How do you deal with an invisible hurricane? The COVID-19 pandemic is reaching a tipping point in India, the point where numbers do not need to be interpreted, the picture on the ground speaks the entire story.
For the countries who have done a decent job in combating the pandemic, this Financial times extract captures the essence.
Early travel restrictions, aggressive testing and screening of contacts and strict quarantine rules have been crucial. Universal healthcare, clear management structures for the public health response and proactive communication to get the population on board have also helped.
Lets break it down.
- Early travel restrictions
- Aggressive testing
- Screening of contacts
- Strict quarantine rules
- Universal Healthcare
- Clear management structures for public health response
- Proactive communication
The WHO advice to all countries is “Test, Track, and Trace”.
Test for Virus Infection.
Track the infected patients movement in recent days.
Trace people who interacted with the infected patients.
When you trace people, you quarantine or test them. The cycle begins all over again if the people traced test positive.
The WHO advice when executed to perfection is a necessary first step to create a ringfence, a container for isolating the disease-afflicted and slowing the spread.
This WHO advice has two underlying assumptions – 1) countries have scaled-up capacity to test in large numbers 2) The population spread and density is discrete enough to enable track and trace.
Following this advice is necesary, but may not be sufficient. To get an even more effective handle over this dangerous situation, countries have to enforce a range of controls over people movement. This range of controls stretches from voluntary invitations for social distancing, to exhortations to stay at home to a complete lockdown, where only emergency movement is allowed.
This is a two pronged-strategy where the country has to succeed in
- Test-Track-Trace
- Partial to Complete Lockdown
China is a huge country. Their authoritarian government enforced a complete lockdown of Wuhan, the epicenter of the outbreak. They poured massive resources on both counts – test, track,test and partial to complete lockdown. They still took a big hit, because the government took some time in grasping the severity of the situation and acknowledging it.
Taiwan, Hongkong & Singapore were really quick off the blocks.
Here is a TIME extract.
In Taiwan, an island of 23 million, arrivals from Wuhan were subject to health screenings before human-to-human transmission of the virus was confirmed on Jan. 20. By Feb. 1, Taiwan, Hong Kong and Singapore had all proactively implemented travel restrictions on passengers coming from the mainland, contravening the World Health Organization’s [WHO] insistence that travel bans were not necessary. The precautions came at a significant economic cost to these international hubs, which all rely on mainland China as their biggest trading partner and source of tourists. The three destinations were also well prepared, making rapid response possible.
The countries that have done well are the countries that decided on a disproportionately aggressive response. They did not bother about the possible charge of having over-reacted.
Where does that leave India?
Let us look at the check-list items again.
- Early travel restrictions
- Aggressive testing
- Screening of contacts
- Strict quarantine rules
- Universal Healthcare
- Clear management structures for public health response
- Proactive communication
No two countries can have the exact same response even if they have similar resource-base. A country will survey the check-list items and aim to maximise effectiveness in areas where it is strong and cover up for weaknesses. If you do not have universal health-care, you try your best with quarantine rules. What choice do you have? You can’t do aggressive testing, then you impose travel restrictions early and usher in strict quarantine rules. You strive for your own balancing act that will address the situation. National cultures are also big determinants. People in Singapore and China are predisposed to obeying public authorities, and this expected obedience is factored into the decision-making.
India has had a conservative approach towards testing, knowing it has limited testing capacity. It imposed early flight travel restrictions but no domestic travel restrictions, either inter-state or intra-city. The cost of testing and consequent health care is being borne by the government. The communication has been coordinated at two levels – national and state. The public health response has followed the management structure and process.
As India reaches tipping point, it will revisit the basic two pronged strategy a) Test-Track-Trace and b) Partial to Complete Lockdown. And it seems highly likely that it will have to bite the bullet of complete lockdown as a means of last resort. It has to also scale up testing capacity. In retrospect, it would probably have to double down in frenetic execution on both fronts.
It does appear that India was wagering on a lack of community transmission and hedging its response. Only time will tell, how India makes up for the lost time and lost ground. Perhaps, the government has a full-fledged battle plan in place. A complete lockdown in a country that has hundreds of millions who are daily wage-earners is a foreboding scenario. If that was what prevented an early announcement, it has still become imminent. The most crucial piece of planning has to be for those who are the most vulnerable – people who don’t have two square meals a day and those who don’t have a home to take refuge in.
This post is incomplete as there can’t be a conclusion. We are at crossroads.