Non-pharmaceutical interventions, such as lockdowns and wearing face masks, are effective measures to reduce COVID-19 transmission, contrary to claims in viral video

Key takeaway

Scientific evidence indicates that lockdowns are an effective measure to reduce the spread and burden of COVID-19. However, lockdowns should not be used as a primary control measure, as they can also cause profound negative effects on a community due to disruptions in healthcare and supply chains. Testing, contact tracing, and isolation of positive cases are public health strategies that can help prevent and identify community outbreaks. Combined with widespread use of face masks, such measures can help reduce disease transmission and avoid further lockdowns.

Reviewed content

Verdict:

Misleading

Claim:

Lockdowns and face masks do not work to control the COVID-19 pandemic

Verdict detail

Misleading: Countries imposed lockdowns as an emergency measure to avoid overloading health care systems during the COVID-19 pandemic. However, public health authorities recognize the high socioeconomic impact of these lockdowns and only advise them under exceptional circumstances. Other public health measures, such as wearing face masks, efficient testing, contact tracing, and isolation of positive cases are recommended to reduce COVID-19 transmission.
Inaccurate: Scientific evidence indicates that control measures, such as lockdowns and the use of face masks, effectively reduce the spread of COVID-19, contrary to the claims in the video.
Misrepresents a complex reality: Correlating face mask mandates and COVID-19 infection rates in different countries ignores other factors that influence the course of the pandemic, such as additional public health measures, testing capacity, or population demographics.

See our method of evaluation

Full Claim

The response to the COVID-19 pandemic is “a cult” and “evidence doesn’t matter”; "There is no connection whatsoever" between the number of COVID-19 cases and deaths; Lockdowns are ineffective for controlling the COVID-19 pandemic; "Lockdowns delay necessary health procedures, disrupt supply chains, […] cause two million excess deaths from [tuberculosis], HIV, and malaria, and lead to depression and despair"; Face mask mandate in some countries did not help to reduce the spread of COVID-19

This video, published on 13 November 2020 by the student activism organization Young Americans for Liberty (YAL), features the historian Tom Woods in a 7 November symposium in Texas. In it, Woods presents the COVID-19 pandemic and the public health recommendations as a “mainstream cult” with no scientific basis. The video received more than 47,000 interactions on Facebook in less than a week, according to the social media analytics tool CrowdTangle.

Claim 1 (Inaccurate): “there is no connection whatsoever” between the number of COVID-19 cases and deaths

The graph in Figure 1 shows a correlation between the number of COVID-19 cases and deaths, contrary to Wood’s claim. In the U.S., the number of COVID-19 deaths increases about four weeks after increases in COVID-19 cases are detected. It should be noted, however, that the detection of new positive cases highly depends on testing capacity, which was much more limited at the beginning of the pandemic. As of 17 November 2020, more than 245,000 people in the U.S. have died from COVID-19, according to the Johns Hopkins University Coronavirus Resource Center. COVID-19 is currently the third leading cause of death in the U.S., only behind heart disease and cancer, and the U.S. Centers for Disease Control and Prevention estimates that the pandemic is associated with nearly 300,000 excess deaths.

Figure 1. COVID-19 cases and deaths in the U.S. The gray curve (left y-axis) represents the average number of deaths in the previous seven days. The red curve (right y-axis) represents the average number of cases in the previous seven days. Source: COVID-19 Tracking Project

Claim 2 (Misleading): Lockdowns are ineffective for controlling the COVID-19 pandemic

In the first part of the video, Woods advocates against lockdowns, claiming that they are ineffective and negatively impact human health and economies. In response to the COVID-19 outbreak, most countries used lockdowns to alleviate the exponential growth in hospital admissions and local intensive care units’ saturation. Mathematical models and observational studies indicate that lockdowns have been an effective measure to control COVID-19 outbreaks and reduce the burden of the disease. Specifically, estimates show that non-pharmaceutical interventions, including lockdowns, reduced the number of COVID-19 infections, hospitalizations, and deaths in several European countries^[1-4]. One study published in Nature quantified the effect of major non-pharmaceutical interventions across 11 European countries combined. The authors estimated that lockdowns reduced viral transmission in these countries by 81%^[1].

