COVID19- Beyond Lockdown
Like an apocalypse, coronavirus hit our lives suddenly, not just our lives but impacted lives globally, sparing no one from its terror anywhere around the world. Coronavirus didn’t discriminate among anyone; it is equally dangerous for Queen Elizabeth as it is for me.
As per the advice of experts, the world confronted the virus in an unprecedented manner- by shutting down schools and workplaces, therefore declaring a complete lockdown to limit social interaction in order to regulate transmission. This lockdown robbed us of our freedoms and our daily lives and personal contacts and interactions.
Almost everyone followed the norms of the lockdown religiously, but a recent study showed that the strategy of complete lockdown wasn’t effective. This raised alarms because the lockdown that governments of almost 170 countries imposed in their respective lands came at a very high economic loss. And so, the question is, was the cost worth the proportional risk?
WHY LOCKDOWN DIDN’T WORK?
First, because of the delayed implementation of lockdown; part of it is because of the delay which China made in informing the world about the outbreak. In many countries, before the announcement of its implementation, the virus had already spread. It was apparently clear that efforts to stop or slow its spread were futile. Countries that have been able to tackle COVID through lockdown had all started early with this.
Second, short notice, and no preparation. There was a four-hour prior notice given by the honourable Prime Minister on the national address on television about the country entering in complete lockdown. As it was sudden, there was no time given to adjust, prepare and settle down. This was also the reason for migrant labour crises and migration despite lockdown.
There has been an international debate about which way is better to handle COVID- either mitigation or suppression. Interventions in the mitigation strategy would be case isolation, quarantine of household contacts of a case and social distancing of the elderly (>70 years), interventions have to be timely instituted (not too early) to give chance for herd immunity to develop.
In the suppression group social distancing of all age groups, household quarantine and closing schools and universities are further interventions. The latter is not to be applied in case of India, considering its huge population.
Let’s understand it this way. Every day, almost 80,000 women deliver all over India. They will be looking for places to go and deliver. If we suddenly stop all the transportation, then how are they going to even reach hospitals, especially in rural areas where there is no good connectivity. In my opinion, suppression works only in well-organized society, where food can be delivered to each household, and public healthcare is managed efficiently etc. In India, suppression would mean hurting each other, exploitation, giving power to the wrong kind of people. That’s not how one should respond to a public health emergency. Instead, community participation and cooperation is a better approach to go forward with. And, suppression and community participation do not go hand in hand. If drastic measures are imposed, then people might turn rebellious because they are unable to fulfil their basic needs- food and health care supplies for their families.
To be honest, there are no answers to the question of what would have worked in confronting a virus without a vaccine. According to data, in the late 1950s, influenza vaccines were available and yet excess deaths were higher globally than the 2020 episode of no vaccine. Therefore, according to data and past experience, it is clear that lockdowns are ineffective in regulating the virus.
WHY IMPOSING LOCKDOWN IS A BAD IDEA NOW?
When we were suddenly hit by COVID-19 at the beginning of 2020, it was a mystery to the whole humankind. There were apprehensions regarding the virus and lack of awareness of its functioning and the adverse impact it can lead to. The public health infrastructure wasn’t ready to face a pandemic at that very moment. Experts predicted the death toll to be catastrophic if areas didn’t lock down because too rapid an increase in cases could overwhelm hospital systems. Therefore, the initial strategy wasn’t to stop the virus but to slow the spread. Governments needed time to prepare themselves against it. But today, we are much more educated, aware and prepared as compared to 6 months back. We have an idea of the virus’s functioning metabolism, treatment, control and prevention. It is clear that the possibility of transmission in the open air is very low, therefore it does not make sense from an efficiency or public health point of view, to force people to stay at home.
Secondly, we might be seeing a rise in the number of infected patients and death rate. We may be worried but there is no reason to be so because, as more testing is being done, so more numbers are appearing and they’ll continue to grow up, and that’s not necessarily bad news. As more people are out there, more people are going to be affected and going to get this virus, and eventually more people are going to build antibodies leading to the development of herd immunity.
Third, constant opening and closing of the economy again is going to lead to long term negative impact and has the potential to destroy our current built economic structure. With economic decline, people are losing their jobs leading to a considerable increase in the rate of unemployment, poverty, anxiety, depression and people indulging in heinous crimes. A striking rise is seen in suicide rate since COVID, not just in India but across the globe.
WHAT CAN BE DONE NOW TO REGULATE THE SPREAD?
Not only did India see its cases shoot up, but even geographical spread of infection also wasn’t contained with the lockdown. Instead of going the old way by imposing the blunt instrument of lockdown, India must take a smarter approach by strictly implementing behavioural changes, at least until COVID vaccine isn’t introduced in markets..
One most important thing to note is that coronavirus spreads during social interaction- but not because of social interaction. Therefore, we need to change our ways of social interaction and not necessarily stop it. We have been seeing epidemics and pandemics since early times and COVID isn’t the first one. We should go back to our old lessons to get over this too. Understand it this way- Cholera spreads through water supply, but that doesn’t mean that we should shut off the water supply. But instead, it’s recommended to filter water. HIV spreads through sexual contact but that doesn’t necessarily mean that we stop indulging in sexual interactions but instead what we do, is make practice of sex safe.
As the second wave of COVID is out to strike it’s peak globally, so we need to be careful of what action we take to get through it. Keeping in mind the above examples, instead of imposing another draconian lockdown, we should try to incorporate behavioural changes and encourage wearing of masks to practice safe breathing and should practice safe social interaction by regularly washing hands and maintaining the norm of social distancing. Behavioural changes definitely do not come only by restrictions but also by engaging people and getting them involved in preventing transmission. To be honest, until and unless we don’t have a vaccine in our hands, there is no medical treatment available to tackle this and so all we can do is to change our behaviour as per the demanding circumstances.
Secondly, local targeted lockdowns could be used if cases are going out of control but that should be decided in terms of the area’s ability to cope with things like hospitals, beds, ICUs and that is a local decision to be made. Lockdown should be used as the last resort.
Most importantly, policymakers must decide as to which is worse: the rapid spread of disease or emotional and economic fallout of quarantining everyone except essential workers.
It would be very wrong to dismiss and neglect the positive impacts of lockdown. I must accept that lockdown definitely created a temporary fear and a permanent awareness about the disease in even the most remote areas too. Today everyone is aware of a disease called COVID. And this mass awareness is only possible because people’s normal lives were hindered due to lockdown.
What we need to understand now is that the next possible approach that we have now is ‘Herd- Immunity’. An epidemic is like an earthquake- it hits you hard, and then you do the best you can, and live with it. Small countries like Sweden, Netherlands etc. have denied getting into another lockdown during the second wave of COVID-19, and have decided to tackle this through the concept of herd immunity.
Though the possibility of another lockdown can never be ‘ruled out’ but there are apprehensions as to how effective it would prove to be. What we need to understand is that lockdown is a temporary strategy because we cannot depend or live with it for the rest of our lives. So, we need to find and focus on solutions like herd immunity which can work for the long run. Whatever way our policymakers decide to go during the second wave, one thing that they should keep in mind, is that the proposed strategy and action should be of minimum cost and maximum benefit for everyone.