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 Science of the Total Environment 775 (2021) 145801

Contents lists available at ScienceDirect

Science of the Total Environment

journal homepage: www.elsevier.com/locate/scitotenv

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 and to
constrain the deterioration of economic system
Mario Coccia
CNR — National Research Council of Italy, Via Real Collegio, n. 30 (Collegio Carlo Alberto), 10024 - Moncalieri (Torino), Italy

H I G H L I G H T S G R A P H I C A L A B S T R A C T

• A longer period of lockdown has a nega-

tive impact on economic growth.
• A longer period of lockdown does not
reduce significantly fatality rate.
• Countries with a weak healthcare sector
apply lockdown of longer duration
• High healthcare expenditures (as % of
GDP) reduce COVID-19 fatality rates.
• An efficient strategy for future pandemics
is to increase healthcare investments.

a r t i c l e i n f o a b s t r a c t

Article history: How is the relation between duration of lockdown and numbers of infected people and deaths of Coronavirus dis-
Received 22 October 2020 ease 2019 (COVID-19), and growth level of Gross Domestic Product (GDP) in countries? Results here suggest
Received in revised form 7 February 2021 that, during the first wave of COVID-19 pandemic, countries with a shorter period of lockdown (about
Accepted 7 February 2021
15 days: Austria, Portugal and Sweden) have average confirmed cases divided by population higher than coun-
Available online 12 February 2021
tries with a longer period of lockdown (about 60 days, i.e., 2 months: France, Italy and Spain); moreover, coun-
Editor: Jay Gan tries with a shorter period of lockdown have average fatality rate (5.45%) lower than countries with a longer
length of lockdown (12.70%), whereas average variation of fatality rate from March to August 2020 (first pan-
Keywords: demic wave of COVID-19) suggests a higher reduction in countries with a longer period of lockdown than coun-
COVID-19 tries with a shorter duration (−1.9% vs. −0.72%). Independent Samples Test reveals that average fatality rate of
Lockdown countries with a shorter period of lockdown was significantly lower than countries with a longer period of lock-
Crisis management down (5.4% vs. 12.7%, p-value<.05). The Mann-Whitney Test confirms that average fatality rate of countries with
COVID-19 mortality a shorter period of lockdown is significantly lower than countries having a longer period of lockdown (U = 0, p-
Infected people
value = .005). In addition, results show that lockdowns of longer duration have generated negative effects on
Pandemic crisis
GDP growth: average contraction of GDP (index 2010 = 100) from second quarter 2019 to second quarter of
Health policy
Healthcare sector 2020 in countries applying a longer period of lockdown (i.e., about two months) is about −21%, whereas it is
Economic growth −13% in countries applying a shorter period of lockdown of about 15 days (significant difference with Indepen-
Stay-at-home dent Samples Test: t4 = −2.274, p-value < .085). This finding shows a systematic deterioration of economic sys-
Business closures tem because of containment policies based on a longer duration of lockdown in society. Another novel finding
Nonpharmaceutical interventions here reveals that countries with higher investments in healthcare (as percentage of GDP) have alleviated fatality
rate of COVID-19 and simultaneously have 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 the first

E-mail address: [email protected].

https://doi.org/10.1016/j.scitotenv.2021.145801
0048-9697/© 2021 Elsevier B.V. All rights reserved.
M. Coccia Science of the Total Environment 775 (2021) 145801

wave of COVID-19 pandemic crisis, this study must conclude that a strategy to reduce the negative impact of fu-
ture epidemics similar to COVID-19 has to be based on a reinforcement of healthcare sector to have efficient
health organizations to cope with pandemics of new viral agents by minimizing fatality rates; finally, high invest-
ments in health sector create the social conditions to apply lockdowns of short run with lower negative effects on
socioeconomic systems.
© 2021 Elsevier B.V. All rights reserved.

