Containing Pandemics in India-Going Beyond Lockdowns
In India, it is exactly two
months since the lockdowns began. But lockdown doesn’t seem to have reasonably attained
its objective-to contain the spread of COVID-19 virus. Every second day is a
new high of emergent cases for the nation. Moreover, a new debate has begun
questioning the efficacy of the lockdown as a pandemic containment strategy.1
Lockdowns have led to an unprecedented migrant crisis in India. Here, we
will look at why lockdowns are not an effective strategy for pandemic control.
We will also analyze alternative, benign solutions for pandemic control.
1.
Authoritarian
mimic
During previous
pandemics, since the start of the 20th century, most responses to
pandemic outbreaks were determined by the first world nations, which were
primarily democratic and liberal, at least domestically. The COVID-19 pandemic
is the first one, where the global response has been led by the People’s Republic
of China, an authoritarian regime2. Most nations mimicked the Chinese
response with some modifications. Ever since the 2008 financial crisis, the United
States gradually withdrew from the leading global response to crises. This has led
to China attempting to take leadership role in global crises.2a The
COVID pandemic is the first major crisis since the 2008 financial crisis when the Chinese response was the leading solution. However, there has been a substantial
backlash from the crisis against China. It
is also worth recalling that even though China led the lockdown and relief
response initially, but as soon as the US mandated compulsory masks for all, most
nations started insisting the same, including China. This highlights the
importance that the country still holds in the global milieu. The situation unraveled
like this- If five neighbors face a similar kind of problem at different
periods, chances are that the other four will mimic the response of the one,
who first faced the problem, especially successfully (or, with the perception
of success). This is what happened; as soon as Chinese lockdowns seemed to be
successful, most countries didn’t waste time brainstorming alternatives and
went into lockdown mode.
2.
Recent origins of lockdowns
Essentially,
lockdowns as a concept found their way into serious policy considerations in
20063. It was incorporated into the then US President Bush’s policy
through a paper titled “Targeted Social Distancing Designs for Pandemic
Influenza.” The idea of social distancing germinated from a computer modeling
done by a 14-year old student. However, Dr. D.A. Henderson, who led the
international effort to eradicate smallpox, completely rejected lockdowns so
much so that he exhorted policymakers to eliminate such strict lockdowns from
serious considerations. In a paper titled “Disease Mitigation Measures in
the Control of Pandemic Influenza,” Dr. Henderson and
others insist- experience
has shown that communities faced with epidemics or other adverse events respond
best and with the least anxiety when the normal social functioning of the
community is least disrupted.
As we are seeing, lockdowns are not able to
‘flatten the curve’ as was expected4. Taiwan, a no-lockdown country,
had 0.3 deaths per million. (The country has had a total of seven deaths.) No-lockdown
Sweden has had 347 deaths per million; lockdown Belgium, with a similar
population, has had 763 deaths per million. Ethiopia, with a population of 109
million had no lockdown — and a death rate of 0.04 per million.
3.
A little bit of autocracy
The implementation of lockdowns, quarantine and
tracing is surely going to increase the government’s interference and authority.
Already there are many reports on excesses by government authorities on
citizens.5 Global liberal thinkers are expressing concerns over how
lockdown measures may diminish gains made in individual liberties, especially internet
privacy.6 But, it needs to be emphasized that some form of government control is a necessary compromise citizens will need to make to
control the pandemic outbreak. The author however suggests fewer blanket lockdowns
and rather government focus on localized, targeted containment. The focus
should be the least amount of disruption to the normal way of life. This should ensure
reduced panic and anxiety among citizens, which was a prime cause for the
migrant crisis in India. Trust in government needs to be assiduously addressed
as Dr. Henderson warns, “If [governmental reassurance] is seen to be less than
optimal, a manageable epidemic could move toward catastrophe.”
4.
Alternatives-1- Taiwan7
Exploring alternatives is imperative for
governments. If reports are to be believed in, COVID-19 may show a resurgence in the
winter of 2020.8 In such a scenario, re-implementing lockdowns may
result in substantial damage to not just the economy, but also human resources.9
So, here we will look into alternatives to blanket lockdowns. The first case is
Taiwan.
