key: cord-0893619-7rn0mf1w authors: Coccia, Mario title: The relation between length of lockdown, numbers of infected people and deaths of Covid-19, and economic growth of countries: Lessons learned to cope with future pandemics similar to Covid-19 date: 2021-02-12 journal: Sci Total Environ DOI: 10.1016/j.scitotenv.2021.145801 sha: ac643d06a9b42e86d44c93169681cc2d19d635a3 doc_id: 893619 cord_uid: 7rn0mf1w How is the relation between duration of lockdown and numbers of infected people and deaths of Coronavirus disease 2019 (COVID-19), and growth level of Gross Domestic Product (GDP) in countries? Results here suggest that countries with a shorter period of lockdown (about 15 days) have confirmed cases divided by population higher than countries with a longer period of lockdown (about 60 days, i.e., 2 months); moreover, countries with a shorter period of lockdown have average fatality rate (5.45%) lower than countries with a longer length of lockdown (12.70%), whereas variation of fatality rate from March to August 2020 (first pandemic wave of COVID-19) suggests a higher reduction in countries with a longer period of lockdown than countries with a shorter duration (−1.9% vs. -0.72%). Independent Samples Test reveals that the fatality rate of countries with a shorter period of lockdown was significantly lower than countries with a longer period of lockdown (5.4% vs. 12.7%, p-value<.05). The Mann-Whitney Test confirms that fatality rate of countries with a shorter period of lockdown is significantly lower than countries having a longer period of lockdown (U = 0, p-value = .005). In addition, lockdowns of longer duration have generated negative effects on GDP growth: contraction of GDP (index 2010 = 100) from second quarter 2019 to second quarter of 2020 in countries applying a longer period of lockdown (i.e., about two months) is about −21%, whereas it is −13% in countries applying a shorter period of lockdown of about 15 days (significant difference with Independent Samples Test: t4 = −2.274, p-value < .085). This finding shows a systematic deterioration of economic system because of containment policies based on a longer duration of lockdown in society. Another novel finding here reveals that countries with higher investments in healthcare (as percentage of GDP) have alleviated fatality rate of COVID-19 and simultaneously applied a shorter period of lockdown, reducing negative effects on economic system in terms of contraction of economic growth. Overall, then, using lessons learned of COVID-19 pandemic crisis, this study must conclude that a strategy to reduce the negative impact of future epidemics similar to COVID-19 has to be based on a reinforcement of healthcare sector to have an efficient organization to cope with pandemics of new viral agents and to be able to minimize fatality rates, reducing at the same time restriction policies based on longer duration of lockdowns that generates negative effects on socioeconomic systems. 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)". This containment measure, in the presence of pandemics or epidemics, has a variable duration and a variety of restrictions, such as: school and workplace closing, cancellation of public/private events, closure of museums, banned mass gatherings in public and private places, stay at home requirements, reduction of internal mobility and international travel, maintain social distancing, etc. (Nicoll and Coulombier, 2009; Petherick et al., 2020) . Atalan (2020) argues that countries can start the public policy of lockdown when there is an acceleration of daily confirmed cases beyond a critical threshold and can stop it when there is a strong reduction of Intensive Care Unit (ICU) admissions. Tobías (2020, p. 2) states that: "Lockdown, including restricted social contact and keeping open only those businesses essential to the country's supply chains, has had a beneficial effect". Flaxman et al. (2020) show that lockdowns seem to have effectively reduced transmission of the COVID-19. Verma et al. (2020) argue that to reduce the spread of COVID-19, lockdown policy must be timely implemented and enforced, representing a step towards social distancing to decrease the impact of this pandemic in society. Tarrataca et al. (2021) suggest that the spread of COVID-19 generates consequential waves of decreasing amplitude and this dynamics persists even if the lockdown release is gradual. Lockdown generates different effects on manifold factors in society, such as on rate of mortality and of infection, Intensive Care Unit (ICU) admission, level of air pollution, growth of Gross Domestic Product (i.e., wealth) of countries, etc. (Chakraborty and Mait, 2020; Coccia, 2020 Coccia, , 2020a Coccia, , 2020b Coccia, , 2021 Coccia, , 2021a . Islam et al. (2020) argue that early application of lockdown can reduce the incidence of COVID-19 cases. In this context, the model by Balmford et al. (2020) reveals that countries with J o u r n a l P r e -p r o o f an immediate application of lockdown reduced deaths compared to countries that delayed the application of this strong containment measure. Chaudhry et al. (2020) show, analyzing fifty countries having high numbers