undiagnosed because doctors were spending all their time on COVID patients. Critical surgeries were put on hold. There was a dramatic rise in deaths due to alcohol and drug abuse. According to the CDC, one in five high-school students had suicidal thoughts during the pandemic. Domestic violence rose. One New York emergency-room doctor recalls that after the steady stream of COVID patients during March and April of 2020, “our ER was basically empty.” He added, “Nobody was coming in because they were afraid of getting COVID — or they believed we were only handling COVID patients.”
So in attempting to gauge the value of lockdowns, the most appropriate way is to look not just at COVID deaths but at all deaths during the pandemic years. That’s known as the “excess deaths” — a measure of how many more people died than in a normal year. One authoritative accounting was compiled by The Spectator using data gathered by the OECD. It showed that during the first two years of the pandemic — 2020 and 2021 — the U.S. had 19 percent more deaths than it normally saw in two years’ time. For the U.K., there was a 10 percent rise. And for Sweden — one of the few countries that had refused to lock down its society — it was just 4 percent. An analysis by Bloomberg found broadly similar results. In other words, for all the criticism Sweden shouldered from the world’s public health officials for refusing to institute lockdowns, it wound up seeing a lower overall death rate during the pandemic than most peer nations that shut down schools and public gatherings. It is not unreasonable to conclude from the available data that the lockdowns led to more overall deaths in the U.S. than a policy that resembled Sweden’s would have.
There were other negative consequences too. In the U.S., lockdowns forced hundreds of thousands of small business closures. They exacerbated inequality, as Amazon warehouse workers and meatpackers showed up to crowded workplaces while the “Zoom class” locked down at home. Worst of all, though, it had a devastating effect on children whose schools were closed as part of a lockdown. During the first weeks of the pandemic it probably made sense to close schools given how little was known about the coronavirus. Better safe than sorry. But by the time school started up again in the fall of 2020, two things were clear. The first was that remote learning was a disaster. The second was that there was surprisingly little transmission among kids in school. Well-to-do parents moved their children to private schools, many of which reopened their classrooms. But most big-city public-school systems continued to rely on remote learning well into the 2020–2021 school year. It was a tragic policy choice.
In ProPublica and The New Yorker, the journalist Alec MacGillis vividly described the consequences in Baltimore. With no classrooms to go to, thousands of students abandoned school. The school system made free laptops available, but few students took the trouble to get one. Teachers gave up trying to prod those who didn’t log onto their remote classes. Plus, teachers had kids of their own to take care of, which made it difficult to teach.
The anti-lockdown scientist Jay Bhattacharya of Stanford University recalls a photograph in the San Jose Mercury News during the early months of the pandemic. It showed two children, 7 or 8 years old, sitting with Google Chromebooks outside a Taco Bell. “They were on the sidewalk doing schoolwork because that was the only place they could get free Wi-Fi,” Bhattacharya said. “Their parents weren’t there because they had to go to work. I mean, that should have ended the lockdown right then and there. It should have at least ended school closures.”
Public schools have an importance that goes beyond education. It’s where many of the rituals of childhood and young adulthood take place. For children who live in unstable homes, school offers some stability. Public schools serve free breakfast and lunch to disadvantaged kids. And they’re a place where parents know their children are safe when they’re at work. One consequence of lockdowns was that millions of children had to fend for themselves because their parents couldn’t afford to quit their jobs to take care of them.
One child psychiatrist, who works with underprivileged autistic kids, began the pandemic believing in the importance of lockdowns and other mitigation measures. But over time, she changed her mind.
“What really drove me was my clinical experience,” she said. “What happens to a child when every single support is removed from them? What’s the impact on the family and the siblings? What I was seeing was complete regression. It was devastating, and the downsides of lockdowns and school closings were not being openly discussed in the mainstream media. I was horrified. Why aren’t we talking about this?” She described the situation she saw as 2022 wore on as a “sickening mental-health crisis.”
