Mass quarantine

from Wikipedia, the free encyclopedia
Road sealed off during mass quarantine as a measure against the COVID-19 pandemic in India ( Bhopal , April 14, 2020)

A mass quarantine ( English mass quarantine ) refers to a temporary, state-imposed and enforced quarantine for the general population with limitations of public life. By temporarily limiting or completely abolishing the freedom of movement of the population, spatial distancing is to be enforced in order to prevent the further spread of an infectious disease and thus contain an epidemic or pandemic . Mass quarantine is not sharply defined, but rather summarizes different measures for the purpose ofInfection protection . Specific measures such as the closure of shops, schools and other public facilities, can Assembly bans or curfews take place, possibly in conjunction with the declaration of a major emergency or martial law .

Mass quarantine for disease control has essentially been abandoned in the last century. Since then, they have rarely been used. for example in 1918 with the Spanish flu , in 2002 with the SARS pandemic 2002/2003 , with the Ebola fever epidemic from 2014 to 2016 and most recently from the end of 2019 as part of the COVID-19 pandemic also largely worldwide.

Both the effectiveness of mass quarantines as a containment measure and the cost-benefit ratio are controversial. During the COVID-19 pandemic, the measures ordered by politicians to reduce COVID-19 transmissions that are improperly applied to the general population are mostly referred to as "lockdown measures". Some studies suggest that the arrangement is suitable lockdown to during an acute epidemic phase the overall incidence of infections to reduce significantly. In particular, this can avert an imminent overload of the health system. On the other hand, he is always with significant social, economic, psychological and health consequences and strong Freedom - or limitation of fundamental rights connected and therefore often than is ultima ratio (last resort) considered. The World Health Organization is critical of lockdowns and advocates instead of lockdowns as the primary measure to combat COVID-19, targeted interventions at the local level that address the epidemic situation in the respective area (see # statements by WHO and other institutions ).

definition

In general, under a mass quarantine , population-based quarantine understood the "stay at home" on or "go safer place in the building" to a based in order to temporarily limit or complete abolition of the freedom of movement of the population spatial distancing inside and outside a enforce certain territory. The aim is to counteract a sustained outbreak of an epidemic or pandemic by reducing contact . The aim of this containment strategy is to prevent areas with a high outbreak rate from spreading the virus to other regions or parts of the country. The people affected are obliged to only leave their homes when it is absolutely necessary. Necessary activities (e.g. visits to the doctor, caring for a vulnerable person, buying medication, food and beverages, etc.) as well as work in system-relevant professions (e.g. in health care , social welfare, police and in the armed forces, in fire fighting, water and electricity supply or in critical infrastructure ). All other non-system-relevant activities should be temporarily interrupted in the event of a mass quarantine and / or carried out from home ( teleworking ). In order to implement mass quarantine measures, the police, security forces and possibly the military or the army are deployed. Mass quarantine is not sharply defined, but summarizes various non- pharmaceutical measures to protect against infection , such as the closure of shops, educational institutions and public facilities, assembly bans , curfews or the declaration of a disaster or state of emergency .

Examples

Spanish flu

Mass quarantine was ordered in the US during the 1918-1919 Spanish flu epidemic. The government closed schools, shops, canceled services, stopped train and ship traffic and put people in quarantine camps.

SARS pandemic 2002/2003

During the SARS pandemic of 2002/2003, educational institutions, restaurants and cinemas were closed in the severely affected regions in order to contain the spread of the virus.

It is controversial whether isolation or the ordering of a mass quarantine had the greater impact on containing the spread of SARS or whether both control measures were essential. In the case of SARS, only a small percentage of the quarantined individuals were actually infected.

Ordering mass quarantine for people who may have been infected with SARS was most aggressively enforced in Toronto compared to other SARS outbreaks . In the end, more than 30,000 people were under mass quarantine. Later empirical evidence confirmed that SARS was not infectious during its incubation period - which the quarantine is aimed at . The WHO is now advising against ordering a mass quarantine to contain SARS.

Ebola virus epidemic in West Africa

During the West African Ebola outbreak 2014-2016, mass quarantines were also ordered after they had not been used for almost a century. At the time of the West African Ebola epidemic in 2014, the West Point slum in the Liberian capital Monrovia was cordoned off with around 75,000 residents. The measure was lifted after two weeks because the uninformed and left to their own devices rebelled against it.

COVID-19 pandemic

From left to right and from top to bottom, the development of mass quarantine measures as part of the 2020 COVID-19 pandemic in several countries: hospital beds in a medical center in Wuhan (People's Republic of China), deserted streets in Lima (Peru) and Madrid ( Spain) and cleaning measures in Tehran (Iran) and Manila (Philippines)

In connection with the COVID-19 pandemic, nationwide restrictions were set (as of March 30, 2020) in over 50 countries worldwide to contain SARS-CoV-2 infections, including in Great Britain, Italy, Spain, France, Germany, Austria, South Africa, India, Colombia, New Zealand and several US states. It is estimated that there were over 280 million people in mass quarantine across Europe, 150 million in the United States, nearly 1.3 billion in India and 50 to 60 million in China. More than a third of humanity is subject to restrictive measures due to the COVID-19 pandemic.

As part of the COVID-19 pandemic, the People's Republic of China was the first country to put areas under mass quarantine, first the city of Wuhan and then the entire province of Hubei . After 76 days of isolation, the mass quarantine for Wuhan ended on April 8, 2020.

Different mass quarantine scenarios

In general, a distinction must be made between the ordering of an immediate mass quarantine and a gradual approach. A gradual approach is based on a political reaction in the form of advice and awareness-raising for possible penalties for violating selected instructions. This does not rule out the possibility that a later mass quarantine will become inevitable as the crisis progresses. The intention of a gradual approach is to keep as many people as possible in work for as long as possible so that the economy continues to function.

An analysis published on April 5, 2020 with the help of a decision tree came to the conclusion that under the assumptions made for the assumed probabilities in the decision tree there was only a one in four chance that the negative economic and isolation effects in the maintenance of a gradual Politics are less serious than a policy of direct mass quarantine. Likewise, the probability that fewer COVID-19 cases will occur with a policy of gradual measures is zero. The author comes to the conclusion that under the assumptions made, an immediate mass quarantine is preferable to a gradual approach. Decision-theoretic approaches might have meant that many countries have now introduced binding mass quarantine guidelines.

Lockdown, shutdown

In the public discussion in the context of the COVID-19 pandemic , the term lockdown ( English for “ lockdown , curfew ”) is used as a linguistic surrogate for “mass quarantine”. In scientific terminology, the word “lockdown” stands for “restrictive mass quarantine”. Instead of the more formal term “restrictive” or “mandatory mass quarantine”, the term “lockdown” has become established worldwide in the course of the pandemic and has been integrated into several languages. It was not until March 25, 2020 that the WHO described the distancing and quarantine measures as “so-called lockdown measures”, although the term “lockdown” was already in use before that. The Singapore government used contrary to the majority of countries for established her distancing measures instead of "Lockdown", the term "Circuit Breaker" ( German about overload switch or circuit breaker ), and the Philippine government used the term "community Quarantine" ( quarantine for the general population ).

