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Any decision on extending coronavirus lockdown must be based on extreme circumspection, realistic cost-benefit analysis

Efficacy of universal lockdown isn’t completely endorsed, nor is there indisputable evidence to suggest it is optimal response.

Written by Aruna Sundararajan | Updated: April 13, 2020 10:01:15 am
coronavirus india lockdown, coronavirus update, corona, coronavirus update in india, coronavirus in india, coronavirus india, coronavirus cases in india, coronavirus latest news, coronavirus news update, coronavirus latest news update, corona virus, corona virus in india, corona virus news update Lockdowns can indeed reduce mortality rates by flattening the infection curve, thereby ensuring an even distribution of cases.

As the country approaches the end of its nationwide lockdown on April 14, one question dominates national discourse: Should India extend the lockdown? Never before has India confronted a public policy dilemma that impacts the lives and fates of millions so critically.

A number of states have already announced extension of the lockdown till the end of the month; more are expected to do so. It would appear that the lockdown is likely to get extended by two more weeks, calling to mind TS Eliot’s haunting line about April being the cruelest month.

Can India afford such an extension, seeing the costs so far? What are the trade-offs involved?

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In the first flush of the pandemic, when the world’s experts and governments were scrambling to come to terms with its etiology and effects, as well as the appropriate policy response, many countries, including India, opted to erect a barrier of containment by locking down the population. The trade-off seemed simple enough — a choice between saving lives or livelihoods. Unsurprisingly, every country, barring Sweden, chose to save lives. This set a powerful precedent for India.

However, as days pass, the trade-off is looking increasingly complex and open to challenge, given the life-threatening consequences that look likely if the lockdown is extended, unless massive relief and support are forthcoming from the government, ensuring access to livelihoods and sustenance for all.

In making the decision, one must acknowledge that much has changed since the epidemic first struck.

We are now in a much better position to understand the trajectory of the disease, as well as to have a fair assessment of the impacts and limitations of lockdowns and social distancing. We now know, for example, that in place of a one-size-fits-all lockdown, there can be graded containment strategies that can be fine-tuned against three vectors: Geographic, depending on the varying locational intensity of the disease; vulnerability-oriented, with differing containment strategies for more vulnerable sections like the aged; and sectoral, with a more liberal containment regime in place for essential activities like agriculture.

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A significant number of reputed global health experts, who have spent decades studying epidemics, are beginning to question the validity of initial assumptions about the nature of the illness, and the efficacy of radical remedial strategies such as lockdown.

We can no longer go solely on the basis of international precedent. Nor can our sole consideration be to halt the pandemic, no matter the cost. India’s present lockdown has been rated as the severest in the world and the most disruptive by far, impacting a seventh of the world’s population. Whatever decision we take, we must keep foremost the impact of the lockdown on the poorest and the most vulnerable: For it is they who are likely to bear the brunt.

While we know that the COVID pandemic is much more infectious and more virulent than the flu, it is also a widely accepted fact that viral epidemics abate only when around 60-80 per cent of the population acquires “herd-immunity” — either by vaccination or by acquiring the disease.

Lockdowns can indeed reduce mortality rates by flattening the infection curve, thereby ensuring an even distribution of cases. But much depends on how effectively we are able to use the intervening time available — to train personnel as well as procure the requisite devices, supplies and protective equipment, amongst other things.

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Recent global experience also teaches that the timing of the lockdown is critical. Unlike what is intuitively believed, early lockdowns are known to be suboptimal because they merely postpone the peak, but do not reduce the numbers. Many countries have imposed lockdowns only when infections peaked to levels that threatened to swamp the capacity of their healthcare systems.

Based on the trajectory so far, there is also fair likelihood to suspect that India, like other tropical countries, may be experiencing a less virulent epidemic than seen in the west; either due to higher natural immunity, or vastly different demographics. Some countries around us, like Pakistan Singapore, Thailand, Malaysia, Singapore, Philippines, Japan etc appear thus far also to be having a relatively flatter disease trajectory at present. Most of Africa does not seem to have entered the epidemic phase.

One-size-fits-all lockdowns are similar at this point to an experimental one-shot drug; with potentially unknown and possibly undesirable side effects. The efficacy of universal lockdowns is by no means completely endorsed, nor is there indisputable evidence to suggest that it is an optimal response.

Whereas countries initially had only the Wuhan model of containment to go by as precedent, we now have a wide spectrum of responses and strategies — ranging from India’s total lockdown to Sweden’s largely non-interventionist, voluntary social distancing. In between, we have countries like Korea that have followed a strategy of aggressive, widespread diagnostic testing and isolation coupled with social distancing, as well as others that have imposed highly limited geographic and demographic containment protocols.

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We also now know that several leading global health experts have questioned the numbers projected in the initial studies and forecasts as being inordinately high. These experts have urged greater conservatism and caution before radical, society-altering methodologies like universal lockdowns are extended. Some are even arguing that the earlier a population acquires herd-immunity, the better the outcomes of the disease. It is incumbent that our experts and advisors present the decision-makers with the full facts, the latest knowledge and insights and a broader array of options rather than merely a single option; namely, to extend or not extend.

Economists and social scientists have already drawn attention to the possible impacts of a prolonged lockdown on India’s economy and the lives and livelihoods of the vast majority, as well as the emergent need for massive relief and fiscal stimulus to get the economy rebooted. Reports have highlighted the unprecedented surge in unemployment levels, emerging widespread farm and rural distress, and incipient starvation even as harvests wilt in the fields. Food and medical supply chains are broken in parts, and even hospitals are closed in a few small towns, at a time when their need has never been greater.

This is all happening a mere two weeks into the lockdown. Further decisions on the relief and stimulus packages that are awaited, may yet hopefully mitigate to some extent the losses. Any amount of relief notwithstanding, the costs are bound to be substantive and disproportionately high for those who can least afford it.

Given the momentousness of the decision, it is incumbent that it is guided by extreme circumspection and informed by a clear-eyed, realistic cost-benefit analysis arising from our own and global experience; so that we are not caught in a proverbial chakravyuh from which there is no exit.

Most importantly, any decision must be preceded by the widest possible public consultation. For, collective knowledge and reason alone can illumine these dark times.

This article first appeared in the print edition of April 13, 2020, under the name ‘April’s cruel dilemma’. The writer is a retired civil servant

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