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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 316-321

Impact of lockdown during COVID-19 pandemic and its advantages


Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

Date of Submission01-May-2020
Date of Decision02-May-2020
Date of Acceptance05-May-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. K L Krishna
Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore - 570 015 Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_77_20

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  Abstract 


COVID-19, caused by novel coronavirus SARCoV2, is a contagious disease, emerged in the end of December 2019, at Wuhan seafood market, China. This disease is spiraling like a wildfire and rapidly spreading worldwide, overburdening the health system with newly infected cases. As of April 25, 2020, a total of 2,846,536 COVID-19-positive cases and 197,859 total deaths were reported across the globe. This epidemic has exponential growth characteristics in the absence of specific vaccine and treatment for COVID-19. Many countries across the world including India, the USA, China, Italy, and German are implementing the lockdown measures to control the COVID-19 pandemic and to maintain the infection at manageable levels. Keeping the prospectus of future such pandemics, we reviewed; what is lockdown and containment? Does it works? What are the advantages of lockdown and containment in cotrolling the spread of the virus?. The present review answers these questions and tries to spread light on the impact of lockdown. Our review concludes that the implementation of lockdown has forced many countries in flattening the epidemic curve and strengthening the health-care system and improves the environmental quality during the COVID-19 pandemic.

Keywords: COVID-19, epidemic, lockdown, pandemic, social distance, WHO


How to cite this article:
Nadig AP, Krishna K L. Impact of lockdown during COVID-19 pandemic and its advantages. Int J Health Allied Sci 2020;9:316-21

How to cite this URL:
Nadig AP, Krishna K L. Impact of lockdown during COVID-19 pandemic and its advantages. Int J Health Allied Sci [serial online] 2020 [cited 2020 Nov 23];9:316-21. Available from: https://www.ijhas.in/text.asp?2020/9/4/316/298124




  Introduction Top


A case of unknown pneumonia in late 2019 December was reported in Wuhan, China. The clinical characteristic of this disease was very much similar to viral pneumonia. Analysis on case samples by the Chinese Center For Disease Control and Communication (CDC) officially declared that pneumonia was caused by novel coronavirus and named it as novel coronavirus pneumonia.[1] Later on January 7, 2020, the World Health Organization (WHO) officially named it as COVID-19. Novel coronavirus belongs to a large family of viruses, family Coronaviridae and subfamily Coronavirinae.[2] According to the WHO, COVID-19 belongs to Group 2 of betacoronavirus, which is similar to severe acute respiratory syndrome coronavirus (SARS-CoV) widespread of 2002–2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in 2013–2015. Despite both COVID-19 and SARS-CoV belong to betacoronavirus subgroup.[3] Initially, cases of COVID-19 reported that it may be less severe than SARS and MERS, but later, the virus was transmitting rapidly from human to human, and evidence suggested that novel coronavirus is more a infectious disease than SARS-CoV and MERS-CoV.[4],[5]

COVID-19 is a respiratory disease,[6] which affects many people in different ways, and infected people will get mild-to-moderate symptoms, usually seen after 2–14 days. Common symptoms include fever, cough, sneezing, runny nose, sore throat, exacerbated asthma, and diarrhea.[7] The National Institutes of Health reported that young children, people above 60 years or older, pregnant women, and people underlying disease conditions have a higher risk of getting infected with the disease and prone to mortality. Respiratory infections usually transmit from person to person through droplets varying of different sizes, when the diameter of droplet size >5 μm is called respiratory droplets and <5 μm is called droplet nuclei.[8] According to the WHO, the spread of coronavirus is basically through respiratory droplets and contacts.[9],[10]

The novel coronavirus epidemic has an exponential growth characteristic; till now, no specific vaccines and antiviral treatment are approved for COVID-19 treatment.[11] According to the WHO, it will take at least 18 months since from March 2020; hence, nonpharmaceutical interventions are the only way to control this pandemic and thereby impact on individual health can be reduced.[12],[13]

According to the WHO and Johns Hopkins University, COVID-19 has affected more than 28,46,536 people and total deaths were 1,97,859 across worldwide. Countries including the USA, Spain, Italy, France, Germany, the UK, and China have been exposed to this virus intensely.[14] By imposing the largest and continuous lockdown in India, according to Ministry of Health and Family Welfare (MoHFW) by 25 April 2020, a total 24,530 positive cases were witnessed among 1.3 billion population which is almost 4 times more population than US, thus number of positive cases reported were less as compared to other countries.[15] If in case, the epidemic of coronavirus hits with the speed of the USA, Spain, or Italy, then it is very much difficult to handle the situation without having the specific vaccine.[14] The main reason behind the increased number of COVID-19-positive cases and maximum death in European countries such as Italy and Spain is because of late response to the outbreak and delayed lockdown measures.[16] It is reported that after lockdown in China, the number of COVID-19-positive cases was decreased.[17] Our analysis reports the impact and advantages of lockdown during COVID-19.


