Lockdown & After: Balancing Resources Key To Keep The Curve Flattened

As we all know by now – COVID-19 is here to stay. At the moment, neither are vaccines available nor do we know when vaccines will be commercially available in large numbers at a reasonable price. The current phase of lockdown will be over in a week. Social restrictions will inevitably continue to be in place, possibly in some modified form, to keep the pandemic in check. Let’s take stock of how we have fared so far and what options we have going forward.

As far as India is concerned, there are a few stark observations over the past 5 weeks. One, the total number of cases, predicted to be about around 35,000 by April 30 was expected, considering the affected numbers around April 15. Two, the 10 cities of Mumbai, NCR, Ahmedabad, Indore, Pune, Jaipur, Thane, Hyderabad, Chennai and Surat together constitute about 50% of the total cases in the country and they constitute less than 10% of the total population. Three, only about 85 districts have not reported any cases in the past 2 weeks, which is a little over 10% of the districts.  Only 16 districts, which earlier had cases, have not reported any cases in the past 28 days. Four, more than 75% of the reported cases have come from the 7 states of Maharashtra, Gujarat, Delhi, Madhya Pradesh, Rajasthan, Uttar Pradesh and Tamil Nadu. In these 7 states, the 10 cities mentioned above constitute two-thirds of the cases.

What do we make out of these numbers? One, the current containment strategies are working, but we are not safe. It will take the 8-10 week lockdown, as in other courties, before the numbers of cases per day start reducing. We have a far better hang of the pandemic and know what works and what mistakes were committed (and hence must be avoided at all costs in the future). There is a wealth of credible research by experts and actionable pointers, which are helpful in policy and designing operating processes (at individual, home, work and community levels).

Two, on April 27 in terms of total affected cases India is in the top 20 in the world, before March 22 India was not even in the top 50.  In terms of the number of fresh cases per day, India is in the top 10. If our rate of growth continues at this pace for another 4-5 weeks (most countries have required a 10-week lockdown for the pace of cases to reduce), by May-end we will be touching 5000 to 10,000 cases per day. This is alarming, but not scary. This adds up to hospital bed capacity of about 300,000 people, assuming an affected person stays in the hospital for about 30 days. If 10% of such people require ventilators, we will need about 30,000 of them. These numbers are manageable and, thus, this implies, we have flattened the curve but far from safe.

Three, for the top ten cities, the situation is actually quite bad. If they are reporting 50% of all the cases, the spread in these places is faster than the rest of India and by May-end they will together report more than 5000 cases per day and will consume most of the health infrastructure. This is worrying. The health infrastructure needs to be beefed up urgently in these cities and other hotspots, maybe totally about 30 cities in India. Also, these cities need to be isolated from the rest of the country for another 6-8 weeks. It is very important to understand these cities are the nerve wires and cutting them off, will be dangerous for the economy.

Four, the virus has spread all over the country. However, many states and districts are very much within safe zones, thanks to concerted efforts by government machinery and in many cases NGOs. Such zones cater to more than 80% of the population and area. The virus has spread very slowly in most places, which is a major plus. If we continue to remain responsible in social distancing, we have an excellent chance of surviving well till the vaccines arrive.

We have kind of flattened the curve. That was the original objective of policymakers and pandemic experts. It is not possible to hide from a virus forever; we have to face the prospect of having it. As long we can get medical treatment, we should feel assured.

While we seem to have won the first round of the battle against COVID, a different front has opened up. To win the war, we need to balance our resources to fight both the pandemic and the economic stress. We can leverage flattening of the curve, if we economically hang on for the long haul.

The numbers show the situation is quite disparate across hotspots and relatively less infected zones. A one-size-fit-all strategy may not be correct anymore. All districts, which are still showing regular spikes, need to be put possibly in a quasi-curfew mode and the lockdown may be imposed for another 8 weeks at least, considering the lessons learnt from other countries.

Considering the nerve centres are badly affected, we need to re-energise the cities to limit the impact. We may build on the first steps taken last week – to resume activities and lift other restrictions, albeit cautiously. In the relatively safe districts, it may be a good idea to start with concrete steps to revive travel (which is the first step and a key component of a sustained economic activity), while strictly adhering to social distancing norms and health check-up guidelines, as well as restrictions on public gatherings. There are possibly more than 500 districts and more than 80% of the population in this category. Needless to say, travel from hotspots need to be banned, and in case people travel they may need to be quarantined.  For safe districts (for intra and inter state) road travel can be given the green light, flight and train travel may wait for a few more weeks, for the spread to start reducing and for safe SOPs to be in place. In any case most of the high density flight travel destinations are hit. Community patrolling (or panchayat patrolling in villages as initiated in Odisha) is a must to ensure social distancing. Continuous focus on social awareness and exemplary punishments for callous behaviour will help maintain the seriousness for a prolonged period.

We must be ready for a new normal, both economically and behaviorally – which is neither paranoia (standstill) nor casual approach (free for all) – of good habits of hygiene, social distancing, no large gatherings during social functions for months to come, and quasi-emergency governance to enforce the relevant guidelines, which will keep changing with the changing situation. The community, in most cases, has understood the potential danger of this disease and has started self-policing. Organizations and individuals have changed the behavioral and consumption patterns to live up to the occasion.

Lastly, very importantly, the key will be to keep watching the scenario in every pocket and clamp strict measures (including prolonged 8-10 weeks lockdowns) in identified pockets if somewhere the infected cases cross alarming levels and there is a fear of health infrastructure levels being breached (very similar to releasing water downstream during a flood situation to limit the damage, if the water levels cross the danger mark).