- metadata: - source: https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051 - people: - [[Dr. Jay Bhattacharya]] --- # Covid-19 Lockdown Cost/Benefits: A Critical Assessment of the Literature > ## Excerpt > An examination of over 100 Covid-19 studies reveals that many relied on false assumptions that over-estimated the benefits and under-estimated the costs of lockdown. The most recent research has sh... --- ## 1\. Introduction In March 2020 countries around the world, including the U.S., Canada, and the U.K., deployed various forms of lockdown that dragged on for over a year in many jurisdictions and show signs of returning in the fall of 2021 under the threat of new Covid-19 variants. This response to the pandemic has dominated not only the daily lives of ordinary people, but also the economic reality within which most businesses have been forced to operate. Lockdowns and the reactions to them, have had consequences for consumer demands, supply chains, profitability, and the redistribution of wealth. The average citizen and business person has had to trust that such a blunt and destructive policy tool was justified in the face of a novel viral pandemic. The public and business trust has been necessary because most people have limited or no access to the immense research response to the Covid-19 pandemic — with estimates of over 40,000 related papers produced in one year. Even with access, most people lack the time or training to decipher the complex and often conflicting reports. Thus, although the research covers every imaginable aspect of Covid-19, and despite the explosion of knowledge regarding the virus, the human reactions to it, and the consequences of these reactions, the average person and corporate executive remains unaware of most of it. The public and business trust has also been reinforced by the one-sided, incomplete, and almost unchanging ubiquitous media, public health, and political response to the pandemic. With respect to lockdown policies, many political jurisdictions have repeated the same spring 2020 programs in 2021, ignoring what has been learned in the meantime. Often public announcements were made that were inconsistent with basic Covid-19 facts that were easy to find, if you knew where to look. Furthermore, when research results contrary to the official government response were shared on social media, they were often pulled from these platforms, making access to the full research picture generally unavailable to an average citizen. As a result, for most citizens and business people the public media and official public health news conferences have been the only source of Covid-19 information. At the same time, over the course of the pandemic, general information about the virus, transmissions, deaths, and lockdowns across different jurisdictions has become available on various platforms. On the surface, it appears that lockdowns are not necessary for viral waves of deaths and cases to end. Nor does it appear that there was ever any widespread over-utilization of hospitals, especially in locations with little or no lockdown. Furthermore, casual observation shows that jurisdictions with lockdowns often did not avoid large waves of cases and deaths. In many ways, the virus seemed to progress independently of lockdown policy. Thus, on the one hand citizens and business people have been asked, in a blind trust, to go along with drastic and unprecedented lockdowns; while on the other hand, becoming aware of apparent inconsistencies. How is a reasonable person to think about all of this? This review of a segment of the Covid-19 literature is intended to give some broader access to the academic research and issues around the common response of lockdown, and to help provide an understanding of these issues to both access government lockdown policy and understand the general information they are receiving. The focus is to critically assess the cost/benefit studies that have been written over the past sixteen months on lockdown policies related to the Covid-19 pandemic. The review covers over 100 different academic studies, along with related Covid-19 data sites. I have sought out studies that (i) dealt with matters of ‘lockdown’ either directly or indirectly, and (ii) were related directly or indirectly to issues relevant to the costs or benefits of lockdown. The term ‘lockdown’ is used to generically refer to state actions that imposed various forms of non-pharmaceutical interventions. That is, it is used to include mandatory state-enforced closing of non-essential business, education, recreation, and spiritual facilities; mask and social distancing orders; stay-in-place orders; and restrictions on private social gatherings. ‘Lockdown’ does not refer to cases of ‘isolation,’ where a country was able to engage in an early and sufficient border closure that prevented trans-border transmission, followed by a mandated lockdown that eliminated the virus in the domestic population, which was then followed by perpetual isolation until the population is fully vaccinated. This strategy was adopted by a number of island countries like New Zealand.[1](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0001) Here I will only consider lockdown as it took place in most of the world; that is, within a country where the virus became established. The report begins with an examination of four critical assumptions often made within the context of estimating benefits and costs. Understanding these assumptions explains why early studies claimed that the benefits of lockdown were so high, and also explains why the predictions of those studies turned out to be false. Then I examine the major cost/benefit studies in roughly chronological order, and focus on the critical factor in these studies: distinguishing between mandated and voluntary changes in behavior. Preliminary work on the costs of lockdown is reviewed, and finally a simple cost/benefit methodology is used to generate several cost/benefit ratios of lockdown for my home country of Canada. In no scenario does lockdown pass a cost/benefit test; indeed, the most reasonable estimates suggest that lockdown is a great policy disaster. ## 2\. Cost benefit studies When it comes to the question of choosing any type of public policy, the Nobel prize winner Ronald Coase put it best: It would clearly be desirable if the only actions performed were those in which what was gained was worth more than what was lost. But in choosing between social arrangements within the context of which individual decisions are made, we have to bear in mind that a change in the existing system which will lead to an improvement in some decisions may well lead to a worsening of others. In devising and choosing between social arrangements we should have regard for the total effect. \[Coase p. 44, [1960](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#) 1960. The Problem of Social Cost. _The Journal of Law and Economics_ 3: 1–44. doi:[https://doi.org/10.1086/466560](https://doi.org/10.1086/466560). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0033&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1086%2F466560), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0033&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=A1960CHK3800001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=3&publication_year=1960&pages=1-44&author=R.+Coase&title=The+Problem+of+Social+Cost&doi=10.1086%2F466560)\] Coase was making two points. The first should be obvious: policy decisions should be made based on both costs and benefits. To focus on one side of the issue and consider only costs or only benefits necessarily leads to a mistaken policy. The second point is more subtle: an attempt to achieve a particular benefit through one mechanism might lead to an exacerbation of the costs. There are multiple methods to achieve a goal, but the cost consequences might be different for each method. At the end of the day, choosing the optimal policy requires a ‘regard for the total effect.’[2](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0002) Over the course of the Covid-19 pandemic, there has been no public evidence that governments around the world have considered both the benefit and cost sides of their policy decisions. To my knowledge, no government has provided any formal cost/benefit analysis of their actions. Indeed, the steady press conferences and news releases almost entirely focus on one single feature of the disease. Although the focus of government announcements has changed over the year, from ‘flattening the curve’, number of Covid-19 deaths, number of Covid19 cases, hospital capacity, and variant transmissions (especially the delta variant), there has seldom been any official mention of the costs of the actions taken to address these concerns. Economists and other social scientists have been attracted to the policy issues regarding Covid-19. Economists in particular, given their training in modeling human behavior and testing those models with real world data, have written hundreds of papers that deal with both the costs and the benefits of lockdown. Here, aside from going through some of the theoretical issues, I provide a summary of the major findings. ### 2.1. Issues in determining lockdown benefits Most of the ‘action’ in the early cost/benefit studies came from the benefit side. That is, many early studies reported enormous benefits to lockdown, and little attention was given to the particulars of lockdown costs. The claims of extremely high benefits, however, were almost entirely theoretical and sensitive to model assumptions. It is important to understand these theoretical issues and how they manifested in determining Covid-19 lockdown benefits.[3](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0003) #### 2.1.1. The counterfactual number of cases/deaths The argument for lockdown benefits is intuitive. If a new virus enters an unknowing population with no immunity and spreads _exponentially_, causing an overwhelming of hospitals and subsequent large numbers of deaths, then a physical, government mandated, intervention that isolates people and slows down the transmission of the virus can reduce the spike of infections, allow hospitals to cope given their capacity constraints, postpone deaths, and possibly reduce deaths until a vaccine can be created. Lockdown is a formal, state-mandated ‘one size fits all’ version of the social norm ‘keep your distance from people who are sick.’[4](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0004) If lockdown reduces the transmission of the virus, the natural question to ask is ‘by how much?’ In other words, ‘but for the lockdown’ what would the level of infection/transmission/deaths be? What is the counterfactual to lockdowns? Within the field of epidemiology it is common to model disease through what is called a SIR model.[5](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0005) Although these models can vary in many ways, they all model virus progression through a population in a mechanical fashion. One key parameter is the basic reproduction number, _Rt_ which indicates the expected number of secondary infections in a vulnerable population generated by a single given infection. Cases of the virus explode exponentially when the _Rt >_ 1, and then collapse as herd immunity is reached and the virus recedes to an endemic state (_Rt ≈_ 1). Lockdowns are often interpreted as a means of effectively altering the reproduction number. Early in the pandemic the Neil Ferguson et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ferguson, N., D. Laydon, G. Nedjati-Gilani, et al. 2020. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College London. doi:[https://doi.org/10.25561/77482](https://doi.org/10.25561/77482). [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Ferguson%2C+N.%2C+D.+Laydon%2C+G.+Nedjati-Gilani%2C+et+al.+2020.+Impact+of+non-pharmaceutical+interventions+%28NPIs%29+to+reduce+COVID-19+mortality+and+healthcare+demand.+Imperial+College+London.+doi%3A+10.25561%2F77482.)) model appeared to drive many lockdown decisions and was widely covered in the media. [Figure 1](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#F0001) reproduces a key figure of that paper (Table 2, p. 8), and shows the results of various types of lockdown on occupied ICU beds. The symmetry, smoothness, and orderly appearance of the functions is a result of the mechanical nature of the model. This type of figure is found, in one form or another, in most papers based on a SIR model. Covid-19 Lockdown Cost/Benefits: A Critical Assessment of the Literature ###### Published online: 29 September 2021 Figure 1. ICU predictions in ICL model. [](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#) Figure 1. ICU predictions in ICL model. In [Figure 1](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#F0001) the black ‘do nothing’ line is the counterfactual, while the other lines are various types of lockdowns. The harsher the lockdown, the ‘flatter’ the case load, with the blue line being the strongest lockdown. The difference between the black line and another line is the benefit of that particular lockdown in terms of cases delayed. Clearly the exponential growth of the ‘do nothing’ counterfactual leads to enormous differences, and makes lockdown look better. The ICL model made dire predictions that saturated media coverage in the first wave of the pandemic. Table 1 shows some death predictions for four countries. Column (i) contains Ferguson _et al._’s predictions for an unmitigated, no lockdown pandemic. In the U.S., close to 2.2 million people were predicted to die by the end of July 30, 2020. Column (ii) is the Ferguson _et al._ prediction with full lockdown, based on a reproduction number of 2.4.[6](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0006) Column (iii) is the actual cumulative deaths as of July 30, 2020. The U.K., U.S., and Canada all had lockdowns in the spring of 2020, and so the appropriate comparison is between columns (ii) and (iii). Column (iv) takes the ratio of these two columns and shows that the Ferguson _et al._ model was spectacularly wrong; off by factors of 5.88 to 14.71. Sweden had minimal restrictions, and so depending if actual deaths are compared to column (i) or (ii), the error ratio is either 11.56 or 5.30; either way, the model missed for Sweden as well. Covid-19 Lockdown Cost/Benefits: A Critical Assessment of the Literature ###### Published online: 29 September 2021 ### Table 1. Predicted and actual deaths. Given the prediction that lockdowns would lower deaths by one-half, the authors made a dramatic recommendation: ‘We therefore conclude that epidemic suppression is the only viable strategy at the current time. The social and economic effects of the measures which are needed to achieve this policy goal will be profound.’ (Ferguson et al. [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ferguson, N., D. Laydon, G. Nedjati-Gilani, et al. 2020. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Imperial College London. doi:[https://doi.org/10.25561/77482](https://doi.org/10.25561/77482). [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Ferguson%2C+N.%2C+D.+Laydon%2C+G.+Nedjati-Gilani%2C+et+al.+2020.+Impact+of+non-pharmaceutical+interventions+%28NPIs%29+to+reduce+COVID-19+mortality+and+healthcare+demand.+Imperial+College+London.+doi%3A+10.25561%2F77482.), p. 16). In retrospect it is remarkable that such a conclusion was drawn. The authors recognized that the ‘social and economic effects’ would be ‘profound,’ and that the predictions were based on the ‘unlikely’ behavioral assumption that there would be no change to individual reactions to the virus. However, given the large counterfactual numbers, presumably they felt no lockdown cost could justify remaining open. Problems with the ICL model were pointed out immediately: i) the reproduction number (_Rt_) of 2.4 was too high; ii) the assumed infection fatality rate (IFR) of 0.9% was too high and not age dependent; iii) hospital capacity was assumed fixed and unchangeable; and iv) individuals in the model were assumed to not change behavior in the face of a new virus.[7](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0007) All of these assumptions have the effect of over-estimating the counterfactual number of cases, transmissions, and deaths.[8](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0008) #### 2.1.2. The exogenous behavior assumption A major reason for the failure of SIR models to predict _actual_ cases and deaths is because they assume no individual in the model ever changes behavior.[9](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0009) The implication of ignoring individual responses to a viral threat are dramatic. Atkeson ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Atkeson, A. 2021. A Parsimonious Behavioral SEIR Model of the 2020 Covid Epidemic in the Unisted States and the United Kingdom. _NBER_ WP: 28434. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0008&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.21034%2Fsr.619), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=A.+Atkeson&title=A+Parsimonious+Behavioral+SEIR+Model+of+the+2020+Covid+Epidemic+in+the+Unisted+States+and+the+United+Kingdom)) used a standard SIR model (with exogenous behavior) that included seasonal effects and the introduction of a more contagious variant in December 2020 to forecast daily U.S. deaths out to July 2023. The results of this standard model were typical: the model made apocalyptic predictions on deaths that were off by a factor of twelve by the summer of 2020. However, he then used _the same model_ with a simple behavioral adjustment that allowed individuals to change behavior in light of the value of _Rt_. The new forecast of daily deaths based on this single addition completely changed the model’s predictive power. The model now tracked the actual progression of the daily deaths very closely. In correspondence with Atkeson he provided his explanation for this result: The intuition for this result is simple. If new infections and daily deaths from the disease grow too high, people take costly efforts to avoid interaction and thus slow disease spread. Likewise, if the prevalence of the disease falls toward zero, then the demand for costly disease prevention efforts also falls towards zero, and so the disease will come back unless the population has already achieved herd immunity measured at pre-pandemic levels of behavior. Whether Atkeson ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Atkeson, A. 2021. A Parsimonious Behavioral SEIR Model of the 2020 Covid Epidemic in the Unisted States and the United Kingdom. _NBER_ WP: 28434. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0008&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.21034%2Fsr.619), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=A.+Atkeson&title=A+Parsimonious+Behavioral+SEIR+Model+of+the+2020+Covid+Epidemic+in+the+Unisted+States+and+the+United+Kingdom)) has correctly modeled the Covid-19 virus is not at issue. Nor is it the case that the assumption of exogenous behavior is the only failing of the SIR model.[10](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0010) The point is, there is a dramatic change in predicted behavior once human reactions are included. Voluntary changes in behavior are optimal for the individual given their health circumstances, and therefore are likely to have large effects on cases and mortality. On the other hand, the blunt instrument of lockdown has little impact on mortality for those who have voluntarily locked down on their own, and likewise little impact on mortality for those who have not locked down but are either immune or unlikely to die given their age and health status. A model lacking endogenous individual adjustment then, radically over-estimates the number of daily deaths, and this is a common problem in many cost/benefit studies. The fact that individuals privately and voluntarily respond to risks has two important implications. First, it influences how any counterfactual outcome is understood with respect to the lockdown. When no voluntary response is assumed, models predict exponential caseloads and deaths without lockdowns. If lockdowns are imposed and cases coincidently fall, the actual number of cases is then compared to a counterfactual that never would have happened.[11](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0011) Therefore, not accounting for rational, voluntary individual responses within a SIR model drastically over-states any benefit from lockdown.