Sustainable Post Covid19 Lockdown Strategy Through Evidence-Based Policy


Risk Categories
Healthy People
Health Policy
Public Health

How to Cite

Boretti A. Sustainable Post Covid19 Lockdown Strategy Through Evidence-Based Policy: Analysis of Covid19 Fatalities Across Europe. Integr J Med Sci [Internet]. 2020Jun.14 [cited 2020Jul.11];7. Available from:


The Covid19 epidemic is having much larger fatalities in western Europe than everywhere else in the world. However, the greater peak daily fatalities have been 10 to 20 times less than the models’ predictions and similarly occurred after half the time predicted by the models. Similar patterns of the outbreak have been achieved regardless of diversity in the containment measures. Thanks to a strict, generalized, lockdown, the United Kingdom, or Belgium, had after about the same number of days, much larger peak daily fatalities per million that countries adopting more sustainable approaches such as the Netherlands or Sweden. In the Netherlands, social distancing is suggested but not forced through an “intelligent lockdown”.  In Sweden, there is simply no lockdown.  It is now evident that Covid19 is much less contagious and lethal than what was thought, and if care is taken of the risk categories, but basic freedom is not removed restricting every movement of the healthy population damaging democracy and economy, it is possible to achieve better results. With fatalities uniformly declining across Europe, it is therefore advocated to return the sooner the better as before the lockdown period, with full compliance with preventive health instructions and social divergence, and care to protect the highest-risk groups from infection, especially for the elderly and those with chronic and respiratory diseases.


Bendavid E, Mulaney B, Sood N, Shah S, Ling E, Bromley-Dulfano R, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. 2020; DOI:10.1101/2020.04.14.20062463

Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the United States — 2018–2019 influenza season | CDC [Internet]. [cited 2020 Jun 17]. Available from:

Caratteristiche dei pazienti deceduti positivi all’infezione da SARS-CoV-2 in Italia [Internet]. [cited 2020 Jun 17]. Available from:

Oke J, Heneghan C. Global Covid-19 Case Fatality Rates. OXFORD CEBM Research. 2020. [Internet]. [cited 2020 Jun 17]. Available from:

French carrier surpasses Theodore Roosevelt with over 1,000 confirmed cases of COVID-19 [Internet]. [cited 2020 Jun 17]. Available from:

Coronavirus sur le « Charles de Gaulle » : Cinq marins toujours hospitalisés, le porte-avions totalement désinfecté [Internet]. [cited 2020 Jun 17]. Available from:

Prado B. COVID-19 in Brazil:“So what?”. TheLancet, 395. 2020;10235:1461. DOI:10.1016/S0140-6736(20)31095-3

Fraser B. ‘Medications should be prescribed by doctors, not the president’: leading Brazilian scientist discusses the pandemic. Nature. 2020 May 22; DOI: 10.1038/d41586-020-01506-2

Adam D. Special report: The simulations driving the world's response to COVID-19. Nature. 2020 Apr;580(7803):316. DOI: 10.1038/d41586-020-01003-6

Ferguson N, Laydon D, Nedjati Gilani G, Imai N, Ainslie K, Baguelin M, Bhatia S, Boonyasiri A, Cucunuba Perez ZU, Cuomo-Dannenburg G, Dighe A. Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand. DOI: 10.25561/77482.

Kermack WO, McKendrick AG. A contribution to the mathematical theory of epidemics. Proceedings of the royal society of london. Series A, Containing papers of a mathematical and physical character. 1927 Aug 1;115(772):700-21.