  Lockdown Top


An emergence protocol prevents the spread of infection between individuals from staying in a given area. The lockdown protocol usually allows essential supplies such as pharmacies, hospitals, banks, and grocery shops and shut down of all nonessential activities throughout the period. Around the world, most of the countries including India, America, China, Italy, and Spain are implementing the lockdown protocol to control the spread of COVID-19.[18] Even the WHO recommends the strict lockdown protocol to fight against the COVID-19.

The epidemic of COVID-19 began by the end of December 2019 in Wuhan seafood market, China, and a day-by-day number of cases are increasing; due to this, remarkable and unparalleled steps took by the China Government to control the infectious virus by massive lockdown which involves of travel restriction, work from home, etc., Lockdown in Wuhan and other cities in Hubei province of China was commenced from 23 January 2020. Implementation of such lockdown resulted in reduced spread of the virus both in Hubei and in other parts of China by 2 weeks period. The epidemic was peaked on 5 February 2020 in Hubei and 3 February 2020 in the rest of China and thereafter it was declined.[19] According to Union Health Ministry, Govt. of India, India would have seen 8.2 lakh COVID-19 positive cases by April 15, 2020 if there was no lockdown and containment measures were implemented. If containment measures were taken but no lockdown, then the cases would have raised to 1.2 lakh. However, after implementation of complete nationwide lockdown and containment measure India witnessed only 7,447 COVID19 positive cases by April 15, 2020. Hence, lockdown was effective in controlling the spread of virus.

Social distancing

Social distancing also called as physical distancing is a non-pharmaceutical intervention or measures undertaken to prevent the spread of contagious diseases by reducing the close contact between the individual. It typically involves avoid of gathering and maintaining a physical distance from each others. This could be, one of the best way of controlling the spread of disease in the absence of available pharmaceutical remedies.[20] The reason behind the social distancing is to reduce the outbreak of an infectious disease. Epidemiologists quantify the intensity of outbreak of COVID-19 using Ro number, unlike SARS pandemic in 2003, H1N1 influenza in 2009, and Ebola in 2014.[21] Ro indicates the reproduction number which describes an average number of patients getting infected during the infectious period. Ro is calculated by the following formula.[22]

RO = p × c × D

Where, P = probability of transmission per exposure, c = number of contacts per unit time, and D = duration of infectiousness

From the knowledge of epidemiologists, if RO is above 1 infection will become epidemic, RO is equal to 1 infection will become endemic, and if RO is <1, then the infection will disappear.[23] An earlier study by Tim Churches reported on March 3, 2020, that the reproductive number of COVID-19 in the United States ranges from 1.4 to 6.5 on an average of 2.5, which indicates that infection will become epidemic in the coming days. Researchers from the Indian Council of Medical Research and Imperial College, London, suggested that the epidemic of COVID-19 cases can be reduced up to 62% if quarantine and social distancing are strictly followed.[24] Similarly, many studies had reported that the spread of COVID-19 can be controlled by maintaining social distance.[25],[26] Hence, the main aim of social distancing is to reduce the reproduction or R value below 1.[13] Similar to COVID-19, In the year 1957-1958 Influenza infection (Asian Flu) infected 50% of the population but on implementing lockdown, social distance and containment measures, this epidemic was reduced by more than 90% was observed.[27]

Researchers from the University of Johns Hopkins report the spread of COVID-19 before and after lockdown in India. With the absence of lockdown, the disease would continue to spread without any interventions and reproduction number (RO) = 2.66. At lockdown, the reproduction number will reduce to 2. After hard lockdown and continuation of interventions, the reproduction number will reduce to 1.5; hence, the continuation of lockdown with interventions significantly reduces the epidemic of COVID-19 in India.