The science also weighed heavily in favor of opening schools. By mid-summer 2020, when cities were trying to decide whether to reopen schools in September, 146,000 Americans had died of COVID-19. Fewer than 20 were children between the ages of 5 and 14. More schoolchildren died from mass shootings in a typical year. Emily Oster, a Brown University economist, conducted a survey of about 200,000 children who were back in classrooms. The infection rate, she discovered, was 0.13 percent among students and 0.24 percent among teachers — an astonishing low number. Oster then set up what she called the National COVID-19 School Response Dashboard, which eventually tracked 12 million kids in both public and private schools and continued to collect infection-rate data over the next nine months. Not once did the student rate hit one percent during any two-week span.
“We do not want to be cavalier or put people at risk,” Oster wrote in The Atlantic . “But by not opening, we are putting people at risk, too.”
Over the entirety of the pandemic, the essential facts about schools never changed. The infection rate for teachers in Sweden, where most schools stayed open, was no higher than the infection rate for teachers in Finland, which had closed its schools. In early 2021, three CDC scientists acknowledged in the Journal of the American Medical Association : “As many schools have reopened for in-person instruction in some parts of the U.S. … there has been little evidence that schools have contributed meaningfully to increased community transmission.”
So why did so many big-city schools stay closed long after the evidence was clear? There were three reasons. The first, and most understandable, was fear. No matter how small the chance, no parent wanted his or her child to die from COVID-19. And no teacher wanted to become infected while in school and bring COVID-19 home. Because kids often brought colds and flus to school — which then spread to others — both parents and teachers had a hard time accepting that that was not how the virus spread. Here, for instance, was a typical comment from a teacher in Westchester, reacting to a series of New York Times ’ articles about reopening schools:
Tell me how to get a 6-year-old to not sneeze on his friends let alone play and work from a distance (mucus, saliva, pee, poop, this is all part of our day at the lower levels of education). Tell me how each child is going to have her own supplies for the day as shared supplies are no longer an option. No more Legos, no more books. Tell me how to comfort a hysterical child from a distance of six feet.
That it was well established that the coronavirus was not spread through saliva or pee or by sharing books didn’t matter. Too many people were simply unable to judge risk rationally — a problem due in part to unwillingness of government officials to talk honestly about COVID-19. In 2020, for instance, COVID-19 ranked below suicide, cancer, accidents, homicide, and even heart disease as a cause of death for children under the age of 15, according to CDC data. Yet public-health experts did not stress any of this — on the contrary, many of them emphasized instead that children could get COVID-19 without explaining how small the risk was. Is it any wonder, then, that COVID-19 seemed to be the only thing parents and teachers focused on?
The second factor was Trump. On July 6, he tweeted, “SCHOOLS MUST REOPEN IN THE FALL!!” The next day, at a White House event, the president said, “We’re very much going to put pressure on governors and everybody else to open the schools. It’s very important for our country. It’s very important for the well-being of the student and the parents.”
In this case, Trump happened to be right; it was important. But by this late stage in his presidency, most Democrats assumed that anything he said was a lie. If Trump said schools should reopen, that was reason enough for them to assume they should stay closed. The sense that opening up was a Trump-endorsed policy seems to have energized opposition to it in blue America — even as data accumulated that the harm being done to the country’s children outweighed any potential benefit.
The third reason was the teachers’ unions. Public-school teachers were unionized, and their unions — American Federation of Teachers (AFT) and the National Education Association (NEA) — were allies of, and contributors to, the Democratic Party, which dominated most major urban areas. They held enormous sway over big-city school systems.
No one can doubt that teachers were afraid of dying of COVID-19. They truly believed they were putting themselves in harm’s way if they went back into a classroom full of children. But instead of helping their members see how small the risk truly was, the teachers’ unions embraced the fight to keep teachers away from the classroom.
By the time September 2020 rolled around, at least a dozen of America’s biggest cities started the school year remotely. They included Los Angeles, San Francisco, New York, Chicago, and Houston — all cities with the kind of large, disadvantaged communities that would suffer the most if schools were closed. In most cases, city officials said they were trying to move from remote learning to at least a hybrid model, in which students would spend several days a week in classrooms and the rest of the week online.
