Five years on: The countries that never locked down for Covid-19

Most of the world found itself confined to their homes in March 2020 as Covid-19 spread at a blistering pace. Some countries didn't impose any lockdown restrictions – so was their decision the right one?

In March 2020, billions of people stared out through their windows at a world they no longer recognised. Suddenly confined to their homes, their lives had shrunk abruptly to four walls and computer screens.

Around the world, national leaders appeared on television, telling them to stay put – only leave the house to buy essential supplies or for once-daily exercise, maybe. It was a last-ditch attempt to curb the spread of a terrifying virus that had already killed many thousands of people worldwide.

In London, theatre worker Tony Beckingham and his partner decided to use their daily exercise to cycle into the centre of the city one evening. "We thought it'd be really fun to see no-one around," he says. It wasn't. Places the pair knew well, like Piccadilly Circus and Leicester Square, perennially abuzz with people, were chillingly quiet. "It was really upsetting – instantly," says Beckingham.

This deletion of the public from city streets, venues and businesses first began in China, where Covid-19 emerged. Quarantine orders were soon replicated in other countries after the World Health Organization (WHO) declared a pandemic on 11 March 2020. At no prior point in human history have people faced restrictions like this on such a scale.

But a handful of countries did things differently. Sweden, Taiwan, Uruguay, Iceland and a few others never enacted a lockdown that involved severe restrictions on the movement of people, such as legally binding stay-at-home orders applied across large swathes of the population. Those countries instead chose other measures, such as restrictions on large gatherings of people, extensive testing and quarantining infected people or travel restrictions.

Five years later, the scientific studies and data have piled up, offering a detailed, long-term assessment of whether these countries were right to reject this most drastic of public health interventions.

The Swedish city of Gothenburg is a haven for dog-lovers, says HR administrator and blogger Anna Mc Manus, "We have a very dog-friendly city here," she says. "We even have a dog-friendly cinema." As countries around the world, including Sweden's neighbours Norway, Finland and Denmark, ushered in national lockdowns in March 2020, Mc Manus was aware that her own government had decided to buck the trend.

She heard how dog owners in some nations couldn't even take their pets out for walks because of lockdown rules. South Africa was one such country. This struck Mc Manus as terrible. At the time, she wrote a blog post in which she said, "I am convinced that my government is acting in a secure and correct way". However, she also expressed concern that her fellow Swedes were not always following the official public health guidelines around social distancing, such as limiting the number of people who could meet together in a group.

Mc Manus remembers taking frequent walks in beauty spots, but also that she and her colleagues continually wore masks to help prevent Covid-19 transmission at the veterinary hospital where she worked in 2020. Plus, she and her partner avoided restaurants and meeting up with lots of other people. Even now, Mc Manus says she is not sure what to make of Sweden's official strategy.

"I want to base it on facts – like how many people died," she says. "Could we have saved a lot more people if we had had a lockdown?"

Scientists have tried to answer that question. Ingeborg Forthun at the Norwegian Institute of Public Health and researchers in other countries including Sweden published a study in May 2024 that compared excess deaths in Sweden, Norway, Denmark and Finland during the first years of the pandemic.

While Sweden avoided strict government imposed controls, instead relying mainly on voluntary behavioural changes from is citizens, the other three nations imposed strict lockdowns in the early stages of the pandemic. Norway, Finland and Denmark closed schools and most other aspects of public life while also asking people to work from home, but they stopped short of confining people to their homes in the way other countries such as the UK did.

Perhaps unsurprisingly, the researchers found a noticeable spike in excess deaths in Sweden during the initial waves of the pandemic during the spring and winter of 2020, when Covid-19 was able to spread more freely than in neighbouring nations. But while excess mortality fell in the three other countries in 2020, it rose compared to Sweden in 2021 and 2022.

"The four countries have a comparable number of excess deaths when you account for the fact that population sizes differ," says Forthun. What lockdowns did affect, in part, was the timing of when spikes in excess deaths occurred. Of Norway's approach, Forthun adds: "We probably kept some older and vulnerable people alive for a longer period." Whereas authorities in Sweden were criticised in 2020 over high numbers of deaths at care homes.