Woods frames lockdowns as a primary recommended measure to mitigate the spread of COVID-19. However, public health authorities like the World Health Organization (WHO) advise using strict lockdowns only in a localized and time-limited fashion. Instead, they recommend  implementing other public health measures, such as efficient testing, contact tracing, and isolation:

“WHO recognizes that at certain points, some countries have had no choice but to issue stay-at-home orders and other measures, to buy time. Governments must make the most of the extra time granted by ‘lockdown’ measures by doing all they can to build their capacities to detect, isolate, test and care for all cases; trace and quarantine all contacts; engage, empower and enable populations to drive the societal response and more. WHO is hopeful that countries will use targeted interventions where and when needed, based on the local situation.”

Claim 3 (Mostly accurate): Lockdowns have negative socioeconomic effects and can cause additional deaths

Contrary to what the video suggests, public health authorities like the WHO acknowledge the negative socioeconomic impact that lockdowns can have:

“Large scale physical distancing measures and movement restrictions, often referred to as ‘lockdowns,’ can slow COVID‑19 transmission by limiting contact between people. However, these measures can have a profound negative impact on individuals, communities, and societies by bringing social and economic life to a near stop. Such measures disproportionately affect disadvantaged groups, including people in poverty, migrants, internally displaced people and refugees, who most often live in overcrowded and under resourced settings, and depend on daily labour for subsistence.”

Specifically, Woods states that “lockdowns delay necessary health procedures, disrupt supply chains, […] cause two million excess deaths from [tuberculosis], HIV, and malaria, and lead to depression and despair.” Indeed, experts warned that disruptions in healthcare systems and supplies due to the COVID-19 pandemic could profoundly impact public health in the next few years, but these effects cannot be solely attributed to lockdowns. The COVID-19 pandemic also exposed preexisting structural problems and inequalities in healthcare systems in many countries, including the U.S. While lockdowns can have a negative socioeconomic impact, many countries used them as an emergency measure to mitigate uncontrolled COVID-19 outbreaks and prevent a collapse of healthcare systems. However, lockdowns do not eliminate the virus and, therefore, controlling the spread of COVID-19 requires implementing further public health strategies.

The February Report of the WHO-China Joint Mission on COVID-19 noted, “much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain Covid-19 in China […] Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.”

Disruptions due to public health measures implemented to reduce the spread of COVID-19 could be particularly hard for low-income countries and individuals from socially disadvantaged backgrounds, which would likely increase poverty and inequalities at a global scale. According to a WHO global survey, 90% of countries reported disruptions to essential health services due to the pandemic. Also, a Global Fund survey found that COVID-19 has led to disruptions in about 80% of the HIV, tuberculosis, and malaria programs due to delays in diagnosis and treatment interruptions. Particularly concerning is the 2020 report on child mortality from UNICEF that warns about the substantial increase in wasting prevalence and child mortality. Over 1 million more children under five years old could die in the next six months due to the disruption of essential life-saving interventions like antenatal care, childbirth delivery care, postnatal care, vaccinations, and early childhood preventative and curative services.

The COVID-19 pandemic has also caused delays in the diagnosis and treatment of cancer and cardiovascular diseases, as well as increases in the prevalence of mental health conditions, substance abuse, and suicidal ideation in the U.S.^[5,6]. Although Woods claims that lockdowns caused an estimated 75,000 excess “deaths of despair, drug and alcohol overdose, and suicide,” there is currently no official data from that time period to support this claim. The most recent data from the U.S. National Center for Health Statistics for causes of all deaths in the U.S. is from 2018. The Samaritans, a U.K.-based charity that provides help for those at risk of suicide, shared in a Tweet, “there is currently no evidence of a rise in suicide rates.” Accordingly, a 20 October 2020 preprint also found no increase in suicide rates during the stay-at-home advisory period in Massachusetts^[7]. However, the actual impact of the COVID-19 pandemic on suicide and other causes of death will only be clear after time, when complete data for that period is available.