1. The problem transmission of the COVID-19. Verma et al. (2020) argue that to reduce
the spread of COVID-19, lockdown policy must be timely implemented
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the and enforced, representing a step toward social distancing to decrease
strain of novel coronavirus that causes the Coronavirus Disease 2019 the impact of this pandemic in society. Tarrataca et al. (2021) suggest
(COVID-19). The World Health Organization (WHO) states, on 11 that the spread of COVID-19 generates consequential waves of decreas-
March 2020, that COVID-19 is characterized as a pandemic. COVID-19 is ing amplitude and this dynamics persists even if the lockdown release is
predominantly a respiratory illness that can affect other organs, generat- a gradual process. Lockdown generates different effects on manifold fac-
ing a wide range of symptoms from mild respiratory disorders to severe tors in society, such as on rate of mortality and of infection, Intensive
pneumonia and death (Coccia, 2020a, 2021a). In the presence of COVID- Care Unit (ICU) admission, level of air pollution, growth of Gross
19 pandemic crisis, and in general of epidemics of novel viruses without Domestic Product (i.e., wealth) of countries, etc. (Chakraborty and
appropriate treatments based on effective antiviral drugs and/or new vac- Maity, 2020; Coccia, 2020a, 2020b, 2020c, 2021a, 2021b). Islam et al.
cines, governments can cope with health emergencies with containment (2020) argue that early application of lockdown can reduce the inci-
measures based on restriction policies, such as stay-at-home, business dence of COVID-19 cases. In this context, the model by Balmford et al.
closures, full lockdown in society, etc. (Ardito et al., 2021; Atalan, 2020; (2020) reveals that countries with an immediate application of lock-
Coccia, 2020b; Liu et al., 2021; Mahato et al., 2020; Tobías, 2020). down reduced deaths compared to countries that delayed the applica-
In this context, the main goal of this study is to explain how the du- tion of this strong containment measure. Chaudhry et al. (2020) show,
ration of lockdown, applied to constraint COVID-19 pandemic, can affect analyzing fifty countries having high numbers of confirmed cases of
rates of infected people and deaths, and growth of Gross Domestic COVID-19, that 40 countries applied a full lockdown, 5 a partial one
Product (in short, GDP) of nations. This study focuses on data of the and 5 curfew only with different effects. In addition, this study suggests
first wave of COVID-19 pandemic (from March to August 2020) in six that a decreased country vulnerability to biological threats was signifi-
European countries that have applied lockdowns of different duration cantly associated with the increase of patient recovery rates
to analyze effects in society directed to design effective public responses (Chaudhry et al., 2020). Gatto et al. (2020) maintain that restriction to
for constraining future pandemic waves of the COVID-19 and similar in- mobility and to human interactions can reduce transmission dynamics
fectious diseases within and between countries, and at the same time of the COVID-19 by about 45%. Instead, Tobías (2020) shows that after
for alleviating negative effects on economic system. the first lockdown in Spain and Italy, the slopes of daily confirmed
cases, of deaths and of Intensive Care Unit (ICU) admissions have been
2. Theoretical framework flattened, but the evolution of COVID-19 pandemic has not changed un-
derlying dynamics that continued to increase. Instead, the second lock-
What is already known on these topics is based on different studies. down, based on stronger containment measures for mobility, seems to
Nicoll and Coulombier (2009, p. 3ff) argue that containment measures have reduced basic trend of growth. Glass (2020, p.11) analyzes four
have the goal to stop as many transmissions of infectious diseases as large countries in Europe and the USA: “The results indicate that relax-
possible. In particular, governments can constrain/prevent chains of ations took effect in terms of increasing numbers of cases with dates
transmission and outbreaks through different restriction policies ranging from early June in some countries to mid-July in other coun-
based on quarantine of people, social distancing, business closures, full tries. For the European countries, results suggest relaxations ranging
lockdown, etc. or a combination of these measures (Atalan, 2020; from 31% to 57% are underway and if current trends continue un-
Petherick et al., 2020). The crux of the study here is rooted in the con- checked could lead to significant second waves that last longer than
cept of lockdown as policy response of countries to cope with diffusion the corresponding earlier waves. In the case of the US, where the num-
of pandemics in society and some brief backgrounds are useful to un- ber of cases has already peaked for a second time, an extended version
derstand and clarify it. The dictionary of Merriam-Webster (2021) de- of the model suggests that the level of transmission may now be similar
fines lockdown as: “a temporary condition imposed by governmental to that after the first peak”. Renardy et al. (2020) apply a model based on
authorities (as during the outbreak of an epidemic disease) in which discrete and stochastic networks in a case study of Washtenaw County
people are required to stay in their homes and refrain from or limit ac- in Michigan (USA); results show that a delay of reopening does not re-
tivities outside the home involving public contact (such as dining out or duce total impact of the second peak of confirmed cases, but only delays
attending large gatherings)”. This containment measure, in the pres- it. Simulations of this model reveal that a reduction of casual contacts
ence of pandemics or epidemics, has a variable duration and a variety between people can both delay and reduce the peak of the second
of restrictions, such as: school and workplace closing, cancellation of wave of COVID-19 pandemic (Renardy et al., 2020). New studies show
public/private events, closure of museums, banned mass gatherings in that specific places have a high risk to be COVID-19 outbreaks
public and private places, stay at home requirements, reduction of inter- (e.g., restaurants, cafeterias, gyms, stadium, discotheques, etc.), generat-
nal mobility and international travel, maintain social distancing, etc. ing a lot of infections (Chang et al., 2020); as a consequence, the restric-
(Nicoll and Coulombier, 2009; Petherick et al., 2020). Atalan (2020) ar- tion of maximum occupancy in these specific places is more effective
gues that countries can start the public policy of lockdown when there is than uniformly reducing mobility of people (Chang et al., 2020). More-
an acceleration of daily confirmed cases beyond a critical threshold and over, in the presence of pandemics, the possibilities that a mandatory
can stop it when there is a strong reduction of Intensive Care Unit (ICU) lockdown will or will not be required at a later stage of health crises
admissions. Tobías (2020, p. 2) states that: “Lockdown, including re- can depend on three aspects (Karnon, 2020): 1) number of COVID-19
stricted social contact and keeping open only those businesses essential confirmed cases; 2) effects on the economy; 3) effects of quarantine
to the country's supply chains, has had a beneficial effect”. Flaxman et al. on well-being of population. In particular, Karnon (2020, p. 330) argues
(2020) show that lockdowns seem to have effectively reduced that: “a longer but less intense period of social distancing is highly likely