Some economists have combined similar data with comparisons of economic performance indicators between the same four Nordic countries to argue that, overall, Sweden's approach was justified due to the relatively low economic costs. But such arguments are controversial and the lack of a lockdown in Sweden remains an area for heated debate among some.

Another study by a group of German economists – who modelled how a lockdown could have affected pandemic outcomes in Sweden – suggests that the substantial voluntary restraints enacted by people in the country appear to have replicated some of the effects of a lockdown anyway.

One Swedish epidemiologist, Nele Brusselaers, of the Karolinska Institute, has criticised her country's Covid-19 strategy. She moved to Belgium during the pandemic.

"I'm a medical doctor so of course I care about lives," she says. "We want to save every single life." She says many of her fellow Swedes are "still in denial" about Covid-19 though some have come to question the lack of lockdown in recent years.

Brusselaers, who lived in Sweden in 2020, notes how her posts about Covid-19 on social media resulted in fierce pushback from some who disagreed with her stance on lockdown as an appropriate strategy. "You get so much hatred," she says. "That's not something I was used to."

Even today, some people find it hard to move past the hostility they faced on the topic of lockdowns. One university researcher approached by the BBC for this article said they were so traumatised by the abuse they received online in 2020 that they never intended to comment on Covid-19 control measures, or lockdowns, publicly again.

Furthermore, some people who lived in countries without lockdowns, and who disagreed with their government's approach, are still reeling from the experience. Tanzania never had any Covid-19 lockdowns. The country's former President, John Magufuli, who dismissed lockdowns and other public health interventions, died in 2021. Magufuli's approach to the pandemic was "unscientific", says history lecturer Fadhili Mtani at the Muslim University of Morogoro in Tanzania. "He advocated for traditional herbs and later he rejected vaccines."

But Mtani recalls visiting hospitals where members of his own family had passed away of an illness. "I saw people suffocating in the hospitals," he says. "The hospital said we should not say it's Covid." Official figures suggest around 840 people have died of Covid-19 in Tanzania since the start of the pandemic. Mtani says that the government has not made accurate statistics available, however. An international collaboration aimed at estimating the global excess deaths during the first two years of the pandemic has put the total number of deaths in Tanzania at somewhere between 102,000-188,000.

Mtani argues that Tanzania should have enforced a lockdown, though without placing excessive restrictions on the movement of workers. "The majority of people are poor. To deny movement for them is to deny their existence," Mtani explains.

Many scientists emphasise that lockdowns were crucial for saving lives in the early part of the pandemic, before vaccines were available, and also for limiting the pressure on health services. By March 2020, this pressure was already severe in the UK, says Adam Kucharski, professor of infectious disease epidemiology, at the London School of Hygiene & Tropical Medicine. "The NHS was overwhelmed," Kucharski explains, referring to the emotional testimony of doctors who have spoken to the UK's public inquiry into the government’s Covid-19 response. "It's ridiculous to suggest [the NHS] wasn't under effectively breaking pressure by that point," adds Kucharski.

Kucharski also says that, because of the UK's global connections and the large number of young people who live together or with their parents compared to Sweden, for example, it might have been much harder for the UK to control Covid-19 transmission without imposing a lockdown.

He also points to a 2021 study that attempted to quantify the effect of specific government interventions on the spread of Covid-19, using data from 41 countries. It reveals that certain aspects of national lockdowns might have been more impactful than others. The researchers found, for example, that banning gatherings of more than 10 people or closing schools and universities was especially effective, reducing transmission by more than 35% on average. Shutting restaurants and bars seemed to make slightly less difference to transmission, however.

What's more, the researchers suggest that adding a strict stay-at-home order on top of such measures "only had a small additional effect" in terms of slowing down Covid-19 – estimated at below 17.5% on average.

Countries that chose not to lock down severely may also have had more time to prepare for the arrival of Covid-19, or social and structural reasons as to why the Sars-CoV-2 virus was less likely to spread quickly there versus other nations. Even then, there are surprising comparisons to be made. Take Iceland and New Zealand, for instance. Both are wealthy island nations with relatively small populations but while New Zealand introduced a strict lockdown on 25 March 2020, Iceland never did.