In the context of the COVID-19 pandemic, the term shutdown (" shutdown , disconnection") is also used in the media to compete with the term lockdown . It actually means "the closure of a factory, shop or other company, either for a short time or forever".

Annette Klosa-Kückelhaus describes the lockdown period in the neologism dictionary New Vocabulary around the corona pandemic of the Leibniz Institute for the German Language as "a period in which almost all economic and social activities are shut down by political order (e.g. to protect against infection ) ". The Merriam-Webster's Collegiate Dictionary describes the lockdown condition as:

“A temporary condition imposed by government agencies (such as during an epidemic outbreak ) where people stay in their homes and do outside activities that involve public contact (such as going out to eat or at large gatherings participate), omit or restrict. "

Olaf Müller et al. define a lockdown as a bundle of “[...] measures to reduce transmission; these vary from simple distance and hygiene rules to bans on assemblies and the extension of school and university holidays to the closure of all non-systemic facilities in a country in connection with regulation of individual freedom of movement (lockdown). "

Leonard Mboera, et al. define lockdown as "a set of measures to reduce COVID-19 transmissions that originate in the general population, that are mandatory and that are applied inappropriately to the general population". This definition excludes measures that are mandatory but target individuals or groups of the population who are at high risk. With this definition, three lockdown measures relevant to COVID-19 can be isolated:

  1. geographic containment measures,
  2. the order to the population to “stay at home” and
  3. the shutdown of social, educational and economic activities and the prohibition of mass gatherings.

Although these are different measures, to some extent they overlap and work in synergy with each other. Each of these measures can vary in a spectrum ranging from " draconian " on one end to "lenient" on the other end.

The terms “Lockdown” and “Shutdown” have their origins in American usage: Lockdown describes a police order to people not to leave their current whereabouts or to go to a “safer place in the building”, for example during a manhunt in a company , a school or a residential area. This word was used by the international press in the initial phase of the COVID-19 pandemic for the quarantine position of the city of Wuhan and 15 other cities in Hubei province from January 23, 2020 and has since spread as a linguistic surrogate for " Mass quarantine ". The term "lockdown" is probably most closely associated with the decision by the Chinese authorities to quarantine the city of Wuhan. Shutdown alludes to the American phenomenon of government shutdown , in which federal authorities are "shut down" to emergency operation as part of a budget freeze - a situation similar to that of mass quarantine, in which not only authorities but also the private sector have to go into emergency operation .

This section presents the situation in Germany . Help us to describe the situation in other countries.

Both terms are measures for communicable disease control after the infection protection law is that the basic rights of the person freedom ( Art. 2 , para. 2 sentence 2 GG ), the freedom of assembly ( Art. 8 GG), the freedom of movement ( Art. 11 , para. 1 GG) and the inviolability of the home ( Art. 13 Para. 1 GG), such as the closure of almost all shops and public facilities, an extensive cessation of production, working from home and people staying at home due to the coronavirus -Pandemic. Public life, working life and private life are being “shut down” in the broader sense and thus come to a “standstill”. That is why some media also describe this state as a standstill .

The doctor for psychotherapeutic medicine Ulrich Schultz-Venrath saw in the course of the COVID-19 pandemic in the media an accumulation of previously unknown "military-looking terms, such as. B. 'Shut-down', 'Lock-down', ' Quarantine ', ' Triage ', ' No contact ' and ' Social distancing ' ". According to Jörg Seidel ( WDR ), it is questionable whether the terms “lockdown” and “shutdown” are appropriate for the comparatively mild corona measures in Germany. When using these words, one should be aware that they can sound dramatic. According to Lennart Garbes ( rbb24 ), there has not yet been a lockdown, at least in Germany. In contrast to Italy or Spain, there was never a curfew in Germany . However, contrary to some media reports, the terms lockdown and shutdown are not to be equated with the terms curfew or closings , as they mean much more than these words. Rather, in summary, different non- pharmaceutical measures to protect against infection are meant (see #Definition ), which were also ordered in Germany in the course of the COVID-19 pandemic (see reactions and measures in the health system and incorrect information about corona measures ). According to Roland Roth , common terms such as lockdown, shutdown and quarantine would hide the fact that they are used internationally to describe a bundle of measures with very different depths of intervention in everyday life. Even in the first phase of the pandemic, the population in Germany was spared an almost complete social standstill, as was the case at times in Italy or Spain. Leonard Mboera, et al. indicate that lockdown (mass quarantine) is not strictly defined. There is no clear or generally accepted definition of the term. The term lockdown does not appear in the WHO guidelines for preparing for a national influenza pandemic for 2018 or in the guidelines for risk management for influenza pandemics in 2017. The lack of definition and clarity, given the widespread reference to different degrees of lockdown, such as: B. “complete lockdown” and “partial lockdown” or “hard lockdown” and “soft lockdown”, surprising. Likewise, the relationship between "lockdowns" and other communicable disease control measures is unclear. According to James J. James, the implementation of a lockdown is characterized by the absence of a) any measure of standardization or even a uniform definition, b) clear quantitative goals and c) an objective assessment of the relative costs and benefits of various measures.

Hans-Jürgen Arlt points out that the lockdown affects the family, upbringing and education system, sport, art and religion. Family life is restricted - for example by bans on visiting hospitals and old people's homes - and just as heavily burdened. Many families not only struggle with financial problems, but also have to redesign their everyday lives. The problem of domestic violence is coming more and more into the focus of the public and the educational process is almost completely shifted back into the responsibility of the families. The global start of fully digitized teaching should be seen as a "large-scale experiment".

Breakwater lockdown

A variation of the traditional lockdown is an anticipatory lockdown, which is only ordered for a short period of time and includes strict non-pharmaceutical measures to significantly reduce the number of cases. In the literature, this kind is from lockdown as a "circuit breaker" ( English circuit breaker ) or more precisely "precautionary Pause" ( English precautionary break ), respectively. This lockdown is around the coronavirus pandemic than in the public debate in Germany Circuit Breakers ( English circuit breaker ), Breakwater lockdown or frequently simply as breakwater called. One of the hallmarks of a breakwater lockdown is that it is a conglomerate of different, strict, non- pharmaceutical interventions of limited duration that aim to specifically reduce the prevalence of COVID-19 diseases. This type of lockdown should be used every time the burden on the health system due to the large number of illnesses becomes so great that a “break” has to be taken in order to relieve the health system. The functionality is similar to the principle of a circuit breaker, which protects a circuit from overload. An advantage of this approach would be that control over the epidemic can be obtained, the population is at the same time warned and informed about the duration of the measures, which leads to a reduction in the social harm as the population adjusts to the short-term strict interventions can.

Drivers of decision-making in the fight against pandemics

According to James J. James, one of the problems that led to the lockdown strategy was the lack of information about the actual number of people infected and the overall ratio of unsusceptible people in the population. After Mariano Cadoni and Giuseppe Gaeta, the lockdown was decided in order to slow the outbreak of the epidemic, to have time to prepare for the epidemic wave, e.g. B. in relation to the capacity of hospitals or intensive care units or in relation to the inventory of individual protective devices.

