Where the govt erred with the coronavirus response

Lock down virus, not people

The lockdown was meant to arrest the virus from transmission, not people. And people should have been allowed to, even helped to, return home safely before imposing the lockdown and asking them to stay confined. Now, in 319 districts out of 733 in the country, we are not achieving anything epidemiologically by lockdown, except self-inflicted economic destruction and social inconveniences. The only caution that needs to be taken: seal the district borders to prevent passage into and out of such ‘green zones’.

On May 11, the chief ministers of states finally spoke boldly about the ground realities and made suggestions to the Prime Minister. Many wanted only identification and cordoning off of containment zones, rather than the Centre’s red-orange-green zoning. Disappointingly, lifting of the nationwide lockdown and return to full economic activity and normal life did not happen even in the green zone districts.

Epidemiologically-guided containment measures and a granular decentralised hotspot-based approach is missing. Had the lockdown been lifted in the 319 green zone districts at the end of lockdown 2.0 on May 3, as was widely expected, it would have allowed governments to focus attention on the 130 red and 284 orange zone districts.

To confine 1.3 billion people to their homes (for those who have homes) and stopping all economic activities was a needlessly drastic step – without evidence of where the virus was and where it wasn’t in this vast country, it was a wild shot into the bush even before the game had reached the bush.

The virus originated in Wuhan and entered India via the airports. Indians studying, working or travelling in affected countries or foreigners visiting India on business or for tourism brought in the virus. The first two cases were of two medical students who returned to Kerala from Wuhan. Later cases were of Indian pilgrims and workers returning from Iran and Saudi Arabia, where the virus had already spread.

But what did the government do as the first coronavirus cases arrived in India on January 30? Even at the end of February, the central government was busy hosting US President Donald Trump and dealing with the Delhi riots. The Centre seemed to take note of Covid-19 only around March 3 when cases started appearing in Delhi and Jaipur.

Travellers should not have landed in India from the day the WHO declared Covid-19 a pandemic, that is on March 11. Putting a stop to international and domestic flights and interstate movement by train or bus to and from 75 districts in the three states of Kerala, Maharashtra and Delhi would have been justified. A timely action missed! Had that been done, then from April first week, the lockdown could have been extended justifiably to only six more states -- Gujarat, Madhya Pradesh, Rajasthan, Tamil Nadu, Andhra Pradesh and Telangana. Instead, on March 24, the entire country was shutdown with four hours’ notice.

The sensible surveillance and containment measures would have been a thorough screening at airports and ensuring every healthy passenger from the affected countries undergoing self-quarantine plus daily monitoring by the local health staff. If they developed any symptoms, they should have been transported to an isolation hospital immediately and their nasal/throat samples tested for confirmation of Covid-19. If there was any worsening of symptoms, intensive care with ventilator support and medications should have been provided. Positive cases should have been interrogated for their travel and contact history. The re-constructed route map and identified cluster of friends and relatives contacted should have been put under active surveillance. That would have been a perfect wartime strategy without restricting economic activity and the social life of communities. Kerala demonstrated that such a surveillance and containment model was operationally feasible with a dedicated public health team, community support and political will and leadership.

Unfortunately, that model was not emulated in metro cities and at the major international airports at the right time. Many imported cases in Delhi, Jaipur, Punjab, Mumbai and Pune could have been detected and dealt with, but the screening of all flight passengers started only on March 4. Even then, active surveillance of all travellers was not done. Had that been done, then the international participants at the Tablighi Jamaat event in Delhi would have been stopped at the airports themselves. But religious, academic and other gatherings weren’t stopped until the nationwide lockdown was announced.

Health Minister Dr Harsh Vardhan himself admitted that the “Lockdown is an extreme intervention to break the chain of transmission. It has great repercussions for the economy, society and psychology”. Even China did not undertake a full national lockdown. Initially, only Wuhan city and later, on January 23, Hubei province of 50 million population were put under lockdown. India clamped its national lockdown abruptly on the night of March 24 with only nine deaths and fewer than 550 cases at the time. Lockdown is one of the strongest weapons, to be used only when significant community transmission has started. Without any evidence of such a community spread, arresting people in their homes made no sense, especially in 433 out of the 733 districts in the country.

With such a Hitlerian Blitzkrieg strategy of fighting an imported virus, brought in by the privileged travelling classes, the cruellest collateral damage was inflicted on the millions of migrant labourers and slum-dwellers in our cities. They did not know or had heard of such a virus in their vicinity and were not prepared to face the lockdown. It was crucial to have arranged the fastest transport by special trains or interstate buses for the migrant workers to help them reach their hometowns before imposing a long lockdown. Tiny Singapore gave a 5-day notice to its citizens to get ready for a lockdown; New Zealand gave a two-day notice to its citizens.

While the migrant workers were ‘imprisoned’ in the cities for weeks, the imported virus landed in their slums and shanties, too. And it has started spreading like wildfire in summer. The expected main outcome of the lockdown was the flattening of the bell-shaped curve of incidence, theoretically three weeks after the lockdown. Instead, we are seeing new peaks of infection every day. There is no flattening of the curve, neither on a numerical nor on a log scale.

Political leaders safeguarded their vote banks and governmental untruths, allegedly superseding the technical advice of public health experts and even of the ICMR. Our country is blessed with abundant professional resources. Shouldn’t they be heard?

(The writer is a Consultant on public health, child survival and development in Kochi)