Covid-19: Lockdown Bought Us Time But Will Not Eliminate The Virus; Phased Opening Of Economy Must Begin Now

The Prime Minister took a characteristically decisive action by announcing the immediate nationwide lockdown last month.

It was inevitable in view of the enormous threat posed by the previously unknown Wuhan Virus.

While this was a huge political risk, it was the right thing to do in view of the danger posed by the pandemic.

Other countries have followed similar or radically different routes and we have bought time to study and learn from their policy and clinical experience.

The lockdown was justified on this basis alone. We were early supporters of the lockdown and our only grouse is that it was not imposed sooner.

However, the PM was diffident when it came to the extension of the lockdown while the CMs publicly clamoured for it.

This, again, is understandable as the economic costs become clearer every day. Unlike the PM, the CMs are unlikely to pay the political price for this decision.

The clarity regarding an exit strategy from the lockdown is not easy. It is apparent now that we are in for an exceptionally long fight against this threat.

Lockdown must end

We need to recognise the reality that the lockdown must end soon. The nation’s capacity and resources are being stretched to the maximum to keep this lockdown going for so long.

People must get back to work and the engines of the economy must start running again.

We simply cannot afford to continue this too far. Even if the middle class continues to dip into their savings for some more time, the poor will simply lose their patience very soon.

The only open question is whether the lockdown will end under the control of the state authorities or otherwise.

It will be very unfortunate if the lockdown dissolves under the pressure of a disregard from the people.

That will be an explosion, resulting in chaos. The state machinery is already under prolonged stress and will be unable to exercise any control in such a situation.

The only way out is for a planned and controlled relaxation of the lockdown, and it must start now.

Can any strategy eliminate the virus?

Even if we had the luxury of a few more months, would a lockdown eliminate the virus completely?

Would we be able to start from a clean slate?

If this was possible, any extension might, perhaps, be worth the pain. Unfortunately, the answer is a clear no.

We know that a high percentage of infected people are asymptomatic. Moreover, the incubation period of the virus is spread over a wide range.

This means that a significant number of the carriers will remain undetected even after extended periods.

While we may succeed in bending the curve for a while, the curve will bounce back again after some time.

This has been the experience of countries like Japan, Singapore and China.

Also, we have a big danger looming ahead of us. Millions of Indians work in the Gulf, US, UK, and other pandemic-affected areas.

It seems inevitable that lakhs of Indians living or stranded there will head back home as soon as the flights resume.

No quarantine will be able to deal with such huge numbers. The virus will sneak back into our borders with them.

We must shed the notion that the Wuhan Virus is going away. It is going to stay with us for a long time.

Combating the Virus and the risks involved

Most experts seem to agree that a reliable vaccine is at least a year away or, perhaps, more. We might turn out to be lucky and it might happen sooner. But nobody really knows for sure at present.

So, our current strategy must assume that the vaccine is unavailable. What options do we have then?

1. The infamous ‘herd immunity’ – It’s important to recognise that there is inherently nothing wrong with this at all. The key issue is to manage the hospitalisation load and death count while the population acquires herd immunity. While the experiences of other countries are useful, there is no substitute for trying this out on a limited scale in our conditions.
2. Innovation in clinical treatment protocol — There is enormous scope for innovation and experimentation to develop new clinical protocols to treat the disease in its various stages. The obvious objective is to reduce hospitalisations and mortality. The traditional model of clinical trials is, perhaps, too slow in a pandemic scenario. Indian doctors have the talent to respond to challenges and ICMR must facilitate them creatively.

This combined approach does not come without risk. But an alternative approach with lesser risk is not readily visible currently. Two major risks that can force us to rollback this strategy are:

1. Evidence that the disease inflicts an unacceptable permanent damage to the health of the survivors.
2. Proof that there is no herd immunity at all. It means that those who survive the infections can get reinfected again.

The weight of the evidence so far is that these risks are low especially considering the younger demographic profile of our population. There are also heart-breaking anecdotes of individual cases where young healthy adults have died suddenly. But it is reasonable to believe that the situation will improve with improved clinical protocols.

A phased ramp down of the lockdown

The way forward is a phased and planned relaxation of the lockdown. We propose that Low risk areas (Green Zones) can resume full economic activity right away within their district boundaries. Free movement of goods can be allowed while still restricting the movement of people across the districts.

There is no reason to restrict any outdoor activity. If possible, schools and government offices can function outdoors when possible.

The restriction on movie halls and large gatherings may have to continue for a while. People would continue to wear masks and maintain social distancing as a way of life.

Restaurants, markets, and all other industries will need to alter their way of functioning.

The Arogya Setu App can, perhaps, provide a live “crowd index” for all locations using mobile phone data. This can enable both people to avoid large crowds and authorities to control the movement of people.

One of the biggest challenges would be to protect the elderly and those who are immunologically compromised.

The structure of our families where multiple generations live together presents both a challenge and an opportunity. This means that we cannot easily isolate the elderly from their families. At the same time, a single super spreader (like a nursing home attendant) is unlikely to infect hundreds of elderly at once.

Can the elderly and other vulnerable individuals be provided with PPE kits? Honestly, we have no perfect answers.

We can only hope that our families and communities will figure out ways to deal with this challenge with the support of the government.

Authorities and communities can share their experiences and learn from each other as the number of districts in the Green Zone are large.

Ideally, at this stage, health authorities have mastered the lessons to keep hospitalisation and mortality low.

In the next stage, high risk zones will also be opened in a similar manner while restricting the lockdown to identified hotspots.

Ideally, this approach should lead to opening more than 70 per cent of the country immediately and the whole of the country in a month from now.

Random sample-testing of the population for antibodies can provide indications as to when a region has acquired a level of herd immunity.

Contact Tracing and Quarantine

When the eventual goal is ‘herd immunity’, contact tracing and quarantining of asymptomatic individuals is futile.

It makes a lot of sense to publish the identity and location of infected individuals along with their treatment status.

This can help other people weigh the risks and make informed decisions about their own movement and social contacts.

Contact tracing will become unnecessary and superfluous once there is community transmission.

There is unfortunately no herd immunity without community transmission.

State resources are better spent on building isolation facilities for the immunologically vulnerable/elderly people and health workers rather than quarantining young and healthy asymptomatic people.

High quality PPE kits for doctors including private practitioners is a no-brainer.

Conclusion

The PM is faced with the difficult decision on when to lift the lockdown. We recommend that an immediate planned relaxation in the low risk zones is the way forward.

There are sound reasons for this from the viewpoints of both the economy and the response to the Wuhan pandemic.

The present approach of contact tracing and quarantine are unsustainable beyond a point.

In the absence of a vaccine, a controlled journey to herd immunity seems to be the only option.

There are enough grounds to be optimistic about this approach based on our demographic profile and the risks seem manageable.

There is no reason to delay this any longer and a phased relaxation of lockdown should start immediately.