According to a statistical analysis published in the journal PNAS , governments follow the example of others and base their decisions on what other countries do. Governments in countries with a stronger democratic structure reacted more slowly, but more sensitively to the example of other countries. Within two weeks in March, 80% of OECD countries introduced four out of five non-pharmaceutical measures. In view of the heterogeneity of the countries and the unclear effectiveness of the measures, this is strange. Since the countries had completely different characteristics, it was noticeable that there was a homogeneity with regard to the point in time at which the measures were applied. On the one hand, this is due to the fact that the countries were uniformly exposed to the same universal threat; on the other hand, the results suggest that it is not primarily the needs of the country with regard to exposure to COVID-19, the demographic structure or the capacity of the health system who predicted the pace of adoption of non-pharmaceutical interventions, rather the number of previous users in the same region.

Evaluation of the measure

Effectiveness as a tool to contain pandemics

There are controversial opinions among public health experts about the effectiveness of mass quarantines. This became clear in China: the WHO-China joint mission praised its effectiveness. In contrast, other experts in medicine, epidemiology, and public health have questioned this assessment. For example, Crystal Watson (Senior Scholar at the Johns Hopkins Center for Health Security and Assistant Professor in the Department of Environmental Health and Engineering ) sees no need for lockdown: "Our historical experiences with mandatory quarantines and mass quarantines and cordons are just not good, they are not effectively".

According to an April 2020 study, the mass quarantine strategy has been shown to be effective in containing the COVID-19 outbreak in China and slowing the course of the pandemic.

One argument by proponents of mass quarantine is that shortening the duration of the crisis would reduce the number of COVID-19 cases and thus shorten the period in which the economy is disrupted.

In the early stages of the pandemic, the mathematical simulation model in particular received a lot of attention from the COVID-19 response team at Imperial College London , led by epidemiologist Neil Ferguson . When calculations using this model published on March 16, 2020 showed that the UK healthcare system would soon be overwhelmed by severe COVID-19 cases and more than 500,000 deaths could occur if the UK government did not take action, Prime Minister Boris Johnson announced in Immediate response to impose new restrictions on people's movement. The same model suggested that without action, the United States could suffer around 2.2 million deaths. After the data was presented to the White House, new guidelines on spatial distancing quickly followed. According to reports from Italian doctors, the proportion of invasive ventilators among the expected hospital patients had been increased from 15 to 30 percent in the short term. The model assumptions regarding the number of reproductions , mortality and the number of asymptomatic infected and thus immune persons were very uncertain during the modeling period. Also, with no information available, it was assumed that there was no natural immunity . After Ferguson released a SEIR differential equation model with similar results on March 26 , he conceded that up to two-thirds of predicted deaths due to age composition were part of normal mortality in a year. However, you could focus on a shorter period of time, according to the seriously ill.

According to a simulation study published in The Lancet , which analyzes the effectiveness of the spatial distancing measures in the context of the mass quarantine of the megacity of Wuhan, the simulations show that the control measures can be effective in reducing spatial mixing in the population reduce the magnitude of the COVID-19 outbreak and delay its peak. The simulation model suggests that the spatial distancing measures are most effective with a staggered return to work in early April. This would reduce the median number of infections in mid-2020 and late 2020 by more than 92% (with an interquartile range of 66–97) and 24% (with an interquartile range of 13–90), respectively.

A model calculation in March 2020, published in the PNAS , examined the effect of travel restrictions and airport screenings in the early phase of the epidemic. The authors concluded that the sub-quarantine of the city of Wuhan and 15 other cities in Hubei province from January 23, 2020 prevented 70% of the expected export cases in the period up to February 15, 2020. Due to the transmission in the pre-symptomatic stage included in the model, the authors attribute the health examinations at airports to only a moderate effect. Taken together, the authors conclude that these measures significantly slowed the spread of the virus. In order to prevent spread, however, the contacts must be efficiently traced.

In March, John Ioannidis described the quarantine of entire cities under alarming circumstances as "extreme measures of unknown effectiveness". As part of the prescribed mass quarantines, schools were closed, social events canceled, air travel restricted, immigration control measures and border closings. However, there is a lack of empirical evidence for the most aggressive measures. A systematic review of the measures to prevent the spread of respiratory viruses would have produced insufficient empirical evidence for screening measures at airports and spatial distancing to reduce the spread of epidemics. Ioannidis cites a meta-study from 2011, according to which the strongest empirical evidence would be available for simple hygiene measures.

According to a systematic review published in The Lancet in April , the empirical evidence for the effectiveness of school closings comes almost entirely from influenza outbreaks, in which the transmission of the virus is usually controlled by children. It is unclear whether school measures in coronavirus outbreaks z. B. are effective due to COVID-19, where the transmission dynamics seem to be different. Four systematic reviews of the effects of school closure on influenza outbreaks or pandemics would suggest that school closings can be a useful control measure, although the effectiveness of mass school closings is often poor. Recent simulation studies of COVID-19 would predict that school closings alone would prevent only 2-4% of deaths, much less than other distance measures .

According to Ross Upshur, it should be noted that despite controversies about the quarantine, it has not been conclusively clarified or there is no consensus on what constitutes an effective quarantine. With this in mind, it is important that the quarantine is carried out properly. Barbera Macintyre et al. have addressed the issue of mass quarantine in connection with bioterrorism . In their opinion, the effectiveness of the quarantine is questionable and not massively justified.

In May and June the journals Science and Nature published a series of simulation studies that confirmed that the “non-pharmaceutical measures” to combat the COVID-19 pandemic were highly effective. A simulation study published in Science by scientists from the Max Planck Institute for Dynamics and Self-Organization examined the relationship between political measures in Germany and the growth rate of infections. It comes to the conclusion that the three successive packages of measures at the beginning of March - the cancellation of major events with more than 1000 participants, the closure of schools, day-care centers and shops and the ban on contact and the closure of all non-systemically relevant facilities - each resulted in a very significant reduction in the New infections related. According to the study, all three together were necessary to stop the exponential growth in the number of infections. The economic geographer Thomas Wieland summarized criticism, in particular that with data on the onset of the disease, which are initially not publicly available, the time of infection, which is decisive for an influence of measures, can be estimated more precisely than with reporting data that had been used by the Science study. He himself analyzed RKI data for the onset of symptoms for Germany between February 15 and May 31, 2020 and identified three “ structural breaks ” in the course curves. He concluded that the decline in the number of infections in early March could be attributed to "relatively minor interventions and voluntary behavioral changes". The effects of later measures could not be clearly recognized with his approach, nor did the liberalization of the government measures of April 20 lead to a renewed increase in infections.

A study by scientists from Imperial College London published on June 8, 2020 in the journal Nature estimated the effect of non-pharmaceutical measures to combat the pandemic based on the number of deaths recorded for eleven European countries, including Germany. From these, they recalculated the number of infections and compared them with the simulations of a “hypothetical counterfactual scenario [s]” in which the pandemic continues with an unchanged rate of reproduction. They came to the conclusion that the measures had had a very large effect. In particular, a general lockdown with extensive contact and movement restrictions for the entire population could reduce the infection rate by more than 80%.