of confirmed cases of COVID-19, that 40 countries applied a full lockdown, 5 a partial one and 5 curfew only with different effects. In addition, this study suggests that full lockdowns and decreased country vulnerability to biological threats were significantly associated with the increase of patient recovery rates (Chaudhry et al., 2020) . Gatto et al. (2020) maintain that restriction to mobility and to human interactions can reduce transmission dynamics of the COVID-19 by about 45%. Instead, Tobías (2020) shows that after the first lockdown in Spain and Italy, the slopes of daily confirmed cases, of deaths and of Intensive Care Unit (ICU) admissions have been flattened, but the dynamics of COVID-19 pandemic has not changed underlying trend that continued to increase. Instead, the second lockdown, based on stronger containment measures for mobility, seems to have reduced basic trend. Glass (2020, p.11) analyses four large countries in Europe and the USA: "The results indicate that relaxations took effect in terms of increasing numbers of cases with dates ranging from early June in some countries to mid-July in other countries. For the European countries, results suggest relaxations ranging from 31% to 57% are underway and if current trends continue unchecked could lead to significant second waves that last longer than the corresponding earlier waves. In the case of the US, where the number of cases has already peaked for a second time, an extended version of the model suggests that the level of transmission may now be similar to that after the first peak". Renardy et al. (2020) apply a model based on discrete and stochastic networks in a case study of Washtenaw County in Michigan (USA); results show that a delay of reopening does not reduce total impact of the second peak of confirmed cases, but only delays it. Simulations of this model reveal that a reduction of casual contacts between people can both J o u r n a l P r e -p r o o f delay and reduce the peak of the second wave of COVID-19 pandemic (Renardy et al., 2020) . New studies show that specific places have a high risk to be restaurants, cafeterias, gyms, stadium, discotheques, etc.) , generating a lot of infections (Chang et al., 2020) ; as a consequence, restricting maximum occupancy of these specific places is more effective than uniformly reducing mobility of people (Chang et al., 2020) . In the presence of pandemics, the possibilities that a mandatory lockdown will or will not be required at a later stage of the crises can depend on three aspects (Karnon, 2020) : 1) number of COVID-19 confirmed cases; 2) effects on the economy; 3) effects of quarantine on well-being of population. In particular, Karnon (2020, p. 330) argues that: "a longer but less intense period of social distancing is highly likely to reduce the economic and isolation effects of the crisis". Finally, Sabat et al. (2020) confirm that the COVID-19 pandemic acts as a social stressor, causing health and economic anxieties even in households that were not directly affected by the virus. However, in this vast literature, what is hardly known is how the duration of full lockdown to cope with COVID-19 pandemic has affected numbers of COVID-19 infected people and deaths, and growth of the Gross Domestic Product of nations. The investigation of this problem here is part of a large research project that analyses factors determining the transmission dynamics of the COVID-19 pandemic and public policies to constrain the impact of pandemic crisis in society. Results of the study here can explain, whenever possible, the effects in society of different durations of full lockdown, focusing on first wave of COVID-19 pandemic crisis in duration of full lockdown affects health of population and the dynamics of socioeconomic systems. The study is based on a specific analysis of six countries in Europe because they have a comparable institutional and socioeconomic background in this geographical area; countries under study are: Austria, France, Italy, Portugal, Spain and Sweden. In particular, these six European countries are homogenous units of investigation to support a case study research that captures the effects in society of lockdowns having a different length to cope with COVID-19 pandemic crisis. This case study research based on six countries may be conceptualized as a basis for a possible generalization of results to explain effects of lockdowns of different duration to design better public policies to cope with health and social threats of future infectious diseases in society (cf., Gomm et al., 2000 for different approaches of case study research ; Eisenhardt 1989, Eisenhardt and Graebner 2007 for supporting theoretical contributions from case study research). The study here considers data of confirmed cases, fatality rates and Gross Domestic Product (GDP) aggregates in countries under study after they have applied full lockdowns in the period from 15 April to 30 August 2020, time interval indicating the first wave of COVID-19 pandemic. These data provide important information to analyze the effects in society of lockdowns of different length to cope with COVID-19 pandemic crisis. Data of COVID-19 