2
M. Coccia Science of the Total Environment 775 (2021) 145801

to reduce the economic and isolation effects of the crisis”. Finally, Sabat Product (GDP) based on chain linked volumes, using index 2010 =
et al. (2020) confirm that the COVID-19 pandemic acts as a social 100. The accounting period is the calendar quarter (Q) based on
stressor, causing health and economic anxieties even in households 2019-Q2, 2020-Q1 and 2020-Q2 (Q1 = January, February, March;
that were not directly affected by the novel coronavirus. Q2 = April, May, June). Quarterly national accounts are vital data for
However, in this vast literature, what is hardly known is how the economic analysis to assess the dynamics of business cycles
duration of full lockdown to cope with COVID-19 pandemic has affected supporting long-run economic growth of countries.
numbers of COVID-19 infected people and deaths, and growth of the ▪ Total healthcare expenditure quantifies the economic resources dedi-
Gross Domestic Product of nations. The investigation of this problem cated to health functions. Healthcare expenditure concerns healthcare
here is part of a large research project that analyzes factors determining goods and services that are consumed by resident units. Unit of mea-
the transmission dynamics of the COVID-19 pandemic and public policies sure of healthcare expenditure is given by annual Euro per inhabitant,
to constrain the impact of pandemic crisis in society. Results of the study Purchasing power standard-PPS-per inhabitant, and healthcare ex-
here can explain, whenever possible, the effects in society of different penditure as percentage of Gross Domestic Product-GDP in 2018.
durations of full lockdown, focusing on first wave of COVID-19 pandemic ▪ Structure of population is measured with median age of population in
crisis in 2020, to design effective strategies to cope with future waves of 2019. Median age divides a population into two numerically equal
COVID-19 and similar epidemics of infectious diseases, and constrain the groups: half the people are younger than median age and half are
deterioration of driving forces of economic growth. older.

