Lockdowns
must work, mustn’t they? They have to work, nearly every country in the world
is using them to fight against SARS-Cov-2, therefore they must work. There is
no way that so many countries could be using the wrong method to address this
issue. Just like charges into machine gun nests must have worked, because every
nation did that during World War 1. It is not possible for so many nations of
the world to get things wrong, for a sustained period of time, is it? I mean,
just one more charge, surely is all it would have taken to break the enemy
lines. Just one more charge with more men and braver men is all they needed to
do, right? Of course we know what actually happened, virtually every one of
those charges failed. Every single army ground to a halt, and eventually
Germany and its allies surrendered because of sheer inter-nation-wide
exhaustion.
But maybe
those constant charges into machine gun nests did work…from a certain point of
view. Because, if by work you mean the nations with the greatest access to men
and resources who were left sort of standing at the end won the war, I guess
you could argue that these famously inefficient and costly methods worked. In
fact you would have to say that they did. But at what cost? We know there were massive
and real long term effects of the national policies of World War 1, that flowed
on for really the rest of the century.
Also it is
not like the generals in charge were not following the correct knowledge (aka military
science) of their day, they were. Even a brief study of military history from
say A History of Strategy: From Sun Tzu To William S. Lind, by Martin
Van Creveld[1],
shows that the generals of that era were thoroughly schooled in many of the
best theories of war. Sadly none of that meant much for the men on the battle
field. Many scholars of military tactics may have outlined the advantages of
concentrating men and even cavalry forces in a determined attack to overwhelm
the defence’s position. In the age before water cooled machine guns, their
advice was good, but it would take a long time for offensive technology to
equalize with defensive technology for advice in this regard to be helpful to
the average soldier in the lines again. Yet, many generals learnt this very slowly.
I am sure it was incredibly hard for people to have this conversation about
tactics at the time. After all the general’s knowledge and power over the war was
near absolute.
A similar
phenomenon appears to be happening today with Covid lockdowns. This is a
particularly hard conversation to have, because people have simply just
fractured down ideological lines, and drawn their trenches in the sand, about
what they believe. Indeed, as of the day of me writing this very piece, there
are Premiers still using lockdowns in Australian states, in very much the same
manner as they did way back in March 2020. As if there has been very little
learnt in the ensuing months.
But there
ARE very good reasons, - scientific, observational, data based reasons - to
question hard lockdowns, and this is what I want to do today. But rather than
just drawing from one study that supports my position, what I want to do is look
at a broad range of studies from way back in the middle of 2020, right on
through to studies concluded in the last couple of weeks of 2021. I want to show
that as our knowledge of lockdowns and their effects increase, the case for
their effectiveness and morality diminishes. It is not March 2020 anymore, it
is nearly March 2021 and observational scientists have learnt a lot from the last
year. This research was accessed through reputable online journal sources, and
though there are also popular articles to supplement this data, this represents
a broad swath of the best research to date from sources like the Lancet, Nature
and other online journal aggregators, including one source I found through the
Queensland State Library. I want to go through these research pieces briefly in
chronological order, showing their main conclusions and points, and allow you
the reader to make an informed decision about whether or not our hard lockdown
are still best practice.
1. Study One: Chaudhry, Rabail (et al.) 2020,
“A country level analysis measuring the impact of government actions, country
preparedness and socioeconomic factors on COVID-19 mortality and related health
outcomes”, The Lancet, published 21st of July 2020.[2]
This was a
relatively early study, and the researchers who wrote this one note that their
data was limited, because of the still relatively early nature of the pandemic.
However, the study makes some interesting findings. It found that the biggest
risk factors for a society regarding Covid were obesity and age, “Consistent
with reported COVID-19 outcome data from Europe, the United States, and China,
higher caseloads and overall mortality were associated with comorbidities such
as obesity, and advanced population age.”[3]
They found
that lockdowns were helpful in limiting the peak of the virus, so that the
health system could cope with the cases. Which was a valid concern of many at
the time. But it would follow that once your health system was adequately
prepared, then lockdowns should be less necessary right? However, they observed
that lockdowns did help recovery rates, which makes sense, especially for
countries with overwhelmed health systems, which at this stage there were some
in this situation, like Italy, or cities in countries like New York in the USA.
Overall,
their analysis of lockdowns was cautious –
These findings suggest that more restrictive public health
practices may indeed be associated with less transmission and better outcomes.
