If the Southern Indian State of Kerala showed the country how to combat a pandemic, its neighbour, Tamil Nadu is proving to be an example of how not to.
Struggling to control the rise in the number of COVID cases, Tamil Nadu enforced a return to maximum restrictions lockdown - for Chennai city and areas adjoining it- on the 19th of June. It will remain in force, in varying degrees, till the 31st of July.
Data from Tamil Nadu shows that two weeks into the lockdown the rise in the number of cases has not decelerated. On the 19th of June, the State had a total of 52,334 cases and on that day 2141 fresh cases were recorded. On the 1st of July, the State recorded 3,882 fresh cases and had a total number of 94,049 cases, an increase of more than 40,000 cases during lockdown.
Maharashtra, which has reported the maximum number of cases in the country, also extended strict lockdown measures till the 31st of July and has had a similar failure in controlling the graph. It now accounts for 1,80,298 cases (as of 2nd July 4PM)
These two states alone account for 2,74,347 cases and 9,317 deaths (as of 4PM on July 2nd), almost 50 percent of the approximately 6,00,000 cases in India.
IS LOCKDOWN THE SILVER BULLET?
Since lockdown is evidently not turning out the panacea that India expected it to be, after its apparent success in Wuhan, there are questions being raised on its efficacy? Has there been a failure in using it to achieve the appropriate objective, say flattening the infection curve and gaining breathing space, while a host of other measures like mass testing and tracing root out the sources of infection, quarantine them and finally crush the virus in COVID hospitals. Where are we going wrong?
Lockdowns come with a heavy and unbearable economic penalty, especially for a country with almost zero social security and millions in the informal activity dependent upon daily wages, and cannot be imposed indefinitely to see the last of the virus. While a strict curfew imposed by an army of baton-wielding police can halt its vicious spread, this is at best a temporary measure and not a cure. The inevitable restarting of economic activity is bound to reboot the spread of the virus.
The two states failed to contain the spread in “Lockown 1.0” and are fairing no better in its sequel.
PATH TO EXIT A LOCKDOWN
Lockdowns are only a part of the larger game plan of isolating unaffected populations from the bearers of the infection. Since they cannot be maintained in perpetuity, the latter part of the whole exercise, the opening up is critical ("Unlock 1.0" as it is being termed).
For the "Unlock" to allow the resumption of economic activities without an accompanying surge in infections, the emphasis has to be on measures to be taken during the lockdown to prepare for exiting one.
As early as Lockdown 1.0, Synergia Foundation and host of other experts had simulated and suggested measures including a massive ramp-up of public health care facilities and methods to protect vulnerable groups in the post lockdown situation. This includes waging the battle as far forward as possible to prevent the hospitals from getting swamped, and maintaining strict social distancing norms, in travel, workplace and all aspects of human activity.
Unfortunately, the failed COVID states have not studied any exit strategy carefully.
A classic example was the chaos caused by the government of Tamil Nadu when it announced suddenly, amid easing restrictions, on 24th of April that there will be a full lockdown between 26th and 29th April.
The panic reaction led to massive crowds thronging for essentials, and it is almost certain that such crowds only accelerated the spread of the virus.
There is absolutely no logic or reasoning for such decisions and a sudden lockdown for two or three days only compounds the situation.
TOO HIGH AN ECONOMICAL PRICE TO PAY
Governments need to appreciate that Lockdowns are too costly an exercise for experimentation and to ostensibly show a decelerating case graph, for domestic consumption.
This point needs emphasis as in several states, including in Karnataka, which has seen a steady rise in the number of cases, the threat of another lockdown seems within the realm of possibility.
There has been re-implementation of restrictions, like a Sunday lockdown in Bengaluru, and Karnataka Chief Minster B.S.Yeddyurappa even appealed to the public to maintain strict social distancing measures and control the numbers if they want to "avert" another lockdown.
It is important for each state to carefully study the ground situation and learn from the mistakes of those who have enforced one without adequate thought or preparation. Much more could be achieved by aggressive testing, careful isolation, and prudent planning.
This was clearly illustrated in the U.S when the states of Massachusetts, New York, New Jersey etc were affected by the pandemic. The governor of New York, Andrew Cuomo cautioned the rest of America that they should learn from the mistakes of these states, else the consequence would be harsh.
States like Texas, Florida ignored best practise, even basic ones like mandatory masks outdoors and social distancing, and they are now paying the price. These are the hazards of a federal system!
While leaders may not have the benefit of hindsight, they do have access to best practices to avoid the same pitfalls.
Creation of localized makeshift community health care centres for mildly symptomatic cases and ensuring the best facilities are devoted to high-risk cases is important.
DHARAVI & DELHI- LIGHT AT THE END OF THE TUNNEL?
While Maharashtra, and Mumbai, have the dubious distinction of being crowned the COVID 19 Capital of India, Dharavi, Asia’s largest slum in the heart of Mumbai, is turning into a classic example, perhaps, of how to contain the spread of the virus. After initial fumbling, the right approach was adopted with strict containment measures coupled with aggressive testing and isolation of all potential carriers.
This is in line with the Kerala model that has been globally lauded.
The national capital claims to have succeeded in arresting the rising number of cases, and that is also being largely attributed to aggressive testing and isolation measures.
Whether the success will be a lasting one is uncertain, and there is a fear of massive underreporting. But if the data can be taken at face value, then it is encouraging that the capital, with its population density, has managed a measure of success.
REIMAGINING CITIES TO COMBAT PANDEMIC
Teeming Indian megapolises are extremely susceptible to pandemics, and there is a need to revamp the way they are administered.
For instance, the Chennai Municipal Corporation does not have authority over water and sewerage in the city, the police force or the major Koyambedu Vegetable market that turned a hotspot. This only results in a lack of co-ordination. Similarly, in Delhi, the state government does not control the police, and the centre appointed Lt Governor enjoys extraordinary administrative powers to render the government helpless.
Most Indian cities are run by different government bodies (sometimes owing allegiance to opposite political parties) and there is a need for a unified command structure. Recognition that this pandemic disaster may become the rule rather than an exception underlines an urgency to re-architect city command chains.
Lasting success as a nation would depend entirely on the success of every state, and as in the chain analogy, the fight is only as strong as the weakest state or city.
- Rethink City administrative structures and incorporate pandemic response a key objective to create a unified command. Anticipate a spike in cases which should automatically trigger a coordinated response.
- A total Lockdown needs to be considered only after exhausting every other option. A standard operating procedure with pre lockdown planning and exit strategy must be in place before imposing one.
- Decisions cannot be taken based on number graphs and panic reactions. There needs to be a realization that COVID is here to stay, and the graph will alternate between crests and troughs. Containment and protection to vulnerable sections must be a priority instead of spreading the resources thin.
- A nationwide standard best response document needs to be prepared, and it is time to focus on long term planning rather than fire-fighting.
Author; TM Veeraraghav, Consulting Editor, Synergia Foundation