3. Materials and methods 3.3. Data analysis procedure

This study has the primary objective to explain how, in the presence The six countries under study are categorized in two groups, coun-
of COVID-19 pandemic, the duration of full lockdown has affected the tries with a shorter period of lockdown and countries with a longer pe-
health of population and the dynamics of socioeconomic systems. The riod of lockdown:
study is based on a specific analysis of six countries in Europe because
they have a comparable institutional and socioeconomic background □ Countries with a shorter period of lockdown are (about 15 average
based on a similar geographical area. Countries under study here are: days of full lockdown):
Austria, France, Italy, Portugal, Spain and Sweden. In particular, these – Austria from March/16/2020 to April/13/2020, 29 days
six European countries are homogenous units of investigation to sup- – Portugal from March/19/2020 to April/2/2020, 15 days
port a case study research that captures the effects in society of lock- – Sweden did not apply any lockdown
downs having a different length to cope with COVID-19 pandemic
crisis. This case study research based on six countries may be conceptu- □ Countries with a longer period of lockdown are (roughly 61 average
alized as a basis for a possible generalization of results to explain effects days of full lockdown; i.e. two months):
of lockdowns of different duration to design better public policies to – France from March/17/2020 to May/11/2020, 56 days
cope with health and socioeconomic threats of future infectious dis- – Italy from March/09/2020 to May/18/2020, 71 days
eases in society (cf., Gomm et al., 2000 for different approaches of case – Spain from March/14/2020 to May/09/2020, 57 days.
study research; Eisenhardt, 1989, Eisenhardt and Graebner, 2007 for
supporting theoretical contributions from case study research).
Firstly, data are analyzed with descriptive statistics, applying a com-
3.1. Data parative approach between countries with a longer and a shorter period
of lockdown, considering arithmetic mean and standard deviation of
The study here considers data of confirmed cases, fatality rates and confirmed cases (standardized with population) and fatality rates
Gross Domestic Product (GDP) levels in countries under study here (i.e., average values from April to August 2020 between countries), of
that have applied full lockdowns of different duration in the period indexes of the quarterly national accounts of GDP level in 2019 and
from 15 April to 30 August 2020, a time interval indicating the first 2020, of healthcare expenditures in 2018 and median age of population
wave of COVID-19 pandemic. These data provide important information in 2019. In addition, the effects of different duration of lockdown on
to analyze the effects in society of lockdowns of different length to cope COVID-19 infected people and deaths are also investigated with average
with effects of COVID-19 pandemic crisis. Data of COVID-19 infected variation of confirmed cases standardized with population and average
people and deaths are from Johns Hopkins Center for System Science variation of fatality rates from 15 April 2020 to 30 August 2020, a period
and Engineering (2020); economic data are from Eurostat (2020c); indicating the first wave of the COVID-19 pandemic crisis in Europe. The
healthcare expenditures are also from Eurostat (2020a); finally, indica- descriptive statistics are also applied categorizing countries having
tor of the structure of population is from Eurostat (2020b) too. high/low investments in healthcare (% of GDP), using as cut-off point
the arithmetic mean of this variable among countries under study to de-
3.2. Research setting and measures tect the effects of different duration of lockdown in countries consider-
ing their level of investments in healthcare sector.
The study, as said, is a specific analysis of six countries in Europe hav- Secondly, the difference of arithmetic mean between countries with
ing a homogenous socioeconomic background given by European area. a shorter and a longer period of lockdown (group 1 and 2) is analyzed
Countries are: Austria, France, Italy, Portugal, Spain and Sweden. by Independent Samples t-Test, comparing the means of these two in-
Period under study is from March to August 2020, a time lapse indi- dependent groups, just mentioned, to determine whether there is sta-
cating the first wave of the COVID-19 pandemic. tistical evidence that associated population means are also
The measures are: significantly different. The null hypothesis (H0) and alternative hypoth-
esis (H1) of the Independent Samples t-Test are:
▪ Number of COVID-19 infected individuals is measured with confirmed
cases of COVID-19 divided by population of countries under H0. μ1 = μ2, the two population means are equal in countries with a
study (%) shorter and a longer period of lockdown.
▪ Number of COVID-19 deaths is measured with fatality rate of COVID-19
given by deaths divided by total infected individuals of countries (%) H1. μ1 ≠ μ2, the two population means are not equal in countries with a
▪ Economic growth of countries is measured with level of Gross Domestic shorter and a longer period of lockdown.

3
M. Coccia Science of the Total Environment 775 (2021) 145801

Fig. 1. Average values and average variation of confirmed cases/population (%) over April–August 2020 period in countries with a shorter length of lockdown of about 15 days and
countries with a longer length of lockdown of roughly 61 days.

Considering the small sample of the study here, the nonparametric than countries with a longer period of lockdown form April to August
Mann-Whitney U Test is also applied to confirm whether there is a 2020 (period indicating the first wave of the COVID-19 pandemic).
difference in dependent variable for independent groups under study. Fig. 2 and Table 1 reveal that countries with a shorter duration of
In particular, this U test compares whether the distribution of the lockdown have a lower average level of fatality rates (%) and an average
dependent variable (i.e., confirmed cases standardized with population reduction of fatality rate lower than countries with a longer period of
or fatality rate) is the same for two groups under study and therefore lockdown over April–August 2020 (−0.72% vs. −1.90%).
from the same population. The difference of arithmetic mean of values, of the variation of
Thirdly, the study represents the trends, from April to August 2020, confirmed cases standardized with population, and of the variation of
of infected individuals and fatality rates in: fatality rates between countries with a shorter and a longer duration
of lockdown is analyzed with Independent Samples t-Test. In this
□ Countries with a shorter period of lockdown of about 15 days
statistical analysis, the p-value of Levene's test is not significant, and
□ Countries with a longer period of lockdown of roughly 61 days.
we have to consider the output of “Equal variances assumed”. Results
show that there is a significant difference in average fatality rates
The study analyzes these trends with a simple regression model (t4 = −3.343, p-value < .05) between countries with a longer and a
based on a linear relationship: shorter duration of lockdown. In particular, the average fatality rate of
yt ¼ α þ β t þ u ð1Þ countries with a shorter period of lockdown was −7.3 percent points
lower than countries with a longer period of lockdown. Other differ-
ences are not significant (Table 2).
Nonparametric Mann-Whitney U Test confirms previous results. In
• y = number of infected individuals or deaths standardized particular, Tables 3 and 4 show that average fatality rate in countries
• t = time from April to August 2020 with a shorter period of lockdown is significantly lower than countries
• u = error term. having a longer period of lockdown (U = 0, p-value = .005). Other dif-
ferences are also here not significant.
Ordinary Least Squares (OLS) method is applied for estimating the Finally, Table 5 of estimated relationships does not provide signifi-
unknown parameters of linear model Eq. (1). Statistical analyses are cant results because of small sample under study. Fig. 3 provides trends
performed with the Statistics Software SPSS® version 26. of confirmed cases and of fatality rates that approximately do not sug-
gest a difference in the evolution of COVID-19 pandemic in countries
4. Results 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
4.1. Impact of COVID-19 and of full lockdowns with different duration on in- a trend toward a decline, but no significant decline in the mean preva-
fected people and deaths lence and mean mortality rate due to the COVID-19 pandemic com-
pared to 15 days before, and 15 days during the lockdown in 27
Fig. 1 and Table 1 reveal that countries with a shorter duration of countries. The mean growth factor for number of cases was 1.18 and for
lockdown have a lower average value of confirmed cases/population mortality rate was 1.16”. The visual representation of Fig. 3 suggests
(%) but a higher average variation of confirmed cases/population (%) that the average reduction of fatality rates over time in groups under