In school districts that did open their schools that fall, the results were remarkably aligned with Emily Oster’s data. In New York, Mayor Bill de Blasio was finally able to get the schools open in late September; between Thanksgiving and the end of the year, the city’s positivity rate rose from 3 percent to 6 percent. The positivity rate in the public schools also rose — from 0.28 percent to 0.67 percent. “The safest place in New York City is, of course, our public schools,” said de Blasio. To the holdout unions, those numbers didn’t matter. Ultimately, only 15 percent of school districts offered full-time classroom instruction during the fall 2020 semester.
By 2022, journalists, academics, and even some public-health officials were finally coming to grips with the enormous damage done to children — especially disadvantaged children — because of remote learning. A lengthy analysis by two professors in The Atlantic toted up some of the issues. First, millions of kids simply gave up on learning. In New York, even after schools had reopened, the chronic absentee rate was 40 percent — up from 26 percent before the pandemic. Studies showed that public-school children got less exercise (no recess) and ate more junk food (no free hot meals) during the pandemic. According to a CDC survey, during the first six months of 2021, nearly half the high-school students surveyed “felt persistently sad or helpless.” Parental emotional abuse was four times higher than in 2013, and parental physical abuse nearly doubled, The Atlantic reported.
A study by three major research institutions, including Harvard’s Center for Education Policy Research, showed that the longer a school relied on remote learning, the further behind their students were. “In high-poverty schools that were remote for more than half of 2021, the loss was about half of a school year’s worth of typical achievement growth,” said Thomas Kane, the director of the Harvard center.
Although test scores in 2023 would suggest that students were slowly catching up, those scores didn’t take into account the kids who had dropped out entirely. One analysis found an estimated 230,000 students in 21 states whose absences could not be accounted for. They had simply gone missing. “The pandemic has amounted to a comprehensive assault on the American public school,” concluded the authors of The Atlantic article. Yet as late as the fall of 2022, there were still those who refused to acknowledge the damage done by lengthy school closings.
One such person was Anthony Fauci. In August 2022, Fauci announced that he planned to retire at the end of the year. Over the next few months, he made the rounds to discuss how the country had fared during the pandemic. Invariably, he was asked whether he regretted his forceful advocacy of lockdowns, especially given its effect on children. At one forum, he said, “Sometimes when you do draconian things, it has collateral negative consequences … on the economy, on the schoolchildren.” But, he added, “The only way to stop something cold in its tracks is to try and shut things down.”
What he could never acknowledge was that “shutting things down” didn’t stop the virus, and that keeping schools closed didn’t save kids’ lives. Then again, to understand that, you had to be willing to follow the science.
Excerpted from The Big Fail: What the Pandemic Revealed About Who America Protects and Who It Leaves Behind, by Joe Nocera and Bethany McLean (Portfolio, October 2023).
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Pandemics That Changed History
By: History.com Editors
Updated: December 21, 2021 | Original: February 27, 2019
In the realm of infectious diseases, a pandemic is the worst case scenario. When an epidemic spreads beyond a country’s borders, that’s when the disease officially becomes a pandemic.
Communicable diseases existed during humankind’s hunter-gatherer days, but the shift to agrarian life 10,000 years ago created communities that made epidemics more possible. Malaria, tuberculosis, leprosy, influenza , smallpox and others first appeared during this period.
READ MORE: See all pandemic coverage here .
The more civilized humans became, building cities and forging trade routes to connect with other cities, and waging wars with them, the more likely pandemics became. See a timeline below of pandemics that, in ravaging human populations, changed history.
430 B.C.: Athens
The earliest recorded pandemic happened during the Peloponnesian War . After the disease passed through Libya, Ethiopia and Egypt, it crossed the Athenian walls as the Spartans laid siege. As much as two-thirds of the population died.
