Lockdowns are not free in terms of public health
The dilemma between maintaining or lifting lockdowns is often counterproductively framed as a contrast between population health and the economy. In the absence of effective therapeutics and vaccines, lockdowns are intended to prevent mass casualties from the rapid introduction of a virus in an immunologically naïve population, especially in countries with a poor health infrastructure, limited surge capacity and/or social inequalities. However, lockdowns themselves have a variety of negative effects on health, which must be balanced against their benefit for controlling the COVID-19 pandemic. These effects are difficult to quantify and often overlooked. Among others, they include difficulty in accessing health care for chronic and other diseases [6], mental and physical issues due to isolation and inactivity, and the long-term effects of children being out of school [7,8]. The economic damage from the lockdown also negatively impacts public health, especially through increased unemployment and inequality [9]. Therefore, restrictive measures should be used judiciously, with a clear rationale and a reasonable expectation of net benefit in terms of population health.
Maintaining a strong lockdown indefinitely implies another strong, and usually unstated, assumption: that there will be a safe and effective vaccine available at the end of the road, produced in sufficient quantities and with a substantial proportion of the population yet uninfected. Success is not guaranteed though [10]. Real concerns exist, for example regarding antibody-dependent enhancement, and any candidate vaccine will have to be thoroughly tested before being rolled out [11]. By the time we have a vaccine, it may already be too late for it to alter the course of the COVID-19 pandemic substantially.