We must not flatten India order to flatten the curve

Covid-19 is a deadly virus but it has an Achilles heel. By mid-February 2020, data had emerged that streamed different age-groups into different risk categories. 

Given this information, I put my aging parents in India into lockdown from 24 February 2020. My brother and sister bring them essentials and no one (not even the maid) is allowed to enter the house. That same day, in Australia, I started wearing a mask and disposable gloves in public transport, discarding the gloves after each trip. A few days later, after determining that my workplace was not taking preventative actions despite well-documented higher risks to my age group (I’m now 60), I started working from home.

The data also tell us that those below 60 (which constitutes most of the working population) can continue to work almost normally. Children, in particular, face a very minor, almost insignificant risk. My advice to the younger members of my family has therefore been that they should continue to work, but with extreme precautions. In particular, they must wear an N95 mask when interacting with others. 

Note that masks hold the key. I have looked at countries (like Taiwan, Singapore, Hong Kong and Japan) that have done well in this pandemic and found that they expect everyone to wear masks in public places. Studies have shown that masks provide fivefold protection. It stands to reason that wearing an N95 mask (even if imperfectly, or reusing a disposable one) creates the equivalent social distance of many metres, thereby reducing the spread ultimately by a factor of thousands.

Taiwan’s CDC website makes it clear that “Prevention [for this virus includes] washing hands frequently [and] wearing masks”. Therefore, in Taiwan life continues as normal with everyone (including toddlers) wearing masks. Schools remain open.

To ensure sufficient supply of masks, the Taiwan government banned face mask exports and capped their price at $0.17 (Rs. 13). Today 10 million masks are reportedly produced daily in Taiwan and one mask is distributed to each resident every two days.

Masks, of course, are not the only remedy. A whole suite of measures needs to be undertaken.  Taiwan implemented over 120 measures upon getting news of the virus in early January. 

I have written about this issue twice already, on 6 March 2020 and 24 March 2020. This time I’m writing to explain why our party has strongly objected to the lockdown imposed by Mr Modi. 

We believe this lockdown is premature. It will be disastrous for the economy and deadly for the poor. Instead, we strongly recommend age-based risk management, along with subsidised masks for everyone. 

Lockdowns only make sense under extremely limited circumstances. First, when we need to urgently flatten the curve to manage the demand for ICU beds. Or second, when we have a guaranteed remedy (vaccine, cheap treatment) at hand and we then impose a lockdown for a few weeks till the remedy becomes widely available.

No such pre-condition has been met. India’s ICUs are not under immediate threat (unless India has been hiding the truth from the world). Further, we can’t make policy on an unproven belief that a vaccine will soon become available. Our policy must succeed even if the worst possible case eventuates – in which there is no vaccine or treatment after 18 months. We simply can’t afford to take chances with this virus.

This means only one policy objective: to develop herd immunity in India at the lowest social cost. This needs a minimally invasive regulatory regime that will allow most people (particularly children and the young, who face a lower risk) to work or to go to school with near-normalcy, while incrementally (and without risk to ICUs) developing herd immunity. At the same time we must impose unbreachable lockdowns on the elderly (particularly those over 70 and those with prior health conditions) and ensure they have sufficient food and healthcare in their isolation.

Lockdowns stop herd immunity from being developed. They merely postpone the day or reckoning.  

And they can’t, ever, eliminate the virus. All that a lockdown does is to allow some existing cases to resolve, while generating new cases at the same time. That is because some proportion of those currently with the virus will transmit it to others during the lockdown, either in their own home or in its vicinity. These new infections will then need yet another lockdown. And in a large nation like India small pockets will always continue in remote areas for months on end, undetected by the health system. 

But let’s assume optimistically that India somehow does defeat all cases with a six-month lockdown. The moment we then open India’s borders even to a small extent, or some fishermen come in from Sri Lanka, or some refugees from Bangladesh, or terrorists from Pakistan, the virus will return. 

Consider China’s conundrum. Its lockdown was probably justified because its ICUs were under pressure but now, when it wants to restart its economy, if it doesn’t take precautions, a second wave will inevitably develop. Its only viable strategy, and the only sustainable strategy for all countries till most people have developed herd immunity, is to adopt age-based risk management. 

Depending on how diligently the curve is flattened, it could take up to 18 months for nations to gain immunity. But trying to stop that from happening will badly backfire. We must aim to minimise deaths, we can’t eliminate them. The price to pay for elimination of all deaths will be the death of the nation itself.

The lockdown imposed by Mr Modi is an admission of its intellectual bankruptcy. Such lockdowns – that are unrelated to any immediate ICU emergency – will cost many more lives in the end. Hundreds of millions of poor people in India live a hand-to-mouth existence. They now won’t have money for food and essential medicines for their other diseases. Tens of thousands of these poor will die. Many will commit suicide.

And all this excludes the costs to society by empowering brutal government functionaries and power-hungry politicians. Images of draconian brutality are pouring in. India’s police, always trigger happy, is brutalising those who are performing essential functions. Our Chief Ministers are threatening to shoot people at sight. And langars that are being set up for the poor are going to spread the disease.

We are flattening India in a delusional attempt to flatten the curve. Mr Modi must stop this lockdown immediately and switch to age-based risk management. He must also drastically escalate the production of masks and sanitisers. At least 100 million (ideally 500 million) masks must be produced each day, along with other preventative equipment. 

Mr Modi must also publish a regulatory impact analysis and cost benefit test for each action he takes that curtails basic human freedoms. Our party strongly objects to his heavy-handed and totalitarian approach.

This virus remains completely controllable – but will need a lot of intelligence. Adaptive and nuanced measures will have a very powerful downward effect on the virus without destroying the country.

DISCLAIMER : Views expressed above are the author’s own.

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