[12](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0012) Second, any empirical work that considers _only the total_ change in outcomes and does not attempt to separate the mandated effect from the voluntary effect, will necessarily attribute all of the change in outcome to the mandated lockdown. Once again, this will over-estimate the effect, and quite likely by an order of magnitude. Individuals change behavior for two reasons. They voluntarily respond to the threat of a virus, and they react to mandated lockdowns.[13](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0013) Both channels of behavior create a _total_ effect. It is important for lockdown empirical work to distinguish between the two channels of behavior to determine how much behavior changed because of mandated lockdowns and how much because of voluntary changes.[14](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0014) #### 2.1.3. The assumed value of life All economic cost/benefit studies of Covid-19, either directly or indirectly, utilize some method to estimate the number of cases, infections, or deaths as the virus progresses through the population over time. Counting cases and deaths, however, is only half the process. To estimate benefits and compare them to costs economists assign a dollar value to the change in outcomes. If lockdown benefits are in terms of the number of deaths delayed, then a value to these lives must be used.[15](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0015) Economic value is based on the idea of maximum sacrifice. Thus, when it comes to the value of an individual’s life, this value is determined by the actual individual. In practice, what is measured is the marginal value to extend one’s life a little bit by reducing some type of harm, and then use this to determine a total value of life. This measure, developed in the 1960s by Thomas Schelling, is called ‘The Value of a Statistical Life’ (VSL), and is widely used in policy work. The VSL is estimated by observing individual marginal tradeoffs. Thus, if someone pays $1000 to reduce the chance of death by 1/10,000 over the next year, then this implies a value of life of $10,000,000. One problem with using the VSL for estimating the benefits of saving lives through lockdown is that it measures the total value of life based on a marginal value. Thus, using a VSL (which is based on observing ordinary people _not at the point of death_) as a measure of the value of a life of someone about to die, is likely to provide an _over-estimate_ of the value of the life.[16](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0016) In many Covid-19 cost/benefit studies, however, there is another more serious problem with how the VSL is used. Namely, it is often assumed that i) the VSL is independent of age, and ii) that the VSL is equal to around $10,000,000. Both of these claims are not true.[17](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0017) Hammitt (pp. 10–12) surveys the literature on VSL estimates and shows that all studies reject the idea that the VSL is constant over the life-cycle. For example, one age based VSL estimate from Robinson, et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Robinson, L., R. Sullivan, and J. Shogren. 2020. Do the Benefits of COVID?19 Policies Exceed the Costs? Exploring Uncertainties in the Age–VSL Relationship. _Risk Analysis: An International Journal_. May: 761-770. doi:[https://doi.org/10.1111/risa.13561](https://doi.org/10.1111/risa.13561). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0103&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000548736500001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=L.+Robinson&author=R.+Sullivan&author=J.+Shogren&title=Do+the+Benefits+of+COVID%3F19+Policies+Exceed+the+Costs%3F+Exploring+Uncertainties+in+the+Age%E2%80%93VSL+Relationship&doi=10.1111%2Frisa.13561)) is shown in [Figure 2](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#F0002). Covid-19 Lockdown Cost/Benefits: A Critical Assessment of the Literature ###### Published online: 29 September 2021 Figure 2. Age related estimates of VSL. [](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#) Figure 2. Age related estimates of VSL. To assume that the VSL is constant implies that individuals are indifferent between living one more day or eighty more years. [Figure 2](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#F0002) shows more reasonable estimates, with the value of a child being seven times the value of an 85 year old. The VSL of $2,000,000 for an 85 year old is based on the assumption that life expectancy is still ten years. For someone who is 85, in poor health with multiple serious illnesses, the VSL would be much lower.[18](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0018) Assuming a VSL of $10,000,000 creates a strong bias in the conclusion of many early cost/benefit studies. Since those over age sixty make up a minority of the population, but account for the vast majority of Covid-19 deaths, the use of a constant and large VSL leads to a vast over-estimate of the benefits of lockdown. Consider the ICL case applied to the US. That model predicted 2.2 million Covid- 19 deaths by June without lockdown. If each life lost was worth $10,000,000, then the benefit of lockdown would be $22 trillion dollars. In 2019 US GDP was $21.4 trillion dollars. At this estimate of death and VSL, it would make sense to shut down (not just lockdown) 100% of the US economy for an entire year ### 2.2. An issue with lockdown costs #### 2.2.1. Comparing apples to oranges The final theoretical issue relates to what costs are compared to benefits. As noted, when considering the value of lockdown the VSL is used to determine the value of lives saved. The VSL is based on preferences, as it should be, and so the VSL is a dollar measure of the _utility_ an individual receives from living. Most notably, the VSL is not a measure of how productive an individual is in terms of the dollar value of goods and services they produce. An infant is valuable, as is a retired senior citizen, but neither produces any market goods and services. In contrast, it is common in cost/benefit studies to only use lost GDP as the measure for the cost of lockdown. That is, the reduced value of goods and services caused by lockdown is the only cost of the lockdown considered. For example, US GDP over 2020 fell by 3.5%.[20](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0020) If 100% of the fall in GDP (approximately $770 billion) is attributed to the lockdown (that is, the virus directly had no effect on production), then compared to the presumed ‘22 trillion’ dollar savings in lives, lockdown seems like an excellent policy. This type of comparison, however, is entirely inappropriate. The VSL is based on the utility of life, and therefore, the costs of lockdown must also be based on the lost utility of lockdown. It has been understood from the very beginning of the pandemic that lockdown caused a broad range of costs through lost civil liberty, lost social contact, lost educational opportunities, lost medical preventions and procedures, increased domestic violence, increased anxiety and mental suffering, and increased deaths due to despair and inability to receive medical attention. If the value of lockdown is measured in utility, then the costs of lockdown must be measured in the same fashion. Excluding the value of lost non-market goods (goods not measured by GDP) grossly under-estimates the cost of lockdown. To point out the distinction, assume that instead of using the VSL to measure the value of a life, the gain in GDP was used to measure the benefits of lockdown. Since the large majority of those who died of Covid-19 were retired, elderly, and sick they generally did not contribute to GDP.[21](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0021) Hence, using a GDP only measure for a cost _and_ benefit study would imply virtually no benefits to lockdowns and massive costs. This conclusion would be inappropriate, but at least it compares apples to apples. ## 2.3. Reviewing lockdown cost/benefit studies #### 2.3.1. Early theoretical cost/benefit studies Generally, the earliest cost/benefit studies done in spring 2020 suffered from each of the theoretical assumptions outlined above; assumptions that were either known, or turned out to be, incorrect, and which biased the results in favor of lockdown.[22](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0022) There were few empirical studies done in the earliest stages of the pandemic, but those that were done often relied on mechanical SIR models for counterfactuals, and had very limited data to work with. At the very beginning of the pandemic ‘studies’ were mostly casual, and simply guessed that benefits were likely greater than costs.[23](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0023) By the late spring academic articles appeared that contained the same sentiments. Consider Thunström, _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Thunström, Linda, Stephen C. Newbold, David Finnoff, Madison Ashworth, and Jason F. Shogren. 2020. The Benefits and Costs of Using Social Distancing to Flatten the Curve for COVID-19. _Journal of Benefit-Cost Analysis_ 11 (2): 179–195. doi:[https://doi.org/10.1017/bca.2020.12](https://doi.org/10.1017/bca.2020.12). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0109&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1017%2Fbca.2020.12), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0109&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000559400200002), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=11&publication_year=2020&pages=179-195&issue=2&author=Linda+Thunstr%C3%B6m&author=Stephen+C.+Newbold&author=David+Finnoff&author=Madison+Ashworth&author=Jason+F.+Shogren&title=The+Benefits+and+Costs+of+Using+Social+Distancing+to+Flatten+the+Curve+for+COVID-19&doi=10.1017%2Fbca.2020.12)) who concluded that: … social distancing likely generates net social benefits. In our benchmark case, which we view as the most plausible case among those we examined, the present value of net benefits from social distancing amount to $5.16 trillion. The Thunström, _et al._ article assumed that there was no private voluntary response to the virus, _Rt_ = 2.4, the VSL=$10M, there was a fixed and unchanging hospital capacity, the IFR reached 1.5% at capacity, and costs only entailed a 6.2% fall in GDP. These assumptions generated $12.4 T in the value of 1.24 M lives saved, and $7.21 T in lost GDP. As noted above, every one of these assumptions biased the model in favor of lockdown benefits and against lockdown costs. To see how sensitive the Thunström, _et al._ conclusion is, consider making just _one_ change: using the Robinson _et al._ age-dependent VSL numbers rather than the constant VSL of $10 M. Now the 1.24 M lives only have a value of $5.54 T, and lockdown has a negative value of $-1.66 T. One realistic change in assumptions flipped the cost/benefit conclusion.[24](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0024) #### 2.3.2. April–June: Early challenging results Many of the early theoretical studies received wide media attention, no doubt triggered by the exceptional claims made about deaths and costs. However, even in the early months of April, May, and June 2020 challenges to the sudden conventional wisdom on both the theoretical and empirical front were common.[25](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0025) On April 27, 2020, three economists at the University of Chicago published ‘Some basic economics of Covid-19 policy’ (Mulligan, Murphy, and Topel). The title is very informative. Understanding optimal policy goes back to recognizing that total benefits and costs must be compared (and comparable), and that efforts to increase benefits involve costs. They pointed out what was mentioned above: the VSL is not constant, nor is it appropriate to consider trading off ‘lives for GDP.’: The VSL for very old individuals is lower because they have fewer years of re- maining life to lose, and because they are in generally poorer health than younger people. The value of a statistical life is a powerful tool because it allows us to assess some fundamental trade-offs between health and other aspects of people’s lives. It is critical to remember that the trade-off here is not between ‘lives’ and GDP — it is the trade-off between two things that people themselves value: health and other aspects of their lives. Mulligan _et al._ go on to note that it is improper to consider models in which the individuals do not respond to the presence of a virus: ‘The fact that individuals put great value on their own health and longevity means that there are strong individual incentives to engage in self-protection.’ They also note: (i) that isolation and suppression of the disease delays the development of herd immunity, which ultimately is the way a society comes out of a pandemic; (ii) that since a vaccine takes time to develop, approve, and deliver, the costs of lockdown must be projected out over the entire period; and (iii) that policy must evolve with new information. Mulligan _et al._ use an average VSL of $4.2 M, and given their calculations, a one year lockdown _reduced_ net wealth ‘even ignoring other long-run costs from reduced values of human and physical capital and any intrinsic value of reduced civil liberties.’ They claimed that with the given knowledge of the time, ‘that broad lockdowns make the most sense when the level of infection is high. In the language of economists, the marginal product of mandatory social distancing is greatest when there are many infected individuals circulating.’ In other words, stay-at-home orders make little sense when the fraction of the population infected is less than 1–2% as it was in many places around the world. Other studies in the early spring provided better empirical evidence about the virus. Lewis et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lewis, N. 2020. Did lockdowns really save 3 million Covid-19 deaths, as Flaxman et al. claim? [https://judithcurry.com/2020/06/21/did-lockdowns-really-save-3-million-covid-19-deaths-as-flaxman-et-al-claim/](https://judithcurry.com/2020/06/21/did-lockdowns-really-save-3-million-covid-19-deaths-as-flaxman-et-al-claim/) [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Lewis%2C+N.+2020.+Did+lockdowns+really+save+3+million+Covid-19+deaths%2C+as+Flaxman+et+al.+claim%3F+https%3A%2F%2Fjudithcurry.com%2F2020%2F06%2F21%2Fdid-lockdowns-really-save-3-million-covid-19-deaths-as-flaxman-et-al-claim%2F)) found that there was a 6.19% fall in quarter GDP growth, and that this was attributed to the response to the virus (ie. lockdowns were having negative market consequences). Coibion et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Coibion, O., Y. Gorodnichenko, and M. Weber. 2020. The Cost of the Covid-19 Crisis: Lockdowns, Macroeconomic Expectations, and Consumer Spending. NBER WP: 27141. doi:[https://doi.org/10.3386/w27141](https://doi.org/10.3386/w27141). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0034&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27141), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=O.+Coibion&author=Y.+Gorodnichenko&author=M.+Weber&title=The+Cost+of+the+Covid-19+Crisis%3A+Lockdowns%2C+Macroeconomic+Expectations%2C+and+Consumer+Spending)) found that average individual income losses over the first wave in the U.S. were between $5000–$33,000. Ravindran and Manisha ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ravindran, S., and S. Manisha. 2020. Unintended Consequences of Lockdowns: COVID-1and the Shadow Pandemic. 2020. 9 _NBER_ WP: 27562, doi = 10.3386/w27562 [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0102&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27562), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Ravindran%2C+S.%2C+and+S.+Manisha.+2020.+Unintended+Consequences+of+Lockdowns%3A+COVID-1and+the+Shadow+Pandemic.+2020.+9+NBER+WP%3A+27562%2C+doi+%3D+10.3386%2Fw27562)) was an early paper showing that jurisdictions with lockdown saw in increase in violence against women. Very early in the pandemic it was clear that predictions based on basic SIR models were wrong, and a major factor was the assumed infection fatality rate (IFR). Levin et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Levin, A., W. Hanage, N. Owusu-Boaitey, K. Cochran, S. Walsh, and G. Meyerowitz- Katz. 2020. Assessing the Age Specificity of Infection Fatality Rates for COVID-19: Systematic Review, Meta-Analysis, and Public Policy Implications. _European Journal of Epidemiology_ 35 (12): 1123–1138. doi = 10.1007/s10654-020- 00698-1 doi:[https://doi.org/10.1007/s10654-020-00698-1](https://doi.org/10.1007/s10654-020-00698-1). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0081&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1007%2Fs10654-020-00698-1), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0081&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33289900), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0081&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000599053000001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=35&publication_year=2020&pages=1123-1138&issue=12&author=A.+Levin&author=W.+Hanage&author=N.+Owusu-Boaitey&author=K.+Cochran&author=S.+Walsh&author=G.+Meyerowitz-+Katz&title=Assessing+the+Age+Specificity+of+Infection+Fatality+Rates+for+COVID-19%3A+Systematic+Review%2C+Meta-Analysis%2C+and+Public+Policy+Implications&doi=10.1007%2Fs10654-020-00698-1), but available in July 2020) was one example of an early meta-analysis that brought together a number of smaller studies from around the world to estimate the IFR. They found that the IFR for Covid-19 was extremely age-specific. Children and younger adults have a very low IFR, and this increases with age, and dramatically increases after age 70. They estimated that at age 55 the IFR is 0.4%, but by age 85 it is 14%. Thus, although younger people were bearing the costs of reduced employment and education, any benefits of lockdown were received by much older cohorts. These months also saw the first empirical studies on lockdown effects at the state level, with mixed results. Friedson et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Friedson, A., D. McNichols, J. Sabia, and D. Dhaval. Did California’s Shelter-in-Place Order Work? Early Coronavirus-Related Public Health Effects, 2020. NBER WP: 26992, April doi:[https://doi.org/10.3386/w26992](https://doi.org/10.3386/w26992). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0051&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw26992), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Friedson%2C+A.%2C+D.+McNichols%2C+J.+Sabia%2C+and+D.+Dhaval.+Did+California%E2%80%99s+Shelter-in-Place+Order+Work%3F+Early+Coronavirus-Related+Public+Health+Effects%2C+2020.+NBER+WP%3A+26992%2C+April+doi%3A+10.3386%2Fw26992.)) was an early study of shelter-in-place regulations, and found that in California this policy reduced cases by between 125–219 per 100,000 population, but each death delayed cost 400 jobs. Dhaval, Friedson, Matsuzawa, McNichols, _et al_. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Dhaval, D., A. Friedson, K. Matsuzawa, D. McNichols, C. Redpath, and J. Sabia. 2020. Risk Aversion, Offsetting Community Effects, and COVID-19: Evidence from an Indoor Political Rally, NBER WP: 27522, July doi:[https://doi.org/10.3386/w27522](https://doi.org/10.3386/w27522). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0040&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27522), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Dhaval%2C+D.%2C+A.+Friedson%2C+K.+Matsuzawa%2C+D.+McNichols%2C+C.+Redpath%2C+and+J.+Sabia.+2020.+Risk+Aversion%2C+Offsetting+Community+Effects%2C+and+COVID-19%3A+Evidence+from+an+Indoor+Political+Rally%2C+NBER+WP%3A+27522%2C+July+doi%3A+10.3386%2Fw27522.)) looked at a natural experiment in Texas where there was variation across the state in the timing of lockdowns. They found that urban lockdowns reduced cases by 19–26%, but that there was no overall effect at the state level. Lin and Meissner ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lin, Z., and C. Meissner. 2020. Health vs. Wealth — Public Health Policies and the Economy During Covid-19, NBER WP: 27099, doi:[https://doi.org/10.3386/w27099](https://doi.org/10.3386/w27099). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0085&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27099), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Lin%2C+Z.%2C+and+C.+Meissner.+2020.+Health+vs.+Wealth+%E2%80%94+Public+Health+Policies+and+the+Economy+During+Covid-19%2C+NBER+WP%3A+27099%2C+doi%3A+10.3386%2Fw27099.)), was one of the first empirical studies that showed that the lockdown effect was minimal and that lower workplace interactions invoked larger residential activity. They also found that common shocks across the U.S. had a larger effect than local lockdown shocks.