Calling for benefit–risk evaluations of COVID-19 control measures
Authors: Günter Kampf, Martin Kulldorff
Journal: The Lancet (2021)

We think government lockdowns cause substantial collateral health damage. For example, hospital admissions in the USA for emergency treatment of acute ischaemic strokes have been substantially lower in February–March, 2020, than in February–March, 2019, resulting in delayed treatment.1Schirmer CM Ringer AJ Arthur AS et al.Delayed presentation of acute ischemic strokes during the COVID-19 crisis.J Neurointerv Surg. 2020; 12: 639-642Crossref PubMed Scopus (117) Google Scholar Compared with a historical baseline, UK nursing homes and hospices saw an increase in the number of deaths between February and June, 2020, associated with acute coronary syndrome (a 41% increase), stroke (a 39% increase), and heart failure (a 25% increase).2Wu J Mamas MA Mohamed MO et al.Place and causes of acute cardiovascular mortality during the COVID-19 pandemic.Heart. 2021; 107: 113-119Crossref PubMed Scopus (125) Google Scholar The situation is similar for patients with cancer. In German hospitals, cancer cases decreased during the first national lockdown between March 12 and April 19, 2020: by 13·9% for breast cancer, 16·5% for bladder cancer, 18·4% for gastric cancer, 19·8% for lung cancer, 22·3% for colon cancer, and 23·1% for prostate cancer,3Initiative QualitätsmedizinCOVID-19 Pandemie. Effekte der SARS-CoV-2 Pandemie auf die stationäre Versorgung im ersten Halbjahr 2020. Eine Analyse der §21 Routinedaten an 421 Kliniken der Initiative Qualitätsmedizin (IQM).https://www.initiative-qualitaetsmedizin.de/covid-19-pandemieDate: Nov 26, 2020Date accessed: November 28, 2020Google Scholar suggesting that cancers might have been undetected and untreated during this period. In England, hospital admissions for chemotherapy appointments have fallen by 60%, and urgent referrals for early diagnosis of suspected cancers have decreased by 76% compared with pre-COVID-19 levels, which could contribute to 6270 additional deaths within 1 year.4Wise J Covid-19: cancer mortality could rise at least 20% because of pandemic, study finds.BMJ. 2020; 369m1735Crossref PubMed Scopus (33) Google Scholar Delayed diagnosis and treatment are expected to increase the numbers of deaths up to year 5 after diagnosis by 7·9–9·6% for breast cancer, 15·3–16·6% for colorectal cancer, 4·8–5·3% for lung cancer, and 5·8–6·0% for oesophageal cancer.5Maringe C Spicer J Morris M et al.The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.Lancet Oncol. 2020; 21: 1023-1034Summary Full Text Full Text PDF PubMed Scopus (1074) Google Scholar Government restrictions are disrupting traditional means of support between friends and family members. Physical distancing and contact reduction are causing severe stress to many people and might increase the risk of suicide.6Reger MA Stanley IH Joiner TE Suicide mortality and coronavirus disease 2019—a perfect storm?.JAMA Psychiatry. 2020; 77: 1093-1094Crossref PubMed Scopus (651) Google Scholar In a meta-analysis of the prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic,7Salari N Hosseinian-Far A Jalali R et al.Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis.Global Health. 2020; 16: 57Crossref PubMed Scopus (2273) Google Scholar the prevalence of depression in the months of the pandemic up to May, 2020, was 33·7% (95% CI 27·5–40·6). Between April 22 and May 11, 2020, 795 (78·9%) of 1008 people aged 18–35 years in the USA reported symptoms of depression.8Horigian VE Schmidt RD Feaster DJ Loneliness, mental health, and substance use among US young adults during COVID-19.J Psychoactive Drugs. 2020; (published online Oct 28.)https://doi.org/10.1080/02791072.2020.1836435Crossref PubMed Scopus (203) Google Scholar Further and stronger restrictions on physical and social contact could lead to a further increase in the prevalence of depression. We call on all scientists, public health officials, journalists, and politicians to weigh and consider the collateral damage from government COVID-19 control measures and their negative effect on many short-term and long-term health outcomes. While trying to control COVID-19, all aspects of physical and mental health need to be jointly considered. Other life-threatening diseases are being neglected, and patients with these diseases should receive the same timely and appropriate medical treatment as patients with COVID-19. GK has received honoraria for consultation and presentation from Dr Schumacher. MK declares no competing interests.