Lockdown as experimental therapy for population health. A research protocol

In order to evaluate a therapy in medical trials, it is ideally subjected to randomized, placebo ("sham") controlled trials. Often, medicine is practiced with lesser levels of evidence
1/n

Next highest level of study: prospective cohort study: case population is matched to a control population, & then followed prospectively (forward in time). Outcomes of both groups are compared. Prospective selection of groups & designation of outcomes prevents "revisionism"
2/n

Can lockdown experimental therapy be examined via prospective cohort study? No, because we are already well into its deployment as a therapy. If a previously covid-unaffected population were to attempt this, they could select one group to lockdown, another to leave alone
3/n

Using a prospective cohort study would be ideal. It is unlikely that any advanced government would do this because of political considerations and pressure. This leads to an attainable study design: retrospective case-control
4/n

Retrospective (looking back) case-control studies attempt to look at the effect of a therapy by matching a population or group of individuals who received a therapy, to a population or group of individuals who did not receive a therapy.
5/n

Is retrospective case-control study design possible for lockdown therapy? Yes, many RCC studies have been done. Two challenges of medical studies to explore here: how to match case population to control population. Both groups should have similar "baseline characteristics"...
6/n

Baseline characteristics would include variables that are known to affect outcomes: age, poverty/wealth, climate, health care system, race.
The second challenge of RCC study design is retrospection, i.e. A RCC may select a control group that did horribly without the therapy
7/n

Within medicine, debates regarding the efficacy of a therapy can take decades to resolve. For example, in 2001 an ICU study proposed using large amounts of IV fluids in septic shock. It took sixteen years for this study to be debunked
https://journalfeed.org/article-a-day/2017/the-process-of-dismantling-early-goal-directed-therapy
8/n

Back to the construction of a case-control study for the evaluation of lockdown therapy. As with medical therapy and the example of IV fluids in septic shock, it can be a lengthy and challenging process to debunk a therapy, particularly when the study is well-designed
9/n

What type of experimental design is lockdown therapy based upon? So far, we have not seen it.
The next level of design is the case series, where a group of individuals who received a therapy are retrospectively examined in detail to see what outcomes they had.
10/n

Here is where the 21st century is attempting to overturn the 20th: whether a mathematical/computer simulation of a population or group of individuals is the equivalent of a control group.
This bears repeating: that a simulation of a population is equivalent of a population
11/n

In clinical medicine, I am not aware of any instance of using a computer model of a human being in order to evaluate the safety and efficacy of a therapy. For the moment, such a study would be regarded as grossly inadequate, as there is no computer model of human physiology
12/n

If and when the dust settles from covid19 and experimental lockdown therapy, one of the main areas for scrutiny and growth in terms of the science will be in the use of math models and simulations to provide control groups in experiments
13/n

For the time being, given that the vast number of variables to be included in a math model of a single individual, let alone a population of such individuals, it is experimentation of the most tentative sort to employ computer simulations as a control group for a therapy.
14/n

But what about Wuhan? Surely that was a strong example of the efficacy of lockdown, a case so utterly convincing that no equivocation, no hestiation as to whether or not lockdowns are therapeutic for a population is possible.
15/n

"Wuhan is a case of lockdown therapy efficacy" is an argument one could propose.
What type of evidence is this on continuum of therapeutic trial designs?
A case report - a retrospective, non-controlled, single subject study. It is considered the weakest form of evidence
16/n

Looking at the arc of how we got to our current governmental consensus on lockdown therapy, it has two steps:
1) Case report from Wuhan re efficacy of lockdown
2) Theoretical/simulated computer-modelled prospective cohort study of lockdown efficacy
17/n