[26](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0026) Chaudhry et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Chaudhry, R., G. Dranitsaris, T. Mubashir, J. Bartoszko, and S. Riazi. 2020. A Country Level Analysis Measuring the Impact of Government Actions, Country Preparedness and Socioeconomic Factors on COVID-19 Mortality and Related Health Outcomes. _EClinicalMedicine_ 25: 100464. doi:[https://doi.org/10.1016/j.eclinm.2020.100464](https://doi.org/10.1016/j.eclinm.2020.100464). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0029&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.eclinm.2020.100464), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0029&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32838237), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=25&publication_year=2020&pages=100464&author=R.+Chaudhry&author=G.+Dranitsaris&author=T.+Mubashir&author=J.+Bartoszko&author=S.+Riazi&title=A+Country+Level+Analysis+Measuring+the+Impact+of+Government+Actions%2C+Country+Preparedness+and+Socioeconomic+Factors+on+COVID-19+Mortality+and+Related+Health+Outcomes&doi=10.1016%2Fj.eclinm.2020.100464)), examining the fifty most infected countries and exploiting the timing and degree of interventions, found no relation between border closures, full lockdowns, and testing on Covid-19 mortality. Despite the mixed results, one early empirical paper on lockdown was widely cited and heavily influential: Flaxman _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Flaxman, S., S. Mishra, A. Gandy, H. Juliette T. Unwin, T. Mellan, H. Coupland, C. Whittaker, et al. 2020. Estimating the Effects of Non-Pharmaceutical Interventions on COVID-19 in Europe. _Nature_ 584 (7820): 257–261. doi:[https://doi.org/10.1038/s41586-020-2405-7](https://doi.org/10.1038/s41586-020-2405-7). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0050&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1038%2Fs41586-020-2405-7), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0050&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32512579), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0050&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000556239300001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=584&publication_year=2020&pages=257-261&issue=7820&author=S.+Flaxman&author=S.+Mishra&author=A.+Gandy&author=H.+Juliette+T.+Unwin&author=T.+Mellan&author=H.+Coupland&author=C.+Whittaker&title=Estimating+the+Effects+of+Non-Pharmaceutical+Interventions+on+COVID-19+in+Europe&doi=10.1038%2Fs41586-020-2405-7)) claimed lockdowns saved 3 million lives in Europe. This paper looked at lockdowns across 11 European countries in the spring of 2020. It inferred transmission rates based on observed deaths, assumed homogeneity across the countries, and critically assumed that the reproduction number _R_(_t_) only changed because of the immediate response to the mandated lockdown. They concluded that (p. 260): In our analysis, we find that only the effect of lockdown is identifiable, and that it has a substantial effect (81% (75–87%) reduction in _Rt_). Taking into account country-specific effects, the effect size of lockdown remains large across all coun- tries The Flaxman _et al._ paper received criticism on a number of fronts: they assumed homogeneous populations, they lumped vastly different country policies into single indicator variables, and they assumed exogenous human behavior.[27](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0027) Homburg and Kuhbandner ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Homburg, S. and C. Kuhbandner. 2020. Comment on Flaxman et al.‘The Illusory Effects of Non-Pharmaceutical Interventions on COVID-19 in Europe. _Nature_. doi:[https://doi.org/10.1038/s41586-020-2405-7](https://doi.org/10.1038/s41586-020-2405-7). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0064&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000556239300001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=S.+Homburg&author=C.+Kuhbandner&title=Comment+on+Flaxman+et+al.%E2%80%98The+Illusory+Effects+of+Non-Pharmaceutical+Interventions+on+COVID-19+in+Europe&doi=10.1038%2Fs41586-020-2405-7)), focus on the fact that _Rt_, by definition within a fixed population, must decline over time as recovered individuals are no longer susceptible to infection. However, Flaxman _et al._ assumed that the reproduction number was fixed at _Rt_ = _R_0 up until the moment of lockdown, at which point it changed to a new fixed level. This forced the model to put all of the explanatory power on the lockdown indicator variable and grossly exaggerated the effect of lockdown. Homburg and Kuhbandner conclude that ‘… the results of Flaxman _et al._ are artifacts of an inappropriate model.’[28](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0028) Despite the modeling issues and structural econometric tricks, one other feature of Flaxman _et al._ needs to be highlighted: the problem of attributing the ‘total’ effect on transmission to lockdown, and not breaking down the channels by which an effect might have happened. Flaxman _et al._ state that ‘Our parametric form of _Rt_ assumes that changes in _Rt_ are an immediate response to interventions rather than gradual changes in behaviour, …’. This means that the only interpretation possible for the empirical results is that lockdown mattered. Thus, even if the estimated effect was true, it raised the question: was it caused by the mandated lockdown or voluntary individual reactions to the virus?[29](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0029) #### 2.3.4. Four stylized facts about covid-19 Atkeson et al.’s ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Atkeson, A., K. Kopecky, and T. Zha. 2020. Four Stylized Facts about COVID-19, _NBER_ WP: 27719, August, 2020. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Atkeson%2C+A.%2C+K.+Kopecky%2C+and+T.+Zha.+2020.+Four+Stylized+Facts+about+COVID-19%2C+NBER+WP%3A+27719%2C+August%2C+2020.)) paper ‘Four Stylized Facts About Covid-19’ was a watershed result that appeared six months into the pandemic. Using data from 23 countries and all U.S. states that had experienced at least 1000 cumulative deaths up to July 2020, it discovered important features of the progression of the virus across countries that cast serious doubt that any forms of lockdown had a significant large impact on transmission and death rates. In particular, they found that across all of the jurisdictions there was an initial high variance in the daily death and transmission rates, but that this ended very rapidly. After 20–30 days of the 25th death the growth rate in deaths fell to close to zero, and the transmission rate hovered around one.[30](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0030) Not only did Atkeson _et al._ find a dramatic drop and stability of the death and transmission rates, but the spread in these rates across jurisdictions was very narrow. That is, across all jurisdictions, after 20–30 days the virus reached a steady state where each infected person transmmited the virus to one other person, and the number of daily deaths from the virus became constant over time. This finding contrasted with all of the early local, small sample, studies that found any effects of lockdown on cases and deaths. Across all jurisdictions the progression of the virus was the same, despite wide ranging differences in the degree and type of lockdown. In their words: Our finding in Fact 1 that early declines in the transmission rate of COVID- 19 were nearly universal worldwide suggest that the role of region-specific NPI’s implemented in this early phase of the pandemic is likely overstated Our findings in Fact 2 and Fact 3 further raise doubt about the importance in NPI’s (lockdown policies in particular) in accounting for the evolution of COVID-19 transmission rates over time and across locations. Many of the regions in our sample that instigated lockdown policies early on in their local epidemic, removed them later on in our estimation period, or have have not relied on mandated NPI’s much at all. Yet, effective reproduction numbers in all regions have continued to remain low relative to initial levels indicating that the removal of lockdown policies has had little effect on transmission rates. \[pp. 15–16\] Atkeson _et al._ speculated on three reasons for their findings. First, unlike the assumptions made in the SIR models, individuals do not ignore risks, and when a virus enters a population people take mitigating or risky actions based on their own assessments of that risk.[31](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0031) Second, again in contrast to the classic SIR model where individuals uniformly interact with each other, actual human networks are limited and this can limit the spread of the virus after a short period. Finally, like other pandemics, there may be natural forces associated with Covid-19 that explain the rapid move to a steady state death and transmission rate. Each of these reasons suggest that the early correlative findings between lockdowns and cases were not causal linkages. At best the early findings have to be considered with caution. As noted above, Atkeson ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Atkeson, A. 2021. A Parsimonious Behavioral SEIR Model of the 2020 Covid Epidemic in the Unisted States and the United Kingdom. _NBER_ WP: 28434. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0008&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.21034%2Fsr.619), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=A.+Atkeson&title=A+Parsimonious+Behavioral+SEIR+Model+of+the+2020+Covid+Epidemic+in+the+Unisted+States+and+the+United+Kingdom)) continued pandemic modeling shows the critical importance of including seasonality, lockdown fatigue, and behavioral responses to the virus. #### 2.3.5. Voluntary versus mandated lockdown channels As the summer and fall of 2020 progressed Covid-19 research continued as academics studied finer details based on new data and modeling refinements. Perhaps most significantly a number of papers found strong evidence that changes in human behavior significantly affected the progression of the virus, and that this channel was more important than mandated lockdowns for altering the number of cases, transmission rates, and deaths. Bjørnskov ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bjørnskov, C. 2021. Did Lockdown Work? An Economist’s Cross-Country Comparison. _CESifo Economic Studies_ : ifab003, 1–14. March. [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&pages=1-14&author=C.+Bj%C3%B8rnskov&title=Did+Lockdown+Work%3F+An+Economist%E2%80%99s+Cross-Country+Comparison)) exploited cross-country variation in European lockdown policy and found that (p. 7): Comparing weekly mortality in 24 European countries, the findings in this paper suggest that more severe lockdown policies have not been associated with lower mortality. In other words, the lockdowns have not worked as intended. Eichenbaum, de Matos, _et al_. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Eichenbaum, M., S. Rebelo, and M. Trabandt. 2020. The Macroeconomics of Epidemics, _NBER_ WP: 26882, March 2020. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Eichenbaum%2C+M.%2C+S.+Rebelo%2C+and+M.+Trabandt.+2020.+The+Macroeconomics+of+Epidemics%2C+NBER+WP%3A+26882%2C+March+2020.)) showed that elderly people in particular are more likely to reduce spending, time away from home, and the consumption of goods likely to involve high contact with other people. Hunt et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Hunt, A., L. Boxell, J. Conway, B. Ferguson, M. Gentzkow, and B. Goldman.2020. What Explains Temporal and Geographic Variation in the Early US Coronavirus Pandemic. _NBER_ WP: 27965, October, 2020. doi:[https://doi.org/10.3386/w27965](https://doi.org/10.3386/w27965). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0066&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27965), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Hunt%2C+A.%2C+L.+Boxell%2C+J.+Conway%2C+B.+Ferguson%2C+M.+Gentzkow%2C+and+B.+Goldman.2020.+What+Explains+Temporal+and+Geographic+Variation+in+the+Early+US+Coronavirus+Pandemic.+NBER+WP%3A+27965%2C+October%2C+2020.+doi%3A+10.3386%2Fw27965.)) exploited the variation in stay-at-home orders across the U.S. and found that lockdowns had only modest effects on Covid-19 transmission rates. Rather, they found that …most social distancing is driven by voluntary responses. Moreover, we show that neither policy nor rates of voluntary social distancing explain a meaningful share of geographic variation. The most important predictors of which cities were hardest hit by the pandemic are exogenous characteristics such as population and density. Large urban centers got hit harder by the virus, but consistent with the Atkeson et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Atkeson, A., K. Kopecky, and T. Zha. 2020. Four Stylized Facts about COVID-19, _NBER_ WP: 27719, August, 2020. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Atkeson%2C+A.%2C+K.+Kopecky%2C+and+T.+Zha.+2020.+Four+Stylized+Facts+about+COVID-19%2C+NBER+WP%3A+27719%2C+August%2C+2020.)) finding, the transmission rate of the virus depended on endogenous individual responses.[32](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0032) Goolsbee and Syverson ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Goolsbee, A., and C. Syverson. 2020. Fear, Lockdown, and Diversion: Comparing Drivers of Pandemic Economic Decline¿ (University of Chicago, Becker Friedman Institute for Economics) June 2020. [https://ssrn.com/abstract=3631180](https://ssrn.com/abstract=3631180) or doi:[https://doi.org/10.2139/ssrn.3631180](https://doi.org/10.2139/ssrn.3631180). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0056&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.2139%2Fssrn.3631180), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Goolsbee%2C+A.%2C+and+C.+Syverson.+2020.+Fear%2C+Lockdown%2C+and+Diversion%3A+Comparing+Drivers+of+Pandemic+Economic+Decline%C2%BF+%28University+of+Chicago%2C+Becker+Friedman+Institute+for+Economics%29+June+2020.+https%3A%2F%2Fssrn.com%2Fabstract%3D3631180+or+doi%3A+10.2139%2Fssrn.3631180.)), using cellular phone location records, found that voluntary ‘self-lockdown’ explained most of the enormous change in behavior in the spring, and that they ‘do not find evidence of large temporal or spatial shifting in response to shelter-in-place policies’ (p. 12). There are, by my count, over twenty studies that distinguish between voluntary and mandated lockdown effects. Although they vary in terms of data, locations, methods, and authors, all of them find that mandated lockdowns have only marginal effects and that voluntary changes in behavior explain large parts of the changes in cases, transmissions, and deaths. Consider the following: This observational study, using a generalized phenomenological method based on official daily deaths records only, shows that _full lockdown policies of France, Italy, Spain and United Kingdom haven’t had the expected effects in the evolution of theCOVID-19 epidemic._ Our results show a general decay trend in the growth rates and reproduction numbers two to three weeks before the full lock- down policies would be expected to have visible effects. Comparison of pre and post lockdown observations reveals a counter-intuitive slowdown in the decay of the epidemic after lockdown. \[Meunier, p. 6, May [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Meunier, T. 2020. Full Lockdown Policies in Western Europe Countries Have No Evident Impacts on the COVID-19 Epidemic. MedRxiv Pre-print May 1, [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0093&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1101%2F2020.04.24.20078717), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=T.+Meunier&title=Full+Lockdown+Policies+in+Western+Europe+Countries+Have+No+Evident+Impacts+on+the+COVID-19+Epidemic), emphasis added\] Lockdowns are overall effective at curbing the spread of the disease and at reducing deaths (after about 30 days). _But the harsher is not the better: partial lockdowns are as effective as stricter ones,_ but at a lower cost. \[Bonardi _et al._, June [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bonardi, J. P., Q. Gallea, D. Kalanoski, and R. Lalive. 2020. Fast and Local: How Lockdown Policies Affect the Spread and Severity of Covid-19. CEPR Covid Economics 27, [https://cepr.org/sites/default/files/CovidEconomics23.pdf](https://cepr.org/sites/default/files/CovidEconomics23.pdf). [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Bonardi%2C+J.+P.%2C+Q.+Gallea%2C+D.+Kalanoski%2C+and+R.+Lalive.+2020.+Fast+and+Local%3A+How+Lockdown+Policies+Affect+the+Spread+and+Severity+of+Covid-19.+CEPR+Covid+Economics+27%2C+https%3A%2F%2Fcepr.org%2Fsites%2Fdefault%2Ffiles%2FCovidEconomics23.pdf.), emphasis added\] _We test and find wanting the popular notions that lockdowns with their attendant social distancing and various other NPIs confer protection._ \[Nell, _et al._, July 2020, emphasis added\] … our analysis shows that people voluntarily reduce their visits to workplace, retails, grocery stores, and limit their use of public transit when they receive information on a higher number of new cases and deaths. _This suggests that individuals make decisions to voluntarily limit their contact with others in response to greater transmission risks, leading to an important feedback mechanism that affects future cases and deaths._ Model simulations that ignore this voluntary behavioral response to information on transmission risks would over-predict the future number of cases and deaths. \[Chernozhukov _et al._ p. 52, [2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Chernozhukov, V., H. Kasahara, and P. Schrimpf. 2021. Causal Impact of Masks, Policies, Behavior on Early Covid-19 Pandemic in the U.S. _Journal of Econometrics_ 220 (1): 23–62. doi:[https://doi.org/10.1016/j.jeconom.2020.09.003](https://doi.org/10.1016/j.jeconom.2020.09.003). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0030&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jeconom.2020.09.003), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0030&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33100476), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0030&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000599461000003), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=220&publication_year=2021&pages=23-62&issue=1&author=V.+Chernozhukov&author=H.+Kasahara&author=P.+Schrimpf&title=Causal+Impact+of+Masks%2C+Policies%2C+Behavior+on+Early+Covid-19+Pandemic+in+the+U.S&doi=10.1016%2Fj.jeconom.2020.09.003), emphasis added.[33](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0033)\] Lockdowns are ineffective at reducing Covid-19 deaths. Variation amongst counties in the United States, where over one-fifth had no lockdown, shows no impact of lockdowns. Specifically, _one cannot reject the hypothesis of zero difference in deaths between lockdown and non-lockdown counties._ \[Gibson, p. 8, November [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Gibson, J. 2020. Government Mandated Lockdowns Do Not reduceCovid-19 Deaths: implications for Evaluating the Stringent New Zealand Response. _New Zealand Economic Papers_ 0(0): 1–12. doi:[https://doi.org/10.1080/00779954.2020.1844786](https://doi.org/10.1080/00779954.2020.1844786). [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&pages=1-12&author=J.+Gibson&title=Government+Mandated+Lockdowns+Do+Not+reduceCovid-19+Deaths%3A+implications+for+Evaluating+the+Stringent+New+Zealand+Response&doi=10.1080%2F00779954.2020.1844786), emphasis added\] These findings of the relative importance of voluntary responses relative to mandated lockdowns have continued to be confirmed.[34](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0034) A study by Bendavid _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bendavid, E., C. Oh, J. Bhattacharya, and J. Ioannidis. 2021. Assessing Mandatory Stay-at-Home and Business Closure Effects on the Spread of COVID-19. _European Journal of Clinical Investigation_. 51(4). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0015&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000613404500001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=E.+Bendavid&author=C.+Oh&author=J.+Bhattacharya&author=J.