State-wise shutdowns may be only way to prepare for spike

OUR OWN ESTIMATES SUGGEST THAT A FULL AND COMPLETE LOCKDOWN FOR THREE WEEKS COULD REDUCE THE NUMBER OF INFECTIONS BY AS MUCH AS 80%

In every way I can think of, India’s response to Covid-19 has been exemplary. Borders have been shut early in the epidemic, public messaging has been prompt, state governments have been responsive, industry has cooperated, and the population is gearing up for a once-in-a-lifetime event.

The one shortfall has been in testing, as many public health experts have been reiterating for weeks now.

Thankfully, that gap has now been bridged and we will have better eyes on the ground starting Monday when private laboratories start testing people. Yet, the question that is uppermost i n t he mind o f e v e r y Indian, including those in the senior leadership of this country, is whether we should shut down large parts of the country, if not the whole country, for a period of t i me t o st amp out transmission.

It’s a tough call.

On the one hand, shutdowns have helped in other countries. Every infectious disease model supports a total shutdown.

Our own estimates from IndiASIM, an agent-based model that has been constructed on Indian data over many years, suggests that a full and complete lockdown for three weeks could reduce the number of infections by as much as 80%.

But there are many unknowns.

The virus could mutate to be less virulent as most viruses tend to. Killing is not part of their plan, it’s just an unintended side-effect. Also, it is possible that increased temperature and humidity may give us a break in the way that new, albeit unpublished data from Tsinghua University in China indicates, although no serious scientist would bet on it.

Also, our models suggest that a shutdown would have to be at least three weeks long to have its full effect, although even a two-week full shutdown would have a partial effect.

On the other hand, a shutdown would exact tremendous economic costs across India. And it is not clear that a shutdown would work in India.

On Saturday, we saw images of hundreds of thousands of migrant workers heading back to their home villages in the rural hinterland. Quite likely, they have taken the virus back with them to areas with weak health care facilities.

How likely is it that they will be quarantined in their homes? Or will they be spreading the infection to their neighbours? As has often been said, all disease models are wrong, but some are useful.

What we mean by that is that these are meant to guide our thinking but not meant to be followed blindly. Disease models cannot consider the impact on livelihoods or national morale. They cannot take into account the effect of hunger and despair because of a lockdown on people’s ability to withstand disease. They cannot predict challenges to law and order from an irate population that has lost hope.

What are the alternatives to a shutdown? We should certainly emphasise the main messages of social distancing, avoiding gatherings larger than 10 people and i ncrease, r at her t han decrease, the availability of public transportation.

We should remember to wash our hands, stay home when sick and make sure that our elderly and small children are sheltered at home. We should remember to cough into our elbows or not spit.

A state level lockdown or even stopping traffic across states is likely to be far more effective.

The railways and inter-state bus shutdown that has been announced probably has the best effect of all measures, even if it inconveniences people — but the economic damage is far less than a full lock down of the country.

Covid-19 is a true Black Swan event and we may have to take it on the chin.

India needs at least a million ICU beds and oxygen equipment and probably half a million ventilators nationwide, in every district, to blunt the impact when it happens. We need temporary treatment of about 10,000 beds on average in every state capital and 1,000 in every district capital. But this is within India’s capacity to prepare for. We organise both the largest elections in the world and the largest i mmunisation campaigns. It may be better for us to prepare for mitigation at massive scale and with a population which is not hungry and impoverished.

Epidemiology would suggest a total shutdown; economics would recommend restrictions on movement and a focus on mitigation.

My own vote would probably be to take the route of state-wise shutdowns. This would allow us to rebuild the economy, maintain the public health messaging, keep social distancing, vastly expand testing and surveillance, and prepare our population for a spike in cases. That way, we will be ready when it does arrive — and it will be an opportunity for the nation to come t ogether as one i n i t s response.