How to open up?
To know where to go, we must know where we are; a nation-wide seroprevalencestudymaycostone-hundredthofthegdpitcanhelpsave
With active Covid cases having fallen to nearly half the peak seen three weeks back, and daily new cases down by nearly two-thirds, the discourse is now shifting towards the process of easing restrictions. At a national level, such talk may appear to be premature, as despite the fall from the recent peak, both daily new cases and active cases are still one and a half times the peak in the first wave. However, trends vary across regions, and states like Delhi, Bihar, and Jharkhand already have active cases well below the peak of the first wave (a steep fall in positive test ratios suggests this is not just due to under-reporting). Several other states have cases declining at a pace that mirrors the devastatingly steep rise earlier, and can soon hope to open up too.
Early announcements from some states link the opening up of a district to its oxygen-bed utilisation and test positivity ratios. This makes explicit the underlying reality that the virus can no longer be eliminated through containment. One can only hope to minimise loss of lives by providing sufficient medical care to those infected, and prevent superspreader events.
Keeping activity restrictions at current levels till at least three-fourths of the population have been vaccinated (herd immunity) may also be an unreasonable goal: Every month at current depressed levels of mobility means a loss of more than 1 per cent of full year GDP. As seen elsewhere in the world, and also in the first wave in India, much of this loss is being borne by lower-income households, and the country does not have the toolkit to target much beyond sustenance support (like free grains or MGNREGA jobs) to such households.
Further, the Indian state has limited capability in enforcing lockdowns for sustained periods. Once the panic around the pandemic subsides, it may become harder to get people to stay at home. In fact, in districts seeing a drop in active cases, mobility has already improved by 10 to 20 per cent, much before lockdowns started easing. The risk is in getting the worst of both worlds: Restricting economically productive but lower-risk activities even as some higher-risk behaviours evade scrutiny or continue with the connivance of local administrations.
At the same time, opening up fully too early would mean exposing ourselves to a third wave, like seen now in countries like the UK among unvaccinated parts of the population (the younger folks). Even economies like Taiwan and Vietnam, which had been very successful in controlling the first wave, are struggling, the latter with a new variant.
A more data-driven and calibrated approach may help balance the risks to lives and livelihoods.
Granular seroprevalence studies may be necessary to assess the readiness of a district or a block to relaxation of activity restrictions. The Covid-19 virus and the more infective newer variants cause numerous asymptomatic infections which mostly do not show up as cases. Commentators use an infection-to-case ratio of 10 to 20, but it could very well be higher. According to the ICMR’S national study, the ratio was 28 in the first wave till December last year: 21 per cent of the population had antibodies whereas cumulative cases were only threefourths of 1 per cent at that point. Compared to the first wave, the positive test ratio has been significantly higher in the second one, suggesting the under-counting was worse. The frequency of the comment “Bukhaar aaya, khaansi hui, theek ho gaye” (“had fever and a bit of cough, but now I am fine”) has been troublingly high in rural areas (as, sadly, have been news reports of deaths preceded by fever and cough). If the infection-to-case ratio was 20 this calendar year, nearly half of India should already have antibodies due to infections, in addition to the 12 per cent that have received at least one shot of the vaccine. The virus itself therefore may have inoculated many more individuals than the vaccine. If the infection-to-case ratio is 30, large parts of India may already have herd-immunity.
It is therefore important to understand the levels of seroprevalence at a granular level to not only appropriately pace the opening-up process, but also prioritise the allocation of still scarce vaccines. Some recent studies have shown that immunity from previous infections lasts a while in most people. That said, as only symptomatic cases were studied, it is as yet unclear if asymptomatic infections also lead to immunity lasting beyond a certain short period.
Given the new lessons learnt about the virus, like airborne transmission (versus droplet transmission being the standard earlier), new norms need to be communicated for pandemic-appropriate behaviour, perhaps relaxing open-air activities and designing ventilation standards, while restricting crowds at weddings, festivals, and social/political/sporting events. The latter may need to wait till seroprevalence reaches a sufficient level.
As vaccine supply now picks up, we must also start preparing to deal with vaccine hesitancy. There is a reasonable risk of vaccination slowing down within the next two months due to shortage of demand, and it may be prudent to be prepared with effective intervention.
Devising economic measures in the coming months is likely to be challenging, given the need to stimulate economic activity even as several restrictions are in place. Further, while for the population as a whole the demand lost during lockdowns is mostly of the “did not earn, did not consume” type and is “water under the bridge”, the folks who do not earn are different from those that do not consume. Some households are left with excess savings while others are forced to take more loans. The resultant impact on wealth and income inequality creates economic as well as social distortions. While it may be tempting to use taxes to equalise, even if temporarily, the inefficiencies of taxation and of allocating resources should drive caution. Even as the sovereign debt to GDP ratio climbs up (government spending cannot and should not stop, but taxes slow, and the denominator stalls), one must remember that higher sovereign debt is also a liability of taxpayers. It may be more efficient to use temporary indirect tax cuts to stimulate those left with surplus savings to spend on labour-intensive sectors.
As the coming months require deft manoeuvring by the Central and state governments, from an administrative perspective it is critical to manage public health and the economy together.