+Ioannidis&title=Assessing+Mandatory+Stay-at-Home+and+Business+Closure+Effects+on+the+Spread+of+COVID-19)) that distinguished between strong and weak lockdown countries concluded:[35](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0035) In the framework of this analysis, there is no evidence that more restrictive non- pharmaceutical interventions (‘lockdowns’) contributed substantially to bending the curve of new cases in England, France, Germany, Iran, Italy, the Netherlands, Spain or the United States in early 2020. By comparing the effectiveness of NPIs on case growth rates in countries that implemented more restrictive measures with those that implemented less restrictive measures, the evidence points away from indicating that \[more restrictive\] NPIs provided additional meaningful ben- efit above and beyond \[light restrictive\] NPIs. While modest decreases in daily growth (under 30%) cannot be excluded in a few countries, the possibility of large decreases in daily growth due to \[more restrictive\] NPIs is incompatible with the accumulated data. emphasis added A reasonable conclusion to draw from the sum of lockdown findings on mortality is that a small reduction (benefit) cannot be ruled out for early and light levels of lockdown restrictions. There is almost no consistent evidence that strong levels of lockdown have a beneficial effect, and given the large levels of statistical noise in most studies, a zero (or even negative) effect cannot be ruled out. Maybe lockdowns have a marginal effect, but maybe they do not; a reasonable range of the decline in Covid-19 mortality is 0–20%. ### 2.4. The costs of lockdown Research on the cost of lockdowns has lagged that of the benefits, and even still is incomplete and piecemeal because there are several critical issues which will take time to sort out. First, lockdown costs depend on the expectations people have on how long they will last. These expectations have been constantly changing as lockdowns have been repeatedly extended from an initial two weeks to over sixteen months. Second, many costs will manifest over time, and estimates of these costs can not been done yet. Third, without lockdowns there still would have been negative consequences from the virus itself, and these must be separated from the costs of the lockdown reaction. Fourth, lockdowns take place in the context of other countries and there are general equilibrium and feedback effects that require sorting out. Finally, it is still unknown how permanent many of the effects will be. #### 2.4.1. Lost GDP These issues have meant that all estimates of lockdown costs to date in cost/benefit studies have been limited and unsatisfactory. For example, Miles _et al._ provides a good discussion of cost estimation issues, but then settles on using different scenarios of lost GDP in the U.K. as a cost estimate. There is no question that lost GDP from lockdown is a cost. Lockdowns that close non-essential businesses, supply chains, and various service sector activities, must reduce the production of goods and services. Since these goods and services are valued, this loss is an obvious cost of lockdown. Measures of GDP losses over the year abound. Miles _et al._have different scenario losses attributed to lockdown that range from _£_200B – _£_550B for the U.K. In terms of actual losses, Sweden had a _−_ 7.4% change in the second quarter of 2020, compared to _−_13.9% change for the EU in the same time period (Eurostat, [2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Eurostat 2021. GDP down by 0.7% in the Euro Area and by 0.5% in the EU. _Euroindicators_. Feb.: 1–3. [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&pages=1-3&author=Eurostat&title=GDP+down+by+0.7%25+in+the+Euro+Area+and+by+0.5%25+in+the+EU)). If we used Sweden (which had GDP fall 2.8% over the year) as a lockdown counterfactual, then perhaps one half of the EU fall in GDP could be contributed to lockdowns.[36](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0036) Applying this to a country like Canada, that experienced about an 11% fall in the second quarter GDP and overall a 5.1% fall in GDP, then Canada’s lockdown cost about $89 billion dollars.[37](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0037) When considering losses of GDP, it is important to note that these losses have not been evenly distributed. Canada, like most countries, borrowed to finance lockdown transfer payments, which transfers the debt burden to younger generations. Furthermore, GDP losses vary across industries. In Canada, for example, retail sales experienced a drop of 30% in the second quarter of 2020, but then mostly recovered. Full-service dining sales, on the other hand, dropped by 80% in the second quarter, but by the end of the year were still down 52%. Finally, international flights fell by an enormous 90% in the second quarter, and remained there for the rest of the year.[38](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0038) As noted earlier in section II.B, only using GDP losses as a measure of lockdown costs grossly under-estimates the costs. Despite this, it is often the case that studies with this methodology still find that costs of lockdown exceed any benefits. For example, Miles _et al._ find that costs exceed benefits for every one of their forty scenarios — even though they use the over-estimated Ferguson _et al._ counterfactual of lives saved. In other words, despite under-estimating the costs and over-estimating the benefits (and only for the first three months of lockdown) they still concluded: We find that the costs of the three-month lockdown in the UK are likely to have been high relative to benefits, so that a continuation of severe restrictions is un- likely to be warranted. \[p. R75, August 2020\] #### 2.4.2. Other costs From the beginning it has been recognized that costs involved both the lost goods and services from shutting down economic activity and the lost utility from restricting individual freedoms. Over the course of the year the list of costs beyond lost GDP has increased, and the reach of lockdowns in terms of suffering has turned out to be nuanced and long. Many of the costs will not be known for years as they work out in reduced graduation rates, increased structural unemployment, reduced future earnings, permanent changes to the workforce and organization of businesses, reduced social capital, and reduced long run health status. Here I provide a short list of some of the findings arrived at thus far. 1. **Lost educational opportunities.** Lost, delayed, or poor education leads to reduced human capital that has life long negative consequences.[39](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0039) Not only has lockdown reduced educational opportunities for the young, the distribution of the effects is not equal. Bonal and Gonz’alez ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bonal, X., and S. Gonz’Alez. 2020. The Impact of Lockdown on the Learning Gap: family and School Divisions in Times of crisis. _International review of education. Internationale Zeitschrift fur Erziehungswissenschaft. Revue internationale de pedagogie_ 66: 1–21. doi:[https://doi.org/10.1007/s11159-020-09860-z](https://doi.org/10.1007/s11159-020-09860-z). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0023&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000569543300001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=66&publication_year=2020&pages=1-21&author=X.+Bonal&author=S.+Gonz%E2%80%99Alez&title=The+Impact+of+Lockdown+on+the+Learning+Gap%3A+family+and+School+Divisions+in+Times+of+crisis&doi=10.1007%2Fs11159-020-09860-z)), find that children in low income families, with poor access to online resources, suffer more than others. 2. **Additional effects of school closures.**[40](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0040) Closing schools creates isolation for children, which is known to increase the risk of mental health conditions.[41](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0041) Agostinelli et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Agostinelli, F., M. Doepke, G. Sorrenti, and F. Zilibotti. 2020. When the Great Equalizer Shuts Down: Schools, Peers, and Parents in Pandemic Times. NBER WP: 28264. doi:[https://doi.org/10.3386/w28264](https://doi.org/10.3386/w28264). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0003&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw28264), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Agostinelli%2C+F.%2C+M.+Doepke%2C+G.+Sorrenti%2C+and+F.+Zilibotti.+2020.+When+the+Great+Equalizer+Shuts+Down%3A+Schools%2C+Peers%2C+and+Parents+in+Pandemic+Times.+NBER+WP%3A+28264.+doi%3A+10.3386%2Fw28264.)) showed that school closures hurt students from low income families more. Baron et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Baron, E. J., E. Goldstein, and C. Wallace. 2020. Suffering in Silence: How COVID-19 School Closures Inhibit the Reporting of Child maltreatment. _Journal of Public Economics_ 190: 104258. doi:[https://doi.org/10.1016/j.jpubeco.2020.104258](https://doi.org/10.1016/j.jpubeco.2020.104258). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jpubeco.2020.104258), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32863462), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000576646800019), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=190&publication_year=2020&pages=104258&author=E.+J.+Baron&author=E.+Goldstein&author=C.+Wallace&title=Suffering+in+Silence%3A+How+COVID-19+School+Closures+Inhibit+the+Reporting+of+Child+maltreatment&doi=10.1016%2Fj.jpubeco.2020.104258)) reported that school closures inhibit the reporting of child abuse. Green et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Green, D., A. Karimirad, G. Simard-Duplain, and H. Siu. 2020. COVID and the Economic Importance of In-Person K-12 Schooling, 2020. NBER WP: 28200, December doi:[https://doi.org/10.3386/w28200](https://doi.org/10.3386/w28200). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0057&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw28200), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Green%2C+D.%2C+A.+Karimirad%2C+G.+Simard-Duplain%2C+and+H.+Siu.+2020.+COVID+and+the+Economic+Importance+of+In-Person+K-12+Schooling%2C+2020.+NBER+WP%3A+28200%2C+December+doi%3A+10.3386%2Fw28200.)), using Canadian data found that closing schools and having children learn from home meant that parents reduced labor force participation. Lewis, et al. ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lewis, S., Munro, A. Smith, G., and A. Pollock, Allyson. 2021. Closing Schools is Not Evidence Based and Harms Children. _BMJ_ 372: 1–2. [https://www.bmj.com/content/372/bmj.n521](https://www.bmj.com/content/372/bmj.n521). [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=372&publication_year=2021&pages=1-2&author=S.+Lewis&author=A.+Munro&author=G.+Smith&author=A.+Pollock&title=Closing+Schools+is+Not+Evidence+Based+and+Harms+Children)) provide an extensive list of literature on the harm school closures have had on children and conclude: ‘School closures have been implemented internationally with insufficient evidence for their role in minimising covid-19 transmission and insufficient consideration of the harms to children.’[42](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0042) Perhaps the most startling education finding was from Christakis et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Christakis, D. A., W. Van Cleve, and F. J. Zimmerman. 2020. Estimation of US Children's Educational Attainment and Years of Life Lost Associated with Primary School Closures during the Coronavirus Disease 2019 Pandemic. _JAMA Network Open_ 3 (11): e2028786. doi:[https://doi.org/10.1001/jamanetworkopen.2020.28786](https://doi.org/10.1001/jamanetworkopen.2020.28786). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0032&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1001%2Fjamanetworkopen.2020.28786), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0032&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33180132), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0032&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000593977900008), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=3&publication_year=2020&pages=e2028786&issue=11&author=D.+A.+Christakis&author=W.+Van+Cleve&author=F.+J.+Zimmerman&title=Estimation+of+US+Children%27s+Educational+Attainment+and+Years+of+Life+Lost+Associated+with+Primary+School+Closures+during+the+Coronavirus+Disease+2019+Pandemic&doi=10.1001%2Fjamanetworkopen.2020.28786)), who estimated the linkage between school, lost educational attainment, and life expectancy. Over the course of just the first wave of the pandemic their point estimate on the estimated effect of school closures on life expectancy was 13.8 million lost years of life. To put this in context, the average age of Covid-19 death in the US is about 75. A healthy 75 year old American has a 12 year life expectancy. Thus, the 13.8 million lost life years translates into 1,150,000 75 year old deaths. These lost life years were over the first wave of the pandemic, and are more than twice the number of all U.S. Covid-19 deaths in the first year. - **Increased deaths expected from unemployment.** Life expectancy depends on wealth levels.[43](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0043) McIntyre and Lee ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)McIntyre, R. S., and Y. Lee. 2020. Projected Increases in Suicide in Canada as a Consequence of COVID-19. _Psychiatry Research_ 290: 113104. doi:[https://doi.org/10.1016/j.psychres.2020.113104](https://doi.org/10.1016/j.psychres.2020.113104). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0092&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.psychres.2020.113104), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0092&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32460184), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0092&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000558466900059), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=290&publication_year=2020&pages=113104&author=R.+S.+McIntyre&author=Y.+Lee&title=Projected+Increases+in+Suicide+in+Canada+as+a+Consequence+of+COVID-19&doi=10.1016%2Fj.psychres.2020.113104)) predict between 418–2114 excess suicides in Canada based on increased unemployment over the pandemic year. Bianchi et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bianchi, F., G. Bianchi, and D. Song. The Long-Term Impact of the COVID-19 Unemployment Shock on Life Expectancy and Mortality Rates, _NBER_ WP: 28304, December, 2020. doi:[https://doi.org/10.3386/w28304](https://doi.org/10.3386/w28304). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0019&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw28304), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Bianchi%2C+F.%2C+G.+Bianchi%2C+and+D.+Song.+The+Long-Term+Impact+of+the+COVID-19+Unemployment+Shock+on+Life+Expectancy+and+Mortality+Rates%2C+NBER+WP%3A+28304%2C+December%2C+2020.+doi%3A+10.3386%2Fw28304.)), using time-series data on unemployment, life expectancy, and mortality, estimate the effect of Covid-19 unemployment shocks on future deaths. They find that for the U.S. over the next 15 years unemployment shocks caused by the lockdown reaction will increase deaths by 800,000. These deaths will disproportionately effect women and African-Americans. Since the authors do not distinguish between the effect of the pandemic and lockdowns, not all of the deaths can be attributed to lockdown. However, the link between lockdowns and unemployment is well established. - **Increased deaths from overdoses and other deaths of despair.** Lockdowns disrupt illegal drug channels, often resulting in a more contaminated drug supply. Lockdowns also increase human isolation, leading to increased depression and suicides.[44](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0044) As early has June 2020, Jia _et al._ reported substantial increases in depression, stress, and anxiety were linked to lockdown. Mulligan ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Mulligan, C., K. Murphy, and R. Topel. 2020. Some Basic Economics of COVID-19 Policy a Look at the Trade-Offs we Face in Regulating Behavior during the Pandemic. _Chicago Booth Review_, April 27. [https://review.chicagobooth.edu/economics/2020/article/some-basic-economics-covid-19-policy#ftnref1](https://review.chicagobooth.edu/economics/2020/article/some-basic-economics-covid-19-policy#ftnref1). [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=C.+Mulligan&author=K.+Murphy&author=R.+Topel&title=Some+Basic+Economics+of+COVID-19+Policy+a+Look+at+the+Trade-Offs+we+Face+in+Regulating+Behavior+during+the+Pandemic)) found that over the course of 2020 across the U.S. deaths of despair increased between 10–60%. Killgore et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Killgore, W., S. Cloonan, E. Taylor, M. Allbright, and N. Dailey. 2020. Trends in Suicidal Ideation over the First Three Months of COVID-19 lockdowns. _Psychiatry Research_ 293: 113390. doi:[https://doi.org/10.1016/j.psychres.2020.113390](https://doi.org/10.1016/j.psychres.2020.113390). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0073&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.psychres.2020.113390), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0073&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32835926), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0073&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000591588300059), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=293&publication_year=2020&pages=113390&author=W.+Killgore&author=S.+Cloonan&author=E.+Taylor&author=M.+Allbright&author=N.+Dailey&title=Trends+in+Suicidal+Ideation+over+the+First+Three+Months+of+COVID-19+lockdowns&doi=10.1016%2Fj.psychres.2020.113390)) found that the number of people with thoughts of suicide in the U.S. states with lockdown increased with each passing month, but remained stable in states without lockdown. - **Increased domestic violence.** Chalfin et al. ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Chalfin, A., S. Danagoulian, and M. Deza. 2021. COVID-19 Has Strengthened the Rela- tionship Between Alcohol Consumption and Domestic Violence, _NBER_ WP: 28523, March, 2021. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Chalfin%2C+A.%2C+S.+Danagoulian%2C+and+M.+Deza.+2021.+COVID-19+Has+Strengthened+the+Rela-+tionship+Between+Alcohol+Consumption+and+Domestic+Violence%2C+NBER+WP%3A+28523%2C+March%2C+2021.)) found that much of the increased domestic violence is related to increased alcohol which increased during lockdown.[45](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0045) - **Lost non-Covid-19 medical service.** In the spring lockdown hospitals cancelled scheduled appointments for screenings and treatments (e.g. London et al. [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)London, J., E. Fazio-Eynullayeva, M. Palchuk, P. Sankey, and C. McNair. 2020. Effects of the COVID-19 Pandemic on Cancer-Related Patient Encounters. _JCO Clinical Cancer Informatics_ 4: 657–665. Junedoi:[https://doi.org/10.1200/cci.20.00068](https://doi.org/10.1200/cci.20.00068). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0088&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1200%2FCCI.20.00068), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0088&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32716647), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0088&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000618844800001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=4&publication_year=2020&pages=657-665&author=J.+London&author=E.+Fazio-Eynullayeva&author=M.+Palchuk&author=P.+Sankey&author=C.+McNair&title=Effects+of+the+COVID-19+Pandemic+on+Cancer-Related+Patient+Encounters&doi=10.1200%2Fcci.20.00068); Garcia _et al._ [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Garcia, S., M. Albaghdadi, P. Meraj, C. Schmidt, R. Garberich, F. Jaffer, S. Dixon, et al. 2020. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic. _Journal of the American College of Cardiology_ 75 (22): 2871–2872. doi:[https://doi.org/10.1016/j.jacc.2020.04.011](https://doi.org/10.1016/j.jacc.2020.04.011). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0053&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jacc.2020.04.011), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0053&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32283124), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0053&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000539419300015), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=75&publication_year=2020&pages=2871-2872&issue=22&author=S.+Garcia&author=M.+Albaghdadi&author=P.+Meraj&author=C.+Schmidt&author=R.+Garberich&author=F.+Jaffer&author=S.+Dixon&title=Reduction+in+ST-Segment+Elevation+Cardiac+Catheterization+Laboratory+Activations+in+the+United+States+during+COVID-19+Pandemic&doi=10.1016%2Fj.jacc.2020.04.011)), this created fear among individuals who required emergency treatments and, ironically, although emergency calls for treatment often fell, things like deaths from Cardiac ar- rest increased (e.g. Holland et al. [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Holland, M., J. Burke, S. Hulac, M. Morris, G. Bryskiewicz, A. Goold, K. McVaney, L. Rappaport, and B. Stauffer. 