The symptoms included fever, thirst, bloody throat and tongue, red skin and lesions. The disease, suspected to have been typhoid fever, weakened the Athenians significantly and was a significant factor in their defeat by the Spartans.
165 A.D.: Antonine Plague
The Antonine plague was possibly an early appearance of smallpox that began with the Huns. The Huns then infected the Germans, who passed it to the Romans and then returning troops spread it throughout the Roman empire . Symptoms included fever, sore throat, diarrhea and, if the patient lived long enough, pus-filled sores. This plague continued until about 180 A.D., claiming Emperor Marcus Aurelius as one of its victims.
250 A.D.: Cyprian Plague
Named after the first known victim, the Christian bishop of Carthage, the Cyprian plague entailed diarrhea, vomiting, throat ulcers, fever and gangrenous hands and feet.
City dwellers fled to the country to escape infection but instead spread the disease further. Possibly starting in Ethiopia, it passed through Northern Africa, into Rome, then onto Egypt and northward.
There were recurring outbreaks over the next three centuries. In 444 A.D., it hit Britain and obstructed defense efforts against the Picts and the Scots, causing the British to seek help from the Saxons, who would soon control the island.
541 A.D.: Justinian Plague
First appearing in Egypt, the Justinian plague spread through Palestine and the Byzantine Empire , and then throughout the Mediterranean.
The plague changed the course of the empire, squelching Emperor Justinian's plans to bring the Roman Empire back together and causing massive economic struggle. It is also credited with creating an apocalyptic atmosphere that spurred the rapid spread of Christianity.
Recurrences over the next two centuries eventually killed about 50 million people, 26 percent of the world population. It is believed to be the first significant appearance of the bubonic plague , which features enlarged lymphatic gland and is carried by rats and spread by fleas.
11th Century: Leprosy
Though it had been around for ages, leprosy grew into a pandemic in Europe in the Middle Ages , resulting in the building of numerous leprosy-focused hospitals to accommodate the vast number of victims.
A slow-developing bacterial disease that causes sores and deformities, leprosy was believed to be a punishment from God that ran in families. This belief led to moral judgments and ostracization of victims. Now known as Hansen’s disease, it still afflicts tens of thousands of people a year and can be fatal if not treated with antibiotics.
1350: The Black Death
Responsible for the death of one-third of the world population, this second large outbreak of the bubonic plague possibly started in Asia and moved west in caravans. Entering through Sicily in 1347 A.D. when plague sufferers arrived in the port of Messina, it spread throughout Europe rapidly. Dead bodies became so prevalent that many remained rotting on the ground and created a constant stench in cities.
England and France were so incapacitated by the plague that the countries called a truce to their war. The British feudal system collapsed when the plague changed economic circumstances and demographics. Ravaging populations in Greenland, Vikings lost the strength to wage battle against native populations, and their exploration of North America halted.
1492: The Columbian Exchange
Following the arrival of the Spanish in the Caribbean, diseases such as smallpox, measles and bubonic plague were passed along to the native populations by the Europeans. With no previous exposure, these diseases devastated indigenous people, with as many as 90 percent dying throughout the north and south continents.
Upon arrival on the island of Hispaniola, Christopher Columbus encountered the Taino people, population 60,000. By 1548, the population stood at less than 500. This scenario repeated itself throughout the Americas.
In 1520, the Aztec Empire was destroyed by a smallpox infection. The disease killed many of its victims and incapacitated others. It weakened the population so they were unable to resist Spanish colonizers and left farmers unable to produce needed crops.
Research in 2019 even concluded that the deaths of some 56 million Native Americans in the 16th and 17th centuries, largely through disease, may have altered Earth’s climate as vegetation growth on previously tilled land drew more CO2 from the atmosphere and caused a cooling event.