A study by UC Berkeley published at the same time in Nature modeled the influence of non-pharmaceutical interventions in six countries (China, South Korea, Italy, France, Iran and the USA) based on the measured infection rates. Individual measures such as school closings or a ban on major events therefore had different effects in different countries. Taken together, however, the measures had a strong effect everywhere and were able to prevent 530 million infections by the beginning of April (of which 63 million were confirmed infections, the remainder being unreported).

The results did not remain undisputed. The medical statistician Gerd Antes said on June 16, 2020 on Deutschlandfunk that although the lockdown in March was correct as a pure precautionary measure, it had been decided "certainly without evidence". However, the opportunity for systematic accompanying research had been missed, so that knowing about the effectiveness of individual measures looked “very, very bad”.

According to a report by the International Society for Infectious Diseases, mass quarantine ordering is a very powerful public health tool, but it has significant complex effects outside the public health domain. Mass quarantines would have a major impact on reducing SARS-CoV-2 transmission. The initial reproduction number R 0 was 3.8 (2.4-5.6), but through non-pharmaceutical measures this value had fallen to 0.44 (Norway) to 0.82 (Belgium), which is an average of 0.66 in 11 countries (a decrease of 82% compared to the values ​​before the measures).

Similarly, a study examining the COVID-19 pandemic in France concluded that the lockdown reduced the number of reproductions from 2.90 to 0.67, a 77% reduction.

The virologist Christian Drosten rejects the criticism of the lockdown. According to him, it is "certainly not the case" that it did not need the shutdown. In doing so, he refers to the prevention paradox . As a result, a paradoxical situation would exist, as the shutdown measures were subsequently questioned by part of the population on the grounds that a predicted spread of the virus and the overloading of the health system had not taken place. However, the measures served to prevent the virus from spreading and may have prevented it.

According to Johan Giesecke (Professor Emeritus at the Karolinska Institute ) it has been shown that a hard lockdown does not protect old and frail people in nursing homes. Nor would it reduce mortality from COVID-19 , which is evident when comparing the UK's experience with that of other European countries. Measures to flatten the curve could have an impact, but a lockdown would not prevent the serious cases, it would only move them into the future.

A working paper by the National Bureau of Economic Research (NBER) compared the development of SARS-CoV-2 deaths by the end of July 2020 in 25 US states and 23 countries, each with over 1,000 deaths. The statistical study found a uniform development from an observation time of 25 deaths, regardless of the type and the period of government action. So fell within 20-30 days, the growth rate of deaths to 0, and the variability between regions was high only at the beginning of the epidemic. The authors conclude that the effective reproduction number R eff calculated on the basis of various models such as the SIR model has fluctuated around 1 worldwide after 30 days. They find no evidence that lockdowns, travel restrictions or quarantines have an impact on virus transmission. In studies to the contrary, they suspect a bias due to omitted variables . Candidates for this are voluntary spatial distancing, the structure of networks of interaction (initially rapid spread of an infection through people with many contacts) and a natural tendency, observed in earlier influenza pandemics, but not yet understood, to initially rapid and then slower spread . The reviewer Stephen C. Miller concludes an inadequacy of the popular simple epidemiological models to represent reality.

A previously only as Preprint available statistical quasi-experimental study by Paul Hunter (Professor of Medicine at the University of East Anglia ) was using Bayesian generalized additive and multi-level - regression models with mixed effects to the conclusion that both models would suggest that closing educational facilities, banning mass gatherings, and closing some non-essential businesses have been associated with a reduced incidence , while ordering the population to "stay at home", closing all public facilities and requiring face masks have none independent additional effect.

In September 2020, a review article on the effectiveness of different non- pharmaceutical measures (such as quarantine and mass quarantine) to combat the COVID-19 pandemic was published in the Cochrane Library . The authors evaluated a total of 51 studies. You consider the evidence to be uncertain. This is because the results of most studies are strongly influenced by the initial assumptions of the mathematical models used. Overall, the studies consistently showed that the quarantine measures were working. But it is uncertain how strong the effect is. The authors conclude from this that quarantine measures must be taken early and combined with other measures. In addition, the effectiveness and necessity of the measures must be checked regularly.

Cost-benefit ratio

Mass quarantines have considerable social, economic, psychological and also health consequences, so that their use must be carefully considered. Weeks of curfew disrupt social habits and relationships; Sections of the population are at risk of diseases such as insulin resistance , muscle atrophy , high blood pressure and heart rate , fatty liver disease, non-alcoholic steatohepatitis or lipid metabolism disorders (dyslipidaemia). Mass quarantine, self-quarantine, and isolation are linked to depression, anger, and chronic stress. During this time, additional stress is caused by lengthy quarantine, frustration, lack of sleep, social isolation , inadequate care, inadequate information, financial loss, and stigma . Additionally, during the outbreak, people are afraid of getting sick or of dying themselves. These negative feelings are linked to systemic inflammation and endothelial dysfunction, as well as a tendency to adopt an unhealthy lifestyle. According to a study by the medical faculty of Leipzig University , quarantine measures are stressful life events. The connection between stressful life events and negative consequences for psychosocial health has long been proven. Spatial separation from loved ones, the loss of freedom, uncertainty about illness status, and boredom and loneliness could have dramatic effects on mental health. The uncertainty about the duration of the contact restriction could also have a negative effect on the mental state. From a public health perspective , it is important to carefully weigh the potential benefits of mandatory mass quarantine against the psychosocial consequences and any associated long-term costs. In an October study, the International Monetary Fund came to the conclusion that early lockdowns were significantly more effective in terms of economic costs than long-lasting, comparatively mild measures. The voluntary changes in behavior that occur when the number of infections remains high without lockdown due to the risk of infection would cause more costs in the long term than the short-term lockdown.

According to a study involving University College London and Cancer Patient Treatment Data Research, DATA-CAN, which analyzed data from major cancer centers in the UK, the number of urgency referrals with suspected cancer from primary care physicians decreased by around 76 percent. According to the analysis, around 6,000 more people could die of cancer than the average year. If you include all people currently living with cancer, the number of additional deaths could rise to around 18,000.

According to a position paper by the Leibniz Institute for Economic Research by Christoph M. Schmidt , a general lockdown would, based on the experience of the past few weeks, effectively protect health, but at the same time it would inevitably cripple social and economic life in a way that is not It would have to be sustained over a longer period of time, as it would cause noticeably large collateral damage.

Mass quarantines mainly affect urban life, while such measures are sometimes barely noticeable in rural areas. This gives wealthy city-dwellers an incentive to move to rural secondary homes before such measures are imposed. If possible, less well-off people also try to stay with relatives in the country for a while. This carries the risk of spreading the disease further and putting additional strain on rural infrastructure through the additional residents.