In short, lockdowns are an effective strategy in exceptional situations of uncontrolled virus transmission that pose a threat to the health care system. However, lockdowns have a disproportionate impact on the most disadvantaged people in society, and as the WHO recommends, should be used carefully by weighing their benefits against the potential negative consequences.

Claim 4 (Misrepresents a complex reality): Face mask mandate in some countries did not help to reduce the spread of COVID-19

In the second part of the video, Woods claims that face masks are ineffective at reducing the spread of COVID-19 by comparing the number of COVID-19 cases per million people in some European countries and U.S. states that implemented the use of face masks and others that did not. Even if the figures supporting the claim are accurate, a lack of context and the cherry-picking of countries used in the comparison lead to misleading conclusions, as Health Feedback explained in this previous review covering the same comparisons.

The course of the COVID-19 pandemic in different countries or states does not depend solely on the use of face masks. Direct comparisons between different regions ignore other factors that can significantly alter the evolution of the pandemic, such as quality of the healthcare systems, population demographics, testing and tracing capacity, and the overall health status of the population. Furthermore, the graphs cherry-pick countries by excluding those with wide use of face masks but low death rates, like China, South Korea, and Japan^[8].

Finally, while scientific evidence indicates that wearing face masks effectively reduces the spread of COVID-19^{[8, 9]} by blocking viral transmission through respiratory droplets and some aerosol particles between an infected and uninfected individual if both wear masks, face masks do not confer 100% protection. For this reason, a combination of multiple measures for reducing the spread of COVID-19, such as physical distancing and lockdowns, are also required. Universal use of face masks can help avert future lockdowns, especially if combined with other public health measures, like physical distancing, good hand hygiene, and adequate ventilation.

In summary, epidemiological data suggest that lockdowns and the use of face masks by the general population are effective strategies to reduce the spread of COVID-19, and in turn, the burden it places on the healthcare system. However, the socioeconomic impacts of transmission control measures are also important to consider, in addition to their effectiveness in controlling the spread of COVID-19. While lockdowns are highly effective at reducing the spread of COVID-19, public health authorities emphasized that they should be viewed as a last resort, owing to its detrimental effects on human health and the economy. Comparisons between different regions are difficult, as countries differ widely in aspects that can significantly influence the course of the pandemic, such as economics, demographics, and politics.

Additional context

Woods uses a mix of accurate information and flawed reasoning to support the so-called “Great Barrington Declaration,” a 4 October 2020 statement from the American Institute for Economic Research in Great Barrington that advocates for herd immunity over lockdowns and focused protection of the vulnerable population. As PolitiFact explained in this review, health officials and scientists worldwide criticized this statement for being dangerous, scientifically problematic, and unethical.

READ MORE

This article by The Conversation explains which strategies countries have used to reduce the spread of COVID-19, apart from lockdowns.

REFERENCES

• 1 – Flaxman et al. 2020. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature.
• 2 – Salje et al. (2020) Estimating the burden of SARS-CoV-2 in France. Science.
• 3 – Dehning et al. (2020) Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions. Science.
• 4 – Cauchemez et al. (2020) Lockdown impact on COVID-19 epidemics in regions across metropolitan France. The Lancet.
• 5 – Czeisler et al. (2020) Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. Morbidity and Mortality Weekly Report.
• 6 – O’Connor et al. (2020) Mental health and wellbeing during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study. The British Journal of Psychiatry.
• 7 – Faust et al. (2020) Suicide Deaths during the Stay-at-Home Advisory in Massachusetts. medRxiv [Note: This is a pre-print that has not yet been peer-reviewed or published in a journal at the time of this review’s publication.]
• 8 – Leffler et al. (2020) Association of Country-wide Coronavirus Mortality with Demographics, Testing, Lockdowns, and Public Wearing of Masks. American Journal of Tropical Medicine and Hygiene.
• 9 – Zhang et al. (2020) The impact of mask-wearing and shelter-in-place on COVID-19 outbreaks in the United States. International Journal of Infectious Diseases.