"They [Iceland] had more of a mitigation strategy," says Leah Grout, a research data analyst specialising in public health at the Southern California University of Health Sciences. Grout was lead author on a research paper about the contrasting Covid-19 strategies and outcomes of these two countries. Iceland introduced a test and trace programme, in which infections and contacts between people were monitored so that individuals – rather than entire populations – were asked to observe quarantine for a time. This measure was also used in many countries that also applied lockdowns, when those lockdowns were lifted. Iceland had some restrictions on social gatherings and it did close its borders to some travellers, briefly.

"New Zealand had one of the lowest mortality rates globally with their approach," says Grout. "Iceland also fared pretty well." Plus, the economic impacts on both countries were limited, she adds. Other researchers have made similar findings regarding New Zealand and Iceland.

Much was written in 2020 about various countries' efforts to tackle the Covid-19 pandemic. But, in retrospect, that seems much too early to come to any real conclusions. Uruguay was lauded at the time for apparently managing to keep Covid-19 at bay, despite never enacting a strict lockdown. The country's government enforced some forms of social distancing, including the closure of some gyms, and Uruguay's borders were also closed to certain travellers, for instance. But ports remained open and there was no stay-at-home order affecting the entire population.

A study published in 2024 found that, while excess deaths were low in Uruguay during 2020, they actually rose substantially in 2021 and 2022. Excess deaths in 2021, for example, were nearly 19% above the expected figure, based on historical trends. The study's authors put this down mostly to the spread of Covid-19 but add that impacts from the pandemic on the ability to provide healthcare in other ways probably also played a role.

Similarly, Japan was able to keep mortality from Covid-19 to a relatively low level in the early part of the pandemic. By the summer of 2022, Covid-19 deaths had reached 36,200. Today, they stand at 130,000.

So, what happened in the interim? The Omicron variant. New, mutated forms of the early Sars-CoV-2 virus that spread worldwide in 2022 and 2023.

Some researchers argue that Japan’s approach proved to be the right one overall. "Even without lockdown, suppression of epidemic curves has been largely successful," argues Hiroshi Nishiura, a professor in the graduate school of medicine at Kyoto University.

However, as in other countries where legally binding lockdowns did not come into force, there is evidence that people in Japan changed their behaviour significantly anyway. One study of people's movements based on mobile phone data suggests that, when the Japanese government declared a nationwide state of emergency in April 2020, people in Tokyo reduced their outings from home roughly as much as people in the US who, conversely, faced legally binding lockdowns.

Despite this, Yasuharu Tokuda, a clinical epidemiologist and director of the Muribushi Okinawa Center for Teaching Hospitals in Okinawa, Japan, argues that a tougher approach might have been beneficial. "Some patients could not be admitted to the hospital because of the lack of available beds," he says. "If we have a strong viral pandemic, then we need to have a stricter lockdown in Japan." Research suggests that there might be resistance to such an idea among members of the public in Japan, however.

It is important to reflect on just how drastic a measure lockdown really is. Kucharski, for one, calls it a "blunt" tool. "We should never have got to that point where we were in so much trouble, with so little visibility of what the pandemic was doing," he says. It was due to a lack of certainty over what would happen next, and a dearth of other interventions on the table, that the UK was more or less forced into lockdown, he suggests.

Many have still not got over the effects of lockdown. In March 2020, Bill Allison, a former civil servant in Scotland, was in his mid-60s. He had many plans for his retirement – he wanted to see the world. Back then, Allison was also an avid pub-goer who frequently met up with his friends for a pint. Lockdown stopped him in his tracks. He says he followed the rules at all times but this left him feeling a profound sense of loneliness and isolation.

"I gathered up all the scraps of wood that I had and decided to see if I could make them into an electric guitar," he says. "I would work late at night. There was nothing else to do, really." He found a guitar-making group online, through which he met people with similar interests. "I made quite a lot of new friends."

But when the world gradually began to open up again, Allison was struck by a strong sense of what he had been missing and was hard to regain.

