For the last four weeks, I have had the privilege of leading over a hundred of Australia’s brightest medical scientists, economists and political scientists to develop a report called the “Roadmap to Recovery”. It outlines two options for Australia — elimination of the virus, or controlled adaptation to it. I have wondered whether these options make sense for India, but neither of these approaches will work for India: The country needs to pioneer its own pragmatic way.
Australia is a small country of 26 million people spread across a vast continent with a well-developed health system. This makes elimination possible. In fact, five regions in Australia have successfully eliminated the virus already and now have extensive testing to certify that. In a country of India’s scale and size, and limited healthcare resources, the elimination of COVID is not possible anymore. India will have to live with it.
The rest of Australia is now going for “controlled adaptation” where the virus is suppressed to very low levels. Australia right now has 10-20 new cases a day, and it is hoped that it will be held at this level while gradually releasing restrictions. To achieve this, one needs a precise handle on the total number of cases and extensive testing. I fear none of these conditions apply to India.
India currently reports approximately 3,000 cases a day and has relatively limited testing. The London School of Hygiene estimates that the real number in India is closer to 2,00,000 total cases, and rising fast. Even if India wishes to hold the numbers to this level, the scale of testing required for finely tuned relaxation of social distancing is in the range of 10,000 to 20,000 per million. India currently stands at 700 per million. India would have to increase its testing by a factor of 20. No country can do that in the next few weeks.
The lives versus livelihood trade-off for India is not the same as that for Western nations. A study done by Barnett-Howell and Mobarak of the Yale University School of management shows how the cost-benefit trade-off of social distancing makes good sense in Western nations while in nations like India, using local costs and local values, the returns are meagre. Social distancing in countries like the US and Germany delivers economic returns more than 10 times greater than the returns for countries like India. So, why is India following the same prescription?
We need our own approach that capitalises on the realities of the virus and the virtues of India. First, it is becoming clear that the fatality rate of the virus is much lower than it appears. Antibody studies in Italy, Germany, California and New York show that for every one case recorded in the system, there may be five-10 others who have immunity. In all likelihood, they got their immunity from very mild or silent infections. If confirmed, this has two implications. First, the virus is too widespread to allow for controlled suppression in India, and that the virus is not as fatal as has been initially assumed.
Add to that, COVID-19 is much less dangerous, almost 20 times less dangerous, for those under the age of 50. Three-quarters of Indians are under 50, and they account for more than 80 per cent of its productivity. They are the ones who earn to support the young and the old. India’s under-50 could thus “recover” back from social distancing into productive employment.
“Recover” does not mean back to normal. It means a large-scale return to work but with a few practical conditions: No physical contact, everyone wears home-made masks, places of employment provide water and soap and require disinfection three times a day, maintain “arm span” distance where practical; amplify in the media the three major symptoms of COVID and provide advice on self-isolation if any two of those three present; and, testing and tracing where possible. No large parties, no large gatherings. A simple message, posted all over the country.
While allowing this, one would selectively “shield” the elderly, the vulnerable and those who feel particularly at risk. They should continue to practise social distancing as they do now, and should use face masks and “arm span” when interacting with the young.
Modelling studies by the London School of Hygiene show that such an approach of “recover and shield” for countries like India could achieve the benefits of an early economic recovery, and dramatically decrease the number of cases requiring hospitalisation and deaths. Indeed, the number of deaths in India could be held to less than those lost every year from smoking and air pollution.
India could use its sophisticated system of collecting data by districts and zoning them by COVID cases to implement this model in stages, comparing districts as it goes along, refining the method and sharing it with the rest of the world.
The strategies of the West will not work for India, nor for the other low and middle-income countries. Following them will lead to an economic and humanitarian disaster. With its own version of “recover and shield”, India can pioneer a better way. And it does not have to wait. It can start tomorrow.
This article appeared in the print edition of May 15, 2020, under the title ‘Recover and shield’. The writer is dean of the faculty of medicine, dentistry and health sciences at The University of Melbourne