Medical journal The BMJ published a pro-and-con statement by Edward Melnick and John Ioannidis on whether to extend government lockdown measures. In doing so, Melnick argues that due to the absence of a safe and effective vaccine, treatment, and prophylaxis, non-pharmaceutical interventions are the only options available to slow the spread of the virus. Mass quarantines are associated with costs, risks and collateral damage; but it should be prevented that the disease becomes locally endemic . The order of a mass quarantine is the comparatively most draconian non-pharmaceutical intervention. However, if implemented successfully, it would reduce disease transmission by limiting human contact. This is supported by a historical archive analysis of 43 cities in the pandemic influenza of 1918-19, which shows a strong association between mass quarantines and delayed or reduced mortality rates and reduced cumulative deaths. Earlier implementation and longer mass quarantines were also associated with reduced overall mortality . In response, Ioannidis replied that if measures were relaxed, however, most, if not all, deaths from COVID-19 would still occur - unless effective treatments and / or vaccines did occur. In addition, the principles from Lockdown to Flatten the curve! the seasonality ignore and old 100 years of observations of a pandemic of 1918 with a 100 times higher infected dead-share as COVID-19 support. Mass quarantines would increase child abuse and domestic violence. Discomfort and social disintegration could also advance, with unforeseeable consequences such as unrest or even war. Mass quarantines were a desperate decision at the beginning of the crisis that could have been argued for when little was known about COVID-19. But now it is important to avoid them and gradually remove them. Otherwise “mass suicide” can be expected in the case of extended mass quarantines. It is well known that for every 1 percent increase in unemployment, the suicide rate increases by 1 percent.

John Ioannidis also warned of the “potentially enormous social and financial”, and thus also health consequences, of the interruption of contacts and economic relationships. Depending on the scenario, these could potentially be much more serious than the direct consequences of the virus.

The epidemiologist Marc Lipsitch sees the examples of sudden severe disease courses in Wuhan and Italy as a result of delayed reactions to the crisis. Lipsitch recognizes a broad consensus among epidemiologists that spatial distancing is temporarily the only way to avoid overloading the health system and to use the time to develop other measures against the virus. Nevertheless, he agrees with Ioannidis that further data are required for a reliable assessment.

According to economics professor Ulrich Schmidt, more lives could have been saved without a shutdown. It is known from previous crises that those affected suffer psychological stress, which on average shortens their lifespan. According to health economist Afschin Gandjour, a possible increase in deaths due to psychological stress must be weighed against a possible decrease in deaths due to a reduction in air pollution, traffic accidents, accidents on construction sites and flu. Perhaps these factors offset each other.

Nancy Kass and James Childress developed frameworks for the ethical evaluation of public health interventions. In their framework, the effectiveness of an intervention plays an important role in justifying public health interventions. However, this is a double-edged sword. Restricting action due to a lack of evidence of efficacy would seriously affect the public health response - and potentially lead to further disease transmission. As public health officials face these difficult dilemmas, it is important that they take the side of public safety. It would be far better to defend yourself against unnecessary quarantine than to fail to act and expose people to a preventable disease with subsequent morbidity and mortality.

A study published on May 13 by the Ifo Institute for Economic Research and the Helmholtz Center for Infection Research found that health protection through a lockdown and economic development are not in direct conflict. Both a very hard lockdown and an excessive relaxation of measures could severely restrict economic development. The authors assumed the least economic damage for Germany was a slight, step-by-step relaxation of the restrictions in force at the beginning of May and a reproduction number of around 0.75.

Disproportionately burdened groups

The effects of mass quarantines disproportionately affect the members of disadvantaged social classes, for whom permanent residence in their small apartments appears to be much more stressful than for the better-off, who often live in houses with gardens. At the same time, members of the working class are more likely to expect a loss of income or job losses than groups of employees who can also work from home and whose jobs are less affected by short-term economic fluctuations.

The World Health Organization also points out that the lockdown measures affect disproportionately disadvantaged groups. Refugees are particularly affected, who often live in overcrowded and poorly equipped accommodation, are dependent on daily work for their livelihood and therefore suffer particularly from the measures. People in poverty, migrants and internally displaced persons are also disproportionately burdened by the lockdown measures.

Statements from WHO and other institutions

With regard to containment strategies, measures to restrict freedom of movement depend on the particular infectious disease. In the COVID-19 pandemic, the World Health Organization (WHO) strongly recommended isolating confirmed infections and quarantining their contacts; however, it did not recommend mass quarantines. In the midst of the coronavirus pandemic, many countries around the world imposed mass quarantines in a domino-like fashion (see #Drivers of Pandemic Control Decision Making ). Although the WHO has never recommended them even in the current pandemic, it does provide this possibility of an order. However, the WHO does not make any general statements as to whether the most dramatic human rights restrictions, i. H. Mass quarantines, justified or not. According to her, the measures can also have “profound negative effects on individuals, communities and societies by bringing social and economic life to a virtual standstill.” Instead of lockdowns as the primary measure to combat COVID-19, she speaks up first for targeted interventions at local level that address the epidemic situation in the respective area.

With regard to the current mass quarantines, the WHO has taken an ambivalent approach. On the one hand, she praised the governments of China and Italy for their population-wide measures. At the same time, the standard recommendations for responding to coronavirus only include individualized quarantines and isolations.

WHO Director General Tedros Adhanom Ghebreyesus said at the beginning of the pandemic that lockdowns should not be the primary response to the spread of the virus. A complete lockdown is not expedient, especially for countries with a considerable proportion of poor people in the population. The WHO special envoy for precautionary and countermeasures related to COVID-19 David Nabarro spoke out against lockdowns as the primary means of combating pandemics in October 2020. He said, "We in the World Health Organization do not advocate lockdowns as the primary means of controlling this virus" and further, "Lockdowns have only one consequence that you must never belittle, and that is that it makes poor people a lot poorer [...] it seems that by next year we will have world poverty doubling. We may have at least a doubling of child malnutrition . ”The WHO only endorses lockdowns if they aim to buy time to reorganize the country's resources or protect medical personnel. Instead of lockdowns, the WHO Regional Office for Europe advocates a multi-tiered approach based on the epidemic situation in each area to address the pandemic at the local level . According to the Director of the WHO Regional Office for Europe Hans Kluge, national lockdowns should be “a measure of last resort”.

In a joint statement, the International Labor Organization , the Food and Agriculture Organization of the United Nations , the International Fund for Agricultural Development and the World Health Organization pointed out that without the means to earn an income during the lockdown, many and their families will be gone can feed themselves. For most, no income means no food, or at best less food and less nutritious food.

United Nations World Food Program Executive Director David Beasley warned of the grave dangers of the coronavirus' economic impact and the risk that it could starve millions further. It is important to balance sensitive measures to contain the spread of the virus, keep borders open, maintain supply chains and keep trade flows moving. COVID-19 pushed many countries around the world into lockdown, destroying the equivalent of 400 million full-time jobs and causing the transfer of funds to collapse. Countries in the middle and lower income groups are mainly affected by this. Even just one more day without work can lead to the living situation of people in these countries deteriorating considerably.

Human rights

According to research by the Max Planck Institute for Comparative Public Law and International Law , quarantines at the population level would pose great challenges to human rights. In terms of international human rights law, it is very difficult to impose restrictions on a person when there is no specific danger or risk associated with that person. It would appear that in cases where they have imposed mass quarantines, governments have not based this measure on normal legal justification but have found it necessary to invoke exceptional powers. For example, Italy, France and Spain would have done so in the current coronavirus pandemic. In order to justify the restriction of ICCPR rights, the States parties must notify the Secretary-General of the United Nations .