2020. Excess Cardiac Arrest in the Community during the COVID-19 Pandemic. _JACC. Cardiovascular Interventions_ 13 (16): 1968–1969. doi:[https://doi.org/10.1016/j.jcin.2020.06.022](https://doi.org/10.1016/j.jcin.2020.06.022). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0062&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jcin.2020.06.022), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0062&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32819492), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0062&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000563091200028), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=13&publication_year=2020&pages=1968-1969&issue=16&author=M.+Holland&author=J.+Burke&author=S.+Hulac&author=M.+Morris&author=G.+Bryskiewicz&author=A.+Goold&author=K.+McVaney&author=L.+Rappaport&author=B.+Stauffer&title=Excess+Cardiac+Arrest+in+the+Community+during+the+COVID-19+Pandemic&doi=10.1016%2Fj.jcin.2020.06.022)). Woolf et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Woolf, S., D. Chapman, R. Sabo, D. Weinberger, L. Hill, and D. Taylor. 2020. Excess Deaths from COVID-19 and Other Causes, March-July 2020. _JAMA_ 324 (15): 1562–1564. doi:[https://doi.org/10.1001/jama.2020.19545](https://doi.org/10.1001/jama.2020.19545). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0112&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1001%2Fjama.2020.19545), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0112&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33044483), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0112&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000581900600006), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=324&publication_year=2020&pages=1562-1564&issue=15&author=S.+Woolf&author=D.+Chapman&author=R.+Sabo&author=D.+Weinberger&author=L.+Hill&author=D.+Taylor&title=Excess+Deaths+from+COVID-19+and+Other+Causes%2C+March-July+2020&doi=10.1001%2Fjama.2020.19545)) estimate that in the U.S. about 1/3 of the excess deaths over 2020 are not Covid-19 deaths. Maringe et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Maringe, C., J. Spicer, M. Morris, A. Purushotham, E. Nolte, R. Sullivan, B. Rachet, and A. Aggarwal. 2020. The Impact of the COVID-19 Pandemic on Cancer Deaths Due to Delays in Diagnosis in England, UK: A National, Population-Based, Mod- Elling Study. _The Lancet Oncology_ 21 (8): 1023–1034. August, doi:[https://doi.org/10.1016/S1470-2045(20)30388-0](https://doi.org/10.1016/S1470-2045(20)30388-0). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0091&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2FS1470-2045%2820%2930388-0), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0091&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32702310), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0091&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000555457500020), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=21&publication_year=2020&pages=1023-1034&issue=8&author=C.+Maringe&author=J.+Spicer&author=M.+Morris&author=A.+Purushotham&author=E.+Nolte&author=R.+Sullivan&author=B.+Rachet&author=A.+Aggarwal&title=The+Impact+of+the+COVID-19+Pandemic+on+Cancer+Deaths+Due+to+Delays+in+Diagnosis+in+England%2C+UK%3A+A+National%2C+Population-Based%2C+Mod-+Elling+Study&doi=10.1016%2FS1470-2045%2820%2930388-0)) estimate that approximately 60,000 years of lost life will result in England from increased cancer deaths resulting from suspended screenings. (see also Lai [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lai, A. 2020. Estimating Excess Mortality in People with Cancer and Multimorbidity in the COVID-19 Emergency. medRxiv. doi:[https://doi.org/10.1101/2020.05.27.20083287](https://doi.org/10.1101/2020.05.27.20083287). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0076&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1101%2F2020.05.27.20083287), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=A.+Lai&title=Estimating+Excess+Mortality+in+People+with+Cancer+and+Multimorbidity+in+the+COVID-19+Emergency)). These results are supported by Williams _et al_. ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Williams, S., A. Crookes, K. Glass, and A. Glass. 2021. Covid-19 Mortalities in England and Wales and the Peltzman Offsetting Effect. _Applied Economics_, 0(0): 1–17. doi:[https://doi.org/10.1080/00036846.2021.1955089](https://doi.org/10.1080/00036846.2021.1955089). [\[Taylor & Francis Online\]](https://www.tandfonline.com/doi/10.1080/00036846.2021.1955089), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=0&publication_year=2021&pages=1-17&issue=0&author=S.+Williams&author=A.+Crookes&author=K.+Glass&author=A.+Glass&title=Covid-19+Mortalities+in+England+and+Wales+and+the+Peltzman+Offsetting+Effect&doi=10.1080%2F00036846.2021.1955089)) who find that during the first wave of the pandemic in England and Wales the non-Covid-19 related excess mortality caused by lockdowns ‘more than offset’ any decrease in Covid-19 deaths attributed to lockdown.[46](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0046) The opportunity costs of lockdown are widespread across societies, and everyone has faced some type of lockdown consequence. These costs are often non-market and in the future, making them difficult for third parties to measure. They are also unevenly distributed onto the young and the poor who have been unable to mitigate the consequences of lockdown. These characteristics contribute to the lack of attention given to them, and stand in sharp contrast to Covid-19 case loads and deaths that are measured, highly concentrated, and widely reported. In light of the nature and measurement problems associated with the costs of lockdown, as of July 2021 no true, standard, cost benefit study has been conducted. All efforts have rested on assumptions and guesses of things not yet known. It will still take time for a systematic, ground-up, attempt to determine the total lost quality of life brought about by lockdown. Even though such studies do not exist, there is still weight to the economic logic that, with negligible benefits and obvious high costs, lockdown is an inefficient policy. ## 3\. An alternative cost/benefit methodology Professor Caplan ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Caplan, B. 2020. Life years lost: the quantity and the quality. November 24, 2020. [https://www.econlib.org/life-years-lost-the-quantity-and-the-quality/](https://www.econlib.org/life-years-lost-the-quantity-and-the-quality/) [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Caplan%2C+B.+2020.+Life+years+lost%3A+the+quantity+and+the+quality.+November+24%2C+2020.+https%3A%2F%2Fwww.econlib.org%2Flife-years-lost-the-quantity-and-the-quality%2F)) has suggested a thought experiment that provides a solution for the cost measurement issue. Rather than attempt to measure a long list of costs and add them up, Caplan proposes a method that exploits our willingness to pay to avoid the harms of lockdown. If lockdown imposed net costs of $1000 on a person, then that person would be willing to pay up to $1000 to avoid lockdown. Caplan, however, poses the matter in terms of time rather than dollars. His (paraphrased) thought experiment is the following: Suppose you could either live a year of life in the COVID era with lockdowns (e.g. like what happened in the U.K.), or 12-X months with the virus but no lockdowns (e.g. like what happened in Sweden or Florida). What value of X would make the AVERAGE person indifferent? Professor Caplan’s thought experiment addresses the total costs of all covid prevention as _perceived_ by each person living under it, and therefore is an appropriate utility based cost measure to hold up against the value of lives saved through lockdown: _X_ is the number of months a person is willing to pay to avoid lockdowns, other things equal. To make this more explicit, let _y_0 be the set of behaviors one would engage in during the Covid-19 pandemic year _without_ lockdown (Swedish case), and _y_1 be the set of behaviors engaged in with _actual_ lockdown (UK case). Let _U_ (_y_0, 12 _−_ _Xmonths_) be the utility of the former, and _U_ (_y_1, 12 _months_) be the utility of the latter. Professor Caplan is asking: what value of _X_ makes the two utilities equal? For any _random_ individual, _X_ could take on a wide range of values. For some this past year has been horrific, and perhaps they would have preferred it never happened. Perhaps they suffered violence or abuse that was fueled by frustration and alcohol while locked down during a long stay-at-home order. Or perhaps they lost a business, a major career opportunity, or struggled over a long period of unemployment and induced depression. For these people, _X_ equals 12 — they would have paid 12 months of their life to have avoided this past year. Others might have been willing to pay even more. For the vast majority of populations, Covid-19 was not a serious health risk. Lockdowns provided no benefits and only costs. Thus, for the vast majority, _X_ likely takes on a value in the order of a few months. On the other hand, consider the case of an elderly person in relatively poor health. Such a person, as we know from the research done on voluntary responses, will very likely isolate and lockdown voluntarily. Mandated lockdowns impose no marginal costs on them, and as a result, this person would set _X_ = 0. That is, they would pay _nothing_ to have avoided mandated lockdowns. There are others for whom lockdown was also just a minor inconvenience. Those who are professional and have no children at home; who have access to Amazon, Zoom, and the internet; who live in a large house with a garden, dislike travel (and travelers), and have poorer health are also likely to pay very little to avoid lockdown. These folks might be willing to sacrifice only a week or two (e.g. _X_ = .25) to avoid lockdown. The question is: how many months would be sacrificed on _average_? Professor Caplan argues that _X_ = 2 months is a conservative estimate. That is, on average, two months would be sacrificed to have avoided lockdown. For the sake of demonstration, I will use this value of two months, in the context of Canada, to calculate the costs of lockdown. As of March 2021 the pandemic had lasted one year, and by assumption the average Canadian had lost two months of normal life due to lockdown. The population of Canada is 37.7 million people, which means that 6,283,333 years of life were lost due to Canada’s lockdown policy. This number of years can be converted into ‘lives’ using average life expectancy. The average age of reported Covid-19 deaths in Canada over the first year of the pandemic was 80.[47](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0047) In Canada an average 80 year old has a life expectancy of 9.79 years.[48](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0048) This means that the 6,283,333 million years of lost life is equivalent to the deaths of 643,513 80 year olds.[49](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0049) As of March 22, 2021 Canada had a total of 22,716 deaths due to Covid-19 (or 222,389 lost years of life). The question is, however, how many lost years of life would have resulted from Covid-19 deaths if there had been no lockdown? Within the econometric evidence, one of the highest counterfactual upper bounds on the number of Covid-19 deaths was found by Chernozhukov _et al._ (p. 51) at 50%; that is, deaths would have been, at most, 50% higher had there been no lockdown.[50](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0050) Given that most of the literature finds a zero effect of lockdowns on deaths, perhaps a mid-point estimate between zero and the Chernozhukov _et al._ upper bound would be a 20% increase in the number of deaths. In the table below I will calculate benefits for both scenarios. Therefore, in the two cases of an increase of 20% or 50% in deaths with no lockdown, Canada would have experienced an additional 4543 or 11,358 deaths. Meaning there would have been additional 44,430 or 111,081 years of lost life due to Covid-19 deaths. The benefit of lockdown, therefore, was the avoidance of these extra years of lost life. As noted, the cost of lockdown was 6,283,333 years of lost life, and therefore, the cost/benefit ratio of lockdown is 141 (6,283,333/44,430) or 56 (6,283,333/111,081). Table 2 below shows nine different cost-benefit ratios using the same procedure, but with different assumptions. In terms of lockdown costs the table considers two extremes. The first is that _X_ = .5 or two weeks. In other words, lockdowns were little more than an inconvenience for the average Canadian. The second is that _X_ = 5, in which case the average Canadian was willing to sacrifice almost half of a year to avoid lockdowns. In terms of the benefits of lockdown the table uses three cases: the 20% mid-point estimate, the 50% upper bound, and the apocalyptic values of the Ferguson _et al._, Imperial College of London (ICL) model.[51](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0051) All three of these benefit estimates are on the high side, and so the cost/benefit ratios are conservative. Covid-19 Lockdown Cost/Benefits: A Critical Assessment of the Literature ###### Published online: 29 September 2021 ### Table 2. Cost/benefit ratios. The cost/benefit ratios based on the Ferguson _et al._ model are presented only to show that even under that nonsense scenario lockdown is a failure as a policy by cost/benefit standards. The review of the literature suggests that lives saved likely ranged between 0-20% of actual deaths. Thus, even under the assumption that lockdowns were little more than a minor inconvenience on average (_X_ = .5), the costs were at least thirty-five times higher than the benefits. The reasonable conservative case is that the cost/benefit ratio is around 141, which means that by any cost/benefit standard, lockdown has been a public policy disaster. This analysis only considers the _number_ of years of lost life. A proper cost/benefit analysis would consider the _value_ of these lost years. As noted above, the value of life is not constant across age. Since the life years lost to Covid-19 deaths were mostly among those older than 60, and since the years of lost life because of lockdown have mostly been among the young, adjusting the above cost/benefit ratios for the value of life will make lockdown an even worse policy.[52](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0052) ## 4\. Conclusion After more than a year of gathering aggregate data, a puzzle has emerged. Lockdowns were brought on with claims that they were effective and the only means of dealing with the pandemic. However, across many different jurisdictions this relationship does not hold when looking at the raw data. A casual examination of lockdown intensity and the number of cumulative deaths attributed to Covid-19 across jurisdictions shows no obvious relationship.[53](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0053) Indeed, often the least intensive locations had equal or better performance. For example, using the _OurWorldInData_ stringency index (SI) as a measure of lockdown, Pakistan (SI: 50), Finland (SI: 52), and Bulgaria (SI: 50) had similar degrees of lockdown, but the cumulative deaths per million were 61, 141, and 1023. Peru (SI: 83) and the U.K. (SI: 78) had some of the most stringent lockdowns, but also experienced some of the largest cumulative deaths per million: 1475 and 1868.[54](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0054) Using information from _OurWorldInData_, the cumulative deaths per million on March 28, 2021 in North America were 1351 and for the European Union 1368. Sweden had light restrictions, but cumulative deaths were 1327; while the UK had heavy lockdowns and 1868 cumulative deaths per million. This stands in sharp contrast to the dire predictions that were made about Sweden in the first six months of the pandemic.[55](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0055) Similar findings arise when comparing various US states. Florida and California were often compared because they are similar in terms of size and latitude, but had different lockdown policies. Florida locked down in the spring but then started lifting restrictions, on September 25th, 2020 all restrictions were lifted. California has had various mandates throughout 2020, but in early December issued a stay-at-home order that remained in place until January 25th, 2021.[56](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0056) However, the cumulative deaths per 100,000 people are practically indistinguishable: 152 for Florida and 143 for California.[57](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0057) It is easy to find counter examples when using unconditional counts on deaths across different jurisdictions. That is, one can find cases where lockdown states had fewer deaths per million than some non-lockdown states (e.g. Ireland and Germany had high stringency indexes and below average deaths per million). However, it remains the case that lockdown is not associated with fewer deaths per million, but (likely) more.[58](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#EN0058) These unconditional observation puzzles are resolved by the research done over the past year. The preconceived success of lockdowns was driven by theoretical models that were based on assumptions that were unrealistic and often false. The lack of any clear and large lockdown effect is because there isn’t one to be found. The consideration of any policy must consider all costs and all benefits of that policy. All estimates of costs and benefits depend on various assumptions of parameters and structural model forms, and many of the studies examined (especially the early ones) relied on assumptions that were false, and which tended to over-estimate the benefits and under-estimate the costs of lockdown. As a result, most of the early cost/benefit studies arrived at conclusions that were refuted later by data, and which rendered their cost/benefit findings incorrect. Advances in models and data over the past year have showed that lockdowns have had, at best, a marginal effect on the number of Covid-19 deaths. Generally speaking, the ineffectiveness of lockdown stems from voluntary changes in behavior. Lockdown jurisdictions were not able to prevent non-compliance, and non-lockdown jurisdictions benefited from voluntary changes in behavior that mimicked lockdowns. Using a cost/benefit method proposed by Professor Bryan Caplan the most reasonable cost/benefit ratio of lockdowns in terms of life-years saved in Canada is 141. However, given their limited effectiveness, lockdowns still fail under extremely conservative estimates of costs. Furthermore, if the fall of 2021 results in many cases resulting from the more transmissible delta variant among a shrinking number of unvaccinated people, then the expected benefits of lockdown policies become even smaller. Lockdowns are not just an inefficient policy, they must rank as one of the greatest peacetime policy disasters of all time. 1 Other island countries with this strategy include many Pacific island nations (like Samoa and Tonga), Caribbean islands (like Cuba and Jamaica), and Iceland. 2 It has been a sad irony that Covid-19 policy has not been driven by economics, the discipline that specializes in the study of costs and benefits, but by epidemiologists who have ‘no expertise in weighing health benefits against other costs’ (Boettke and Powell [2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Boettke, P., and B. Powell. 2021. The Political Economy of the Covid-19 Pandemic. _Southern Economic Journal_ 87 (4): 1090–1106. doi:[https://doi.org/10.1002/soej.12488](https://doi.org/10.1002/soej.12488). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0022&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1002%2Fsoej.12488), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0022&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000617336200001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=87&publication_year=2021&pages=1090-1106&issue=4&author=P.+Boettke&author=B.+Powell&title=The+Political+Economy+of+the+Covid-19+Pandemic&doi=10.1002%2Fsoej.12488), p. 1092). For example, Miles _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Miles, D., M. Stedman, and A. Heald. 2020. Living with Covid-19: Balancing Costs against Benefits in the Face of the Virus. _National Institute Economic Review_ 253: R60–R76. doi:[https://doi.org/10.1017/nie.2020.30](https://doi.org/10.1017/nie.2020.30). