Lives vs livelihood

THIS is how the debate on how to react to the coronavirus disease 2019 ( Covid- 19) is framed in much of social and regular media. With the exception of the United States and perhaps Brazil where it has unfortunately been polarized into an either- or situation, all governments are grasping with how to address both simultaneously. Now let me initially lay the premise, regardless of location and one’s political view — I do not think any government anywhere is undertaking the painful and restrictive steps it has imposed out of popularity or some warped sense of sadism.

They are sincerely responding to a difficult, vexing and unprecedented crisis that, even worse, is global in scope. Unlike in economic crises of the past, we cannot rely on one region to help out the weaker one ( for example Asia was less affected than the West in 2008, and the West was not affected directly by the Asian crisis in 1997) or localized or regional pandemics ( Ebola, swine flu). This is a global pandemic economic crisis, both very severe and unprecedented in scope and speed. So, let us cut our government some slack and unlike others, I actually praise its willingness to adapt and change course even if it seems haphazard as I would rather have a government that understands it is adapting to a situation and has the humility and flexibility to reverse course rather than have an attitude that I will lose face or seem weak if I alter my position. Something we saw enough of previously.

So, how does one deal with both? First, being humble enough to know we are not sure of the answers and there will have to be experiments, alterations and mid- course changes. Then be clear and humble in explaining what is being done and why there may be changes and reversals in policy based on results and what we find out works and does not. Also, get rid of those who are not up to the task. The last thing we want is to have a pestiferous recrudescence of Covid.

Success and failure

Tolstoy wrote in

“All happy families resemble each other; each unhappy family is unhappy in its own way.” Same with dealing with pandemic — success has the same characterisTICS, A flATTENED CURVE OF INFECTION, followed by diminution and elimination and a reopened and recovering economy. Failure will have many different ways and means to manifest itself.

Most intelligent research and analysis provide that lockdowns or quarantines are needed to arrest spread, flatten the curve of increase and then diminish cases. However, that merely provides a respite until the solution which is immunity via vaccine or treatment, unless one is of the view that herd immunity and the resulting deaths are an acceptable price. Sweden sort of took the latter approach and is now being criticized for its relatively higher deaths than its neighbors who managed at least so far to be more restrictive without ruining their economies, but of course all countries in the region suffered economic and social hardship. The United Kingdom was initially thinking of the same until deaths got out of control and they had to abandon that approach. Another problem with extended lockdowns or quarantines in a country like ours is it is premised on compliance and enforcement remaining steady. I think both are likely to deteriorate with time.

The paramount issue is what do you do in between lockdown and vaccines? Treatments are not ready and I am not an expert who knows when it will be safely available. Quarantines cannot last until then for social and economic reasons. What should be done?

First, see what other success stories and failures have been. No country is perfect, but clearly, China, Hong Kong, Taiwan, South Korea and Vietnam are success stories we can study and adapt. Failures need not be mentioned here but are obvious to anyone who thinks rather than vents. Sadly, I see a lot of venting. However, what is important in understanding the success stories?

The successful ones while learning from previous experience with the severe acute respiratory syndrome and from other countries shared one critical aspect? They all used independent thinking and thought not just what did others do but what would work best in our country given where we are and our limitations. There wasn’t a slavish imitation of what was done elsewhere and just copy it.

Vietnam

I don’t have space or time to list what the successful countries did but let me highlight the most analogous to ours, Vietnam. Their gross domestic product per capita is about 10 percent below ours and they have about 96 million people. Unlike us, they have a lot of manufacturing. My sources if you want to read for yourself are the ( March 24),

( April 13),

( April 16) and ( April 24).

Right away they recognized they did not have the means to widely test like South Korea or Taiwan and had a limited health care system that could easily be overwhelmed. They also knew they had a military that is both respected and feared and a population that is stoic and capable of sacrifice due to their high sense of nationalism and community. I will skip the whole narrative and readers who are interested can see the sources I cited ( you will never see me write I heard in a coffee shop or rumor is). I will concentrate on what they did which was unique to their circumstances and worked. First, they never quarantined a whole city or province. The largest single quarantine was a town of 10,000 outside of Hanoi where the first cases were and quarantined it for three weeks. From what I read they never quarantined more than 275,000 people at a time while they did have lockdown restrictions for the country analogous to the original softer quarantine plan for Metro Manila. They also closed all flights domestically and internationally and restricted travel out of your town or district except as needed for industry or trade. The amazing result to date is 324 cases, 263 recovered and zero deaths. The highest number of new cases a day was 25 on May 15. Even giving allowance for underreporting and errors this is phenomenal and has been cited by many as exemplary.

To not overwhelm their health care system, the first step was the isolation and treatment at hospital of people confirmed with the virus or with symptoms. THEN WITH VERY EFfiCIENT CONTACT tracing, second- and third- level contacts were forced to selfquarantine for two weeks even