The coronavirus disease (Covid-19) is an unprecedented global challenge for both health and economic well-being. As seen in Italy and New York City, the exponential growth of Covid-19 infections can quickly overwhelm health systems and lead to tens of thousands of deaths. Wary of the risk of a fast-spreading pandemic, the Indian government enforced arguably the strictest lockdown in the world. This has slowed the spread and saved lives – but at a heavy human and economic cost.
These costs have now polarised the policy debate around the government’s next steps (and similar debates are playing out around the world). Some argue that lockdowns are excessive, hurting us more than the disease itself. Others claim that lockdowns are the only realistic option to prevent a catastrophic increase in cases and deaths. However, framing the debate around lives versus livelihoods is counterproductive because it distracts attention from the most urgent actions we need to take. Specifically, we need a strategy focused on making the public health investments required to reopen the economy safely as soon as possible.
Why we need a public health-driven strategy
India needs a strategy grounded in public health because, at its core, this is a public health crisis. What makes Covid-19 so dangerous is that it takes time for those who are infected to show symptoms, so they remain unaware and active – spreading the virus at scale. This is why governments around the world have resorted to lockdowns as the only option to contain virus spread in a setting where anyone could be a carrier and transmitter.
But a lockdown only slows the spread of the virus. A worrying misconception is that the lockdown will eliminate the coronavirus problem and enable a safe reopening. Yet simply lifting the lockdown after a few weeks will likely lead to a resurgence in the number of cases. Even in green zones with zero active current cases, Covid-19 can reappear and spread rapidly through the community, as seen recently in Singapore and South Korea.
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Thus, a lockdown on its own does not “solve” the problem of the virus. Rather, it needs to be seen as the first step in a long-term “Hammer and Dance” strategy for a battle expected to last at least 12-18 months (which is the earliest that a vaccine may be available). The hammer (lockdown) phase aims to slow down the spread of the virus enough to buy us time to prepare for the “dance” phase, when a substantial amount of economic activity can resume but under modified guidelines and under a much stronger surveillance system – based on testing, tracing, and quarantine – to limit the health costs of reopening the economy.
By ramping up testing among both symptomatic cases and in populations who are at high-risk of contracting and spreading Covid-19 (like frontline workers), we will be able to catch cases early and isolate potential spreaders. Ideally all high-risk individuals should be tested. However, given testing capacity constraints, it makes sense to test random samples of high-risk individuals – even if they show no symptoms. This testing needs to be followed up with diligent contact tracing (up to at least two degrees of contacts) and strict quarantine.
Done well, such an approach could lead to sequestering 1-3% of the population, but allow the rest to prudently resume economic activity with precautions like mandatory mask wearing and social distancing in public places, frequent handwashing with soap, a continued ban on large gatherings, and modified protocols for public transport. This is clearly a much better outcome than a blanket lockdown driven by the fear that anyone may be a carrier. Thus, the main value of increased testing is in allowing us to identify and isolate only those at risk as opposed to the entire population.
Source: Hindustan Times