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0094&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1017%2Fnie.2020.30), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0094&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000553044300009), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=253&publication_year=2020&pages=R60-R76&author=D.+Miles&author=M.+Stedman&author=A.+Heald&title=Living+with+Covid-19%3A+Balancing+Costs+against+Benefits+in+the+Face+of+the+Virus&doi=10.1017%2Fnie.2020.30)) provide an excellent economic assessment of the first pandemic wave in Europe. They pointed out the need to consider all costs and benefits, and recognized that the costs of widespread severe restrictions likely exceeded costs. They also pointed out that economics suggests using more targeted measures to deal with the particular effects of Covid-19. Unfortunately, lockdown proponents have often portrayed arguments like this as a type of ‘moral bankruptcy.’ 3 The vast majority of studies have focused on cases and deaths, and so that is what is dealt with here. Issues of ‘long-covid’ and other non-mortality costs that might be reduced by lockdown are not addressed. See Kniesner and Sullivan ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Kniesner, T. J., and R. Sullivan. 2020. The Forgotten Numbers: A Closer Look at Covid-19 Non-Fatal Valuations. _Journal of Risk and Uncertainty_ 61 (2): 1–176. doi:[https://doi.org/10.1007/s11166-020-09339-0](https://doi.org/10.1007/s11166-020-09339-0). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0075&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1007%2Fs11166-020-09339-0), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0075&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000585723600001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=61&publication_year=2020&pages=1-176&issue=2&author=T.+J.+Kniesner&author=R.+Sullivan&title=The+Forgotten+Numbers%3A+A+Closer+Look+at+Covid-19+Non-Fatal+Valuations&doi=10.1007%2Fs11166-020-09339-0)) for a discussion of non-fatal Covid-19 outcomes. 4 It has become a stylized fact that lockdown was successful during the Spanish flu pandemic in 1918–1919. However, Barro ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Baron, E. J., E. Goldstein, and C. Wallace. 2020. Suffering in Silence: How COVID-19 School Closures Inhibit the Reporting of Child maltreatment. _Journal of Public Economics_ 190: 104258. doi:[https://doi.org/10.1016/j.jpubeco.2020.104258](https://doi.org/10.1016/j.jpubeco.2020.104258). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jpubeco.2020.104258), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32863462), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0011&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000576646800019), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=190&publication_year=2020&pages=104258&author=E.+J.+Baron&author=E.+Goldstein&author=C.+Wallace&title=Suffering+in+Silence%3A+How+COVID-19+School+Closures+Inhibit+the+Reporting+of+Child+maltreatment&doi=10.1016%2Fj.jpubeco.2020.104258)), showed early on in this pandemic that school closures, prohibitions on public gatherings, and isolation orders had no significant effect on overall mortality during the second wave of the great 1918–1919 pandemic. It is also the case that prior to Covid-19 the WHO was opposed to widespread border and school closures, stay at home orders, and lockdowns. 5 This model depends on number of people susceptible (S), infectious (I), or recovered (R). 6 This was the _lowest_ value considered. Other predictions used values as high as 3.3, with considerably more deaths predicted. 7 Estimates of the IFR have continued to fall over the year. Ioannidis ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ioannidis, J. 2020. Infection Fatality Rate of COVID-19 Inferred from Seroprevalence Data. _Bulletin of the World Health Organization_, 99(1):19-33. [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0069&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33716331), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0069&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000662782700006), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=J.+Ioannidis&title=Infection+Fatality+Rate+of+COVID-19+Inferred+from+Seroprevalence+Data)) estimated that the median IFR was 0.27% across 51 locations around the world. He noted that this IFR was ‘much lower than estimates made earlier in the pandemic’ (p.1). Ioannidis ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ioannidis, J. 2021. Reconciling Estimates of Global Spread and Infection Fatality Rates of COVID-19: An Overview of Systematic evaluations. _European Journal of Clinical Investigation_ 51 (5): e13554. March . doi:[https://doi.org/10.1111/eci.13554](https://doi.org/10.1111/eci.13554). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0068&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1111%2Feci.13554), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0068&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33768536), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0068&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000638453600001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=51&publication_year=2021&pages=e13554&issue=5&author=J.+Ioannidis&title=Reconciling+Estimates+of+Global+Spread+and+Infection+Fatality+Rates+of+COVID-19%3A+An+Overview+of+Systematic+evaluations&doi=10.1111%2Feci.13554)) later estimated the average global IFR at 0.15%. 8 There are many forms of SIRs models, and the exact channel by which the virus mechanically progresses varies across studies. For example, Ambikapathy and Krishnamurthy ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ambikapathy, B., and K. Krishnamurthy. 2020. Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation. _JMIR Public Health and Surveillance_ 6 (2): e19368. Maydoi:[https://doi.org/10.2196/19368](https://doi.org/10.2196/19368). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0006&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.2196%2F19368), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0006&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32365045), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=6&publication_year=2020&pages=e19368&issue=2&author=B.+Ambikapathy&author=K.+Krishnamurthy&title=Mathematical+Modelling+to+Assess+the+Impact+of+Lockdown+on+COVID-19+Transmission+in+India%3A+Model+Development+and+Validation&doi=10.2196%2F19368)) model the exponential viral growth using a system of differential equations that mimic a SIR model. Given the assumed parameters in the model, lockdowns inhibit the transmission rates and produce a predicted benefit. See also Sjödin _et al._ [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Sjödin, H., A. Wilder-Smith, S. Osman, Z. Farooq, and J. Rockl’’ov. 2020. Only Strict Quarantine Measures Can Curb the Coronavirus Disease (COVID-19) Outbreak in Italy. _Euro Surveillance_ 25 (13). doi:[https://doi.org/10.2807/1560-](https://doi.org/10.2807/1560-).7917.ES.2020.25.13.2000280 [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0107&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32265005), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=25&publication_year=2020&issue=13&author=H.+Sj%C3%B6din&author=A.+Wilder-Smith&author=S.+Osman&author=Z.+Farooq&author=J.+Rockl%E2%80%99%E2%80%99ov&title=Only+Strict+Quarantine+Measures+Can+Curb+the+Coronavirus+Disease+%28COVID-19%29+Outbreak+in+Italy&doi=10.2807%2F1560-), or Liu _et al._ May 2020 for other examples of mechanical virus models. One problem with SIR models that is not addressed here is their sensitivity to model specification. Chin _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Chin, V., J. Ioannidis, M. Tanner, and S. Cripps. 2021. Effect Estimates of Covid-19 Non-Pharmaceutical Interventions Are Non-Robust and Highly Model-Dependent. _Journal of Clinical Epidemiology_ 136: 96–132. doi:[https://doi.org/10.1016/j.jclinepi.2021.03.014](https://doi.org/10.1016/j.jclinepi.2021.03.014). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0031&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jclinepi.2021.03.014), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0031&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33781862), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0031&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000694917100012), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=136&publication_year=2021&pages=96-132&author=V.+Chin&author=J.+Ioannidis&author=M.+Tanner&author=S.+Cripps&title=Effect+Estimates+of+Covid-19+Non-Pharmaceutical+Interventions+Are+Non-Robust+and+Highly+Model-Dependent&doi=10.1016%2Fj.jclinepi.2021.03.014)) show that the original SIR models used by the ICL were ‘… non-robust and highly sensitive to model specification, assumptions and data employed to fit models.’ (p. 102). 9 The notion that epidemiological models should contain endogenous human behavior was explained in a classic paper by Philipson ([2000](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Philipson, T. 2000. Chapter 33, Economic Epidemiology and Infectious Diseases. In _Handbook of Health Economics_. Vol 1. (Amsterdam: Elsevier). [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2000&author=T.+Philipson&title=Chapter+33%2C+Economic+Epidemiology+and+Infectious+Diseases)). This feature is common in economic models of Covid-19. For example Farboodi _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Farboodi, M., G. Jarosch, and R. Shimer. 2020. Internal and external effects of social distancing in a pandemic. _NBER_ WP: 27059, July 2020. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Farboodi%2C+M.%2C+G.+Jarosch%2C+and+R.+Shimer.+2020.+Internal+and+external+effects+of+social+distancing+in+a+pandemic.+NBER+WP%3A+27059%2C+July+2020.)) and Luther ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Luther, W. Behavioral and Policy Responses to COVID-19: Evidence from Google Mobility Data on State-Level Stay-at-Home Orders. _AIER Sound Money Project Working Paper No. 2020-06_, 2020. May 8, [https://ssrn.com/abstract=3596551](https://ssrn.com/abstract=3596551). or doi:[https://doi.org/10.2139/ssrn.3596551](https://doi.org/10.2139/ssrn.3596551). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0089&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.2139%2Fssrn.3596551), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Luther%2C+W.+Behavioral+and+Policy+Responses+to+COVID-19%3A+Evidence+from+Google+Mobility+Data+on+State-Level+Stay-at-Home+Orders.+AIER+Sound+Money+Project+Working+Paper+No.+2020-06%2C+2020.+May+8%2C+https%3A%2F%2Fssrn.com%2Fabstract%3D3596551.+or+doi%3A+10.2139%2Fssrn.3596551.)) found that individual responses to the virus were substantial and happened before lockdowns were mandated. Leeson and Rouanet ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Leeson, P., and L. Rouanet. 2021. Externality and Covid-19. _Southern Economic Journal_ 87 (4): 1107–1118. April doi:[https://doi.org/10.1002/soej.12497](https://doi.org/10.1002/soej.12497). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0078&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1002%2Fsoej.12497), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0078&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000620992700001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=87&publication_year=2021&pages=1107-1118&issue=4&author=P.+Leeson&author=L.+Rouanet&title=Externality+and+Covid-19&doi=10.1002%2Fsoej.12497)) point out the various ways this endogenous response self-limits the externality of infection, which reduces the presumed rationale for lockdowns in the first place. 10 The effects of lockdown on transmission turned out to be much more nuanced. For example, Mulligan ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Mulligan, C. 2021. The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19. Becker Friedman Institute, WP: 2021–51. 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[\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0065&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1038%2Fs41586-020-2404-8), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0065&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32512578), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0065&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000556239300002), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=584&publication_year=2020&pages=262-267&issue=7820&author=S.+Hsiang&author=D.+Allen&author=S.+Annan-Phan&author=K.+Bell&author=I.+Bolliger&author=T.+Chong&author=H.+Druckenmiller&title=The+Effect+of+Large-Scale+anti-Contagion+Policies+on+the+COVID-19+Pandemic&doi=10.1038%2Fs41586-020-2404-8)), who use the pre-lockdown growth rates of the virus in their calculation of the counterfactual trajectory of new cases. This ignores the fact that transmission and infection rates vary over time, and that a major reason for this variation is voluntary changes in behavior. 12 The use of these models has continued into 2021 with respect to covid-19 variants. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, stated on February 2, 2021 that the new variant would cause a ‘hurricane’ of new cases, and ‘The fact is that the surge that is likely to occur with this new variant from England is going to happen in the next six to fourteen weeks. And, if we see that happen, which my forty-five years in the trenches tell me we will, we are going to see something like we have not seen yet in this country …’. Quoted from [https://nationalinterest.org/blog/coronavirus/health-expert-prepare-category-5-](https://nationalinterest.org/blog/coronavirus/health-expert-prepare-category-5-)coronavirus-hurricane-177476. According to OurWorldInData, on February 2, 2021 there were 428 cases per million (cpm) people in the U.S. Six weeks later on March 14 there were 163 cpm; fourteen weeks later on May 4 there were 145 cpm. Cases did not rise to unprecedented hurricane levels, but rather fell by more than two times. By late August cases were up to 258 cpm, but due to a different (delta) variant and behavior changes caused by vaccinations. 13 Furthermore, these two responses are inter-related: The endogenous behavioral response … may also limit the effectiveness of efforts to reduce the spread of COVID-19. A lockdown, for example, that does not end the pandemic may suppress disease prevalence temporarily only to encourage behavior that leads the disease to become just as prevalent as before the lockdown. \[Leeson and Rouanet, p. 1111, [2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Leeson, P., and L. Rouanet. 2021. Externality and Covid-19. _Southern Economic Journal_ 87 (4): 1107–1118. April doi:[https://doi.org/10.1002/soej.12497](https://doi.org/10.1002/soej.12497). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0078&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1002%2Fsoej.12497), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0078&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000620992700001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=87&publication_year=2021&pages=1107-1118&issue=4&author=P.+Leeson&author=L.+Rouanet&title=Externality+and+Covid-19&doi=10.1002%2Fsoej.12497)\] 14 For example, if only 10% of change in cases is caused by mandated lockdown and 90% is caused by voluntary changes in behavior, then attributing all of the effect to lockdown over-estimates the lockdown effect by nine times. The less important mandated lockdowns are, the greater the over-estimation. This issue was publicly known as early as April 2020. Abouk ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Abouk, R., and B. Heydari. 2020. The Immediate Effect of COVID-19 Policies on Social Distancing Behavior in the United States. MedRxiv. doi:[https://doi.org/10.1101/2020.04.07.20057356](https://doi.org/10.1101/2020.04.07.20057356). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0001&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1101%2F2020.04.07.20057356), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=R.+Abouk&author=B.+Heydari&title=The+Immediate+Effect+of+COVID-19+Policies+on+Social+Distancing+Behavior+in+the+United+States)) examined differences in policies across the U.S. and separated out the voluntary effect. He noted (p. 2): While there is strong evidence for reduced social contact in the US, not all of these reductions can be attributed to NPIs: mobility data show that people in most states had already started to reduce the time they spend outside their homes before any NPI was implemented. He found that stay-at-home orders had a substantial effect on confirmed cases, but business and school closures, along with bans of large gatherings did not. 15 Many object to the assignment of a number to the value of a life. To do so, however, makes it impossible to compare the costs and benefits of a policy decision. Arguing that assigning values to lives is immoral has been one method used to prevent the policy discussions from using cost/benefit analysis. 16 The major alternative to using VSL is a ‘quality of life adjusted years’ (QALY), which takes into account the health status of the individual. Given the age and health of most people who died of Covid-19, the QALY produces a value of life generally lower than the VSL. I ignore the debate over which method is more appropriate since most cost/benefit studies used the VSL; however, see Miles _et al._ for an example of the use of QALY in a Covid-19 study. 17 See Hammitt ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Hammitt, J. 2020. Valuing Mortality Risk in the Time of COVID-19. _SSRN_. [https://ssrn.com/abstract=3615314](https://ssrn.com/abstract=3615314). or doi:[https://doi.org/10.2139/ssrn.3615314](https://doi.org/10.2139/ssrn.3615314). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0060&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.2139%2Fssrn.3615314), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Hammitt%2C+J.+2020.+Valuing+Mortality+Risk+in+the+Time+of+COVID-19.+SSRN.+https%3A%2F%2Fssrn.com%2Fabstract%3D3615314.+or+doi%3A+10.2139%2Fssrn.3615314.)) for an excellent discussion of the VSL and descriptions of how it varies with age. 18 It has been understood for some time that those dying of Covid-19 have comorbidities. Accord- ing to the March 17, 2021 CDC weekly update ([https://www.cdc.gov/nchs/nvss/vsrr/covidweekly/index.htm#ExcessDeaths](https://www.cdc.gov/nchs/nvss/vsrr/covidweekly/index.htm#ExcessDeaths)) only 6% of Covid-19 deaths in the U.S. were attributed to Covid-19 alone. The average number of comorbidities of those who died was 3.8. Thus, even assigning a VSL of $2,000,000 for individuals with multiple comorbidities is too high. 19 The absurdity of such a conclusion points to the problem of using a marginal value of life to estimate a total value. If the entire economy of the US was actually closed for one year, the total loss of life would be in the hundreds of millions. 20 Taken from Bureau of Economic Analysis: [https://www.bea.gov/news/2021/](https://www.bea.gov/news/2021/). 21 As of March 2021, 95.9% of deaths were to individuals over age 60, and 69.1% of deaths were to individuals over 80. Source: [https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html](https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html). 22 I ignore the issue of ‘homogeneity’ in SIR models (the idea that everyone in the model is the same) because most empirical work ignored it. However, this is another significant shortcoming of many models. Acemoglu _et al._, as early as May [2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Acemoglu, D., V. Chernozhukov, I. Werning, and M. Whinston. 2020. Optimal Targeted Lockdowns in a Multi-Group SIR Model. _NBER_. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0002&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27102), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Acemoglu%2C+D.%2C+V.+Chernozhukov%2C+I.+Werning%2C+and+M.+Whinston.+2020.+Optimal+Targeted+Lockdowns+in+a+Multi-Group+SIR+Model.+NBER.), produced a SIR model where there were three different age cohorts, with age-increasing risks from Covid-19. Not too surprisingly, in such a model a uniform, blanket lockdown is not optimal. By June of 2020 models started appearing where individuals could differ in many characteristics like transmissibility, locations, ages, occupations, etc. Both Ellison ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Ellison, G. 2020. Implications of Heterogeneous SIR Models for Analyses of COVID-19. _NBER_ WP: 27373, doi:[https://doi.org/10.3386/w27373](https://doi.org/10.3386/w27373). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0046&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27373), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=G.