infected people and deaths are from Johns Hopkins Center for System Science and Engineering (2020); economic data are from Eurostat (2020); healthcare expenditures are also from Eurostat (2020a); finally, indicator of the structure of population is from Eurostat (2020b) too. The study, as said, is a specific analysis of six countries in Europe having a homogenous Secondly, the difference of arithmetic mean between countries with a shorter and longer period of lockdown is analyzed by Independent Samples t-Test, comparing the means of these two independent groups, just mentioned, to determine whether there is statistical evidence that associated population means are also significantly different. The null hypothesis (H 0 ) and alternative hypothesis (H 1 ) of the Independent Samples t-Test are: H 0 : µ 1 = µ 2 , the two population means are equal in countries with a shorter and longer period of lockdown H 1 : µ 1 ≠ µ 2 , the two population means are not equal in countries with a shorter and longer period of lockdown Considering the small sample of the study here, the nonparametric Mann-Whitney U Test is also applied to confirm whether there is a difference in dependent variable for these two independent groups. This U test compares whether the distribution of the dependent variable (i.e., confirmed cases standardized with population and fatality rate) is the same for the two groups under study and therefore from the same population. Thirdly, the study represents the trends, from April to August 2020, of the average infected individuals and fatality rates of two groups of countries under study, i.e.:  Countries with a shorter period of lockdown of about 15 days  Countries with a longer period of lockdown of roughly 61 days The study analyzes these trends with a simple regression model based on a linear relationship: Table 1 . Descriptive statistics between countries with a shorter and longer period of national lockdown, period April-August 2020 The difference of arithmetic mean and variation of confirmed cases standardized with population, and variation of fatality rates between countries with a shorter and a longer duration of lockdown is analyzed with Independent Samples t Test. In this context, the p-value J o u r n a l P r e -p r o o f of Levene's test is not significant, and we have to consider the output of "Equal variances assumed". Results show that there is a significant difference in average fatality rates (t 4 = 3.343, p-value < .05) between countries with a longer and a shorter duration of lockdown. In particular, the average fatality rate of countries with a shorter period of lockdown was 7.3 percent points lower than countries with a longer period of lockdown. Other differences are not significant (Table 2) . show that fatality rate in countries with a shorter period of lockdown is significantly lower than countries having a longer period of lockdown (U = 0, p-value = .005). Other differences are also here not significant. Finally, table 5 of estimated relationships does not provide significant results because of small sample under study. Figure 3 provides trends of confirmed cases and fatality rates that approximatively do not suggest a difference in the temporal dynamics of COVID-19 pandemic in countries with a longer or a shorter duration of national lockdown. In this context, Meo et al. (2020, p. 1) show that: "15 days after the lockdown there was a trend toward a decline, but no significant decline in the mean prevalence and mean mortality rate due to the COVID-19 pandemic compared to 15 days before, and 15 days during the lockdown in 27 countries. The mean growth factor for number of cases was 1.18 and for mortality rate was 1. Table 7 shows, considering the output of "Equal variances assumed", a significant difference in average GDP from second quarter in 2019 to second quarter in 2020 between countries with a longer and a shorter period of lockdown (t 4 = 2.274, p-value < .085). In particular, reduction of GDP aggregate (based on index 2010=100) in European countries applying a longer period of lockdown was about 7 points compared to countries applying a shorter period lockdown, likely due to systematic factors of deterioration in economic system given by negative impact of COVID-19 pandemic in society and also restriction policies on economic and social activities J o u r n a l P r e -p r o o f that have worsened structural indicators of economic system mainly in countries with longer periods of national lockdown (i.e., >61 days). The study is based on a specific comparative analysis of six countries in Europe because have a comparable institutional and socioeconomic background given by European area. In particular, this study analyzes how policy responses to cope with COVID-19 pandemic, based on a longer or a shorter duration of full lockdown, have affected COVID-19 infected people and deaths, and a main indicator of economic growth of nations (i.e., the GDP). Previous studies suggest that measures of containment can constraint the human-to-human transmission of infectious diseases in different ways (Atalan, 2020; Prem et al., 2020; Tobías, 2020) . However, to our knowledge, none investigations