Introduction
Thus far, COVID-19 caused by SARS-CoV-2 which was officially declared as pandemic by WHO in March 2020 appears to have mainly affected wealthier countries. As of 7 September 2020, 66% of all reported cases globally were from countries in Europe and American continents.1 Although it was predicted that Africa’s epidemic would be delayed compared with Europe and North America due to the relatively lower risk of cases being imported from China,2 3 the number and proportion of reported cases in Africa remains low, amounting to only 1 312 592 cases or 5% of the global total at that time (with South Africa, Egypt, Nigeria and Ghana recording the most cases).1
The reported data from Africa are likely to underestimate the true magnitude of the pandemic due to underdetection of cases, as well as under-reporting of detected cases. However, the experience thus far suggests that the disease is less severe in Africa compared with Europe, North America, Asia and South America.4 On 22 May 2020, WHO even stated that the pandemic ‘appears to be taking a different pathway in Africa’ and that ‘so far, Africa has not experienced the high mortality seen in some parts of the world’.5 Postulated reasons for this include Africa’s younger demographic, higher average temperatures and the existence of higher levels of pre-existing immunity.6
The high transmissibility of COVID-19 and the fact that asymptomatic or presymptomatic individuals may be contagious7 has meant that standard communicable disease (CD) control measures involving active case detection, contact tracing and selective isolation and quarantine may be insufficient to bring transmission under control, especially when infection rates are comparatively high. As a consequence, many countries have deployed community-wide ‘lockdown’ measures to reverse exponential epidemic growth trajectories.
Although the term ‘lockdown’ is now ubiquitous, it is not well-defined. There are also no clear definitions of commonly used adjectives for the term such as ‘total lockdown’ and ‘partial lockdown’; and ‘hard’ or a ‘soft’ lockdown. Indeed, WHO’s reference to ‘so-called lockdown measures’ indicates the absence of a clear and universally accepted definition of the term lockdown.8 Given its widespread use and importance, we have come up with a definition of ‘lockdown’ using a two-by-two matrix based on whether measures are compulsory or voluntary; and whether they are targeted at individuals or applied to a general population (table 1).
Using this matrix, we define lockdown as a set of measures aimed at reducing transmission of COVID-19 that are mandatory, applied indiscriminately to a general population and involve some restrictions on the established pattern of social and economic life. This definition has been refined from an earlier published version9 and excludes measures that are compulsory but targeted at individuals or applied discriminately to selected premises (eg, the closure of the Wuhan food market which was initially believed to be a point source of infection). It also excludes population-wide measures which are compulsory but do not involve a significant restriction on freedom or the established pattern of social and economic life—for example, being required to wear facemasks (FMs) in public or having to abide by physical distancing (PD) stipulations in public.
The boundaries between the four quadrants of the matrix are blurred and open to some varied interpretation, but based on this system of categorising CD control measures, we have defined ‘lockdown’ as consisting of three interventions (in bold) located within the bottom right quadrant of the matrix below: (i) geographic containment; (ii) home confinement and (iii) prohibition of gatherings and closure of establishments and premises.
Geographic containment is a type of lockdown measure that is now associated with the decision of Chinese authorities in January 2020 to stop the movement of people in and out of Wuhan city.10 It is designed to prevent epidemic hotspots from contaminating other parts of a country or region. Exemptions will usually be made to ensure the flow of food and other essential commodities in and out of a locked down area, and there may be minimal or absent restrictions for people travelling into an area that has been put into lockdown. A cordon sanitaire may accompany geographic containment. This term refers to the creation of a buffer zone around an area experiencing an epidemic across which there is movement control and which therefore acts as a barrier to disease transmission.
Home confinement places requirements on a general population to stay at home for prescribed amounts of time. The term ‘curfew’ is sometimes used interchangeably with home confinement, and exemptions are typically made for people whose jobs are considered essential, or for certain permitted activities such as shopping for food or taking exercise.
The third type of lockdown measure is the prohibition of gatherings and the closure of establishments and premises. This includes the closure of shops, businesses, schools, universities, restaurants, cinemas, theatres, churches, mosques and sporting venues; and the prohibition or restriction of gatherings of people. As with other types of lockdown, exemptions are common and may apply to essential businesses and industries or certain types of gatherings (eg, funerals). Alternatively, premises may be kept open for defined groups of people (eg, schools being kept open for the children of essential workers).
A clear and bounded definition of lockdown is important from a research perspective because of the need to monitor its effectiveness and impact on disease control. Furthermore, lockdown poses several threats to health and well-being and may even cause more overall harm than good. At the level of individuals, lockdown can result in psychological and emotional distress; loss of employment and household income and deprive children of the benefits of schooling.11 These harms are aggravated by the effects of lockdown at the societal level including economic contraction and recession, disruption of supply systems, aggravation of social tensions and the potential for lockdown to lead to the long-term erosion of human rights and civil liberties.
It is therefore necessary for public health systems to monitor and evaluate the impact of lockdown on epidemic control, and its wider social, economic, health and political impacts. Attention should also be paid to evaluating the existence of measures designed to mitigate the harms of lockdown, such as providing financial and welfare support to vulnerable households and businesses, organising online schooling for children and introducing fiscal measures to keep the economy afloat.
This paper describes the design, timing and implementation of the three types of lockdown in a set of nine countries in SSA: Ghana, Nigeria, South Africa, Sierra Leone, Sudan, Tanzania, Uganda, Zambia and Zimbabwe (see table 2 and figure 1). It also describes the manner in which lockdown was enforced and the efforts to mitigate the harms of lockdown.
The research was conducted by a group of country-based researchers who volunteered to participate in what was designed to be a rapid research exercise. Data were collected by country-based researchers using a semi-structured questionnaire, supplemented with additional data obtained from the WHO and the African Centres for Disease Control and Prevention websites, and other reliable sources on the worldwide web. Due to constraints in space, we provide a summarised description of lockdown and its impacts here. However, the full set of data we collected is available (on request) for other researchers to assess and use for other studies.