Table 1
Descriptive statistics between countries with a shorter and a longer period of national lockdown, period April–August 2020.

Period April–August 2020 Countries with a shorter period of lockdown, Countries with a longer period of lockdown,
about 15 days (Austria, Portugal, Sweden) roughly 61 days (France, Italy and Spain)

Arithmetic mean Std. deviation Arithmetic mean Std. deviation

⊗ Days of lockdown 14.670 14.503 61.330 8.386

⊗ Cases/population 0.004 0.002 0.004 0.001
⊗ Fatality rate 0.055 0.032 0.127 0.020
⊗ Variation cases/population 0.004 0.003 0.003 0.002
⊗ Variation fatality rate −0.007 0.012 −0.019 0.020
⊗ Healthcare expenditure (Euro per inhabitant) €3806.443 €1692.595 €2937.467 €899.985
⊗ Median age of population (years) 43.033 2.371 44.167 2.454

4
M. Coccia Science of the Total Environment 775 (2021) 145801

Fig. 2. Average value and average reduction of fatality rate (%) over April–August 2020 in countries with a shorter period of lockdown of about 15 days and countries with a longer period of
lockdown of roughly 61 days.

study here seems to be likely associated with approaching of favorable European countries applying a longer period of lockdown was about 7
climate conditions of summer season in 2020; in fact, many studies points less compared to countries applying a shorter period of lock-
show that hot and dry climate can reduce the diffusion of the COVID-19 down. The factors determining the systematic deterioration of eco-
in environment (cf., studies by Coccia, 2020a; Rosario Denes et al., nomic system are likely due to negative impact of COVID-19 pandemic
2020). in society and also restriction policies on economic and social activities
that have worsened structural indicators of economy mainly in coun-
4.2. Impact of COVID-19 and of full lockdown with different length on tries with longer periods of national lockdown (i.e., >61 days).
economic system
5. Discussion on what this study adds
Fig. 4 and Table 6 show ictu oculi that countries applying a longer
period of lockdown, they have had a higher reduction of the level of The study is based on a specific comparative analysis of six countries
GDP, comparing the index 2010 = 100 of the second quarter 2020 to in Europe because have a comparable institutional and socioeconomic
the indicator in the same period of 2019, and comparing the index of background given by European area. In particular, this study analyzes
GDP of the second quarter 2020 to the first quarter (Q) of 2020. how policy responses to cope with COVID-19 pandemic, based on a lon-
Table 7 shows, considering the output of “Equal variances assumed”, ger or a shorter duration of full lockdown, have affected COVID-19 in-
a significant reduction in average GDP level from second quarter in 2019 fected people and deaths, and a main indicator of economic growth of
to second quarter in 2020 between countries with a longer and a shorter nations (i.e., the GDP level). Previous studies suggest that measures of
period of lockdown (t4 = −2.274, p-value < .085). In particular, the containment can constraint the human-to-human transmission of in-
average reduction of GDP level (based on index 2010 = 100) in fectious diseases in different ways (Atalan, 2020; Prem et al., 2020;

Table 2
Independent Samples Test for the impact of lockdown on rate of COVID-19 infected people and fatality.