have performed a comparative analysis of the effects of a longer or a shorter period of national lockdown on rates of COVID-19 infected people and deaths, and on dynamics of economic growth. What this study adds to current studies on the COVID-19 global pandemic crisis is that a longer period of national lockdown to constraint the diffusion of COVID-19 does not seem to be associated with a significant reduction of infected cases on population and of fatality rates in society, whereas results here suggest that countries applying a longer duration of lockdown (> 61 days) generate a significant contraction of GDP growth with subsequent socioeconomic issues. To put it differently, the policy responses of lockdown at nation level seem to have a low effect in terms of significant reduction of COVID-19 infected cases and mortality rates, but a longer duration of national lockdown can slow down the dynamics of economic systems with consequent socioeconomic issues. These results can be schematically summarized in the figure 5. Table 8 . Descriptive statistics of factors associated with COVID-19 pandemic crisis between countries with higher and lower healthcare investments as % of GDP Results suggest that countries with a longer duration of national lockdown have a higher fatality rate of COVID-19 and the reasons can be explained with a lower average level of healthcare expenditure and an older structure of population (i.e., demographic structure has a higher median age in years) as indicated in Table 8 . Hence, many countries with lower investments in healthcare sector and older population were almost obliged to apply a longer duration of national lockdown aimed at delaying and reducing the height of epidemic peak, affording healthcare system more time to expand and respond to this emergency and, as a result reducing the expected negative impact of COVID-19 pandemic in society. However, this public policy of crisis management has a side effect given by a deterioration of structural indicators of economic system, generating a severe contraction of GDP growth with consequential socioeconomic issues, such as higher unemployment, high general government debt-to-GDP ratio, etc. (Coccia, 2017) . The contraction of economic growth can also trigger future reductions of investments in strategic sectors, such as health and research sector, which increased vulnerability of these nations to future pandemics similar to COVID-19 and other environmental threats (cf., Coccia, 2020) . In particular, table 8 reveals vital findings: countries with higher investments in healthcare (as percentage of GDP) have applied lockdowns of a lower duration, reducing the deterioration of economic system in terms of contraction of economic growth, and simultaneously, they have also a lower fatality rate of COVID-19 (because of a consistent healthcare structure), though a higher incidence of confirmed cases in population. In general, the policy response of lockdown has in theory the main goal, as containment measure, to reduce the impact of infectious diseases in society, but results here suggest that in the presence J o u r n a l P r e -p r o o f of pandemics a longer duration of full lockdown has contradictory and not significant effects on reduction of fatality rates but sure negative effects on economic systems compared to a shorter length of lockdown. Instead, higher investments in healthcare sector play a vital role to cope with unforeseen pandemics, alleviating mortality in society. Overall, then, lockdown as policy response to cope with COVID-19 pandemic crisis can generate different effects over time and space. The study here has explained the vital role of duration of full lockdown on COVID-19 infected people and deaths, and on dynamics of economic growth of six countries in Europe having a comparable institutional and socioeconomic background. In short, the results of this analysis are that: countries with a shorter duration of lockdown (about 15 days) are associated with lower average levels of confirmed cases/population (%) but they have a higher variation of confirmed cases/population (%) than countries with a longer duration of lockdown countries with a shorter period of lockdown are associated with an average level of fatality rates (%) lower than countries with a longer duration of lockdown, likely because of high investments in health sector. countries applying a longer duration of lockdown have had a contraction of GDP growth higher than countries with a shorter duration of lockdown (comparing the index of GDP of the second quarter 2020 to the indicator in the same period in 2019 and comparing GDP of the second quarter 2020 to the first quarter of 2020). To put it differently, the statistical analyses here seem in general to reveal that a longer duration J o u r n a l P r e -p r o o f of full lockdown at national level has contradictory and not univocal effects on reduction of COVID-19 infected people and deaths (i.e., it seems of not generate any significant reduction of confirmed cases and fatality rates), whereas can damage mechanisms of socioeconomic systems. Hence, results suggest that extensive and longer containment policies based on