As we near the halfway mark in the 21-day lockdown decreed by the Indian government, the question needs to be asked: what next?
The Prime Minister has had us clap our hands and bang pots and pans one Sunday evening; and another Sunday night he wanted us to light candles and diyas. The public happily obliged – but what does the PM intend to do himself after the current lockdown comes to an end?
Although the Cabinet Secretary was quick to dismiss rumours of an extension of the duration of lockdown, there are concerns about the trajectory of COVID-19 disease after it is lifted. Many have stated that 21 days would not be enough, and some have even suggested that nothing short of an extension of the lockdown to 49 days would end the threat of the virus. Despite what the authors of a widely shared study suggest, the experience in China shows us that the beneficial impact of the lockdown would be revealed only after a few weeks. Similar experiences can be seen in various other regions that have locked down their societies.
What does PM Modi intend to do after the current lockdown comes to an end?
Do we need to extend the lockdown period? If we do, how long can we sustain it?
In addition to maintaining containment, the time has come for us to develop mitigation strategies.
The government needs to plan for a phased resumption of activity after the 21-day lockdown period.
Without extending the lockdown with ensuing economic hardship, we can effectively mitigate the pandemic in India by adopting pragmatic policies.
Lockdown Necessary But How Long Can We Sustain It?
The government of India was right in calling for a nationwide clampdown on non-essential activities. Without it we were staring at a disaster of mammoth proportions. The intent of such a lockdown was to break the chain of transmission from an infected person to a susceptible individual and thereby help flatten the curve of cases diagnosed daily.
Without such an intervention, COVID-19 infection would have risen exponentially and overburdened our health system, resulting in uncontrollable numbers of deaths. But if we carry on like this much longer, our economy will collapse, leading to desperate conditions of unemployment, starvation and worse for millions.
If the 21 days have helped us to flatten the curve—which we would only know in a few weeks’ times—do we need to extend the lockdown period? If we do, how long can we sustain it? Many doctors argue that since the entire human race is immunologically naïve to the novel coronavirus, the pandemic will end only with the development of herd immunity, wherein the virus infects such a large proportion of the population that it fails to find a susceptible new host, or with a mass vaccination campaign for all our citizens. But we are at least a year to 15 months away from identifying a safe and effective vaccine, and we have no idea how affordable it might be.
Time For Mitigation Strategies
Meanwhile, we cannot look away from the hard economic reality of the lockdown. Even in the United States of America, which (thanks to its federal system) does not have a nationwide lockdown, the impact of the pandemic on the economy is reflected in a record surge in unemployment claims. Nearly 10 million people filed for unemployment benefits in the last two weeks of March 2020, compared to the usual half a million. Further cessation of activities would devastate the already-reeling Indian economy.
It’s clear we will soon burn through our capacity to contain the disease through quarantining infected people or isolating them from the unexposed population. In fact, the spread of COVID-19 into more than a dozen states in India suggests that we may have passed the containment stage. In addition to maintaining containment, the time has come for us to develop mitigation strategies.
This requires planning. Mitigation aims at taking measures to slow the spread of the virus, reduce the burden on hospitals, test and isolate at-risk or suspicious individuals, and protect healthcare workers from the risk of catching the infection at work.10 All these measures should be combined with pragmatic policies to ensure economic recovery.
No Abrupt Lifting of Lockdown, No Complacent Attitude
The government needs to plan for a phased resumption of activity after the 21-day lockdown period to achieve the goal of breaking the chain of transmission, which requires physical distancing and good personal and environmental hygiene, while resuming economic activity.
So there should be no abrupt lifting of the lockdown; it should occur in stages. We can ensure physical distancing by continuing closure of schools and colleges for a couple more months and ensuring ongoing education through e-learning applications. Public gatherings of more than 50 persons should be banned until further notice. Not more than five persons should be inside a store at the same time.
Adequate ventilation should be ensured in offices and shops. Malls and cinemas may be permitted to operate, with a ceiling on the number of persons in any one location. Health inspectors should be authorized to investigate and report violations. Immediate punitive action must follow.
We must provide greater electronic access to services in government offices through innovative modalities. At least half of the technology professionals in every company should be allowed to work from home. Government and private sector should be required to provide paid leave for household contacts of patients who test positive for COVID-19 infection. Self-isolation at homes should be closely monitored by heath nurses or ASHA workers from the primary health centre. Local administrations should provide home delivery of services and groceries for such households.
Immediate Guidelines for Universal Use of Masks
We must continue to emphasize the importance of personal and environmental hygiene through print, electronic, and social media. Hand-wash stations should be installed in every junction and marketplace, preferably maintained by local businesses. Easy and subsidized access to hand sanitizers should be made available to all.
And finally, we should encourage the use of clean cloth masks by the general public when in public places such as markets, public transportation etc. The Chief of the Chinese Centre for Disease Control and Prevention, as well as numerous experts including the Principal Scientific Advisor to the Government of India, Dr K Vijayraghavan, have come out strongly in favor of a strategy of universal use of masks to combat the pandemic.
Although such an advice goes against the current recommendation of the World Health Organization and the Indian Council for Medical Research, that masks should be worn by only heath workers and those persons taking care of patients with COVID-19, the situation demands out-of-the-box thinking.
Without extending the lockdown with ensuing economic hardship, we can effectively mitigate the pandemic in India by adopting pragmatic policies to break the chain of transmission and reduce the burden on our health system and its frontline warriors.
(Former UN under-secretary-general, Shashi Tharoor is a Congress MP and an author. He can be reached @ShashiTharoor. Dr Aju Mathew is an oncologist and epidemiologist based in Kochi. He tweets @ajumathew_. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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