Levene's test t-Test for equality of means

for equality
of variances

F Sig. t df Sig. (2-tailed) Mean difference Std. error difference

Days of lockdown --Equal variances assumed 0.445 0.541 −4.825 4 0.008 −46.667 9.672
--Equal variances not assumed −4.825 3.203 0.015 −46.667 9.672
Cases/population --Equal variances assumed 0.047 0.84 −0.382 4 0.722 0.000 0.001
--Equal variances not assumed −0.382 3.83 0.723 0.000 0.001
Fatality rate --Equal variances assumed 1.51 0.286 −3.343 4 0.029 −0.073 0.022
--Equal variances not assumed −3.343 3.386 0.037 −0.073 0.022
Variation cases/population from April to August 2020 --Equal variances assumed 0.132 0.735 0.376 4 0.726 0.001 0.002
--Equal variances not assumed 0.376 3.704 0.727 0.001 0.002
Variation fatality rate from April to August 2020 --Equal variances assumed 0.393 0.565 0.878 4 0.429 0.012 0.013
--Equal variances not assumed 0.878 3.273 0.440 0.012 0.013

Table 3
Mann-Whitney Test. Rank for the impact of lockdown on rate of COVID-19 infected people and fatality.

Period from April to August 2020 Countries with a shorter period of lockdown, Countries with a longer period of lockdown, roughly 61 days
about 15 days (Austria, Portugal, Sweden) (France, Italy and Spain)

Mean rank Sum of ranks Mean rank Sum of ranks

⊗ Days of lockdown 2 6 5 15
⊗ Cases/population 3 9 4 12
⊗ Fatality rates 2 6 5 15
⊗ Variation cases/population 3.67 11 3.33 10
⊗ Variation fatality rate 3.67 11 3.33 10

5
M. Coccia Science of the Total Environment 775 (2021) 145801

Table 4
Mann-Whitney Test for the impact of lockdown on rate of COVID-19 infected people and fatality.

Test statisticsa

Days of Cases/population Fatality Variation of cases/population Variation of fatality rate

lockdown rates from April to August 2020 from April to August 2020

- Mann-Whitney U 0 3 0 4 4
- Wilcoxon W 6 9 6 10 10
-Z −1.964 −0.655 −1.964 −0.218 −0.218
- Asymp. sig. (2-tailed) 0.05 0.513 0.05 0.827 0.827
- Exact sig. [2 ∗ (1-tailed Sig.)] 0.100b 0.700b 0.100b 1.000b 1.000b
a
Grouping variable: groups.
b
Not corrected for ties.

Table 5
Estimated relationships based on linear model of regression.

Confirmed cases in countries Confirmed cases in countries having Fatality rates in countries having Fatality rates in countries having
having lockdown of shorter lockdown of longer duration lockdown of shorter duration lockdown of longer duration
duration (about 15 days) (about 61 days) (about 15 days) (about 61 days)

- Constant α (st. err.) −5.34⁎⁎⁎ (0.18) −2.97⁎⁎⁎ (0.18) 26.00⁎ (8.88) 21.95 (14.06)
- Coefficient β (st. err.) 3.87E−10a (0.00) 2.156E−10a (0.00) −1.88E−9a (0.00) −1.58E−9a (0.00)
- Stand. coefficient beta 0.995 0.896 −72 −0.48
- R2 (st. err. of estimate) 0.99 (0.00) 0.77 (0.00) 0.52 (0.007) 0.23 (0.012)
F-test 869.52⁎⁎⁎ 34.42⁎⁎⁎ 8.54⁎ 2.41

Note: explanatory variable is time.

a
Not indicated.
⁎⁎⁎ Significance: p-value<.001.
⁎ Significance: p-value<.05.

Tobías, 2020). However, to our knowledge, none investigations have study adds to current studies on the COVID-19 global pandemic crisis is
performed a comparative analysis of the effects of a longer or a shorter that a longer period of national lockdown to constraint the diffusion of
period of national lockdown on rates of COVID-19 infected people and COVID-19 does not seem to be associated with a significant reduction
deaths, and on dynamics of economic growth of countries. What this of infected cases on population and of fatality rates in society, whereas

Fig. 3. Trends of confirmed cases/population and of fatality rates over April–August 2020 period in countries with a shorter period of lockdown of about 15 days and with a longer period of
lockdown of roughly 61 days.