However, in our analysis, full lockdowns and wide-spread COVID-19 testing were
not associated with reductions in the number of critical cases or overall
mortality.[4]
Perhaps their
most interesting finding was which countries were the most effected by the
virus,
The findings of this country level analysis on COVID-19
related health outcomes suggest that low levels of national preparedness, scale
of testing, as well as population characteristics such as obesity, advanced age
and higher per capita GDP are associated with increased national case load and
mortality.[5]
I know I had
many friends at the beginning of this crisis who were worried about poorer
countries and their ability to withstand the virus, but as of July 2020, the
countries who were most adversely effected were those with the larger
proportion of overweight, and wealthy elderly people. We all have known for
some time that this virus effects the elderly the worst, but this convergence
of factors with wealth is surprising.
As this
study was done in July 2020, early in our understanding of the virus, the
writers wisely note, that their “…findings propose avenues for further debate,
research, and exploration, and do not support a definitive judgement on the
effectiveness of various public health interventions implemented across
different countries.”[6]
More data is necessary.
2. Study Two – Han, Emeline (et al.)
2020 “Lessons learnt from easing COVID-19 restrictions: an analysis of
countries and regions in Asia Pacific and Europe”, The Lancet, published 24th
September 2020.[7]
This
research paper was overall, more positive regarding lockdowns, and also was
very positive towards face coverings. However, it appears to be strongly
encouraging proportional use of these strategies. Indeed, its emphasis was how
to move out of lockdown, so as to make it as effective as possible, negating
the need for further lockdowns.
The authors
of this study believed that lockdowns had been effective, but their support of
their effectiveness came with caveats,
Although such measures might have saved lives, they have come
at a heavy socioeconomic cost. The World Bank’s projections point to the
deepest global recession since World War 2, with millions of people falling
into unemployment and poverty. Lockdowns and other extreme restrictions cannot
be sustained for the long term in the hope that there will be an effective
vaccine or treatment for COVID-19. Rather, these restrictions give time for
countries to reduce the incidence of disease and put in place robust, yet
sustainable, measures to prevent and control transmission.[8]
Of course
this article was written before emergency use of various vaccines was approved
in nations like the UK, US and others. But it notes, as does the previous
article, that lockdowns come at a serious cost. It also takes a consultative
approach, that many feel our governments have not practiced,
For societies to reopen safely, communities should be fully
engaged and empowered to protect themselves from the virus and the effect of
the crisis, especially the most vulnerable populations (figure 2). Ideally,
authorities should ensure that they fully understand the reality of the
situation faced by the people affected by their decisions, drawing on
principles of coproduction of policy. Advice should also be consistent and
credible.[9]
Again, the
researchers note that a prepared medical system makes an incredible difference,
but importantly they appear to imply that the existence of a vaccine should
negate nonpharmaceutical interventions (i.e lockdowns, etc). So, if lockdowns
are questionably effective without vaccines, why are we even entertaining the
idea of them remaining with the vaccines?[10]
Perhaps,
because of this, “There is increasing realisation that removing COVID-19
restrictions is not about returning to the pre-pandemic normal but about
gradually and cautiously transitioning to a new normal, while being ready to
reimpose measures if, and when, necessary.”[11]
Note, that this is a quote from a reputable scientific journal, and it really
makes you wonder. Perhaps, to give them the benefit of the doubt, they may say
otherwise now that vaccines are on the horizon for many countries. But again,
this makes me wonder, why must lockdowns continue after vaccines have rolled
out to the very vulnerable?
3. Study Three – Cauchemez, Simon (et al.),
2020, “Lockdown impact on COVID-19 epidemics in regions across metropolitan
France”, The Lancet, published 29th of September 2020.[12]
This paper
is perhaps the most pro-lockdown of all the papers I will mention in this
article, at least at least it appears to be until you note something very
important about why it is pro-lockdown.
