![]() After all, lockdowns are a public health response undertaken with the goal of improving population health outcomes from the pandemic. This narrative review aims to take these tragic outcomes of the pandemic seriously, and to also consider the tragic outcomes of the public health response to the pandemic. This morbidity and mortality have been, and continue to be, tragic. The COVID-19 pandemic has caused much morbidity and mortality. I close with some suggestions for moving forward.Īn important point must be emphasized. Fourth, I present a cost-benefit analysis of the response to COVID-19. ![]() Third, I describe how reality started sinking in, with information on significant collateral damage from the response to the pandemic, and on the number of deaths in context. Second, I summarize important information that has emerged relevant to the modeling. First, I explain how the initial modeling predictions induced fear and crowd-effects (i.e., groupthink). ![]() In this narrative review I explain why I changed my mind. I was a strong proponent of lockdowns when the pandemic was first declared ( 1). ![]() Even now, as the so-called “second-wave” of COVID-19 cases is occurring, governments are considering and some implementing another lockdown to again “flatten the curve.” The public health goal of lockdowns is to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) initially caused Coronavirus Disease 2019 (COVID-19) in China in December 2019, and has caused a worldwide pandemic in 2020. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. Controversies and objections about the main points made are considered and addressed. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). In this narrative review I explain why I changed my mind about supporting lockdowns. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. ![]() The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020.
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