READ MORE: How Colonization’s Death Toll May Have Affected Earth’s Climate
1665: The Great Plague of London
In another devastating appearance, the bubonic plague led to the deaths of 20 percent of London’s population. As human death tolls mounted and mass graves appeared, hundreds of thousands of cats and dogs were slaughtered as the possible cause and the disease spread through ports along the Thames. The worst of the outbreak tapered off in the fall of 1666, around the same time as another destructive event—the Great Fire of London .
1817: First Cholera Pandemic
The first of seven cholera pandemics over the next 150 years, this wave of the small intestine infection originated in Russia, where one million people died. Spreading through feces-infected water and food, the bacterium was passed along to British soldiers who brought it to India where millions more died. The reach of the British Empire and its navy spread cholera to Spain, Africa, Indonesia, China, Japan, Italy, Germany and America, where it killed 150,000 people. A vaccine was created in 1885, but pandemics continued.
1855: The Third Plague Pandemic
Starting in China and moving to India and Hong Kong, the bubonic plague claimed 15 million victims. Initially spread by fleas during a mining boom in Yunnan, the plague is considered a factor in the Parthay rebellion and the Taiping rebellion. India faced the most substantial casualties, and the epidemic was used as an excuse for repressive policies that sparked some revolt against the British. The pandemic was considered active until 1960 when cases dropped below a couple hundred.
1875: Fiji Measles Pandemic
After Fiji ceded to the British Empire, a royal party visited Australia as a gift from Queen Victoria . Arriving during a measles outbreak, the royal party brought the disease back to their island, and it was spread further by the tribal heads and police who met with them upon their return.
Spreading quickly, the island was littered with corpses that were scavenged by wild animals, and entire villages died and were burned down, sometimes with the sick trapped inside the fires. One-third of Fiji’s population, a total of 40,000 people, died.
1889: Russian Flu
The first significant flu pandemic started in Siberia and Kazakhstan, traveled to Moscow, and made its way into Finland and then Poland, where it moved into the rest of Europe. By the following year, it had crossed the ocean into North America and Africa. By the end of 1890, 360,000 had died.
1918: Spanish Flu
The avian-borne flu that resulted in 50 million deaths worldwide, the 1918 flu was first observed in Europe, the United States and parts of Asia before swiftly spreading around the world (there is no universal consensus regarding where the virus originated ). At the time, there were no effective drugs or vaccines to treat this killer flu strain. Wire service reports of a flu outbreak in Madrid in the spring of 1918 led to the pandemic being called the “ Spanish flu .”
By October, hundreds of thousands of Americans died and body storage scarcity hit crisis level. But the flu threat disappeared in the summer of 1919 when most of the infected had either developed immunities or died.
READ MORE: Why October 1918 Was America’s Deadliest Month Ever
1957: Asian flu
Starting in Hong Kong and spreading throughout China and then into the United States, the Asian flu became widespread in England where, over six months, 14,000 people died. A second wave followed in early 1958, causing an estimated total of about 1.1 million deaths globally, with 116,000 deaths in the United States alone. A vaccine was developed, effectively containing the pandemic.
First identified in 1981, AIDS destroys a person’s immune system, resulting in eventual death by diseases that the body would usually fight off. Those infected by the HIV virus encounter fever, headache, and enlarged lymph nodes upon infection. When symptoms subside, carriers become highly infectious through blood and genital fluid, and the disease destroys t-cells.
AIDS was first observed in American gay communities but is believed to have developed from a chimpanzee virus from West Africa in the 1920s. The disease, which spreads through certain body fluids, moved to Haiti in the 1960s, and then New York and San Francisco in the 1970s.
Treatments have been developed to slow the progress of the disease, but 35 million people worldwide have died of AIDS since its discovery, and a cure is yet to be found.
First identified in 2003 after several months of cases, Severe Acute Respiratory Syndrome is believed to have possibly started with bats, spread to cats and then to humans in China, followed by 26 other countries, infecting 8,096 people, with 774 deaths.
SARS is characterized by respiratory problems, dry cough, fever and head and body aches and is spread through respiratory droplets from coughs and sneezes.