+Ellison&title=Implications+of+Heterogeneous+SIR+Models+for+Analyses+of+COVID-19)), and Akbarpour _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Akbarpour, M., Cook, C. Marzuoli, A., Mongey, S. Nagaraj, A. Saccarola, M. Tebaldi, P. Vasserman, S. and H. Yang. 2020. Socioeconomic Network Het- Erogeneity and Pandemic Policy Response. _NBER_ WP: 27374, [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0005&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27374), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=M.+Akbarpour&author=C.+Cook&author=A.+Marzuoli&author=S.+Mongey&author=A.+Nagaraj&author=M.+Saccarola&author=P.+Tebaldi&author=S.+Vasserman&author=H.+Yang&title=Socioeconomic+Network+Het-+Erogeneity+and+Pandemic+Policy+Response)) showed that introducing heterogeneity resulted in herd immunity being reached much faster, and which raised the costs of blanket lockdowns. 23 See for example, this March 23, 2020 article: [https://www.nationalreview.com/corner/a-covid-](https://www.nationalreview.com/corner/a-covid-)cost-benefit-analysis/which assumed lockdown saved one million lives all valued at $9M each, and made no guess at costs, but concluded ‘I still think the benefits will easily prevail…’. Another article from March 31, 2020 ([https://www.sciencemag.org/news/2020/03/modelers-weigh-value-lives-and-](https://www.sciencemag.org/news/2020/03/modelers-weigh-value-lives-and-)lockdown-costs-put-price-covid-19), assumed a constant value of life of $9.5M, and a loss of GDP caused by lockdown of 22%, argued that ‘even a yearlong lockdown makes economic sense.’ 24 Almost all of the cost/benefits studies I found from the early spring suffered from the problems of using a standard SIR model to estimate the counterfactual, constant and high VSL, high transmission and infection fatality rates, and costs based on GDP. These include Eichenbaum et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Eichenbaum, M., M. de Matos, F. Lima, S. Rebelo, and M. Trabandt. 2020. How do People Respond to Small Probability Events with Large, Negative Consequences?, _NBER_ WP: 27988, October, 2020. [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Eichenbaum%2C+M.%2C+M.+de+Matos%2C+F.+Lima%2C+S.+Rebelo%2C+and+M.+Trabandt.+2020.+How+do+People+Respond+to+Small+Probability+Events+with+Large%2C+Negative+Consequences%3F%2C+NBER+WP%3A+27988%2C+October%2C+2020.)), Bethune and Korinek ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bethune, Z., and A. Korinek. 2020. Covid-19 Infection Externalities: Trading off Lives vs. Livelihoods. NBER WP: 27009. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0018&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27009), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=Z.+Bethune&author=A.+Korinek&title=Covid-19+Infection+Externalities%3A+Trading+off+Lives+vs.+Livelihoods)), Jones _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Jones, C., T. Philippon, and V. Venkateswaran. 2020. Optimal Mitigation Policies in a Pandemic: Social Distancing and Working from Home, 2020. NBER WP: 26984. doi:[https://doi.org/10.3386/w26984](https://doi.org/10.3386/w26984). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0071&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw26984), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Jones%2C+C.%2C+T.+Philippon%2C+and+V.+Venkateswaran.+2020.+Optimal+Mitigation+Policies+in+a+Pandemic%3A+Social+Distancing+and+Working+from+Home%2C+2020.+NBER+WP%3A+26984.+doi%3A+10.3386%2Fw26984.)), Baker _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Baker, S., N. Bloom, S. Davis, and S. Terry. 2020. COVID-Induced Economic Uncertainty. NBER WP: 26983. doi:[https://doi.org/10.3386/w26983](https://doi.org/10.3386/w26983). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0009&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw26983), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Baker%2C+S.%2C+N.+Bloom%2C+S.+Davis%2C+and+S.+Terry.+2020.+COVID-Induced+Economic+Uncertainty.+NBER+WP%3A+26983.+doi%3A+10.3386%2Fw26983.)), Bloom _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bloom, N., P. Bunn, P. Mizen, P. Smietanka, and G. Thwaites. 2020. The Impact of Covid-19 on Productivity, NBER WP: 28233. doi:[https://doi.org/10.3386/w28233](https://doi.org/10.3386/w28233). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0021&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw28233), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Bloom%2C+N.%2C+P.+Bunn%2C+P.+Mizen%2C+P.+Smietanka%2C+and+G.+Thwaites.+2020.+The+Impact+of+Covid-19+on+Productivity%2C+NBER+WP%3A+28233.+doi%3A+10.3386%2Fw28233.)), Hall _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Hall, R., C. Jones, and P. Klenow. 2020. Trading Off Consumption and COVID-19 Deaths, 2020. NBER WP: 27340. doi:[https://doi.org/10.3386/w27340](https://doi.org/10.3386/w27340). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0059&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27340), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Hall%2C+R.%2C+C.+Jones%2C+and+P.+Klenow.+2020.+Trading+Off+Consumption+and+COVID-19+Deaths%2C+2020.+NBER+WP%3A+27340.+doi%3A+10.3386%2Fw27340.)), Basili and Nicita ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Basili, M., and A. Nicita. 2020. _The Covid-19/SARS-CoV-2 Pandemic Outbreak, the Risk of Institutional Failures and a Coherent Health Policy_. Department of Economics University of Siena 838, Siena. 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[\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0036&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1001%2Fjama.2020.19759), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0036&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33044484), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0036&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000581900600003), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=324&publication_year=2020&pages=1495-1496&issue=15&author=D.+Cutler&author=L.+Summers&title=The+COVID-19+Pandemic+and+the+%2416+Trillion+Virus&doi=10.1001%2Fjama.2020.19759)). An interesting example is Rowthorn and Maciejowski ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Rowthorn, R., and J. Maciejowski. 2020. A Cost-Benefit Analysis of the COVID-19 Disease. _Oxford Review of Economic Policy_ 36 (Supplement\_1): S38–S55. doi:[https://doi.org/10.1093/oxrep/graa030](https://doi.org/10.1093/oxrep/graa030). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0105&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1093%2Foxrep%2Fgraa030), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=36&publication_year=2020&pages=S38-S55&issue=Supplement_1&author=R.+Rowthorn&author=J.+Maciejowski&title=A+Cost-Benefit+Analysis+of+the+COVID-19+Disease&doi=10.1093%2Foxrep%2Fgraa030)). Although it came out later in the summer, it still used a basic SIR model in its cost/benefit analysis. What makes it interesting is that the authors recognized how critical the VSL number was. When a life is worth _£_2m, then only a lockdown of 5.3 weeks was justifiable. When the VSL is _£_10m it still only justified a 10 week lockdown. 25 These challenges came from professionals in public health as well as economics. Rangel _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Rangel, J. C., S. Ranade, P. Sutcliffe, E. Mykhalovskiy, D. Gastaldo, and J. Eakin. 2020. Covid-19 Policy measures-Advocating for the Inclusion of the Social Determinants of Health in Modelling and Decision making. _Journal of Evaluation in Clinical Practice_ 26 (4): 1078–1080. doi:[https://doi.org/10.1111/jep.13436](https://doi.org/10.1111/jep.13436). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0101&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1111%2Fjep.13436), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0101&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32567212), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0101&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000541381300001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=26&publication_year=2020&pages=1078-1080&issue=4&author=J.+C.+Rangel&author=S.+Ranade&author=P.+Sutcliffe&author=E.+Mykhalovskiy&author=D.+Gastaldo&author=J.+Eakin&title=Covid-19+Policy+measures-Advocating+for+the+Inclusion+of+the+Social+Determinants+of+Health+in+Modelling+and+Decision+making&doi=10.1111%2Fjep.13436)) pointed out very early that narrow models that only focused on a few outcomes would lead to terrible public health outcomes. 26 Other early studies showing that lockdown reduced cases include Born _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Born, B.,. A. Dietrich, and G. Mueller. 2020. The Lockdown Effect: A Counter-factual for Sweden. _CEPR Discussion Paper_, 32, July, 2020. [https://cepr.org/active/publications/discussionpapers/dp.php?dpno=14744](https://cepr.org/active/publications/discussionpapers/dp.php?dpno=14744). [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Born%2C+B.%2C.+A.+Dietrich%2C+and+G.+Mueller.+2020.+The+Lockdown+Effect%3A+A+Counter-factual+for+Sweden.+CEPR+Discussion+Paper%2C+32%2C+July%2C+2020.+https%3A%2F%2Fcepr.org%2Factive%2Fpublications%2Fdiscussionpapers%2Fdp.php%3Fdpno%3D14744.)), Courtemanche _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Courtemanche, C., J. Garuccio, A. Le, J. Pinkston, and A. Yelowitz. 2020. Strong Social Distancing Measures in the United States Reduced the COVID-19 Growth Rate. _Health Affairs (Project Hope)_ 39 (7): 1237–1246. 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([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Dehning, J., J. Zierenberg, F. P. Spitzner, M. Wibral, J. P. Neto, M. Wilczek, and V. Priesemann. 2020. Inferring Change Points in the Spread of Covid-19 Reveals the Effectiveness of Interventions. _Science (New York, N.Y.)_ 369 (6500) doi:[https://doi.org/10.1126/science.abb9789](https://doi.org/10.1126/science.abb9789). 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Mina. “Quantifying the impact of us state non-pharmaceutical interventions on covid-19 transmission.” medRxiv, 2020. doi:[https://doi.org/10.1101/2020.06.30.20142877](https://doi.org/10.1101/2020.06.30.20142877). URL [https://www.medrxiv.org/content/early/2020/07/01/2020.06.30.20142877](https://www.medrxiv.org/content/early/2020/07/01/2020.06.30.20142877). [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Hannah+M.+K.%2C+D.+Alexander%2C+I.+Miller%2C+B.+Grenfell%2C+C.+Jessica+E.+Metcalf%2C+and+M.+Mina.+%E2%80%9CQuantifying+the+impact+of+us+state+non-pharmaceutical+interventions+on+covid-19+transmission.%E2%80%9D+medRxiv%2C+2020.+doi%3A+10.1101%2F2020.06.30.20142877.+URL+https%3A%2F%2Fwww.medrxiv.org%2Fcontent%2Fearly%2F2020%2F07%2F01%2F2020.06.30.20142877.)) and Dhaval, Friedson, Matsuzawa, and Sabia ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Dhaval, D., A. Friedson, K. Matsuzawa, J. Sabia, and S. Safford. 2020. Were Urban Cowboys Enough to Control COVID-19? Local Shelter-in-Place Orders and Coronavirus Case Growth, NBER WP: 27229. doi:[https://doi.org/10.3386/w27229](https://doi.org/10.3386/w27229). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0041&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27229), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Dhaval%2C+D.%2C+A.+Friedson%2C+K.+Matsuzawa%2C+J.+Sabia%2C+and+S.+Safford.+2020.+Were+Urban+Cowboys+Enough+to+Control+COVID-19%3F+Local+Shelter-in-Place+Orders+and+Coronavirus+Case+Growth%2C+NBER+WP%3A+27229.+doi%3A+10.3386%2Fw27229.)). Most of the early studies are based on modeling exercises, which again, depend critically on the model’s counterfactual prediction. An exception was Banerjee and Nayak ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Banerjee, T., and A. Nayak. 2020. U.S. county Level Analysis to Determine If Social Distancing Slowed the Spread of COVID-19. _Revista panamericana de salud publica = Pan American journal of public health_ 44: e90. doi:[https://doi.org/10.26633/RPSP.2020.90](https://doi.org/10.26633/RPSP.2020.90). [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0010&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32636878), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0010&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000547490900001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=44&publication_year=2020&pages=e90&author=T.+Banerjee&author=A.+Nayak&title=U.S.+county+Level+Analysis+to+Determine+If+Social+Distancing+Slowed+the+Spread+of+COVID-19&doi=10.26633%2FRPSP.2020.90)) who looked at county level mobility data in the U.S. and did a difference-in-difference analysis between counties with and without lockdown. They found a positive effect of lockdown, but their data only spanned February 1 – March 31 2020, and over this period most of the states without mandated lockdowns had almost no infections. Hence there is a serious endogeneity problem with the cross-section analysis. That is, the lack of response is being attributed to the absence of lockdown, when it likely reflects the absence of the virus. 27 Even Flaxman _et al._ recognize the problem of exogenous behavior: ‘We do not account for changes in behaviour; in reality, even in the absence of government interventions we would expect _Rt_ to decrease and therefore would overestimate deaths in the no-intervention model.’ 28 Lewis (2020), and Lemoine ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lemoine, P. 2020. Lockdowns, science and voodoo magic. [https://necpluribusimpar.net/lockdowns-science-and-voodoo-magic/](https://necpluribusimpar.net/lockdowns-science-and-voodoo-magic/). 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[\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0067&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.scitotenv.2020.138917), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0067&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32387821), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0067&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000537446400012), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=730&publication_year=2020&pages=138917&author=D.+Ibarra-Vega&title=Lockdown%2C+One%2C+Two%2C+None%2C+or+Smart.+Modeling+Containing+Covid-19+Infection.+A+Conceptual+Model&doi=10.1016%2Fj.scitotenv.2020.138917)) uses a similar approach where the counterfactual number of in- fections is determined by a SIR model with exogenous behavior, and then shows that in such an imaginary model lockdowns are effective. 30 Evidence that the virus was not exponentially out of control was available very early on. Harris ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Harris, J. 2020. The Coronavirus Epidemic Curve is Already Flattening in New York City. _NBER_ WP: 26917. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0061&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw26917), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=J.+Harris&title=The+Coronavirus+Epidemic+Curve+is+Already+Flattening+in+New+York+City)) shows that after one month the case load was flattening in NY. 31 See Eksin, Paarporn, and Weitz ([2019](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Eksin, C., K. Paarporn, and J. Weitz. 2019. Systematic Biases in Disease Forecasting? The Role of Behavior Change. _Epidemics_ 27: 96–105. doi:[https://doi.org/10.1016/j.epidem.2019.02.004](https://doi.org/10.1016/j.epidem.2019.02.004). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0044&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.epidem.2019.02.004), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0044&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=30922858), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0044&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000469416700011), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=27&publication_year=2019&pages=96-105&author=C.+Eksin&author=K.+Paarporn&author=J.+Weitz&title=Systematic+Biases+in+Disease+Forecasting%3F+The+Role+of+Behavior+Change&doi=10.1016%2Fj.epidem.2019.02.004)) for a study of the effect of human behavior on the progression of disease. Adding behavioral responses to SIR models in economics goes back at least to Philipson and Posner ([1993](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Philipson, T. J., and R. A. Posner. 1993. _Private Choices and Public Health_. Cambridge, MA: Harvard University Press, [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=1993&author=T.+J.+Philipson&author=R.+A.+Posner&title=Private+Choices+and+Public+Health)). It is not a new idea. Dhaval, Friedson, Matsuzawa, Sabia, et al. ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Dhaval, D., A. Friedson, K. Matsuzawa, J. Sabia, and S. Safford. 2020. Were Urban Cowboys Enough to Control COVID-19? Local Shelter-in-Place Orders and Coronavirus Case Growth, NBER WP: 27229. doi:[https://doi.org/10.3386/w27229](https://doi.org/10.3386/w27229). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0041&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27229), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Dhaval%2C+D.%2C+A.+Friedson%2C+K.+Matsuzawa%2C+J.+Sabia%2C+and+S.+Safford.+2020.+Were+Urban+Cowboys+Enough+to+Control+COVID-19%3F+Local+Shelter-in-Place+Orders+and+Coronavirus+Case+Growth%2C+NBER+WP%3A+27229.+doi%3A+10.3386%2Fw27229.)) had shown early on that in the context of a large political rally local individuals recognized the increased risk of transmission and adjusted their behavior to mitigate this risk, leading to no change in transmission rates. 32 Gupta _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Gupta, S., K. Simon, and C. Wing. 2020. Mandated and Voluntary Social Distancing During The COVID-19 Epidemic: A Review, _NBER_ WP: 28139. 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[\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Lemoine%2C+P.+2020.+Lockdowns%2C+science+and+voodoo+magic.+https%3A%2F%2Fnecpluribusimpar.net%2Flockdowns-science-and-voodoo-magic%2F.)) found that none of their results were robust. 34 Using a natural experiment methodology in Denmark, Kepp and Bjørnskov (2020) find that ‘efficient infection surveillance and voluntary compliance make full lockdowns unnecessary.’ A different type of study is Savaris _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Savaris, R., G. Pumi, J. Dalzochio, and R. Kunst. 2021. Stay-at-Home Policy is a Case of Exception Fallacy: An Internet-Based Ecological Study. _Scientific Reports_ 11 (1): 5313. March . doi:[https://doi.org/10.1038/s41598-021-84092-1](https://doi.org/10.1038/s41598-021-84092-1). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0106&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1038%2Fs41598-021-84092-1), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0106&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33674661), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0106&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000627410600003), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=11&publication_year=2021&pages=5313&issue=1&author=R.+Savaris&author=G.+Pumi&author=J.+Dalzochio&author=R.+Kunst&title=Stay-at-Home+Policy+is+a+Case+of+Exception+Fallacy%3A+An+Internet-Based+Ecological+Study&doi=10.1038%2Fs41598-021-84092-1)) that uses mobility data to identify time spent at home, and looked at over 3700 pairwise jurisdictional comparisons, they found ‘… no evidence that the number of deaths/million is reduced by staying at home.’ Most notably, they were not studying lockdown stay-at-home orders, but actual stay-at-home behaviors. Elenev et al. [2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Elenev, V., L. Quintero, A. Rebucci, and E. Simeonova. 2021. Direct and Spillover Effects from Staggered Adoption of Health Poloicies Evidence from Covid-19 Stay-at- Home Orders. _NBER_ WP: 29088, [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0045&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw29088), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=V.+Elenev&author=L.+Quintero&author=A.+Rebucci&author=E.+Simeonova&title=Direct+and+Spillover+Effects+from+Staggered+Adoption+of+Health+Poloicies+Evidence+from+Covid-19+Stay-at-+Home+Orders)) show that people in neighboring jurisdictions voluntarily respond to stay at home orders elsewhere. Berry _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Berry, C. R., A. Fowler, T. Glazer, S. Handel-Meyer, and A. MacMillen. 2021. EvaluatIng the Effects of Shelter-in-Place Policies during the Covid-19 Pandemic. _Proceedings of the National Academy of Sciences of the United States of America_ 118 (15). doi:[https://doi.org/10.1073/pnas.2019706118](https://doi.org/10.1073/pnas.2019706118). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0017&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000641173000013), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=118&publication_year=2021&issue=15&author=C.