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M. Coccia Science of the Total Environment 775 (2021) 145801

Fig. 4. Average variation of GDP (index 2010 = 100) from 2nd Quarter 2019 to 2nd Quarter of 2020 and from 1st Quarter 2020 to 2nd Quarter of 2020 between countries with a longer and
a shorter period of lockdown. Note: Q1 = January, February, March; Q2 = April, May, June; GDP = Gross Domestic Product.

results here suggest that countries applying a longer duration of lock- of investments in strategic sectors, such as health and research sector,
down (>61 days) generate a significant contraction of GDP growth which increase the vulnerability of these nations to future pandemics
with subsequent socioeconomic issues. To put it differently, in the pres- similar to COVID-19 and other environmental threats (cf., Coccia,
ence of vast pandemics, the policy responses of lockdown with longer 2020a). In particular, Table 8 reveals vital findings: countries with
duration at nation level seem to have a low effect in terms of significant higher investments in healthcare (as percentage of GDP) have applied
reduction of COVID-19 infected cases and mortality rates, but a longer lockdowns of a shorter duration, reducing the deterioration of economic
duration of national lockdown can slow down the dynamics of eco- system in terms of contraction of economic growth, and simultaneously,
nomic systems with consequential socioeconomic issues. These results they have also a lower fatality rate of COVID-19 (because of a consistent
can be schematically summarized in the Fig. 5. healthcare structure), though a higher incidence of confirmed cases in
Results suggest that countries with a longer duration of national population.
lockdown have a higher fatality rate of COVID-19 and the causes can In general, the policy response of lockdown has in theory the main
be explained with a lower average level of healthcare expenditure and goal, as containment measure, to reduce the impact of infectious dis-
an older structure of population (i.e., demographic structure has a eases in society, but results here suggest that in the presence of vast
higher median age in years) as indicated in Table 8. Hence, many coun- pandemics, such as COVID-19, a longer duration of full lockdown has
tries with lower investments in healthcare sector and older population contradictory and not significant effects on reduction of fatality rates,
were almost obliged to apply a longer duration of national lockdown but sure negative effects on economic systems compared to a shorter
aimed at delaying and reducing the height of epidemic peak, affording length of full lockdown. Instead, higher investments in healthcare sector
healthcare system more time to expand and respond to this emergency play a vital role to cope with unforeseen pandemics, alleviating mortal-
and, as a result, reducing the expected negative impact of COVID-19 ity in society.
pandemic in society. However, this public policy of crisis management Overall, then, lockdown as policy response to cope with COVID-19
has a side effect given by a deterioration of structural indicators of eco- pandemic crisis can generate different effects over time and space. The
nomic system, generating a severe contraction of GDP growth with con- study here has explained the vital role of duration of full lockdown on
sequential socioeconomic issues, such as higher unemployment, high COVID-19 infected people and deaths, and on economic growth of six
general government debt-to-GDP ratio, etc. (cf. also, Coccia, 2017). representative countries in Europe having a comparable institutional
The contraction of economic growth can also trigger future reductions and socioeconomic background.

Table 6
Group statistics for GDP level.

Countries with a shorter period of lockdown, about Countries with a longer period of lockdown,
15 days (Austria, Portugal, Sweden) roughly 61 days (France, Italy and Spain)

Arithmetic mean Std. deviation Arithmetic mean Std. deviation

⊕ GDP2019Q2 114.83 9.00 108.67 6.39

⊕ GDP2020Q1 109.83 9.31 100.27 6.90
⊕ GDP2020Q2 100.50 13.52 87.30 4.19
— Δ GDP (2020Q2 − 2019Q2) −14.33 4.59 −21.37 2.76
— Δ GDP (2020Q2 − 2020Q1) −9.33 4.37 −12.97 2.83

Note: GDP = Gross Domestic Product (index 2010 = 100); Q = Quarter of the Gross Domestic Product; Q1 = January, February, March; Q2 = April, May, June.

Table 7
Independent Samples t-Test for the impact of lockdown on economy of countries.

Levene's test t-Test for equality of means

for equality of
variances

F Sig. t df Sig. (2-tailed) Mean difference Std. error difference

Δ (variation) GDP (2020Q2 − 2019Q2) - Equal variances assumed 1.503 0.287 2.274 4 0.085 7.033 3.093
- Equal variances not assumed 2.274 3.276 0.1 7.033 3.093

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M. Coccia Science of the Total Environment 775 (2021) 145801

Fig. 5. Impact of a longer duration of lockdown on COVID-19 infected people and deaths, and Gross Domestic Product level (wealth of nations).