"The pub near me, it's nothing like as busy as it was before Covid," he says. "I became quite introverted and now I find I don't want to interact with people as much as I did before. I was discussing it with a few of my friends. […] We all feel very unhappy."

Soon to turn 72, Allison says his pre-pandemic travel plans remain on hold. "I'm kind of getting to the age where I don't really want to do a nine-hour flight to the other side of the world anymore. It's kind of knocked me back."

Countless studies show that social isolation and loneliness affected thousands of people during the pandemic, and that this was a particularly acute problem during national lockdowns. There were negative impacts on single parents, also, who found it harder to earn an income while looking after their children. There were also concerns that the sudden loss of social interaction and access to education effected the development of young children, with some evidence pointing to an impact on their language skills. More than one billion children and students found themselves shut off from their usual methods of learning. Recently published research using data from 72 countries suggests that the closure of schools during the pandemic may have led to a decline in mathematics scores by an average of 14% – equivalent to seven months of learning.

In countries including the UK, lockdown was associated with a rise in domestic abuse. And, what's more, lockdowns had a huge impact on access to healthcare. Many people found their cancer screenings and treatments were cancelled or delayed, for example.

As for potential benefits of lockdowns not related to Covid-19 transmission, much was made of temporary reductions in air pollution and carbon emissions as a result of the restrictions imposed during the early stages of the pandemic. These turned out to be a temporary blip as greenhouse gas emissions resurged and air quality dipped once people emerged from their confinement.

Authorities in some countries that attempted to enforce strict lockdowns and a "zero Covid" policy were greeted with violent protests from members of the public. Some widely publicised cases of this emerged in China during 2022.

There is no getting away from the fact that a sweeping stay-at-home order is an extreme intervention, and one that comes with heaps of negative consequences. Governments in 2020 had to weigh up whether they could successfully enforce such a measure, and whether it was really worth it.

Unless, of course, they had an alternative. The government in Taiwan, for example, never imposed a lockdown and instead relied on near-universal mask-wearing, border restrictions and intensive contact tracing, which involved access to lots of personal data. This included commuters' smart card information and mobile phone location data. Some of this monitoring was exhaustive.

"[Taiwan Centers for Disease Control] also set up a smartphone-based real-time locating system to track contacts' phone signals and alert local authorities if anyone left their designated location or switched off their phone. Authorities would contact or visit those who triggered an alert within 15 minutes in person," one paper notes.

Essentially, Taiwan (and later South Korea, which to some extent mirrored Taiwan's approach) avoided lockdown through fine-grained monitoring and control of an entire population. Even in Taiwan, however, Covid-19 outbreaks caused problems. Initially, in the first half of 2021 and then again in 2022, cases surged as some preventative measures in the country, and the population itself, started to relax. Researchers note, though, that Covid-19 deaths became less common over time, as Taiwan's health authorities rolled out vaccines to the population.

While these case studies of various countries show that it was clearly possible to tackle the Covid-19 pandemic without resorting to national lockdowns, the end results seem to depend on the attributes of specific countries, their populations, and their healthcare systems. Ultimately, the vast majority of nations did enact lockdowns at some point during 2020 or 2021 and it would be hard to suggest that they are all significantly worse off because of that intervention, specifically.

Still, five years later, the harshness of lockdowns and their effects on millions if not billions of people has become clearer. Even some researchers who have found evidence that lockdowns saved lives have cautioned against turning to this measure in haste in the future. The longer-term effects on children, education and economies are still playing out and will likely not be fully understood for many years to come.

Whatever governments decide to do, having a plan that they communicate in advance of any new pandemic will likely improve public acceptance of and adherence to any strict mitigations, says Grout. "It needs to be super clear." That means everyone could know ahead of time what circumstances would trigger a lockdown.

In Gothenburg, Mc Manus remembers the debates she once had with her fellow Swedes over whether her country was doing the right thing in 2020. And how some people seemed cavalier or uninterested in observing social distancing guidelines at the time.

"You don't even talk about it anymore," she says, "Thinking back, I feel like, as a society, did we really learn anything from this?"

Source: BBC