This is in continuation to posts here, here, and here. This post will summarise certain emergent realities of the Covid 19 world, a possible exit strategy from the lockdown, and some possible opportunities.
The strict lockdown in countries like India was a necessary (perhaps even inevitable) response to a disease about which little else was known except its rapid infection rate. But its relevance wore off after the first few weeks when some unmistakable global trends, especially on deaths, emerged and the economic destruction and human suffering due to the lockdowns became clear.
Certain things have to be acknowledged. One, the likes of hand washing, social distancing, and mass testing are just impractical in large parts of any developing country, especially in the most vulnerable and densely populated areas and among the poor. Besides its practical challenge, testing has technical problems.
Two, when you have reached the stage of community transmission, as is the case in most countries, the likes of contact tracing too becomes ineffective. The value of contact tracing Apps, apart from serious question marks about adoption, technology, accuracy, and privacy concerns, also run into the practical challenge of administration once the numbers increase beyond a point.
Three, it is difficult to believe that anybody takes seriously the number of cases being reported anywhere in the world. They are off by orders of magnitude, perhaps 100 times or more. So asymptomatic cases are everywhere. Testing and detecting them is neither practical nor desirable. Whether we like it or not, it is the reality.
Finally, unlike a few days back when I blogged this, I do not now believe that even the scenarios of relapses should be met with lockdowns. It's just impractical to do micro-surveillance at scale by weak state capacity systems. However, having some form of protocol of options to respond to different emergent situations is part of prudent emergency response drills. We will need to keep options open and respond to situations as they come. Lockdowns should be last resort responses.
In fact, I'll only be surprised if this list of exclusions does not grow in the weeks ahead. For example, even the use of elaborate PPE (as opposed to basic protections) by health staff will start to look impractical. Or pooled testing by employers too could become impractical and superfluous as the devil in its operational details become apparent.
This, by the way, is in the truest traditions of iterative adaptation of policy responses to a completely uncertain situation.
In the circumstances, the time may have come to accept the reality of Covid 19 as the latest addition to the several diseases that human beings cohabit with and whose episodic outbreaks are not uncommon. We have to learn to co-exist with SARS-Cov-2 like we have done with numerous others before. This too shall pass.
So, here is a course of action for developing countries like India:
1. Make the use of masks in public places mandatory. These can be simple hand kerchiefs or some some part of a cloth. A culture of mask wearing may be one of the conspicuous new normals.
2. Screen for symptoms of Covid 19 and use a defined treatment protocol (like the three-level treatment in India). Similar practical protocols for both virus and antibody testing can be adopted.
3. Mandate home isolation for those with symptoms. Also make home quarantine mandatory for those coming into the state. They can be followed-up through regular daily telephone calls.
4. A small share of detected cases will need real hospital care, and a tiny proportion will need tertiary care or ventilators and ICUs. Make a very liberal assessment and keep those beds and hospitals with equipment ready. Release the remaining parts of health care system immediately for their regular activities.
5. The old and immuno-compromised people should take precautions just the same way as they would do in any particular season of very bad infectious disease outbreaks. Households should be left to figure out what can be done based on their circumstances. I'm not sure there is much the government can do in this regard.
6. Finally, and this is very important, there is need for a very aggressive outreach campaign by politicians and officials, with support of media and opinion makers, to de-stigmatise Covid 19. While people need to be conscious of its risks, we appear to have reached a stage when fear and paranoia is triggering social tensions and mental health problems. The hitherto scary narrative around Covid 19 has to be replaced with one which is based on emergent evidence. People need the reassurance of a comforting narrative about Covid 19, one which while does not down-play its risks, places them in its true perspective. The fear psychosis has to be dispelled and only the government can do that, though with the support of civil society.
With these precautions, the economy should be allowed to resume normalcy by gradually phasing in activities over a period no longer than a month. Schools should be re-opened and education resumed after the summer holidays. Factories too should be re-opened. Shops and establishment should be allowed to resume operations. Staggered resumption of businesses, while logical, is impractical in many businesses, besides further weakening the recovery. However, where possible, it could be done. Perhaps some like mass entertainment can be postponed for longer. Mass transit too should be allowed to resume operations immediately, with some gradual phasing towards the normal. All these should be left to state governments, with some broad principles outlined.
Even if full operations are allowed, given the fear around Covid 19, normalcy will take time. As experience from elsewhere in the world shows, even without government restrictions, there will be an inherent self-limiting dynamic to lockdown exit. People will not immediately come out and shop or go to office. Businesses will take time to remobilise. Migrants too will return only slowly. This too will allow normalcy to be phased in naturally.
As to those proclaiming new normals, for sure, there will be some behaviour and other changes with the rich and even middle-class, who can afford those changes. Covid 19 would have accelerated or tipped over certain trends like work from home or reductions in executive travel. But for the vast majority of those less fortunate, it is difficult to believe that much would change, except for greater immediate misery. These changes will be mirrored in developed and developing countries accordingly.
But the lockdown exit may also be an opportunity to target certain long-term public policy goals, whose realisation would have been impossible otherwise. Foremost, given the humanitarian tragedy of migrants, it is the right time to push through a set of measures on the identification and their integration into local public services. While something on their accommodation would be good, I'm not sure about anything practical at scale. Another would be to encourage the permanent transition to a combination of workplace and work from home arrangements in some services sectors. It can have beneficial effects on traffic and housing affordability.
It would be great if we could lockdown (no pun intended) some of the gains on reduced air and water pollution. What changes, which do not have harmful economic consequences, especially on the poor, are possible? I am not optimistic. What else? In any case, something for the central and state governments to examine.
Update 1 (29.05.2020)
This about the practical difficulties of the likes of social distancing for large numbers of urban households,
At least 92 million Indian households live in one room, sometimes six or eight in a space no larger than a cupboard. Work from home is a concept that means nothing. As entire universes are carried on wheels and the country’s largest exodus since Partition unfolds, some of our city-slicker slogans on hygiene and not-crowding are just new kinds of deracinated privilege. In Dharavi, Mumbai, where I spent a considerable number of days reporting, there are 8,000 common toilets for about eight hundred thousand people, which makes containing the virus an enormous challenge.
This is representative of workplaces and the practical difficulties with social distanced work,
“Look at my factory floor. Do you think my 175 workers can work together and still maintain one meter distance,” asks the owner of a factory that makes packaging for medicines and is working with about 50 people now. “The demand is tepid now, so we can manage with less production and people. But when demand improves, it will be difficult to adhere to social distancing guidelines. It is easy for policymakers to ask us to have shifts and rotation of employees, but these rules are difficult to execute,” he says.
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