In short, the results of this analysis are that: contradictory and not univocal effects on reduction of COVID-19 in-
fected people and deaths (i.e., it seems of not generating any significant
□ a longer duration of full lockdown generates uncertain effects on reduc-
reduction of confirmed cases and fatality rates), whereas a longer period
tion of COVID-19 infected people and deaths
of lockdown can damage mechanisms of socioeconomic systems.
– countries with a shorter duration of lockdown (about 15 days) are
Hence, to reiterate, results suggest that extensive and longer contain-
associated with lower average levels of confirmed cases/population
ment policies based on full lockdowns in the presence of widespread in-
(%) but they have a higher average variation of confirmed cases/
fectious diseases, such as COVID-19, can deteriorate economic system
population (%) than countries with a longer duration of lockdown
with uncertain benefits on health of people in terms of significant re-
– countries with a shorter period of lockdown are associated with an
duction of mortality in society. Current lockdown policies to reduce
average level of fatality rates (%) lower than countries with a longer
the diffusion of COVID-19 can bring the world economy to a halt, and
duration of lockdown, likely because of their high investments in
Roy et al. (2021) suggest dynamic lockdown measures that incorporate
health sector.
the healthcare resource budget of people in a zone, restricting the
COVID-19 hospitalizations within its healthcare resource budget. In
□ a longer length of national lockdown generates negative effects on eco- this manner, regions can regulate own lockdown level and also manage
nomic system the overheads associated with time-varying dynamic lockdown poli-
– countries applying a longer duration of lockdown have had a cies. Farsalinos et al. (2021) also argue that full lockdowns can have un-
contraction of GDP growth higher than countries with a shorter intended adverse socioeconomic and health effects, and long-lasting
duration of lockdown (comparing the index of GDP of the second lockdowns cannot provide a solution in pandemic containment but
quarter 2020 to the indicator in the same period in 2019 and they can generate likely a vicious cycle of consecutive lockdowns with
comparing GDP of the second quarter 2020 to the first quarter of in-between breaks. These scholars suggest that community and home
2020). care can be better viable strategies that could mitigate negative effects
of COVID-19 pandemic, associated with social distancing measures
To put it differently, the statistical analyses here seem in general to and facemask wearing (instead of full and longer lockdowns).
reveal that a longer duration of full lockdown at national level has Salvatore et al. (2020) point out that lockdown has been partly effective

Table 8
Descriptive statistics of factors associated with COVID-19 pandemic crisis between countries with higher and lower healthcare investments as % of GDP.

HIGH investments in healthcare as % GDP LOW investments in healthcare as % GDP

Mean St. dev. Mean St. dev.

⊕ Healthcare as percent of GDP 2018 10.83 0.47 9.04 0.39

⊕ Healthcare per inhabitants in Euros, PPS 2018 €3862.947 €142.7616 €2398.337 €150.7042
⊕ Days of lockdown in 2020 28.33 28.01 47.67 29.14
⊕ Difference between GDP2020Q2 and 2019Q2 −15.63 6.27 −20.07 3.43
⊕ Difference between GDP2020Q1 and 2020Q2 −10.13 5.28 −12.17 2.45
⊕ Median age population 2019, years 41.90 1.45 45.30 1.35
⊕ Percent fatality rate COVID-19, December 2020 2.03 0.63 2.60 0.98
⊕ Percent cases/population, December 2020 3.36 0.32 3.33 0.35

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.

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M. Coccia Science of the Total Environment 775 (2021) 145801

in slowing the spread of COVID-19 pandemic in India because of large Overall, then, this study, based on results analyzed here, must con-
state-level variations. Caulkins et al. (2020) show that two different clude that an effective strategy to reduce the negative impact of future
containment measures can be optimal strategies: 1) an eradication strat- epidemics/pandemics similar to COVID-19 has to be based on preven-
egy, where a long lockdown significantly reduces not only the bad health tive high investments in healthcare sector to create an prearranged effi-
effects of the epidemic but also economic activity of countries; 2) curve cient organization directed to cope with pandemics of new viral agents,
flattening strategy characterized by a relatively short lockdown period able to minimize fatality rates, rather than apply general lockdowns of
to reduce epidemic peak of infections, supporting intensive care capacity longer duration that generate ambiguous results on health of people
constraint without damaging economic activity. These different strategies (in terms of significant reduction of fatality rate) but induce sure nega-
of lockdown can produce similar effects to alleviate number of people tive effects on structural indicators of economic systems with conse-
urgently need healthcare when hospitals are already filled to capacity quential socioeconomic issues.
(Caulkins et al., 2020). Bendavid et al. (2021) also argue that small
benefits with mandatory policies of stay-at-home and business closures Declaration of competing interest
cannot be excluded, but results do not support significant benefits on
case growth of more restrictive nonpharmaceutical interventions. Similar The author declares that he has no known competing financial inter-
reductions in case growth may be achievable also with less-restrictive ests or personal relationships that could have appeared to influence the
containment measures (Bendavid et al., 2021). work reported in this paper. No funding was received for this study.
Therefore, the complex problem of epidemic threats has to be solved
with interdisciplinary approaches (Coccia, 2019, 2020e,f), considering References
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