+R.+Berry&author=A.+Fowler&author=T.+Glazer&author=S.+Handel-Meyer&author=A.+MacMillen&title=EvaluatIng+the+Effects+of+Shelter-in-Place+Policies+during+the+Covid-19+Pandemic&doi=10.1073%2Fpnas.2019706118), p. 1) found that ‘shelter-in-place orders had no detectable health benefits, only modest effects on behavior, and small but adverse effects on the economy. … Many people had already changed their behaviors …’. 35 This paper received a number of critical letters and comments to the journal. The authors responded in Bendavid _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Bendavid, E., C. Oh, J. Bhattacharya, and J. Ioannidis. 2021. Assessing Mandatory Stay-at-Home and Business Closure Effects on the Spread of COVID-19. _European Journal of Clinical Investigation_. 51(4). [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0015&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000613404500001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=E.+Bendavid&author=C.+Oh&author=J.+Bhattacharya&author=J.+Ioannidis&title=Assessing+Mandatory+Stay-at-Home+and+Business+Closure+Effects+on+the+Spread+of+COVID-19)), showing that the criticisms were invalid. They conclude in their reply: Given their many uncontestable harms to health and society, we believe that the extant literature does not provide strong support for their \[NPI\] effectiveness at reducing case spread, and should be subjected to careful, critical and rigorous evaluation. If the benefits of such measures are negligible (or worse), their perpetuation may be, on balance, detrimental to the health of the public. p. 3. 36 Sweden’s GDP growth taken from: [https://tradingeconomics.com/sweden/gdp-growth](https://tradingeconomics.com/sweden/gdp-growth). 37 Canada’s GDP levels are from: [https://tradingeconomics.com/canada/gdp](https://tradingeconomics.com/canada/gdp). 38 Data taken from Statistics Canada’s economic dashboard: [https://www150.statcan.gc.ca/n1/pub/71-](https://www150.statcan.gc.ca/n1/pub/71-)607-x/71-607-x2020009-eng.htm. 39 The role of education in the formation of human capital and its importance for individual well being and economic growth is well established in economics. See Becker ([1994](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Becker, G. 1994. _Human Capital: A Theoretical and Empirical Analysis with Special Reference to Education_. Chicago: The University of Chicago Press. 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Chatburn, N. Higson-Sweeney, S. Reynolds, R. Shafran, A. Brig- den, C. Linney, M. McManus, C. Borwick, and E. Crawley. 2020. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Men- Tal Health of Children and Adolescents in the Context of COVID-19. _Journal of the American Academy of Child & Adolescent Psychiatry_ 59 (11): 1218–1239. doi:[https://doi.org/10.1016/j.jaac.2020.05.009](https://doi.org/10.1016/j.jaac.2020.05.009).. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0087&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jaac.2020.05.009), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0087&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32504808), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0087&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000582506100008), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=59&publication_year=2020&pages=1218-1239&issue=11&author=M.+Loades&author=E.+Chatburn&author=N.+Higson-Sweeney&author=S.+Reynolds&author=R.+Shafran&author=A.+Brig-+den&author=C.+Linney&author=M.+McManus&author=C.+Borwick&author=E.+Crawley&title=Rapid+Systematic+Review%3A+The+Impact+of+Social+Isolation+and+Loneliness+on+the+Men-+Tal+Health+of+Children+and+Adolescents+in+the+Context+of+COVID-19&doi=10.1016%2Fj.jaac.2020.05.009)) survey 80 studies related to isolation and children and conclude ‘… increased the risk of depression, and possibly anxiety at the time at which loneliness was measured…’. 42 For other effects of closing schools see also Fuchs-Schndeln _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Fuchs-Schndeln, N., D. Krueger, A. Ludwig, and I. Popova. 2020. The Long-Term Distributional and Welfare Effects of Covid-19 School Closures, NBER WP: 27773, Sept. doi:[https://doi.org/10.3386/w27773](https://doi.org/10.3386/w27773). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0052&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw27773), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Fuchs-Schndeln%2C+N.%2C+D.+Krueger%2C+A.+Ludwig%2C+and+I.+Popova.+2020.+The+Long-Term+Distributional+and+Welfare+Effects+of+Covid-19+School+Closures%2C+NBER+WP%3A+27773%2C+Sept.+doi%3A+10.3386%2Fw27773.)), or Buonsenso _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Buonsenso, D., D. Roland, C. De Rose, P. Vsquez-Hoyos, B. Ramly, J. Nandipa, J. Chakakala-Chaziya, A. Munro, and S. Gonzlez-Dambrauskas. 2020. Schools Closures during the COVID-19 Pandemic: A Catastrophic Global Situation. Preprints doi:[https://doi.org/10.20944/preprints202012.0199.v1](https://doi.org/10.20944/preprints202012.0199.v1). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0026&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.20944%2Fpreprints202012.0199.v1), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=D.+Buonsenso&author=D.+Roland&author=C.+De+Rose&author=P.+Vsquez-Hoyos&author=B.+Ramly&author=J.+Nandipa&author=J.+Chakakala-Chaziya&author=A.+Munro&author=S.+Gonzlez-Dambrauskas&title=Schools+Closures+during+the+COVID-19+Pandemic%3A+A+Catastrophic+Global+Situation)). 43 See Roelfs _et al._ ([2011](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Roelfs, D., E. Shor, K. Davidson, and J. Schwartz. 2011. Losing Life and Livelihood: A Systematic Review and Meta-Analysis of Unemployment and All-Cause Mortality. _Social Science & Medicine (1982)_ 72 (6): 840–854. January doi:[https://doi.org/10.1016/j.socscimed.2011.01.005](https://doi.org/10.1016/j.socscimed.2011.01.005). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0104&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.socscimed.2011.01.005), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0104&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=21330027), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0104&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000290080100005), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=72&publication_year=2011&pages=840-854&issue=6&author=D.+Roelfs&author=E.+Shor&author=K.+Davidson&author=J.+Schwartz&title=Losing+Life+and+Livelihood%3A+A+Systematic+Review+and+Meta-Analysis+of+Unemployment+and+All-Cause+Mortality&doi=10.1016%2Fj.socscimed.2011.01.005)) and references that show this relationship has been understood for some time. Lindo ([2011](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lindo, J. 2011. Parental Job Loss and Infant Health. _Journal of Health Economics_ 30 (5): 869–879. September doi:[https://doi.org/10.1016/j.jhealeco.2011.06.008](https://doi.org/10.1016/j.jhealeco.2011.06.008). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0086&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2Fj.jhealeco.2011.06.008), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0086&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=21798606), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0086&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000295707200003), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=30&publication_year=2011&pages=869-879&issue=5&author=J.+Lindo&title=Parental+Job+Loss+and+Infant+Health&doi=10.1016%2Fj.jhealeco.2011.06.008)) also shows that unemployment contributes to higher infant death. 44 This channel has been known for some time. See Steptoe _et al._ ([2013](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Steptoe, A., A. Shankar, P. Demakakos, and J. Wardle. 2013. Social Isolation, Loneliness, and All-Cause Mortality in Older Men and Women. _Proceeding of the National Academy of Sciences_ 110 (15): 5797–5801. doi:[https://doi.org/10.1073/pnas.1219686110](https://doi.org/10.1073/pnas.1219686110). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0108&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1073%2Fpnas.1219686110), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0108&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=23530191), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0108&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000317537900019), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=110&publication_year=2013&pages=5797-5801&issue=15&author=A.+Steptoe&author=A.+Shankar&author=P.+Demakakos&author=J.+Wardle&title=Social+Isolation%2C+Loneliness%2C+and+All-Cause+Mortality+in+Older+Men+and+Women&doi=10.1073%2Fpnas.1219686110)) and references, or Holt-Lunstad _et al._ ([2015](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Holt-Lunstad, Julianne, Timothy B. Smith, Mark Baker, Tyler Harris, and David Stephenson. 2015. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. _Perspectives on Psychological Science : a Journal of the Association for Psychological Science_ 10 (2): 227–237. doi:[https://doi.org/10.1177/1745691614568352](https://doi.org/10.1177/1745691614568352). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0063&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1177%2F1745691614568352), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0063&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=25910392), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=10&publication_year=2015&pages=227-237&issue=2&author=Julianne+Holt-Lunstad&author=Timothy+B.+Smith&author=Mark+Baker&author=Tyler+Harris&author=David+Stephenson&title=Loneliness+and+Social+Isolation+as+Risk+Factors+for+Mortality%3A+A+Meta-Analytic+Review&doi=10.1177%2F1745691614568352)) who showed that physical isolation and social loneliness increased mortality. The CDC reported in August 2020 (Czeisler _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Czeisler, Mark É., Rashon I. Lane, Emiko Petrosky, Joshua F. Wiley, Aleta Christensen, Rashid Njai, Matthew D. Weaver, et al. 2020. Mental Health, Substance Use, and Suicidal Ideation during the COVID-19 Pandemic - United States, June 24-30, 2020. _MMWR. Morbidity and Mortality Weekly Report_ 69 (32): 1049–1057. [http://dx.doi.org/10.15585/mmwr.mm6932a1externalicon](http://dx.doi.org/10.15585/mmwr.mm6932a1externalicon). doi:[https://doi.org/10.15585/mmwr.mm6932a1](https://doi.org/10.15585/mmwr.mm6932a1). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0037&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.15585%2Fmmwr.mm6932a1), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0037&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=32790653), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0037&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000559795900001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=69&publication_year=2020&pages=1049-1057&issue=32&author=Mark+%C3%89.+Czeisler&author=Rashon+I.+Lane&author=Emiko+Petrosky&author=Joshua+F.+Wiley&author=Aleta+Christensen&author=Rashid+Njai&author=Matthew+D.+Weaver&title=Mental+Health%2C+Substance+Use%2C+and+Suicidal+Ideation+during+the+COVID-19+Pandemic+-+United+States%2C+June+24-30%2C+2020&doi=10.15585%2Fmmwr.mm6932a1)) that there were elevated mental health conditions brought on by the pandemic, and Newlove-Delgado _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Newlove-Delgado, T., S. McManus, K. Sadler, S. Thandi, T. Vizard, C. Cartwright, and T. Ford. 2021. Child Mental Health in England before and during the COVID-19 Lockdown. _The Lancet. Psychiatry_ 8 (5): 353–354. doi:[https://doi.org/10.1016/S2215-0366(20)30570-8](https://doi.org/10.1016/S2215-0366(20)30570-8). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0098&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1016%2FS2215-0366%2820%2930570-8), [\[PubMed\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0098&dbid=8&doi=10.1080%2F13571516.2021.1976051&key=33444548), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=8&publication_year=2021&pages=353-354&issue=5&author=T.+Newlove-Delgado&author=S.+McManus&author=K.+Sadler&author=S.+Thandi&author=T.+Vizard&author=C.+Cartwright&author=T.+Ford&title=Child+Mental+Health+in+England+before+and+during+the+COVID-19+Lockdown&doi=10.1016%2FS2215-0366%2820%2930570-8)) found that lockdown contributed to increased mental health problems among U.K. youth and that this problem was most serious among young women. 45 Awareness about the effect of lockdown on violence against women was available as early as March 2020 when the WHO released a statement: [https://www.who.int/reproductivehealth/publications/emergencies/COVID-19-VAW-full-text.pdf](https://www.who.int/reproductivehealth/publications/emergencies/COVID-19-VAW-full-text.pdf). Binge drinking is strongly associated with stay at home orders (Weerakoon _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Weerakoon, S. M., K. Jetelina, and G. Knell. 2021. Longer Time Spent at Home during COVID-19 Pandemic is Associated with Binge Drinking among US adults. _The American Journal of Drug and Alcohol Abuse_ 47 (1): 98–106. DOI: [https://doi.org/10.1080/00952990. 2020.1832508](https://doi.org/10.1080/00952990.%202020.1832508) [\[Taylor & Francis Online\]](https://www.tandfonline.com/doi/10.1080/00952990.2020.1832508), [\[Web of Science ®\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0110&dbid=128&doi=10.1080%2F13571516.2021.1976051&key=000612767600001), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&volume=47&publication_year=2021&pages=98-106&issue=1&author=S.+M.+Weerakoon&author=K.+Jetelina&author=G.+Knell&title=Longer+Time+Spent+at+Home+during+COVID-19+Pandemic+is+Associated+with+Binge+Drinking+among+US+adults&doi=10.1080%2F00952990.+2020.1832508)).) 46 See also Agrawal _et al._ ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Agrawal, V., J. Cantor, N. Sood, and C. Whaley. 2021. The Impact of the Covid-19 pandemic and policy responses on excess mortality. NBER WP: 28930. [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0004&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.3386%2Fw28930), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Agrawal%2C+V.%2C+J.+Cantor%2C+N.+Sood%2C+and+C.+Whaley.+2021.+The+Impact+of+the+Covid-19+pandemic+and+policy+responses+on+excess+mortality.+NBER+WP%3A+28930.)) for similar findings of increased excess deaths, using data from 43 countries and all US states. Other effects range from increased major amputations, longer wait list times, fewer organ transplants (Manara _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Manara, Alex R., Lisa Mumford, Chris J. Callaghan, Rommel Ravanan, and Dale Gardiner. 2020. Donation and Transplantation Activity in the UK during the COVID-19 Lockdown. _Lancet (London, England)_ 396 (10249): 465–466. doi:[https://doi.org/10.1016/S0140-6736(20)31692-5](https://doi.org/10.1016/S0140-6736(20)31692-5). 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Many primary care appointments switched to telephone and online appointments, which are often inferior substitutes for in-person treatments. 47 [https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html](https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html) 48 [https://knoema.com/atlas/Canada/topics/Demographics/Age/Life-expectancy-at-age-80-years](https://knoema.com/atlas/Canada/topics/Demographics/Age/Life-expectancy-at-age-80-years) 49 The life expectancy of a 25 year old Canadian is 55.2 years, so the 6.3m lost life years is the equivalent of losing 114,130 25 year olds 50 This upper bound was not statistically significant, and Lemoine ([2021](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Lemoine, P. 2020. Lockdowns, science and voodoo magic. [https://necpluribusimpar.net/lockdowns-science-and-voodoo-magic/](https://necpluribusimpar.net/lockdowns-science-and-voodoo-magic/). 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[\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0077&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1101%2F2021.07.15.21260606), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2021&author=M.+Lally&title=The+Costs+and+Benefits+of+Covid-19+Lockdowns+in+New+Zealand)) performs a cost benefit study for New Zealand and compares the cost per QALY to estimates of lost GDP and other costs of lockdown. He concludes these costs ‘… to be at least 13 times the generally employed figure of $62,000 for health interventions in New Zealand; the lockdowns were therefore not justified.’ 53 Whether these deaths were actually caused by Covid-19 is an important matter, but one that I have not dealt with in this paper. 54 All numbers from _OurWorldInData_ are as of March 28, 2021. [https://ourworldindata.org/grapher/covid-](https://ourworldindata.org/grapher/covid-) stringency-index 55 Gardner, _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Gardner, J., W. Van Der Wijngaart, L. Kamerlin, N. Brusselaers, and P. Kasson. 2020. Intervention Strategies against COVID-19 and Their Estimated Impact on- Swedish Healthcare Capacity. _MedRxiv_ April 15, doi:[https://doi.org/10.1101/2020.04.11.20062133](https://doi.org/10.1101/2020.04.11.20062133). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0054&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.1101%2F2020.04.11.20062133), [\[Google Scholar\]](http://scholar.google.com/scholar_lookup?hl=en&publication_year=2020&author=J.+Gardner&author=W.+Van+Der+Wijngaart&author=L.+Kamerlin&author=N.+Brusselaers&author=P.+Kasson&title=Intervention+Strategies+against+COVID-19+and+Their+Estimated+Impact+on-+Swedish+Healthcare+Capacity)), claimed the following about Sweden: ‘This individual-based modelling project predicts that with the current mitigation approach approximately 96,000 deaths (95% CI 52,000 to 183,000) can be expected before 1 July, 2020.’ The original ICL model, Report 12 (appendix) also predicted 90,157 deaths in Sweden by the end of July, 2020. On March 28, 2021 the total number of deaths in Sweden was 13,402. Klein _et al._ ([2020](https://www.tandfonline.com/doi/full/10.1080/13571516.2021.1976051#)Klein, D. B., J. Book, and C. Bjørnskov. 2020. 16 Possible Factors for Sweden?s High COVID Death Rate among the Nordics (August 14, 2020). _GMU Working Paper in Economics No. 20-27_, [https://ssrn.com/abstract=3674138](https://ssrn.com/abstract=3674138) or doi:[https://doi.org/10.2139/ssrn.3674138](https://doi.org/10.2139/ssrn.3674138). [\[Crossref\]](https://www.tandfonline.com/servlet/linkout?suffix=CIT0074&dbid=16&doi=10.1080%2F13571516.2021.1976051&key=10.2139%2Fssrn.3674138), [\[Google Scholar\]](http://scholar.google.com/scholar?hl=en&q=Klein%2C+D.+B.%2C+J.+Book%2C+and+C.+Bj%C3%B8rnskov.+2020.+16+Possible+Factors+for+Sweden%3Fs+High+COVID+Death+Rate+among+the+Nordics+%28August+14%2C+2020%29.+GMU+Working+Paper+in+Economics+No.+20-27%2C+https%3A%2F%2Fssrn.com%2Fabstract%3D3674138+or+doi%3A+10.2139%2Fssrn.3674138.)) pointed out 16 different factors for Sweden compared to other Nordic countries that explained their worse experience with the virus. The most important factor was the ‘dry tinder’ situation; that is, Sweden had a light flu season in the year prior to Covid-19 which meant that it had a large number of elderly people who would have normally died in the previous year. The lower excess deaths in 2019 was then made up by the higher than average excess deaths in the spring of 2020. Overall, the excess deaths for Sweden in 2020 was just 1.5% higher than average. Source: [https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/](https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/) This dry tinder effect accounted between 25–50% of the difference in death rates across the Nordic countries. 56 See John Hopkins Coronavirus Resource Center for lockdown information: [https://coronavirus.jhu.edu/data/state-timeline/](https://coronavirus.jhu.edu/data/state-timeline/). 57 Texas, which removed all lockdown restrictions on March 10, 2021, is another very public case. The reaction to opening up was overwhelmingly negative: the California Governor called it ‘absolutely reckless,’ Dr. Fauci said ‘It just is inexplicable why you would want to pull back now,’ and President Joe Biden said it was ‘a big mistake’ and the result of ‘Neanderthal thinking.’ However, cases and deaths continued to fall after the removal of lockdown restrictions. 58 Simply regressing cumulative deaths per million on lockdown stringency across the 36 countries available with information from _OurWorldInData_, produces: Cum.Death/M \=352.66+10.64(0.80) (1.59) where the t-statistic is in the parentheses. The small positive correlation is the wrong sign for lockdown efficacy and is not statistically significant. One should not put too much stock in such a simple cross section regression, my point is only that a simple correlation isn’t found.