Quarantine efforts proved effective and by July, the virus was contained and hasn’t reappeared since. China was criticized for trying to suppress information about the virus at the beginning of the outbreak.
SARS was seen by global health professionals as a wake-up call to improve outbreak responses, and lessons from the pandemic were used to keep diseases like H1N1, Ebola and Zika under control.
On March 11, 2020, the World Health Organization announced that the COVID-19 virus was officially a pandemic after barreling through 114 countries in three months and infecting over 118,000 people. And the spread wasn’t anywhere near finished.
COVID-19 is caused by SARS-CoV-2, a novel coronavirus strain that had not been previously found in people. Symptoms include respiratory problems, fever and cough, and can lead to pneumonia and death. Like SARS, it’s spread through droplets in the air produced when an infected person coughs or sneezes.
The first reported case in China appeared November 17, 2019, in the Hubei Province, but went unrecognized. Eight more cases appeared in December with researchers pointing to an unknown virus.
Many learned about COVID-19 when ophthalmologist Dr. Li Wenliang defied government orders and released safety information to other doctors. The following day, China informed WHO and charged Li with a crime. Li died from COVID-19 just over a month later.
The virus spread beyond Chinese borders to nearly every country in the world. By December 2020, it had infected more than 75 million people and led to more than 1.6 million deaths worldwide.
Funding and political will in the United States and around the world accelerated the development of vaccines to fight the virus and by December 11, 2020, the FDA issued an Emergency Use Authorization for the use of the first COVID-19 vaccine. A week later the government agency approved a second, and by February 2021, Americans had access to three FDA-approved vaccines. By December 2021, 71 percent of the U.S. population had received at least one dose of a COVID-19 vaccine.
Despite the new vaccines (which all eventually gained full FDA approval), COVID-19 cases and deaths continued to rise as new variants of the virus emerged and some Americans remained reluctant to become vaccinated. As of December, 2021, the confirmed U.S. COVID-19 death toll had surpassed 800,000.
Disease and History by Frederick C. Cartwright, published by Sutton Publishing , 2014.
Disease: The Story of Disease and Mankind's Continuing Struggle Against It by Mary Dobson , published by Quercus, 2007.
Encyclopedia of Pestilence, Pandemics, and Plagues by Ed, Joseph P. Byrne, published by Greenwood Press , 2008.
Influenza, The American Experience .
Source Book of Medical History , Logan Clendening, published by Dover Publications , 1960.
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Friends House Moscow
Supporting quaker work in russia.
31 Dec 2019 – WHO is informed of an outbreak of “pneumonia of unknown cause” (later dubbed COVID-19) in Wuhan, China.
31 Jan 2020 – Two cases of COVID-19 confirmed in Russia, in Tyumen and Chita. They are both Chinese visitors to Russia. Both patients have recovered by 12 February and are discharged from hospital; there are no new cases of COVID-19 after this.
20 Feb 2020 – Russia closes its border with China.
28 Feb 2020 – Eight Russian citizens who were evacuated from the cruise ship Diamond Princess are confirmed to be suffering from COVID-19. They are hospitalised in Kazan.
2 Mar 2020 – First “local” Russian COVID-19 case is detected in Moscow (a Russian who recently returned from Italy).
16 Mar 2020 – Schools are ordered to be closed.
19 Mar 2020 – All persons arriving in Russia from abroad required to undergo a 14-day quarantine.
20 Mar 2020 – The total number of infections reaches 253 but there is only 1 death so far.
24 Mar 2020 – All nightclubs, cinemas and gyms are ordered to be closed.
25 Mar 2020 – The total number of infections doubles over a 5-day period. President Putin announces a one-week “paid holiday” (effectively, a soft lockdown) and the suspension of the referendum on proposed amendments to the Russian constitution.
27 Mar 2020 – All inbound flights to Russia are suspended, other than evacuation flights for Russian citizens abroad. Total number of infections exceeds 1,000.