full lockdowns in the presence of widespread infectious diseases, such as COVID-19, can deteriorate economic system with uncertain benefits on health of people in terms of significant reduction of mortality. urgently need healthcare when hospitals are already filled to capacity (Caulkins et al., 2020) . Hence, the complex problem of epidemic threats has to be treated and solved with interdisciplinary approaches, considering both health and economic aspects, and applying whenever possible, containment policies on specific places having a high risk to be COVID-19 outbreaks, rather than general lockdowns of longer duration (Coccia, 2020c) . In fact, new studies reveal that a minority of places (such as restaurants, cafeterias, gyms, etc.) can generate a large number of infections; as result, selected containment measures in these places and facemask wearing can be more effective policies than national lockdown and uniform reduction of mobility of people (Coccia, 2020c; Chang et al., 2020; Renardy et al., 2020) . Janssen and van der Voort (2020) show positive effects of some countries that have applied the "smart lockdown" based on suggested and not mandated mitigation measures, focusing on responsibility of individuals. In short, general lockdown of longer duration can be substituted with selected policies having agility and speed of responses in specific places at high risk of infections to cope with social threat of new waves of COVID-19 and future similar epidemics/pandemics (Chang et al., 2020; Janssen and van der Voort, 2020; Renardy et al., 2020) . Finally, Evans and Bahrami (2020) pinpoint that super-flexibility can be an appropriate approach to cope with COVID-19 pandemic in which decision making is oriented to versatility, agility, and resilience. The most important finding of this study is that countries having a prior high investment in healthcare (as percentage of GDP) have the social and economic condition of alleviating fatality rate of the COVID-19 (or other infectious diseases) and simultaneously of applying a full lockdown of a lower duration, reducing the deterioration of economic system in terms of J o u r n a l P r e -p r o o f contraction of economic growth, though the risk of a higher incidence of confirmed cases in population. This evidence, of course, is based on a relation of association between variables under study rather than a relation of dependence, because of manifold confounding factors that influence variables under study (Sabat et al., 2020, p. 917) . In fact, the number of confirmed cases and fatality rates are affected by different factors, apart from the length of lockdown; this study has investigated some critical variables and there is need for much more detailed research of other factors associated with reduction of the spread of novel infectious diseases. The positive side of this study is that considers countries located in the same geo-economic area of Europe, having a similar socioeconomic structure, which is appropriate for comparative analyses to assess the effects of containment measures to cope with COVID-19 pandemic crisis. The negative side is a specific analysis of six countries in Europe and results are, of course, tentative. Future studies have to enlarge the sample with other countries, maintaining a comparable framework for performing much more detailed research to support the generalization of these critical findings. Overall, then, this study must conclude that an effective strategy to reduce the negative impact of future epidemics/pandemics similar to COVID-19 has to be based on preventive high investments in healthcare sector to create an prearranged efficient organization directed to cope with pandemics of new viral agents, able to minimize fatality rates, and not apply general lockdowns of longer duration that generate ambiguous results on health of people (in terms of significant reduction of fatality rate) but sure negative effects on structural indicators of economic systems with consequential socioeconomic issues. The author declares that he has no known competing financial interests or personal relationships J o u r n a l P r e -p r o o f 1.000 b) 1.000 b) Note: a) Grouping Variable: groups; b) Not corrected for ties. Note: countries with high investments in healthcare (% of GDP) > 9.93% (arithmetic mean of countries under study); countries with low investments in healthcare (% of GDP)  9.93% (arithmetic mean of countries under study); Purchasing power standard (PPS) per inhabitant; GDP=Gross Domestic Product. J o u r n a l P r e -p r o o f Highlights  A longer period of lockdown has a negative impact on economic growth  A longer period of lockdown does not reduce significantly fatality rate  Countries with a weak healthcare sector apply a longer duration of lockdown  High healthcare expenditures (as % of GDP) reduce COVID-19 fatality rates  An efficient strategy for future pandemics is to increase healthcare investments J o u r n a l P r e -p r o o f Journal Pre-proof Technological exaptation and crisis management: Evidence from COVID-19 outbreaks Is the lockdown important to prevent the COVID-19 pandemic? 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