Warning: Long post.
I have been watching this thread for a while now, and my general view on shutting an economy down is articulated
here (Many parts of India are in curfew). But, that aside, my current view is that the lockdown is here. Like it or not, we have to deal with it. One way to do that is to try to objectively understand why and how we got here, leaving aside our personal feelings about the decision itself.
Certainly, the views from our members are both interesting and enormously informative. However, I do think that in the midst of all the debate, we have maybe missed a chance to step back and get some perspective. So, let us try to unpack this in simple terms.
Why the lockdown and all the heartbreak that goes with it?
As far as my research goes, Covid 19's fatality rate is equal to or, in some cases, even less than other epidemics from the past. The 2015 outbreak of H1N1 in India claimed a few thousand lives is what I understand.
This article is dated March 2015, and even by that time the disease had killed close to 2000 people in India. The fatality rate by the end of 2015 would undoubtedly be higher. The
CDC estimated that the 2009 outbreak of H1N1 carried a fatality rate that, at the very least, compares to that of Covid-19. Then, there was Ebola in Africa. As per the WHO,
the Ebola virus kills almost 50% of everyone it infects!!
So, why all this hand-wringing for Covid-19? The only answer I could come up with has to do with the ease of transmission of Covid-19; meaning that even with its purportedly lower fatality rate, its larger spread will cause higher numbers of infection which, in turn, will stress our healthcare infrastructure, ultimately leading to a spike in the overall death rate.
So this, the higher rate of infection stressing our healthcare infrastructure, is the real reason why we have decided that it may be better for us to put lakhs of our impoverished countrymen out on the streets now and rob some, if not most, of them of their basic dignities, rather than deal with a potentially big death rate in the larger population later.
For all of our sake, I really hope that this choice is the right one. I know that I will forever live with the images of our countrymen who have lost their livelihoods, and / or their lives, for the promise of saving a larger number of people.
Let us be clear that we have extracted, by force, a terrible sacrifice from the weakest amongst us. I don't know who; but, someone somewhere said that all war is immoral. By that logic, no matter what the underlying objectives are here, we will all collectively carry the burden of shame of the experiences that we have thrust on the poor and the feeble in our economy at this time.
Why could we not have planned better?
As saddened as I am about the tragedy of the daily wagers unfolding in front of us, I will disagree with those that are saying that the centre should have taken the time to better plan for the migrant crisis, or for the logistics issue in distributing essentials to everyone. The thing is that once the administration has bought into the idea that the virus's speed of transmission is the real problem to be tackled, then they would have had no choice but to act first and deal with any fall out after the fact. Time would have been the crucial element in the equation. In the heads of the decision makers, any delay would have multiplied the risk of inaction exponentially.
Also, I would not blame anyone in the administration if they believed that no amount of planning beforehand could have eliminate the migrant exodus problem. Think about it. People are out of jobs, out of money and have no food. What would you do in that situation? And how would any administration deal with it if the migration swells into a tidal wave? There really is no telling how things unfold in a crisis despite any amount of time and effort invested in planning for all potential outcome trajectories of a particular decision.
Incidentally, while the WHO and the CDC and everyone else's brother-in-law is tracking Covid-19's death rate, I doubt if anyone is officially recording statistics of people dying due to fatigue on our roads, or due to hunger in other areas of the country. The comparison on lives lost due to an economic shutdown vs. potential lives saved would make for some serious soul searching down the road. At the very least, it will leave us with material to better prepare for crises of the future.
Speaking of which.......
What about the next pandemic?
As far as pandemics go, this is not the first and it won't be the last. Sure, with the nature of transmission of Covid-19, social distancing may work as a deterrent. But, what if we have a pandemic tomorrow where the pathogen simply wafts through the air and infects a person who is alone at home, minding his own business and watching Big Boss or Chitrahar on TV? What are we going to do then? Would we still shut down society and flush our poor down the toilet again? That said, I don't envy the PMO or any other person in civic administration right now. The calls that they have to make now will haunt them forever.
The India Story:
On an aside, I will say this. I see a lot of people here riding on our fellow countrymen as being worthy of only a heavy stick. I think we are being far too unkind on our own. Sure, there are people still disobeying the lockdown. Indeed, some of them are doing so spitefully, and those dill-holes need to get theirs stat. But, 80% of the country is, in fact, staying indoors. And of the ones that are out, a huge swath are the daily wagers who are out of options. As much as we would like 100% compliance, this is as good as it gets. Hoping for a better compliance rate is just us being unrealistic. In the large slums of our cities where people live cheek-by-jowl, how would anyone achieve social distancing even if they were to stay home?