The author’s
note,
Since the different regions were at different stages of the
pandemic at the time the lockdown was implemented, the synchrony in regional
peaks strongly suggests that the lockdown, rather than the natural course of
the epidemic, explains the peak in hospital admissions. Moreover, most regions
were experiencing exponential growth in hospital admissions (appendix), such
that saturation of local intensive care units might have occurred in those
regions in the absence of any lockdown…
…Lockdown therefore appears to have been successful not only
in alleviating the burden on the intensive care units of the two most severely
affected regions of France, but also in preventing uncontrolled epidemics in
other regions. These simple observations support results from other studies
which have estimated the impact of lockdown on SARS-CoV-2 spread to be strong.[13]
This appears
to be a pretty lock-tight argument in favour of lockdowns. However, then you
read this,
Enforcement of public health and social measures in
combination with important testing, tracing, and isolating capacities will be
critical in case of an epidemic rebound to avoid re-introducing a lockdown—a
situation for which the economic cost and broader impact on society are
considerable.[14]
So, their
argument in favour of using lockdown was contingent on the lockdown being done
in such a way as to PREVENT other lockdowns. They saw this as incredibly
important, because “the economic cost and broader impact on society are
considerable.” We must note that this study was published in September 2020,
and we can now say that the early lockdowns did not prevent future lockdowns,
they simply set the precedent for continuing to lockdown societies in a rolling
manner. One wonders what the authors of this article would go on to tell us
about the ongoing costs to society of these lockdowns. But really, you don’t have
to wonder, because other scientists have done that analysis. Let’s observe as
we go along.
4. Study Four - Fagih, Al (et al.) 2020,
“Remotely monitored inactivity due to COVID-19 lockdowns. Potential hazard for
heart failure patients”, Saudi Arabia: Saudi Medical Journal, published
November 2020.[15]
(accessed through the Qld State Library).
Just to
illustrate the negative effects of lockdown, our next article, of which I was
only able to access the summary, was done specifically to ascertain the impacts
“on the physical activity in patients of heart failure implanted with cardiac
implantable electronic devices (CIEDs).”[16]
Their
findings were significant for these patients,
Eighty-two patients with heart failure were included. The
median age was 65 years (58-72), and 53 (64.6%) subjects were men. There was a
27.1% decline in physical activity, and the median physical activity of
patients significantly declined from 2.4 to 1.8 hours/day (p=0.000010). Conclusion: Data obtained by remotely
monitored CIED in heart failure patients suggests a significant decline in
physical activity during the country lockdown due to the pandemic. Awareness
of the future potential hazards in this group of patients is warranted.[17]
(emphasis mine).
The broad application
of these lockdowns did have, and where they are still being applied, continue
to have negative impacts on all sorts of other medical issues. Shutting down
society, does not shut down people’s need for proper medical care, or social
care, or various other forms of care. Humans are social creatures, and there is
a pretty consistent theme in many of these papers that an awareness of the
effects of cutting people off from society, for short or extended periods, can
have unintended consequences.
5. Study Five – Gurdasani, Deepti (et
al.) 2020, “The UK needs a sustainable strategy for COVID-19”, The Lancet,
published 9th November 2020.[18]
This article
argued for more effective responses to the pandemic management across all
levels of society, including better funding and co-ordination for testing and
tracing, better financial support, better communication with the population,
better funding for hospitals, better regulations around schools, and much, much
more. It is less of a paper on the effects of lockdowns, and more a wish-list
for how the writers would like the pandemic to be managed in future. Their
desires for how the situation should be handled are summarized in this graphic here.
For some
reason this paper delves into racism and equality laws. What that has to do
with controlling the spread of the pandemic is beyond me, and beyond the scope
of this article. But it does speak to an interesting progressive bent of the
writers. Indeed, there does appear to be a strong socialist bent in their
wish-list. Maybe a case of never let a good crisis go to waste? However, even
if this is the case, these scientists make valid observations based on solid
reasons.
Interestingly,
for those in Australia who have already had to experience short, sharp
lockdowns, this paper is in favour of their use to limit spread,
On Sept 21, 2020, the Scientific Advisory Group for
Emergencies (SAGE) advised the UK Government to institute a circuit breaker in
England to suppress the epidemic. Instead, the government opted for several
weeks of ineffective local tiered restrictions, and cases continued to rise
exponentially. Finally, on Oct 31, 2020, the government announced a 4-week
national lockdown commencing on Nov 5, 2020.[19]
However,
unlike in Australia, cases were not in the single digits, but rising rather
rapidly. Even still, their conclusion on lockdowns is consistent with many of
our papers so far,
Lockdowns are last resort measures that reflect a failure of
the pandemic control strategy. They have massive impacts on the population and
the economy. To avoid repeated lockdowns and their impacts, we need a
sustainable COVID-19 public health strategy. Here, we make seven evidence-based
recommendations (a schematic representation is available in the appendix).”[20]
They a
referring here to the PDF I linked above. I think it is important to note the
somewhat leftist leaning nature of this paper, as it shows that criticizing
lockdowns is not a right-wing cause. Scientists from across the spectrum are
noting that there are other ways to manage this pandemic, and really, as time
goes on, our strategies should be modified to suit the experiences and data
gathered so far.