Holligan A. Coronavirus: Why Dutch lockdown may be a high-risk strategy. Bbc. 2020; [Internet]. [cited 2020 Jun 17]. Available from:

Loeb A. Theoretical Physics Is Pointless without Experimental Tests - Scientific American Blog Network [Internet]. [cited 2020 Jun 21]. Available from:

Delaying herd immunity is costing lives - spiked [Internet]. [cited 2020 Jun 21]. Available from:

NCHS Mortality Surveillance Data | CDC [Internet]. [cited 2020 Jun 21]. Available from:

NCHS Mortality Surveillance Data | CDC [Internet]. [cited 2020 Jun 21]. Available from:

NCHS Mortality Surveillance Data | CDC [Internet]. [cited 2020 Jun 21]. Available from:

NCHS Mortality Surveillance Data | CDC [Internet]. [cited 2020 Jun 21]. Available from:

NCHS Mortality Surveillance Data | CDC [Internet]. [cited 2020 Jun 21]. Available from:

Jiaquan Xu, M.D., Sherry L. Murphy, B.S., Kenneth D. Kochanek, M.A., and Elizabeth Arias P. Products - Data Briefs - Number 355 - January 2020 [Internet]. [cited 2020 Jun 21]. Available from:

Johnson SL. New Estimates show U.S. Population Growth Continues to Slow [Internet]. The United States Census Bureau. 2019 [cited 2020 Jun 21]. Available from:

Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. 2020 May 22. DOI: 10.1016/S0140-6736(20)31180-6.

WHO SUSPENDS trials of Trump-chosen hydroxychloroquine drug over SAFETY RISKS for Covid-19 patients. RT News [Internet]. [cited 2020 Jun 21]. Available from:

Taccone FS, Gorham J, Vincent JL. Hydroxychloroquine in the management of critically ill patients with COVID-19: the need for an evidence base. The Lancet Respiratory Medicine. 2020 Apr 15. DOI: 10.1016/S2213-2600(20)30172-7

Owens B. Excitement around hydroxychloroquine for treating COVID-19 causes challenges for rheumatology. The Lancet Rheumatology. 2020 May 1;2(5):e257. DOI: 10.1016/S2665-9913(20)30089-8

Sahraei Z, Shabani M, Shokouhi S, Saffaei A. Aminoquinolines against coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int J Antimicrob Agents. 2020 Mar 17. DOI: 10.1016/j.ijantimicag.2020.105945

Jie Z, He H, Xi H, Zhi Z. Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(3):185-8. DOI: 10.3760/cma.j.issn.1001-0939.2020.03.009.

On FRANCE 24 and RFI, Senegal’s Macky Sall continues to demand cancellation of Africa’s debt - The Interview [Internet]. [cited 2020 Jun 21]. Available from:

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience trends. 2020; 14(1):72-73. DOI: 10.5582/bst.2020.01047

Colson P, Rolain J-M, Lagier J-C, Brouqui P, Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int J Antimicrob Agents. 2020 Apr 1;55(4):105932. DOI: 10.1016/j.ijantimicag.2020.105932

1. Devaux CA, Rolain JM, Colson P, Raoult D. New insights on the antiviral effects of chloroquine against coronavirus: what to expect for COVID-19? Int J Antimicrob Agents. 2020 May;55(5):105938. DOI: 10.1016/j.ijantimicag.2020.105938

Gautret P, Lagier JC, Parola P, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Dupont HT, Honoré S. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International journal of antimicrobial agents. 2020 Mar 20:105949. DOI: 10.1016/j.ijantimicag.2020.105949

Nicastri E, Petrosillo N, Ippolito G, D’Offizi G, Marchioni L, Ascoli Bartoli T, et al. National Institute for the Infectious Diseases “L. Spallanzani” IRCCS. Recommendations for COVID-19 Clinical Management. Infect Dis Rep. 2020 Mar 16;12(1). DOI: 10.4081/idr.2020.8543

Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Sevestre J, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: A pilot observational study. Travel Med Infect Dis. 2020 Mar 1;34:101663. DOI: 10.1016/j.tmaid.2020.101663

Rathi S, Ish P, Kalantri A, Kalantri S. Hydroxychloroquine prophylaxis for COVID-19 contacts in India. The Lancet Infectious Diseases. 2020 Apr 17. DOI: 10.1016/S1473-3099(20)30313-3

Principi N, Esposito S. Chloroquine or hydroxychloroquine for prophylaxis of COVID-19. The Lancet Infectious Diseases. 2020 Apr 17. DOI: 10.1016/S1473-3099(20)30296-6

Revised advisory on the use of Hydroxychloroquine (HCQ) as prophylaxis for SARS-CoV-2 infection (in supersession of previous advisory dated 23 rd March, 2020). 2020. dation_22March_final_MM_V2.pdf.