So clearly, putting aside the stragglers, we have shown that we can collectively pull the heavy yoke of a lockdown for the collective good. Now, compare this to the US where the two sides of aisle are forever divided. I'll have my popcorn ready for the unlikely eventuality when President Trump goes against his grain to impose a lockdown. That would be the cue for huge numbers of right-wingers to reach into their vast arsenals of assault rifles. Then all bets are off.
See, every time we have seen an outbreak, the world media has (understandably) hyperventilated about India's capability to handle it. A few of the reasons cited are :
- High population density
- Low quality healthcare
- High level of internal migration
- High level of international migration
All of the reasons cited above are valid. But, here is the track-record.
- Plague (1994) - Done and dusted. Surat almost became a model town after this outbreak with regards to cleanliness.
- Dengue in 1996 and then again in 2006 - It was a huge deal in 1996 when it first showed up. We overcame it; but it keeps coming back. I myself was hospitalized for a week with Dengue in 2014. But, it's scourge status notwithstanding, it has not been the menace that it was once thought to be.
- SARS in 2002/04 - This was a tough time. But, we came through this too.
- Swine Flu in 2015 - Thousands dead. Could have been much worse.
- Nipah in 2018 - Kerala totally kicked this virus's a$$.
- Covid 19 in 2020 - With official positive cases yet to reach even a few hundreds, the government imposed a full lockdown on a nation of 1.3 billion people!! What's more, Indians are largely cooperating with the administration!!
So, after everything has been said and written a few months and years down the road,
it is the India story that is going to lead front and center about how and who beat this virus.
We are strong here.
We are better here. And we have certainly demonstrated
the willingness to make higher sacrifices here for the greater good, while remaining a free and open society.
The Healthcare Conundrum:
Putting up temporary hospitals on a war footing is good. But, it will only go so far. If we have to prepare for pandemics of the future, I feel that we have to turn healthcare on its head. The current model requiring everyone to get to a treatment center does not scale fast enough in emergencies like this. I think we would do well to take a leaf out of other business models in other industries.
For instance, let us look at what the food delivery guys did for the restaurant business. They amplified the market without diluting the core business. People who want to eat at a restaurant can, and still do so. But, now people who don't want to make the trek to a restaurant can get the same food delivered, albeit with a little bit of planning with regards to time.
So, in the future, what if...
- we can get testing kits delivered to people and compliment it with tele-medicine? Once the kit arrives, a doc or technician calls you via WhatsApp video and supervises your self-test, then provides further instructions to either self-quarantine or take a trip to the hospital.
This way, we de-congest the care giving model and make it possible for us to cast a wider net to identify hotspots. Of course, the big assumptions here are that test kits are easily available and affordable, and that the recipient is educated and possesses some purchasing power. But, the model could work if we apply it with the required modifications. Let me explain.
Believe it or not, the famed 911 service in the US is not very old. It came into being only in the 60s and 70s; and it came out of people being forced to think creatively. The medical mandate was that a first-responder should reach a caller within 15 or 20 minutes. The problem was that most healthcare providers were not strategically situated in American cities to make it possible for them to reach any caller within their city within the stipulated time window. While everyone was mulling this problem, someone pointed out that existing city planning codes already mandate that fire stations be situated in strategic points in cities and towns to enable firemen to get to a fire in the shortest possible time. So, why not put a bunch of trained paramedics with those firemen in those same fire stations? Or better yet, why not train some firemen to also serve as paramedics? It worked. In many parts of the US, if a patient calls 911, they will get what looks like a fire truck pull up to help stabilise them. It's typically afterwards that another vehicle pulls up that has better equipment, and the ability to transport the patient to a hospital if needed.** We could apply that model here. In effect, we could....
- train some corporators and staff in our city wards on some basic techniques like in drawing blood, or in taking a patient's vitals. Then, get them to respond to their constituents first with a test kit, along with established protocols on escalating the patient through the healthcare continuum if and as needed.
That's one way. Another way is to....
- identify some key medical equipment, such as ventilators, and find a way to make them cheap enough for the middle class to purchase them for their homes. If a ventilator costs between 5 and 30k, I am betting that a lot of us would buy it (instead of our next phones), and then volunteer to learn techniques like intubation.
So, potentially with better equipment at home, a patient is likely to get better care earlier in their illness possibly leading to better outcomes. Also, with better care at home, chances are that stress on core healthcare facilities, such as hospitals, will reduce thereby allowing those facilities to remain available for those patients who really need more advanced care.
Cheers
** I know this because my team writes healthcare software for some of these first-responders.