Saturation of epic curve

Epic curve is also known as Epidemic curve. A statistical graph in epidemiology displays the onset of illness outbreak.[28]

Epidemic curve helps us to predict:

  1. Illness magnitude
  2. Its time trend of disease outbreak
  3. Inference of illness spread pattern
  4. Time period of exposure
  5. Mode of transmission identification.


As per the report by CDC, nonpharmaceutical intervention including lockdown, social distancing, hand sanitizing, quarantine, and cleaning surfaces can lower the transmission of coronavirus epidemic in the community which helps to improves the health-care system [Figure 1].[7] Strictly practicing the strong massive lockdown rules in China, the saturation or flattening epidemic curve of COVID-19 is observed. Hence, lockdown measures are necessary for epidemic management. The probability of infected person contact with uninfected person can be reduced, which helps to suppress the community spread of illness.[5]
Figure 1: Flattening the curve improves the health-care system[44]

Click here to view


Lockdown and health system

Health-care system has a major role in controlling the epidemic of COVID-19. Massive lockdown protocol benefits the national and global communities. In addition to that, burden and pressure on health-care system get reduced, which helps to serve the COVID-19 as well as non-COVID patients [Figure 2]. If the transmission of COVID-19 is not curtailed or the lockdown breaks, the spread of the virus cannot be controlled easily, and finally, health-care system becomes overwhelmed. We have seen such increasing scenario in many countries including Italy, Spain, and the UK.[16] Hence, lockdown and nonpharmaceutical intervention play a major role in building the health-care system.
Figure 2: Illustration of management health-care system

Click here to view


Lockdown and environmental changes

To reduce the spread of novel coronavirus, most of the countries across the globe adopted lockdown. This action has put automobiles, trains, planes, and major industrial activity on hold. Due to this, unparalleled decrease in air pollution is being noticed in most of the countries.[29] During lockdown, according to the Central Pollution Control Board (CPCB) of India, air quality index was improved up to 90% in major cities of India including Delhi, Mumbai, and North India's many industrial areas [Table 1]. A recent study reported that China has found a big relief in anthropogenic pollution emission which results in a 25% reduction in carbon mission and a 30% reduction in NO2 level during lockdown.[30] The WHO reports that more than 90% of the global population are living in the area where the quality of air is below the guideline level. An ambient air pollution kills nearly 7 million people annually across the globe, and majority of the deaths are in China and India. An increase in NO2 has linked to various diseases including respiratory,[31] cardiac,[32] diabetes,[33] asthma and chronic obstructive pulmonary disease,[34] and hypertension[33] diseases and increased rate of hospitalization.[35] The fatality rate of COVID-19 is significantly higher with the patient who already had preexisting health conditions, specifically those with cardiovascular disease, diabetes, and respiratory disease, and these diseases are strongly connected with the air pollution.[36] In addition to that, the quality of water has seen a significant improvement since enforcement of the lockdown shuts the dumping of industrial waste. According to CPCB, out of 36 water monitoring points, 27 had shown improvement in the quality of water of river Ganga. The following parameter data were measured to assess the quality of water of the river: biochemical oxygen demand (<2 mg/l), dissolved oxygen (>6 mg/l), coliform level (500/10 ml), and pH (6.5–8.5). Hence, the quality of air, water, and health indices improved after the complete lockdown, which directly helps to fight against the coronavirus.
Table 1: Before and after lockdown air pollution in North India's industrial areas

Click here to view


Life easier during lockdown

Strength of health system

Working against COVID-19 victim is necessary, in addition to that health supporters are also continuing their work for non-COVID patients who require regular treatment, especially for chemotherapy, dialysis patients, etc., [Figure 2]. To minimize the overcrowd in hospitals, health-care global has emphasized to monitor through telemedicine, video calls, 24 × 7 health emergency helpline, mobile medical transport units, etc., Suspected COVID-19 patients are quarantined for 14 days; if the patients get COVID-19 positive, then the treatment is followed as per the Ministry of Health and Family Welfare (MoHFW) protocols at COVID-19 care centers, fever clinics, dedicated COVID-19 health center, and dedicated COVID-19 hospital.