Strategies for bypassing a lockdown

According to one study, could also by a so-called digital " contact tracing " (Kontaktpersonennachverfolgung) the COVID-19 pandemic curb. In this way, mass quarantines, which can be associated with negative health consequences for the population, can be avoided. Unlike mass quarantine , which quarantines large numbers of people (who may or may not be infected) , contact tracing can allow a more targeted group of people to be quarantined.

Unlike many European countries, in the framework of COVID-19 pandemic on mass quarantines with weeks of curfews put forego some East Asian countries such as Japan , Vietnam , Singapore , Taiwan and South Korea to mass quarantines and rely on digital " contact tracing " (Contact person tracking) , keep your distance and improve hygiene. This handling was also made possible by early measures following initial information on social media and findings from the SARS pandemic 2002/2003 .

In the course of the COVID-19 pandemic in Germany, strategies for circumventing an apparently inevitable “second lockdown” in the event of a potential “second wave” were discussed. The virologist Christian Drosten suggested a method based on so-called “ source clusters ”. In addition to contact tracking, which primarily determines the contacts of an infected person over the last two days in order to find out who they might have infected, it makes sense to quickly trace new known infections back to their possible source clusters. In this way, one could relieve the health authorities in the event of a possible "second wave" and prevent a non-targeted lockdown.

Environmental impact

Air and water pollution decreased during the lockdown phase during the COVID-19 pandemic. In countries and cities that have been quarantined, there have been anecdotal reports of wildlife venturing into otherwise busy cities.

Exit strategy

Epidemiologists and public health experts point out that having a well-thought-out exit strategy (often called an exit strategy ) is critical in a mass quarantine .

Marius Gilbert et al. propose three complementary measures as part of an exit strategy. First of all, it is necessary to maintain the spatial distancing measures so that the number of sick people does not exceed the treatment capacity of the hospitals. Second, the diagnostic capacity for both the detection of the virus and the identification of immune persons must be greatly increased in parallel . Third, the necessary procedures would need to be put in place to conduct systematic testing and large-scale contact tracing.

literature

  • Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 1 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).

Web links

Wiktionary: Lockdown  - Explanations of meanings, word origins, synonyms, translations
Wiktionary: shutdown

