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Thursday, December 03, 2020

More targeted measures, empathy from policy-makers are needed

I am not a doctor, public health specialist or epidemiologist to weigh in on the public policy response, but my judgement is that a four-month, total lockdown produces unintended consequences and diminishing returns.

Written by R Gopalakrishnan | Updated: July 17, 2020 10:16:31 am
The problem is not about a targeted lockdown, but a total lockdown that exceeds eight weeks. (File)

A citywide lockdown for over six weeks very likely loses effectiveness. As a senior citizen, I empathise with the leaders who bear the responsibility of balancing conflicting interests — they are damned if they do, damned if they don’t. The challenge gets complex when it is between somewhat uncertain and extremely uncertain outcomes, more so where public health is involved. Under exponential uncertainty, the response should evolve exponentially with the crisis.

For example, Johnson and Johnson’s response to the Tylenol crisis was exponential — it is now a classic case study. Vietnam’s response to COVID-19 was exponential, so was Kerala’s. More often, though, the response is linear.

Good decision-making should be driven by data. Judgement is born out of knowledge plus experience. With COVID-19, knowledgeable people don’t have experience. That is why we find that behavioural interventions are key — masking, distancing and hand-washing. Social scientists will confirm that changing behaviour requires an inclusive approach, empathy and common sense.

The initial Indian response looked exponential, though policy empathy as perceived by citizens could have been better about the means (saadhan-samagri). Emotionally-rich solutions from a competent and empathetic practitioner are perceived as better than efficient solutions from a cold practitioner. No one wants to get infected. To remain healthy, everyone needs to stay fit, which means exercise and counselling to cope with the traumatic effects of long lockdowns. Unfortunately, lockdowns and “un-lockdowns” are announced dramatically with the panache of a thriller — it is draconian for the police to impound a car or harass a person for being three kilometres from home.

The problem is not about a targeted lockdown, but a total lockdown that exceeds eight weeks. The comparison is between a four-month total lockdown and targeted lockdowns. I am not a doctor, public health specialist or epidemiologist to weigh in on the public policy response, but my judgement is that a four-month, total lockdown produces unintended consequences and diminishing returns. Mumbai citizens hope that it will not extend to the fifth month.

No doubt, there is misinformation (including an irrepressible Baba announcing a patently fake cure) and inadequate public discipline.

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The following COVID-19 facts are derived from Lisa Lockerd Maragakis (www.hopkinsmedicine.org), as updated on July 1:

Influenza is taken as a benchmark because we have all experienced it. COVID-19 and influenza have similarities, but also differences. Both are infectious respiratory diseases. Although their symptoms are similar, they are caused by different viruses. A lot is known about the influenza virus, far less about COVID-19. Both can spread person-to-person, through droplets or the air. Both can be spread by an infected person for several days before symptoms appear. Neither can be treated with antibiotics. Severe cases in both may require hospitalisation, and the affected could die, though COVID-19 may be more serious.

Testing methods to confirm the incidence of influenza and COVID-19 are similar. In both, the test results are not conclusive. Both are mitigated by behavioural actions like hand washing, coughing/sneezing into the crook of the elbow, limiting contact with affected people and physical distancing. WHO estimates that globally, one billion people get infected with influenza every year. So far, 10 million have been infected by COVID-19. Influenza-caused deaths number 3,00,000-7,00,000 every year; COVID-caused deaths so far are estimated to be 5,25,000. These are bald numbers and should not give the impression that COVID-19 can be taken lightly. Experts think that the mortality rate is higher for COVID-19 than for influenza and also seems to spread more easily. If one does get infected, a pragmatic plan of action has been recommended by Satchit Balsara and Zarir Udwadia (IE, July 2).

A city-wide lockdown provides time to strengthen testing and hospital arrangements. If the infrastructure is so inadequate that it cannot be strengthened in eight weeks, then that society will regrettably face negative consequences. Developing countries cannot emulate rich countries.

Sunetra Gupta is a professor of theoretical epidemiology at Oxford and is a lockdown sceptic. She warns about “immense harm and untold damage from extended lockdown. Lockdown offers preparation time, that too in countries, where people have income and stability”. For those who don’t have income and stability, she worries that like with other diseases — respiratory diseases, TB, diarrhoea — poor countries just don’t have the infrastructure to prevent deaths.

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In a city like Mumbai, where more most residents live in a highly cramped manner, lockdowns have the opposite effect of promoting devastating proximity and “social un-distancing”. Consider that most people with coronavirus won’t spread it, but a few infect many; infected people in crowded places become virus chimneys and act as super-spreaders . Among those who don’t live so cramped, staying home after some weeks becomes depressing. In a calibrated way, citizens must come into open spaces (with masks, distancing and so on). A city like Mumbai grievously suffers after a severely long lockdown. India has had over 25,000 unfortunate COVID deaths in the last five months.

Perhaps an unsuitable comparison, but India suffers 60,000 road-accident deaths in five months — you cannot solve it by stopping all vehicular traffic. There should be a campaign for behaviour change, like the successful Swachh Bharat campaign. We must cross the river by feeling the stones. Courage is about overcoming fear.

This article first appeared in the print edition on July 17, 2020 under the title ‘Counterproductive lockdown’. The writer is a distinguished professor at IIT-Kharagpur and senior citizen living in Mumbai.

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