Zhang L, Liu Y. Potential interventions for novel coronavirus in China: A systematic review. Journal of medical virology. 2020 May;92(5):479-90. DOI: 10.1002/jmv.25707

Savarino A, Boelaert JR, Cassone A, Majori G, Cauda R. Effects of chloroquine on viral infections: an old drug against today's diseases. The Lancet infectious diseases. 2003 Nov 1;3(11):722-7. DOI: 10.1016/s1473-3099(03)00806-5

Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, Seidah NG, Nichol ST. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virology journal. 2005 Dec 1;2(1):69. DOI: 10.1186/1743-422X-2-69

Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, Li Y, Hu Z, Zhong W, Wang M. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell discovery. 2020 Mar 18;6(1):1-4.

Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, Shi Z, Hu Z, Zhong W, Xiao G. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell research. 2020 Mar;30(3):269-71. DOI: 10.1038/s41422-020-0282-0

Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, Liu X, Zhao L, Dong E, Song C, Zhan S. In vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical Infectious Diseases. 2020 Mar 9. DOI: 10.1093/cid/ciaa237

Ball P, Maxmen A. The epic battle against coronavirus misinformation and conspiracy theories. Nature. 2020 May 1;581(7809):371-4. DOI: 10.1038/d41586-020-01452-z

World Health Assembly, 72. (‎2019)‎. Voluntary contributions by fund and by contributor, 2018. World Health Organization [Internet]. [cited 2020 Jun 21]. Available from:

GAVI - Wikipedia [Internet]. [cited 2020 Jun 21]. Available from:

Gavi welcomes election of new WHO Chief [Internet]. [cited 2020 Jun 21]. Available from:

How Vaccines Work | [Internet]. [cited 2020 Jun 21]. Available from:

Enjuanes L, DeDiego ML, Álvarez E, Deming D, Sheahan T, Baric R. Vaccines to prevent severe acute respiratory syndrome coronavirus-induced disease. Virus research. 2008 Apr 1;133(1):45-62. DOI: 10.1016/j.virusres.2007.01.021

Roper RL, Rehm KE. SARS vaccines: where are we?. Expert review of vaccines. 2009 Jul 1;8(7):887-98. DOI: 10.1586/erv.09.43

Mogensen SW, Andersen A, Rodrigues A, Benn CS, Aaby P. The introduction of diphtheria-tetanus-pertussis and oral polio vaccine among young infants in an urban African community: a natural experiment. EBioMedicine. 2017 Mar 1;17:192-8. DOI: 10.1016/j.ebiom.2017.01.041

Coronavirus Pandemic (COVID-19) - Statistics and Research - Our World in Data [Internet]. [cited 2020 Jun 21]. Available from:

BBC World News - HARDtalk, Anders Tegnell - Sweden’s chief epidemiologist, ‘Testing will give us better idea of immunity’ [Internet]. [cited 2020 Jun 21]. Available from:

Ledford H. Chloroquine hype is derailing the search for coronavirus treatments. Nature. 2020 Apr 24. DOI: 10.1038/d41586-020-01165-3

Ball P. Anti-vaccine movement could undermine efforts to end coronavirus pandemic, researchers warn. Nature. 2020 May 13. DOI: 10.1038/d41586-020-01423-4

García PJ. Corruption in global health: the open secret. The Lancet. 2019 Nov 27. DOI: 10.1016/S0140-6736(19)32527-9

Tegnell A - Still not a fan of lockdowns: Sweden’s state epidemiologist says media manufactured his alleged U-turn on Covid-19 measures [Internet]. [cited 2020 Jun 21]. Available from:

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2020 Alberto Boretti