Individual evidence

  1. ↑ Susanne Röhr et al .: Psychosocial Consequences of Quarantine Measures in Serious Coronavirus Outbreaks: A Rapid Review. Psychiatric Practice April 47, 2020.
  2. ^ Richard Schabas: Commentary: Severe acute respiratory syndrome: Did quarantine help? In: Canadian Journal of Infectious Diseases and Medical Microbiology. Volume 15, No. 4, July – August 2004, p. 204 (English; PDF: 1.1 MB at hindawi.com).
  3. ^ Troy Day et al .: When is quarantine a useful control strategy for emerging infectious diseases? In: American Journal of Epidemiology. 2006, p. 480.
  4. ↑ 'Don't waste' COVID-19 lockdowns, WHO Europe warns, as region is pandemic epicenter again. euronews , November 19, 2020, accessed on November 23, 2020 (en).
  5. ↑ Why lockdowns come and how long they might last. Der Standard , October 30, 2020, accessed November 22, 2020.
  6. ↑ 'Don't waste' COVID-19 lockdowns, WHO Europe warns, as region is pandemic epicenter again. euronews , November 19, 2020, accessed on November 23, 2020 (en).
  7. ↑ Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 1 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).
  8. ↑ Garima Singh et al .: A study on mental health and well-being of individuals amid COVID-19 pandemic lockdown. 2020, p. 753.
  9. ↑ Leonard EG Mboera et al .: Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. International Journal of Infectious Diseases. 2020, p. 1.
  10. ↑ Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 1 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).
  11. ↑ David Ruch: Fighting Coronavirus: How Extreme Can It Get? In: T-online.de , March 17, 2020, accessed on April 19, 2020.
  12. ↑ Apoorva Mandavilli: SARS epidemic unmasks age-old quarantine conundrum. 2003.
  13. ^ Troy Day et al .: When is quarantine a useful control strategy for emerging infectious diseases? In: American Journal of Epidemiology. 2006, p. 480.
  14. ^ Katherine Hunting, Brenda L. Gleason: Essential case studies in public health: Putting public health into practice. Jones & Bartlett Publishers, 2011, p. 9.
  15. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 28.
  16. ↑ Ebola - Liberia ends quarantine in poor areas. Zeit Online - Zeitgeschehen, August 30, 2014 (web archive, archived on September 2, 2014).
  17. ↑ Frida Thurm, Dagny Lüdemann: Ebola in Liberia - The lepers of Monrovia. Zeit Online - Zeitgeschehen, August 22, 2014 (web archive, archived on August 23, 2014).
  18. ↑ China relies on mass quarantine against corona virus. Deutsche Welle , February 12, 2020, accessed on April 9, 2020.
  19. ↑ China ends isolation from Wuhan. KBS World, April 8, 2020, accessed April 13, 2020.
  20. ↑ a b c Jonathan Karnon: A Simple Decision Analysis of a Mandatory Lockdown Response to the COVID-19 Pandemic. In: Applied Health Economics and Health Policy. April 5, 2020, pp. 1–3, here p. 1, PMC 7130451 (free full text).
  21. ↑ Jonathan Karnon: A Simple Decision Analysis of a Mandatory Lockdown Response to the COVID-19 Pandemic. In: Applied Health Economics and Health Policy. 2020, p. 2, PMC 7130451 (free full text)
  22. ↑ Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 2 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).
  23. ↑ Lawrence O Gostin, Eric A. Friedman, Sarah A. Wetter: Responding to COVID ‐ 19: How to Navigate a Public Health Emergency Legally and Ethically. Hastings Center Report, 2020, p. 8.
  24. ↑ Deeksha Pandey et al: Psychological impact of mass quarantine on population during pandemics — The COVID-19 Lock-Down (COLD) study. In: PLOS ONE (2020), p. 2.
  25. ↑ Sarmistha Das, et al .: Critical community size for COVID-19: A model based approach for strategic lockdown policy. In: Statistics and Applications (2020), 181–196, here: p. 181.
  26. ↑ Jonathan Karnon: A Simple Decision Analysis of a Mandatory Lockdown Response to the COVID-19 Pandemic. In: Applied Health Economics and Health Policy. 2020, p. 1, PMC 7130451 (free full text)
  27. ↑ Leonard EG Mboera et al .: Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. International Journal of Infectious Diseases, 2020, p. 308.
  28. ↑ Jiayu Li, Federico Tartarini: Changes in Air Quality during the COVID-19 Lockdown in Singapore and Associations with Human Mobility Trends. Aerosol and Air Quality Research 20 (2020), p. 1.
  29. ↑ Julie Aurelio: Eased lockdown till May 31 in Metro Manila, Cebu City, Laguna . In: Inquirer , May 13, 2020. 
  30. ^ Eva Quadbeck: World Medical President Montgomery: "A lockdown is a desperate political measure". In: RP-online.de , accessed on March 20, 2020 (for a fee).
  31. ^ Annette Klosa-Kückelhaus: Shutdown, Lockdown and Exit. 2020, p. 1.
  32. ↑ Annette Klosa-Kückelhaus: New vocabulary about the corona pandemic. Keyword: Lockdown , accessed August 9, 2020.
  33. ↑ lockdown in Merriam Webster , accessed on August 27, 2020, original English wording : “ a temporary condition imposed by governmental authorities (as during the outbreak of an epidemic disease) in which people are required to stay in their homes and refrain from or limit activities outside the home involving public contact (such as dining out or attending large gatherings). ”
  34. ↑ Olaf Müller, Florian Neuhann, Oliver Razum: Epidemiology and control measures for COVID-19. German Medical Weekly, 2020, p. 672.
  35. ↑ Leonard EG Mboera et al .: Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. International Journal of Infectious Diseases, 2020, p. 309.
  36. ↑ Leonard EG Mboera et al .: Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. International Journal of Infectious Diseases, 2020, p. 308.
  37. ^ Annette Klosa-Kückelhaus: Shutdown, Lockdown and Exit. 2020, p. 1.
  38. ↑ Ulrich Schultz-Venrath: The SARS-CoV-2 pandemic as an anti-group event. 2020, pp. 104–110, here: p. 105.
  39. ↑ Jörn Seidel: Lockdown and Shutdown - appropriate terms? In: WDR , June 23, 2020, accessed on August 9, 2020.
  40. ↑ Lennart Garbes: Language and Corona - Precision, Politicization and Perceived Reality. In: rbb24 , July 18, 2020, accessed on August 11, 2020.
  41. ↑ Jörn Seidel: Lockdown and Shutdown - appropriate terms? In: WDR , June 23, 2020, accessed on August 11, 2020.
  42. ↑ Roland Roth : Democracy and Citizen Participation in Times of COVID-19. 2020, p. 11.
  43. ↑ Leonard EG Mboera et al .: Mitigating lockdown challenges in response to COVID-19 in Sub-Saharan Africa. International Journal of Infectious Diseases, 2020, p. 308.
  44. ↑ James J. James: Lockdown or Lockup. Disaster Medicine and Public Health Preparedness, 2020, p. 1 ff.
  45. ↑ Hans-Jürgen Arlt: Pattern recognition in the corona crisis. In: Springer essentials. Wiesbaden 2020, ISBN 978-3-658-31101-8 , p. 23.
  46. ↑ Korinna Hennig, Christian Drosten: Script for Coronavirus Update. Episode 62 , ndr.de, October 28, 2020.
  47. ↑ Prevent instead of reacting: Are breakwater lockdowns the solution? In: ntv.de. October 27, 2020, accessed November 15, 2020 .
  48. ↑ Korinna Hennig, Christian Drosten: Script for Coronavirus Update. Episode 64 , ndr.de, November 12, 2020.
  49. ↑ Korinna Hennig, Christian Drosten: Script for Coronavirus Update. Episode 62 , ndr.de, October 27, 2020.
  50. ↑ Matt J. Keeling, et al .: Precautionary breaks: planned, limited duration circuit breaks to control the prevalence of COVID-19. MedRxiv (2020).
  51. ↑ James J. James: Lockdown or Lockup. Disaster Medicine and Public Health Preparedness, 2020, p. 1 ff.
  52. ↑ Mariano Cadoni, Giuseppe Gaeta: How long does a lockdown need to be? 2020, p. 3.
  53. ↑ Abiel Sebhatu et al .: Explaining the homogeneous diffusion of COVID-19 nonpharmaceutical interventions across heterogeneous countries. Proceedings of the National Academy of Sciences, 2020.
  54. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, pp. 13-14.
  55. ↑ Explaining a mass quarantine: What does it mean to 'shelter in place'? And who has the power to call for it? March 17, 2020, accessed August 23, 2020 .
  56. ↑ Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 1 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).
  57. ↑ a b c David Adam: Special report: The simulations driving the world's response to COVID-19: How epidemiologists rushed to model the coronavirus pandemic. In: Nature , accessed April 7, 2020.
  58. ↑ a b Nick Triggle: Coronavirus: How to understand the death toll. In: BBC News. April 16, 2020, accessed August 25, 2020 .
  59. ↑ Kiesha Prem et al: The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modeling study. The Lancet, March 25, 2020, doi: 10.1016 / S2468-2667 (20) 30073-6
  60. ↑ CR Wells, P. Sah, SM Moghadas, A. Pandey, A. Shoukat, Y. Wang, Z. Wang, L. A. Meyers, B. H. Singer, A. P. Galvani: Impact of international travel and border control measures on the global spread of the novel 2019 coronavirus outbreak. In: Proceedings of the National Academy of Sciences . Volume 117, number 13, March 31, 2020, pp. 7504-7509, doi: 10.1073 / pnas.2002616117 , PMID 32170017 , PMC 7132249 (free full text).