29 Mar 2020 – Moscow mayor issues a “stay-at-home” order for all residents, effective from 30 March. Exceptions are: (1) to go to the nearest shop to buy food; (2) to go to the nearest chemists/pharmacy to purchase medicines; (3) to take out the rubbish; and (4) to walk pets (provided this is within 100 metres of the person’s residence);
2 Apr 2020 – “Paid holiday” period is extended to 30 April.
7 Apr 2020 – Number of new infections over a 24-hour period exceeds 1,000 for the first time; total number of infections is 7,497 with a total of 58 deaths.
9 Apr 2020 – Total number infections exceeds 10,000, with a total of 76 deaths.
14 Apr 2020 – Total number infections exceeds 20,000. Total number of deaths more than doubles in less than a week, to 170.
15 Apr 2020 – System of electronic permits comes into force. Any Moscow resident wishing to move around by car, taxi or public transport must now obtain an electronic permit to do so. [For a cartoonist’s take on what happened, read here …]
16 Apr 2020 – Victory Day parade (traditionally held on 9 May) is postponed to an unspecified future date. [Preparations for the parade resulted in 15,000 soldiers being sent into quarantine: read here …]
28 April 2020 – The lockdown is extended to 11 May 2020. Rospotrebnadzor (the Federal Service for Consumer Protection and Human Wellbeing) is instructed to produce a strategy by 5 May 2020, for easing the lockdown.
29 April 2020 – Russia extends its border closure for an indefinite period.
30 April 2020 – Overall number of infections exceeds 100,000 (surpassing the number of infections reported by China). Prime Minister Mikhail Mishustin discloses that he has tested positive for coronavirus, begins self-isolation.
1 May 2020 – Minister of Construction and Housing Vladimir Yakushev discloses that he has also tested positive for coronavirus.
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Moscow announces one-week lockdown as Russia Covid deaths rise
Mayor’s plan follows Putin announcing a weeklong nationwide paid holiday to stop spread of virus
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Moscow authorities have announced a weeklong closure of most non-essential services from 28 October, as Russia registered its highest daily number of coronavirus deaths and infections since the start of the pandemic.
“The situation in Moscow continues to develop in the worst scenario … In the coming days, we will reach a historic peak in coronavirus battle,” the Moscow mayor, Sergei Sobyanin , said in a statement on Thursday explaining his decision to introduce the measure.
Under the new measures, all non-essential shops, schools and gyms will be shut. Restaurants and cafes will be able to operate as takeaways, while theatres and museums will require proof of Covid-19 vaccination or recovery.
A day earlier, the Russian president, Vladimir Putin , announced a weeklong nationwide paid holiday starting from 30 October to stop the spread of infections.
Russia has repeatedly broken all-time-high numbers of Covid deaths and infections over the last three weeks , with only a third of the country fully vaccinated.
It is currently reporting more than 1,000 daily deaths, the second-highest in the world after the US. Calculations based on publicly available mortality data suggest the excess death toll between the start of the pandemic and August this year is nearly 660,000.
On Thursday a senior government scientist warned Russia’s infections could further spiral after several cases of the new AY.4.2 Delta variant of coronavirus were detected in the country. Officials in the UK said they were closely monitoring the variant as scientists believe it could be more transmissible.
The measures introduced by Sobyanin amount to Moscow’s strictest coronavirus rules since spring last year. The Kremlin has repeatedly avoided pushing through widely unpopular restrictions, despite the country registering high Covid infections for months.
A poll published on Wednesday said a majority of Russian business owners were against new restrictions, citing economic concerns.
Despite widely available vaccines, Russians remain distrustful of domestically made jabs and surveys showed a majority of those who have not yet received a vaccine were not planning to do so. To encourage vaccine uptake, Moscow authorities this week banned unvaccinated elderly people from leaving home until February, while most Russian regions have introduced some form of compulsory vaccination.
Putin this week stressed the importance of vaccination. “It’s strange that well-educated people, people with advanced degrees, don’t want to get vaccinated. We have a safe and effective vaccine,” he said. “I call upon you to go out and get vaccinated. It’s a question of your life and the lives of the people close to you.”