6. Study Six – Haug, Nils (et al.) 2020,
“Ranking the effectiveness of worldwide COVID-19 government interventions”,
Nature, published 16th November 2020.[21]
In my
opinion, this is one of the most important studies done to this date,
ascertaining the effectiveness of lockdowns. Because it helps bridge the gap,
to a degree, between those who are pro and anti lockdowns. It is hard to
convince people that lockdowns don’t achieve anything, because that is very
counterintuitive. We all know that if your co-worker who has the flu comes to
work, they are going to share it, with at least some people. But if they stay
home, they will more likely keep it to themselves. Ergo, doing this society
wide must work.
But when you
listen to educated people talk about why lockdowns don’t work, what they are
really saying is that you can achieve the same results without such extreme
measures, and the negative impacts to society. That is why this study is so
important, it makes this case in the raw data, showing that you can achieve
similar effects to lockdowns, with more reserved methods. As the researchers
note,
Assessing the effectiveness of non-pharmaceutical
interventions (NPIs) to mitigate the spread of SARS-CoV-2 is critical to inform
future preparedness response plans. Here we quantify the impact of
6,068 hierarchically coded NPIs implemented in 79 territories on the effective
reproduction number, Rt, of COVID-19.[22]
What they
found is vitally important for the health of our country as we move forward
with this virus,
Our results indicate that a suitable combination of NPIs is
necessary to curb the spread of the virus. Less disruptive and costly NPIs can
be as effective as more intrusive, drastic, ones (for example, a national
lockdown)…In the absence of vaccines and antiviral medication,
non-pharmaceutical interventions (NPIs) implemented in response to (emerging)
epidemic respiratory viruses are the only option available to delay and
moderate the spread of the virus in a population.[23]
So, these
researchers are not saying that lockdowns do not help to stop the spread of the
virus, indeed they say the measures which have the largest impacts are stopping
small gatherings, closing schools, border restrictions, increasing public
health capacities (especially access to PPE for health care workers),
restricting movement, and national lockdown,[24]
all strict measures. This combination of measures can slow the virus down,
obviously.
What is
fascinating is what they see as the least effective,
Among the least effective interventions we find: government
actions to provide or receive international help, measures to enhance testing
capacity or improve case detection strategy (which can be expected to lead to a
short-term rise in cases), tracing and tracking measures as well as land border
and airport health checks and environmental cleaning.[25]
So, to those
who are not in favour of lockdowns this would appear to be a disheartening find,
because his research paper found that these harsh measures achieve the effects
they intend. Discouraging right? Well, only if you stop reading here…
…Because
they go on to say,
However, such radical measures have adverse consequences.
School closure interrupts learning and can lead to poor nutrition, stress and
social isolation in children. Home confinement has strongly increased the rate
of domestic violence in many countries, with a huge impact on women and
children while it has also limited the access to long-term care such as
chemotherapy, with substantial impacts on patients’ health and survival chance.
Governments may have to look towards less stringent measures, encompassing
maximum effective prevention but enabling an acceptable balance between
benefits and drawbacks…
…This conclusion does not rule out the effectiveness of an
early national lockdown, but suggests that a suitable combination (sequence and
time of implementation) of a smaller package of such measures can substitute
for a full lockdown in terms of effectiveness, while reducing adverse impacts
on society, the economy, the humanitarian response system and the environment…
…Taken together, the social distancing and
movement-restriction measures discussed above can therefore be seen as the
‘nuclear option’ of NPIs: highly effective but causing substantial collateral
damages to society, the economy, trade and human rights…
…We find strong support for the effectiveness of border
restrictions. The role of travelling in the global spread of respiratory
diseases proved central during the first SARS epidemic (2002–2003)42, but
travelling restrictions show a large impact on trade, economy and the
humanitarian response system globally. The effectiveness of social distancing
and travel restrictions is also in line with results from other studies that
used different statistical approaches, epidemiological metrics, geographic
coverage and NPI classification.[26]
So, close
the national borders, encourage social distancing, enact more reasonable, less
draconian measures, and you can have the same effect as a hard lockdown.