People of Taiwan seem to place enormous trust in the
government.10 Indian governments, especially state governments at
the level of District Commissioner (DC), need to build trust with the poor. The easiest way of trust-building is to provide them with rightful public services
on time. These can be food grains, gas cylinders, cash transfers etc. DCs need
to also meet people in their localities, allay concerns, and take feedback regularly.
The Taiwan strategy comes at the enormous cost of
privacy breaches by the government. However, it looks to have been successful
in preventing full lockdowns. The Taiwan strategy could be adopted in Indian
metro cities, where there will be enormous convergence of people from different
geographies through different means. Some plans from Taiwan strategy that could
be adapted in India-
--> Epidemic
taxis/ buses- All arriving passengers will only take these taxis/ buses. They
will go to quarantine facilities if found symptomatic. All asymptomatic
patients under certain criteria such as respiratory illnesses, smoking history
etc. will be compulsorily tested at the airport/ railway/ bus stations. These
passengers will have to remain under quarantine until they are tested negative.
--> Local
symptomatic cases and arriving passengers will have to part their location
tracking to authorities for a certain period of time (14-30 days). They can be
tracked through a unique code without using the passenger’s original name or,
other details.
--> Central
Epidemic Command Center (CECC)- Government can create an Indian version of
Taiwanese CECC. This CECC could act as an independent agency like Election
Commission. The powers could be escalated according to pandemic levels with the highest being when the CECC commander (Generally an epidemiologist) can
directly instruct, like the Chief Election Commissioner, state chief
secretaries and DCs to take top-down instructions.
5.
Alternatives-2-Sweden11
By far the most ‘radical’ strategy against COVID-19
pandemic has been from the Swedes. As a thought experiment, it is worth
wondering what if the world had emulated the Swedish strategy? Would India have
seen less suffering generated through the migrant crisis? Would the world economy
may have seen lesser pecuniary bloodshed? We will never know! But Swedish
strategy comes with its own drawbacks. Moreover, Sweden has been equally
affected by the economic impact all other countries are facing due to the
pandemic. However, the Swedish strategy could be extended to orange and green zones
as defined in Lockdown 3.0 of India.
Some ideas from the Swedish strategy that could be adapted
in India-
- Constant reiteration for self-isolation for the vulnerable groups such as elderly and people with respiratory illnesses.
- Limiting human assembly to 50 people, but not blanket closing of all restaurants, salons etc.
- Establishing of handwashing spots at different public places.
- Trying to take as much university education online as possible.
- Identifying old age homes and special support to protect them from the COVID-19 virus.
6. Looking forward
Lockdowns as a pandemic containment strategy are not
effective.4 Collateral damage to the economy is too huge.12
While there is yet not a single recipe for successful
containment, the government should try different strategies for different places.
The latest regulations post lockdown 4.0 seem to be government learning the
ineffectiveness of lockdowns in containing the pandemic. However, chances are
the pandemic may conceive in a new form in the winter of 2020. It is important
to prepare for that kind of scenario with blanket lockdown out of policy
arsenals.
The disruption to economic life should be least
possible, as such a disruption may have consequences far beyond what pandemic
simulations entail.
The healthcare revamp measures as outlined in the Atma
Nirbhar Bharat Package should be implemented at the earliest. Those measures,
if implemented properly, will be sufficient to handle the pandemic outbreak
locally or, nationally.
The government should also train and create a reserve
pandemic control force, consisting of paramilitary, police, ASHA workers, NSS,
NCC and other such volunteer groups.13 Such reserve force should be
activated for active tracing, testing, containment, constant communication, and
other real-time measures that need to be undertaken during an outbreak.
Much like food stocking facilities of FCI, each
district should have reserve stocks of PPE kits to be used during containment.
Constant communication with citizens is very important
during such crises. When, communication through digital or, other media seems
inappropriate, the local leadership should meet people in-person (with social
distancing norms) and allay the citizens’ concerns.
