No cold turkey start: Experts want phased exit from coronavirus lockdown

Doctors wearing protective suits as a precautionary measure against the coronavirus check patients outside an isolation ward at Govt. Medical College hospital in Jammu
In the midst of the high-pitched life versus business narrative, several opinion makers, analysts and economists are of the view that India should start lifting the stringent lockdown measures in a graded manner across districts unaffected by the COVID-19 virus. It’s another matter that states and the Centre are considering an extension of the three-week lockdown that had begun on March 25.

Pronab Sen, former chief statistician, pointed out, “In the unaffected districts, we should open up the lockdown but not allow movement out of these areas.’’ The numbers show why this theory is gaining credence. As the lockdown enters the third week, more than 80 per cent of the total Covid-19 cases have been detected in 62 districts. And, around 420 of 718 districts in the country had zero cases.

India should get back to normalcy by taking advantage of the data, according to Sen. “Of course, most of the affected areas will include high income urban areas of the country and hence, the production and consumption will take time to restore in the same manner,” he explained, adding that the country has to begin generating livelihood and that a “cold turkey start’’ may not be feasible.

Going ahead, the government’s plan would be to identify the geographical hotspots, which needn’t be an entire district, and take immediate containment action there. “This type of dynamic and quick response can contain the disease,” an official in the know said. Even as several committees are looking at the various aspects of addressing the crisis, economy is a prime concern. One of the committees recently deliberated on the sectors of the economy that can be opened up for operations along with a logistic plan. Comparisons were drawn with other countries as well.

“Wherever there’s a high number of suspected cases or cluster of cases, there’s a need to define those areas as hotspot,’’ said Dr AM Kadri, secretary general of Indian Association of Preventive and Social Medicine. “We need to do community surveillance there,” he said.

Kadri, however, cautioned that India should not wash out the advantages it got out of the lockdown by lifting it in a hurry. “It needn’t be necessary and can be a graded lifting. We need to mark each district into categories – high, medium or low risk. The highly vulnerable districts would require complete lockdown,” he said. Also, the offices that require a large number of workers in a unit should not be opened right now and companies should continue to encourage ‘work from home’. Schools, colleges, cinema halls and malls should remain shut, according to the graded lifting plan.

Experts believe the government needs to formulate a plan to open up transportation as it prepares for the next phase.
“Shutting down railway lines and buses could be terrible. We need quick protocol on opening up the transportation lines. But we need to do it in a way that it’s not damaging and see what elements of transportation should work, whether people would be allowed to stand inside the buses or not. We also need to restart the taxi services,” according to Indian Institute of Management professor Sebastian Morris.

For instance, an alternate seat could be kept empty on modes of transportation to maintain the required ‘social distancing norm’, thereby ensuring that millions of migrants return to cities. Morris is of the view that it’s the moment for bureaucracy to take charge and deliver strategies meant for a dynamic situation.

Medical experts, who anticipate that the coming week would be crucial in deciding the right strategy as the incubation period of the disease is 14 days, too said a complete lockdown for a long period is not feasible. “The actual impact of the lockdown will be visible in the coming week,” Dr G C Khilnani, pulmonologist, who is the chairman of PSRI Institute of Pulmonary, Critical Care and Sleep Medicine, said. He said a complete lockdown may not be feasible looking at the economic considerations. Khilnani advised that till the time the country is equipped with adequate RT-PCR tests for detecting the Covid-19 positive cases, states should ramp up on rapid antibody tests, which were approved by the Indian Council of Medical Research recently.

While the RT-PCR tests cost Rs 4,500, the antibody test costs roughly Rs 300. The latter does not require expertise and the test results are available within an hour. “This will show us the prevalence of the disease. Through the anti-bodies test, we will be able to detect how many persons have become immune to the disease,” Khilnani said.

Khilnani, who thinks testing would be essential in opening up the lockdown, said India will have to divert resources to highly-affected districts and in the meantime prepare for the testing kits.

On the other hand, Dr. Jayaprakash Muliyil, former principal, Christian Medical College, Vellore, and one of the country’s leading epidemiologists, advocated ‘herd immunity’ for the country. That is, let a certain share of the population (young people) get infected by the virus to build immunity towards it. “The disease is going to be there – whether you like it or not even if you ramp up your testing,” Muliyil added.

He said that the three-week national lockdown will help spread awareness among the masses about the disease who would know ways and means to protect themselves, such as not venturing out in the crowd.

“Don’t do overcrowding; try to keep distance from each other. Work has to go on, industry has to be restarted, agricultural activities have to start and at the same time, young people will recover from the infection. When the immunity level is attained to the so-called protective level, or herd immunity, we can say that the epidemic has seized,” he said, adding that the elderly will have to be kept isolated.

However, the government is not yet convinced with the idea of building up ‘herd immunity’, a senior government official said. “Herd immunity can be targeted when there is vaccine in place. We cannot target infecting a share of the population. But what we know is, after analysing the data from Wuhan in China, where the proportion of infected people is low and they have successfully contained it, the proportion of population required to build the immunity could be lower,” the official said.

But to restart the economy, industry will need handholding of the government. Kaushik Basu, Professor of Economics at the Cornell University, US, and former Chief Economic Adviser to Government of India, listed steps to gradually lift the national lockdown. “The virus will be around for some time. Social distancing or lockdowns are a must but we also have to slowly allow trade, exchange and markets to function. Otherwise, there can be a breakdown in food and essentials supply & sharp currency depreciation,” Basu said on Twitter on Monday.


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