  61. ↑ T. Jefferson, CB Del Mar, L. Dooley, E. Ferroni, LA Al-Ansary, GA Bawazeer, M. L. van Driel, S. Nair, M. A. Jones, S. Thorning, J. M. Conly: Physical interventions to interrupt or reduce the spread of respiratory viruses. In: The Cochrane database of systematic reviews. Number 7, July 2011, p. CD006207, doi: 10.1002 / 14651858.CD006207.pub4 , PMID 21735402 , PMC 6993921 (free full text) (review).
  62. ↑ John Ioannidis : Coronavirus disease 2019: the harms of exaggerated information and non ‐ evidence ‐ based measures. European journal of clinical investigation , 2020, p. 2.
  63. ↑ John Ioannidis : School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. The Lancet Child & Adolescent Health , 2020, p. 397.
  64. ↑ Ross Upshur: The Ethics of Quarantine. AMA Journal of Ethics. 2003, pp. 393-395, here: p. 394.
  65. ↑ Jonas Dehning et al .: Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions. AMA Journal of Ethics. Science, 2020, p. 4.
  66. ↑ Thomas Wieland: A phenomenological approach to assessing the effectiveness of COVID-19 related nonpharmaceutical interventions in Germany. In: Safety Science, Volume 131, November 2020 (published online earlier), 104924. Elsevier, July 21, 2020, accessed August 18, 2020 .
  67. ↑ Seth Flaxman et al .: Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe Nature (2020), accessed on October 19, 2020.
  68. ↑ Solomon Hsiang et al .: The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature , 2020.
  69. ↑ “We didn't even begin to understand many factors”. In: deutschlandfunk.de. June 16, 2020, accessed June 26, 2020 .
  70. ↑ Pamela Bailey, Richard P. Wenzel: The Importance of Non-pharmacologic Interventions for the Prevention OF COVID-19 Transmission. In: International Society for Infectious Diseases, p. 4 ff.
  71. ^ Henrik Salje et al .: Estimating the burden of SARS-CoV-2 in France . In: Science . July 10, 2020, doi : 10.1126 / science.abc3517 .
  72. ↑ "Prevention paradox": Drosten sends a warning to all lockdown critics. In: Focus Online . May 13, 2020, accessed August 12, 2020 .
  73. ^ Johan Giesecke: The invisible pandemic. In: The Lancet , 2020.
  74. ↑ a b Stephen C. Miller: Lockdowns and Mask Mandates Do Not Lead to Reduced COVID Transmission Rates or Deaths, New Study Suggests. American Institute for Economic Research, August 26, 2020, accessed on September 11, 2020 (with a link to the full NBER Working Paper from August 2020 , there Figure 2, p. 18).
  75. ↑ Andrew Atkeson, Karen Kopecky, Tao Zha: Four stylized facts about Covid-19. NBER Working Paper, August 2020 (accessed on September 11, 2020), Introduction pp. 2–4, Conclusion pp. 15–16.
  76. ^ Paul R. Hunter et al .: Impact of non-pharmaceutical interventions against COVID-19 in Europe: a quasi-experimental study. 2020.
  77. ↑ Barbara Nussbaumer-Streit u. a .: Quarantine alone or in combination with other public health measures to control COVID ‐ 19: a rapid review . In: Cochrane Database of Systematic Reviews . September 14, 2020, doi : 10.1002 / 14651858.CD013574.pub2 .
  78. ^ Troy Day et al .: When is quarantine a useful control strategy for emerging infectious diseases? In: American Journal of Epidemiology , 2006.
  79. ↑ Brandon Michael Henry, Giuseppe Lippi u. a .: Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19) . In: Diagnosis . April 7, 2020, p. 2 , doi : 10.1515 / dx-2020-0041 (English, degruyter.com ).
  80. ↑ Ralph Hertwig , Mattea Dallacker, Jutta Mata: Isolation: What mass quarantine does to us. In: Zeit Online , April 1, 2020, accessed on April 20, 2020 (guest post ).
  81. ↑ Anna Vittoria Mattioli et al .: COVID 19 outbreak: impact of the quarantine-induced stress on cardiovascular disease risk burden.
  82. ↑ Susanne Röhr et al .: Psychosocial Consequences of Quarantine Measures in Serious Coronavirus Outbreaks: A Rapid Review. Psychiatrische Praxis 47.04, 2020, pp. 179–189, here: p. 180.
  83. ↑ Francesco Grigoli, Damiano Sandri: COVID's Impact in Real Time: Finding Balance Amid the Crisis . In: International Monetary Fund (Ed.): IMFBlog . October 8, 2020, accessed October 14, 2020.
  84. ↑ RedaktionsNetzwerk Deutschland : Lockdown consequences: more cancer deaths than expected. April 29, 2020, accessed May 26, 2020.
  85. ↑ Christoph M. Schmidt : Forward with Corona Dashboard, p. 3.
  86. ↑ Thomas Vitzthum: Corona: The loss of freedom in the cities. In: welt.de . March 24, 2020, accessed June 11, 2020 .
  87. ↑ Heike Buchter: Quarantine: Hamster purchases at a high level. In: zeit.de . March 18, 2020, accessed June 11, 2020 .
  88. ^ Edward R. Melnick, John Ioannidis: Should governments continue lockdown to slow the spread of covid-19? June 3, 2020, accessed August 12, 2020 .
  89. ^ Perspectives on the Pandemic IV: An Update with Dr. John Ioannidis, Stanford University: April 17th, 2020. thepressandthepublic.com, accessed May 19, 2020 .
  90. ^ John PA Ioannidis: A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data. In: www.statnews.com. March 17, 2020, accessed March 20, 2020 .
  91. ↑ Marc Lipsitch: We know enough now to act decisively against Covid-19. Social distancing is a good place to start. In: www.statnews.com. March 18, 2020, accessed March 20, 2020 .
  92. ↑ Ulrich Schmidt: Why we have to talk about the value of life. In: Wirtschaftswoche. Wirtschaftswoche, May 13, 2020, accessed on May 30, 2020 .
  93. ↑ Afschin Gandjour: The clinical and economic value of a successful shutdown during the SARS-CoV-2 pandemic in Germany . In: The Quarterly Review of Economics and Finance . October 14, 2020, ISSN  1062-9769 , doi : 10.1016 / j.qref.2020.10.007 , PMID 33071532 , PMC 7554483 (free full text) - ( sciencedirect.com [accessed November 26, 2020]).
  94. ↑ Ross Upshur: The Ethics of Quarantine. AMA Journal of Ethics, 2003, pp. 393-395, here: p. 394.
  95. ↑ Florian Dorn, Sahamoddin Khailaie, Marc Stöckli, Sebastian Binder, Berit Lange, Andreas Peichl, Patrizio Vanella, Timo Wollmershäuser, Clemens Fuest , Michael Meyer-Hermann : The common interest of health and economy: A scenario calculation to contain the corona pandemic. A joint study by the Ifo Institute (ifo) and the Helmholtz Center for Infection Research (HZI) . In: Ifo Institute for Economic Research (Ed.): Ifo Schnelldienst Digital . No. 6 , 2020 (9 pp., Ifo.de [PDF]).
  96. ↑  ( page no longer available , search in web archives ) zeit.de@1@ 2Template: Dead Link / www.zeit.de
  97. ↑ Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. World Health Organization (WHO), October 15, 2020, accessed September 25, 2020 (en).
  98. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 18.
  99. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 19.
  100. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 20.
  101. ↑ Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. World Health Organization (WHO), October 15, 2020, accessed September 25, 2020 (en).
  102. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 23.
  103. ^ The incredible vanishing World Health Organization. The Spectator , October 12, 2020, accessed November 22, 2020.
  104. ↑ Why lockdowns come and how long they might last. Der Standard , October 30, 2020, accessed November 22, 2020.
  105. ↑ 'Don't waste' COVID-19 lockdowns, WHO Europe warns, as region is pandemic epicenter again. euronews , November 19, 2020, accessed on November 23, 2020 (en).
  106. ↑ Impact of COVID-19 on people's livelihoods, their health and our food systems. World Health Organization (WHO), October 13, 2020, accessed September 22, 2020 (en).
  107. ↑ WFP Chief warns of grave dangers of economic impact of Coronavirus as millions are pushed further into hunger. United Nations World Food Program , November 17, 2020, accessed November 23, 2020 (en).
  108. ↑ Armin Bogdandy, Pedro Villarreal: International law on pandemic response: a first stocktaking in light of the coronavirus crisis. Max Planck Institute for Comparative Public Law and International Law , Preprint Research Paper 2020-07, 2020, p. 19.
  109. ↑ Deutsches Ärzteblatt : Digital "Contact Tracing" could stop SARS-CoV-2. Retrieved April 9, 2020.
  110. ↑ Luca Ferretti, Chris Wymant a. a .: Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. 31 March 2020.
  111. ↑ Selena Simmons-Duffin: How Contact Tracing Works And How It Can Help Reopen The Country. In: NPR , accessed April 15, 2020.
  112. ↑ Wolfram Weimer : Person of the Week: Stefan Löfven - Is Sweden Making It Smarter? n-tv.de , March 31, 2020, accessed on April 13, 2020.
  113. ↑ How has Taiwan kept its coronavirus infection rate so low? In: Deutsche Welle. April 9, 2020, accessed July 21, 2020 .
  114. ↑ Confusion about Drosten's statement. Deutschlandfunk - Die Nachrichten, September 5, 2020, Internet archive, archived on September 4, 2020, accessed on October 5, 2020.
  115. ↑ Marius Gilbert et al .: Preparing for a responsible lockdown exit strategy. In: Nature Medicine , 2020, p. 643 ff.