Government
should also create different scenarios and create appropriate solutions by
identifying gaps through simulation exercises.
The possibility of developing the vaccine for COVID-19
seems to be getting higher, with earliest estimates pegging October-November as
a period when vaccines may become available for the general public.14 In
such a case, the chances of containing a possible second outbreak look
brighter. However, the governments should ensure vaccines are adequately
produced and vaccinated to the right people first, to stop the resurgence of the pandemic.
This author is not prescribing against lockdowns as
voiced out by certain groups for
political purposes. Perhaps, lockdown could have tried to flatten the curve.
Perhaps, it may not. There is no conclusive evidence yet.4
Democratic countries like India, Sweden, Israel,
Germany and others should unite and seek more accountability from the People’s Republic of China. Outbreaks such as these are not subjects that are hidden
from the public or, even global institutions. Earlier detection and containment
could have slowed the pandemic without necessitating a lockdown. International
institutions should devise a way to detect such outbreaks independent of the
government in control, much as it is done with regards to nuclear devices
testing.
Large scale lockdowns seldom do any good, if other
more important strategies such as testing and tracing are ineffective. Also, apart,
such lockdowns generate enormous anxiety in the citizenry accustomed to the
hustle and bustle of life. Therefore, democratic governments should attempt to
create future pandemic containment strategies independent of total lockdown.
Sources-
1- Lockdowns Haven’t Proved They’re Worth the Havoc https://www.bloomberg.com/amp/opinion/articles/2020-05-21/coronavirus-lockdowns-haven-t-proved-they-re-worth-the-havoc?__twitter_impression=true
2-
Democracy Index, Economist https://www.eiu.com/topic/democracy-index and https://carnegieendowment.org/2020/03/31/do-authoritarian-or-democratic-countries-handle-pandemics-better-pub-81404
2a- China
has two paths to global domination https://foreignpolicy.com/2020/05/22/china-superpower-two-paths-global-domination-cold-war/
3- The
2006 origins of lockdown https://www.aier.org/article/the-2006-origins-of-the-lockdown-idea/
4- There Is No Evidence Lockdowns Saved Lives. It Is
Indisputable They Caused Great Harm
5- Lockdown: police ‘excesses’ draw
flak https://www.thehindu.com/news/national/andhra-pradesh/lockdown-police-excesses-draw-flak/article31187504.ece
6- How the Coronavirus Pandemic Will
Permanently Expand Government Powers https://foreignpolicy.com/2020/05/16/future-government-powers-coronavirus-pandemic/
7- Taiwan
strategy https://www.thehindu.com/opinion/op-ed/taiwans-coronavirus-protocol-shows-how-it-is-done/article31484681.ece and https://www.nbcnews.com/news/world/taiwanese-authorities-stay-vigilant-virus-crisis-eases-n1188781
8- Flu and coronavirus will launch dual 'assault' on America
next winter if we don't prepare now, CDC chief warns https://www.livescience.com/covid-19-second-wave-flu-season.html
9- Mental health effects of school closures during COVID-19 https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30109-7/fulltext
10- COVID-19 diary: How Taiwan’s coronavirus response is
exemplary – experiences of an Indian researcher in Taipei https://yourstory.com/2020/04/covid-19-diary-taiwan-coronavirus-response
11- The Government’s work in response to the virus responsible
for COVID-19 https://www.government.se/government-policy/the-governments-work-in-response-to-the-virus-responsible-for-covid-19/
12- COVID-19 Economic Impact Could Reach
$8.8 Trillion Globally https://www.adb.org/news/covid-19-economic-impact-could-reach-8-8-trillion-globally-new-adb-report
13- The
Next Epidemic https://www.nejm.org/doi/suppl/10.1056/NEJMp1502918/suppl_file/nejmp1502918_appendix.pdf
14- Covid vaccine could come by 2020-end but realistic
time-frame would be 2 yrs: Adar Poonawalla https://theprint.in/theprint-otc/covid-vaccine-could-come-by-2020-end-but-realistic-time-frame-would-be-2-yrs-adar-poonawalla/426868/
Comments
Post a Comment