Without all of the devastating negative effects mentioned above. What’s
fascinating is that they found that communicating the seriousness of the
situation, is highly effective, “Surprisingly, communicating on the importance
of social distancing has been only marginally less effective than imposing
distancing measures by law.”[27]
Perhaps the
most important point of this paper though is the analogy it uses to refer to
hard lockdowns - “the nuclear option”. It is disproportionate to the danger,
and therefore should only be seen as a last resort. Health systems which have
had a year to prepare, and societies which are willing to be flexible with
their leaders, should not have to endure lockdowns, because less harmful measures
can be just as effective. I highly recommend reading this paper.
7. Study Seven (An article) – Miltimore,
Jon 2020, “3 Studies That Show Lockdowns Are Ineffective at Slowing COVID-19:
The collateral damage of lockdowns is well documented. Their benefits, however,
remain murky”, Fee, published 9th November 2020.[28]
Unlike all
of my other studies so far, this is an article that refers to three studies,
one of which we looked at above from Lancet. I share this because it allows you
to read three other studies from an article with a similar structure to mine,
only much shorter. Here is what Miltimore says,
1. The Lancet, July
A study published on July 21 in The Lancet, a weekly
peer-reviewed general medical journal founded in 1823, indicated that
government lockdowns were ineffective…
2. Frontiers in Public Health, November
Similarly, a study published by Frontiers in Public Health
several months after The Lancet paper found neither lockdowns nor lockdown
stringency were correlated with lower death rates. Researchers crunched data
from 160 countries over the first 8 months of the pandemic, testing numerous
factors—such as public health, demographics, government policy, economy, and
environment—to determine how each correlated with COVID-19 mortality…
3. Tel Aviv University Study, October
Research from Tel Aviv University published in October on the
website medRxiv said that strict lockdowns may not save lives. Researchers
analyzed mobility data collected from iPhones and found no statistical
association between lockdown severity and the number of COVID-19 fatalities…[29]
All
consistent with our finding so far.
8. Study Eight – Garcia, Santiago (et
al.) 2020, “The hidden costs of national lockdowns”, The Lancet, published 2nd
of February 2020.[30]
This paper
is similar to the Saudi Arabian one shared above. We have already seen
virtually every paper we have looked at so far share the negative effects of
lockdowns, here is another one,
COVID-19 has dramatically impacted healthcare delivery around
the world. As hospitals systems prepared for the actual or perceived onslaught
of COVID-19+ patients, measures were implemented that effectively discouraged
or restricted patient access to outpatient care, and diagnostic and therapeutic
cardiac procedures deemed elective.[31]
Notice that
it notes “the measures” had these negative impacts.
Public fear of contracting COVID-19 in the hospital system,
not disease burden or healthcare system overload, appears to be the main driver
of the reduction in AMI presentations during the pandemic. In fact, dramatic
decreases in emergency department volumes were also reported…
…National lockdowns were disruptive in nature but efforts to
educate the public and maintain timely access to emergency care were important
to minimize morbidity and mortality for patients with cardiovascular disease…
…Also, the recommendation to “self-quarantine” for 2 weeks
when symptoms of COVID-19 were present (many indistinguishable from heart
disease such as dyspnea and cough) likely led many patients to delay or forgo
needed medical care…
…For governments considering additional lockdowns, approaches
that preserve essential healthcare services and expand telemedicine
capabilities, to include rural and institutionalized communities, are needed to
avoid repeating the mistakes of the past…
At this
stage of the pandemic, why are we still seeing governments put in place
policies that discourage people from getting important healthcare, whether
elective or urgent? Especially when certain conditions can share symptoms with
Covid. The justification for hard lockdowns is getting thinner and thinner.
9. Study Nine – Bendavid, Eran (et al.)
2020, “Assessing mandatory stay‐at‐home and business closure effects on the
spread of COVID‐19” Wiley Online Library, published 5th January 2021.[32]
Although
this paper is dated before the previous paper, I have left it to last, because
it was reading the conclusions of this research that inspired me to write this
article. Because really these researchers conclusions are the culmination of
everything we have looked at thus far.
The authors
of this article wanted to access the effectiveness of the most restrictive
nonpharmaceutical interventions (mrNPI’s) with less restrictive pharmaceutical
interventions (lrNPI’s). Why? Because mandatory stay at home orders and
business closures have devastating, devastating effects. We know this now,
indisputably.
