Sure, love thy lockdown, but there’s no evidence to say it’s best done with force

Victoria’s stage four lockdown has been extended for a further two weeks, after which the state moves to a slightly easier stage three.

Although business has complained, it may well prove as popular with the electorate as the second wave measures previously announced.  

The immediate reason why the lockdown is popular is obvious — it helps suppress and (people hope) eliminate the virus.

The puzzling aspect, however, is the degree of support for the methods used. Although medical evidence suggests lockdown helps control virus spread, there is little evidence it needs to be done by force. 

Yet many people of goodwill support not only the lockdown but also hardline policy and military style enforcement of the rules. It appears they have bought the line that there is no alternative.  

Margaret Thatcher in the UK famously used the phrase “there is no alternative” for her market reforms. It suits hardline or controversial policies — dismissing any possibility of argument. Victorian officials frequently use the phrase in relation to lockdowns.

There is justification for the claim in relation to distancing, isolation and quarantine. Public health officials have no real alternatives in the face of a contagious and frequently deadly virus for which there is no vaccine.

But clearly there are alternatives when it comes to how these measures are enforced. Quarantine and distancing are evidence based, supported by the medical profession, and good options for stopping COVID-19.

There, however, appear to be few if any evidence-based articles in medical journals saying the best way to ensure distancing is to bring in the army, institute curfews or have armed police knocking on doors.

A search turned up only one comment along these lines, from a security academic, not an epidemiologist. Indeed, much medical evidence runs counter to the use of armed force.

A rapid review of the literature in the journal Public Health in May found the main factors in adherence to quarantine were knowledge people had about the disease, social norms, perceived benefits of quarantine and perceived risk of the disease.  

A study of the 2003 SARS outbreak in Toronto found the threat of enforcement had less effect on compliance than did the credibility of monitoring. Fighting boredom and other psychological stresses, muting stigma and delivering effective and believable communications to a population of mixed cultures and languages were critical.

There are many similar articles. 

One can see the attractions of using heavy policing and bringing in the army. Since the invention of firearms, military dictators and muggers everywhere have found them persuasive. Pointing a gun will typically make someone obey lockdown laws.

The question is, are there other and better ways?

There probably are — at least, ones worth investigating.

Public information, to encourage communities to develop their own social norms, is effective in public health.  

It works for vaccines which protect the community from diseases, some worse than COVID-19. We don’t send soldiers to stand over parents and make them immunise their kids, yet almost 95% of kids are immunised (more than 95% for Aboriginal and Torres Strait islander kids).

The minority anti-vaxxers are addressed through communications, social pressure and financial disincentives, not armed force.

COVID lockdowns could also use positive incentives, like cash payments, for those who do the right thing rather than punishing those who don’t.

The attraction of armed force for governments is that they control it, can see how it works. If there are alternatives, how would a government know they worked better? 

One good way would be to test them. These days, effective governments test different approaches. The premier’s department has a behavioural insights (or nudge) unit; part of its mandate is to conduct trials. 

But unless a government is prepared to ask questions through trials and testing, we have self-fulfilling slogan: there is no alternative because the government has decided there is none.

In public policy there are always options. It would be astounding if the Victorian government had not been presented options for how to handle lockdown. 

It would be reassuring if we knew the bureaucracy had pointed out the problems with authoritarian approaches — but that there were countervailing reasons for them (so far not disclosed). There would have been alternatives — and a choice would have been made for sound reasons rather than a slogan.

Reliance on authoritarian measures undermines democratic values and social cohesion. For the wealthy and influential they have few negatives, while they harm those at the margins: people, for example, with poor English or literacy, poor relationships with the police, insecure housing or other disadvantages. 

People who fled, or whose ancestors fled, oppressive regimes are especially vulnerable.

Curfews have always been one of the main ways dictators keep people in fear and unable to support each other.

Police knocking on doors to check who is at home and demands that travellers show their permits, might have good health intentions behind them, but for some in the community they bring back memories of terror and oppression.

If the medical evidence is not enough, for social cohesion alone it is worth trying to find more sensitive ways to encourage lockdown and distancing.