Coronavirus (Covid-19): All approaches to easing the lockdown carry risks of infection spikes. How can we minimise the risk while allowing work? The government is following a geographic (zonal) approach. This is a high-risk approach which can also prove ineffective.
A more effective, minimal-risk approach would be to create infection-free worker pools, by a strategic combination of antibody and PCR testing of workers in businesses that open up. Let me explain why.
The government has demarcated three zones: green, orange and red. The green zones are those where no new cases were reported over 28 days since the last case tested negative. The orange zones are those with a few cases, and the red ones have a large number of cases.
The government suggests opening up the green zones first. But these zones may have many asymptomatic cases, that is, infected people with no symptoms. The Delhi government found recently that 25% of those who tested positive had no symptoms. China had 44% asymptomatic cases. These are very high figures.
If green zones are opened and 25% people are asymptomatic carriers, infections will spike. If workers are together in factories, even with social distancing a single asymptomatic carrier can infect others, forcing the entire unit into quarantine. The effort of opening up that factory will be wasted. Moreover, many factories are located in red zones, and supply chains often cut across zones.
For example, Baddi town in Himachal Pradesh is India’s biggest pharma hub, and home to major companies that produce numerous essential drugs for domestic and export markets. It is in a red zone but is being allowed production, with many workers coming from other states. What if the workers bring infection?
A lower risk method would be to create “pools of green workers” (rather than green zones) who are infection free. Hence, if an industry wants to open (and all should be allowed, whether producing essential or non-essential goods) it should first identify its workers.
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Those who have already recovered from the virus will have some immunity. Give them a green certificate or stamp their arms. Give antibody tests to the remaining workers in that industry. These are blood tests which can identify in an hour if someone has been infected, even if asymptomatic. Some antibodies (IgM) appear a few days after infection and others (IgG) a little later.
Some of those who test positive may still be infectious, others would have recovered. To identify the recovered, give a PCR test. Those testing negative can join the green workers. Those testing positive should self-quarantine for say 7-8 more days, and then get PCR tested again and cleared.
This procedure will create a worker pool who can work without endangering others or themselves. They will not need on-site lodgings, since they will have some immunity, and can come from any zone, including red.
What about false negatives or false positives in antibody tests?
The false negatives, that is, those showing no antibodies even if infected, would be excluded anyway from the green worker pool. On false positives, that is those showing antibodies without being infected, if the PCR test finds them infection free and they have been in self-isolation for 14 days, including them in the worker pool will carry minimal risk. There will still be some risk, since they will lack immunity, but their co-workers with antibodies will have immunity.
The second issue is identifying services and businesses for antibody testing.
Health service workers are already on the priority list. Another priority is industries manufacturing PPE kits, ventilators, oxygen concentrators and medicines, but they should also create green worker pools. Beyond this, any factory or business that has its requisite number of green workers should be allowed to open, whichever zone it falls in, with minimum red tape in granting permission. Given low consumer demand, rather few may initially come forward in any case.
By focusing on green workers and not green zones, we can also minimise the need for housing in work locations, which most businesses lack. But those who want to provide housing can minimise the chance of cluster infections, if they have pre-tested workers.
The third issue is housing migrant workers who may join the work force later but need accommodation now, given continued lockdowns across states.
For them, large spaces (stadiums, convention centres) should be opened up. These allow for social distancing, showers and toilets, community kitchens or even self-organised cooking, virus testing spaces, and parking for transport buses, etc. Many states are using schools and colleges for migrants, but these will be needed when they open, and seldom have stadium-type facilities for a few thousand people.
Basically, we need an effective but low risk strategy to return to work and ease the lockdown. A zonal approach can prove ineffective and carries high risk. The answer lies in creating green worker pools, not green zones, through targeted antibody plus PCR testing, and a generous plan to house migrant workers. We can thus work with the lockdown with minimum risk and maximum effectiveness.
Bina Agarwal is Professor of Development Economics and Environment, University of Manchester, UK.
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