Critics have blamed the failing vaccination campaign on the Kremlin’s mixed messaging and low trust in the authorities. A senior official last week said the government “lost the information campaign on the fight against coronavirus”. Vaccine hesitancy has also been prevalent in neighbouring countries, with Ukraine, Belarus and other eastern European nations experiencing new surges in infections.
- Vladimir Putin
How Brooks Plans to Achieve Double-Digit Growth in 2024 As the Running Market Heats Up
Shoshy ciment, business editor.
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While other running brands such as Hoka and On have been generating big buzz, Brooks continues to show solid gains.
As of the third quarter, Brooks’ global revenue grew 5 percent year-to-date, with North America revenues increasing 7 percent. Internationally, Brooks’ revenue increased 22 percent in France and the United Kingdom combined year-to-date and China also saw unspecified growth.
“It’s not a small little niche anymore,” Weber said about the active performance category, which encompasses products for running, walking, cross training, hiking and trail. “It’s just got a broader appeal.”
And even amid an inflationary environment, Weber noted that premium price points for running footwear have “made the cut with the consumer in this environment.”
Looking ahead, Brooks expects to achieve double-digit growth in 2024. To do this, the brand is keeping the focus on its No. 1 consumer group — dedicated, frequent runners — while accelerating the pace of product innovation and expanding its reach to consumers looking for comfort and performance outside of road running.
“Runners have choices … and great product wins the day,” Weber said. “That’s where we’re going to continue to remain focused.”
A return to innovation
The Ghost Max is one example of a recent product innovation from Brooks that is reaping rewards. The shoe features maximum cushioning with GlideRoll rocker technology to help runners move quickly from heel to toe.
The product, which became one of Brooks’ best retail launches in history, was due to market a year ago but was delayed due to supply chain issues that characterized much of Brooks’ business for the last three years, Weber said.
“Managing inventory well is the key to having a healthy business,” Weber said. “We’re finally normalized there.”
Armed with a more stable supply chain, Brooks is planning to keep the innovations coming in 2024. The brand plans to launch the Glycerin 21 and the Hyperion Elite 4 distance racing shoe in time for the 2024 U.S. Olympic Marathon Team Trials in February. Brooks is also launching the Exhilarate-BL to Brooks Run Club loyalty members in early 2024.
While Brooks’ main focus is still the serious performance runner, the brand is aware that its customer base is looking for comfortable, supportive, well-fitting footwear that can be worn for a variety of occasions and activities, such as trail running, hiking, gym training and traveling.
In 2024, Weber said Brooks will begin to make a conscious effort to speak to consumers in these adjacent categories and emphasize the benefits of Brooks’ footwear technology in a broader “active lifestyle” ecosystem.
“If you’re looking for great footwear — if you’re walking or just for travel or comfort — comfort is just such a universal truth for people,” Weber said. “Many of the running silhouettes are such a great solution for that.”
The retail game plan
When it comes to distribution, Brooks is set on a multichannel approach.
Half of Brooks’ business comes from wholesale brick-and-mortar stores. The other half is generated online, with 20 percent of that coming through Brooks’ own website.
While the company’s U.S. e-commerce business increased 25 percent year to date in Q3, its DTC penetration is currently behind its competitors. Hoka’s DTC sales increased 54 percent year-over- year in the first half of the year, to make up 38 percent of the brand’s revenue. On’s DTC share in Q2 was 36.8 percent.
That doesn’t worry Weber, who sees Brooks’ penetration in the wholesale channel as a major benefit.
“That multichannel focus has served us so well because we’ve flexed as the consumer has moved,” he said.
Eventually, Weber anticipates sales to make up an even three-way split between wholesale physical stores, Brooks’ website and third-party websites.
“This category is huge,” Weber said. “And underneath that is not only a generally healthy consumer, but [more] people getting outdoors and moving and just making it a part of their life.”
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