Strengthening immune system

To keep any disease at bay, one must boost and strengthen the immune system, by supplementing nutrients which are rich in Vitamin A, Vitamin C, Vitamin E, Vitamin D, selenium, copper, and zinc-rich foods. In addition to that, regular exercise, yoga, and sufficient sleeping (8–10 h) help reconstruct the immune system to fight against pathogens. Most of the working people are at home in the lockdown period, whereas the free time helped them to get good food and sufficient sleep and lead a stress-free lifestyle which contributed very much in increasing their immunity.

Online classes

As lockdown continuous, online classes have surged in popularity and most of the universities and colleges across the globe are continuing their classes through online to help the students. It is reported that till April 17, 2020, more than 2, 23, 930 online classes on various subjects have been conducted, and these are attended by students in an average of 144,431/day. In addition to that, various online courses are conducted and researchers are published more than 2823 research and review papers and books.

Work from home

To ensure the continuity of business, most of the IT and BPO company employees are continuing their work from home.

24 × 7 helpline

To tackle the complaints and problems faced by citizens, the government has provided helpline number.

Emergency passes

People will get access to emergency purposes including medical and pharmacy and need to specify the place and time.

Carps as friend

Even during the lockdown, carps are serving their duty to help and support the individual on streets with problems.

Relief funds

The government announced immediate financial packages, essential grains, and relief measure to rescue the poor people of the country.

Psychological benefits during COVID-19 lockdown

One of these factors is an emerging sense of shared identity, and concern for others, which arises from a common experience of being in a disaster. This feeling can be harnessed by addressing the public in collective terms and by urging “us”to act for the common good and to help others. When individual thinks, they do so in conformity to norms. Their perception of what others are doing or what they think, others approve or disapprove of, is from an inherent desire to learn from them. During this lockdown, since there is social distance, people crave to gain affiliation, even though the scenario is different.[37]

A study on numerous models of mass emergency behavior suggests a social psychological basis for resilience. Normative approaches and affiliation seem to be most preferred. They are based on the principles of self-categorization theory, comprehending the psychological nature of resilience, and probable conditions will supplement planning of evacuation procedure, emergency services, and suitable after-care procedures.[38] It is interesting to note that moral and political orientation were of less concern in comparison with fear and anxiety symptom predictors on complaint behavior. Fear and anxiety symptoms led individuals into compliance with necessary public health behaviors such as personal hygiene and social distance. Further, the prescribed behavioral change is not noted to have had any decline in quality of life. For some during the lockdown period, they work as usual and they stay with family that make them feel more comfortable rather than thinking of any other issues.[39]

To control the spread of virus, lockdown is a strict action that has to be followed by all the citizens who belong to country. Here, when people have faith and trust in the government bodies and the authorities the way the individual thinks is completely different compared to another scenario. Participants with higher trust in institutions exhibited slightly less anxiety about the coronavirus pandemics.[40] In any global situation of life, avoiding stress is not so easy. It is not the type of stress or the amount of stress that plays an important role in these kinds of situations. Rather, it is the mindset of the individual which helps the person or group of people to face the situation dynamically and alter the impact of situation. Adaptive mindsets about stress could increase positive emotion and reduce negative health symptoms. During this lockdown process, some people instead of thinking only about the stress (virus) have adopted their lifestyle to the current situation. A healthy mindset can entirely change the vision of an individual.[38],[41]

Public health experts believe that “individual behavior will be crucial to control the spread of COVID-19.[42] These prosocial behaviors include washing hands more frequently and for longer, avoiding public gatherings, canceling travel plans, and keeping distance from others. If measures like these are adopted on a temporary basis, experts suggest that the deaths caused by coronavirus would drop dramatically. Hence, all these things will help in limiting social activity. To prevent the spread of contagious disease, travel restrictions were implemented except the emergency services. Work from home option were provided to all professional activities wherever possible to maintain good interpersonal relationship and stable economy by maintaining social distancing to avoid spread of virus.[40]


  Conclusion Top


The coronavirus epidemic has exponential growth characteristics and caused a global mayhem. Due to high degree of contagiousness and absence of specific vaccine, nonpharmaceutical intervention like lockdown is the only prescription to battle the virus. Lockdown prevents the local and global spread of virus which has forced many countries in flattening the epidemic curve and strengthening the health-care system and improves the environmental quality.

Acknowledgment

We thank everyone who is working to control the epidemic of COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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