Their
conclusions are very simple, and profound,
While small benefits cannot be excluded, we do not find
significant benefits on case growth of more restrictive NPIs. Similar
reductions in case growth may be achievable with less‐restrictive interventions…
…Because of the potential harmful health effects of
mrNPI—including hunger,2 opioid‐related overdoses, missed vaccinations,
increase in non‐COVID diseases from missed health services, domestic abuse,
mental health and suicidality, and a host of economic consequences with health
implications—it is increasingly recognized that their postulated benefits
deserve careful study…
…In the framework of this analysis, there is no evidence that
more restrictive nonpharmaceutical 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…
NPIs can also have harms, besides any questionable benefits,
and the harms may be more prominent for some NPIs than for others. For example,
school closures may have very serious harms, estimated at an equivalent of 5.5
million life years for children in the United States during the spring school
closures alone. Considerations of harms should play a prominent role in policy
decisions, especially if an NPI is ineffective at reducing the spread of
infections. Of note, Sweden did not close primary schools throughout 2020 as of
this writing.”[33]
Wow! This is
pretty conclusive is it not? What have we done to our nations with these
lockdowns?
Please read
this paper, or at least the abstract, introduction and discussion. It outlines
very clearly that the strictest of measures are not necessary to achieve
favourable results with the spread of the virus.
To return to
our World War One analogy at the beginning; no, another charge into established
defences is not going to break the enemy lines. And while it may wear them down
eventually, there are far less costly methods of achieving your goals. Which is
why we never saw the same kind of trench warfare practiced in World War 2.
But I have
made a detailed case throughout this piece, let me put some names to the
arguments.
Let me tell
you about Andy Steels, who “tested negative on two occasions for Covid-19,
despite developing a chesty cough around the same time the pandemic was taking
its grip on the UK.”[34]
It turned out that he had lung cancer. He died the day after his 54th
birthday, because his cancer diagnosis was missed because of the lockdowns, and
the focus away from normal healthcare. He was one of as many as 50,000 people
who have missed a cancer diagnosis in the US.[35]
Each one of those people has a name, and a family.
Then there
is Hayden,
A 12-year-old Texas boy who felt “sad and lonely” amid the
coronavirus lockdown measures hanged himself, his father revealed in a report
about the tragedy...
…Hayden Hunstable, of Aledo, took his own life three days
before his 13th birthday in April 2020 because he didn’t know how to deal with
the isolation and depression when the emerging disease caused a nationwide
shutdown, the UK’s Metro reported…
…The dad said his son was hit hard by the lockdown, which
made it impossible to hang out with his friends, and took a strong dislike to
virtual learning.[36]
This story
breaks my heart. I am sure that this young boy had other issues in his life he
was struggling with. But they were exacerbated by the lockdowns. What a
tragedy. A flaw in my article is that it can make you feel like these lockdowns
and other measures just affect statistics, because that is what these
scientists were analysing. But behind every number is a person, a real person,
being affected in real ways. And this young man is not alone, in Japan, during
their second lockdown suicide rates increased by 49% among children and
adolescents, and 37% among women.[37]
These lockdowns are affecting so many people in terrible ways, and this article
only scratches the surface of those ramifications. But what cannot be denied is
that they are real.
I understand
our governmental leaders have a hard job. I think Australians have been very
sympathetic to this fact, and understand the situation is hard. But how often
have those who have questioned the lockdowns been told: don’t ignore the
science. Well, I think I have demonstrated conclusively that it is valid to
question the lockdowns BECAUSE of the science. What do you think?
List of
References:
[1]
Creveld, Martin, 2015. A History of Strategy: From Sun Tzu To William S.
Lind, Castalia House, Finland.
[15] Fagih,
Al (et al.) 2020, “Remotely monitored inactivity due to COVID-19 lockdowns.
Potential hazard for heart failure patients”, Saudi Medical Journal;
ProQuest Central ; 2020-11, Vol.41 (11), p.1211-1216 , accessed via Queensland
State Library, 15/02/2020.
[21] Haug,
Nils (et al.) 2020, “Ranking the effectiveness of worldwide COVID-19 government
interventions”, Nature Human Behviour, volume 4, pp.1303-1312, published 16th
November 2020, https://www.nature.com/articles/s41562-020-01009-0
, accessed 15/02/2020.
