JOIN USCoronavirus lockdown: Cure worse than the disease
Without doubt, the lockdown imposed on the nation on March 24 was needed, even if it could have been better planned and the nation given sufficient notice. It has saved lives by containing the likely spread of the virus. It is time now to seriously consider winding down the lockdown in some fashion, rather than extending it or tightening it. The cost to the nation of the total lockdown may be higher than the benefit if we extend it. This becomes apparent when one compares the Coronavirus-related deaths in India so far with those in the US and European countries.
The lockdown has already resulted in untold hardships to the poor of India. For the middle class, it is only a question of inconvenience. Some 94% of the Indian labour force work in the informal sector and most have problems meeting the daily basic needs of food. Financial and other help extended by the government, although it came late, and by NGOs and activist philanthropists, have gone some way in helping some of them get over the hardships.
But we have failed to assess how the lockdown has affected those in urgent need of medical care for diseases far worse than COVID-19. In addition, there are those who might have suffered because of depression as a result of having been confined to their homes, cut off from friends and relatives. Most of our worries have been focusing on the likely impact on our current and future economic prospects.
Usually, performing any cost-benefit analysis or weighing the pros and cons of any decision, though complex, does not involve putting a value on human life. However, in the case of the decision on the lockdown, we are faced with this difficult situation. If the lockdown is not extended, it will certainly result in some number of additional deaths. But, based on the current experience, it may not be very high. At the same time, though, some experts warn that India may not have yet reached stage 3 (when the virus spreads through community transmission) and we may see an exponential rise in deaths, numbering in the thousands.
On the other hand, if we look at the number of known infected cases and deaths related to COVID-19, they are so insignificant that some have gone so far as to compare it with ordinary flu. For flu, no one thinks of imposing lockdown -- total or partial. Despite India’s specific situation, we seem to be adapting the containment strategy of deeply affected countries like Italy, Spain and get frightened by looking at the daily worsening death rate in the US and Europe.
Two graphs that are in circulation show the number of COVID-19 cases and deaths per million. As of April 9, total number of deaths in India, for a country of 1.3 billion, is 226, while for Italy, Spain and the US, with lesser populations, it is 18,279, 15,447 and 16,150, respectively. On a per million basis, India’s death rate is hardly visible on the graph.
There are several theories about why India has so far had such a low COVID-19 mortality rate. First is the age factor. Based on the study of deaths in China, it has been found that it is the older people, above the age of 60, that are affected the most and younger people are least affected. Since India’s median age is 26.4 years – i.e., a large part of the population is young -- the age factor may be one of the reasons for low incidence of death rate in India.
A second theory is that the virus is not virulent at higher temperatures. One study found that the COVID-19 virus may be less stable at higher temperatures, with the optimal temperature for transmission probably around 8.72°C. COVID-19 related deaths in Africa are considerably fewer than in other countries. However, there is no scientific explanation yet to prove this theory.
The third theory, based on a recent research report by New York Institute of Technology’s College of Osteopathic Medicine, is that those countries which have universal BCG vaccination programmes have lower death rates. This research report is still not peer-reviewed and researchers are conducting more studies on this aspect.
A fourth theory is that Indians may have higher immunity since we are already exposed to an unhealthy environment. As one doctor from Goa described in poetic phrase, Indians are now getting the dividends of their notorious “dirtiness.”
One way to prove the hypothesis that Indians have an innate ability to fight the virus is to conduct a randomised sample survey in a known “hot cluster” where COVID-19 patients might have spread the disease. To get more confidence, at least four to five clusters may be needed where it may be enough to test nearly100 people to get statistically significant results.
Researchers are implementing such a survey in Los Angeles to explore the possibility of ending the lockdown early, according to an article in Washington Post. Los Angeles was among the first cities in the US to issue stay-at-home orders and it has had fewer than 200 deaths while New York has had more than 4,500.
If the estimate of the fatality rate is based on reported cases, then it is 6%. However, since a large percentage of cases are asymptomatic, the actual fatality rate may be around 1.4%, as reported by a Chinese study, too.
For India, it may be as low as 0.004%, after comparing the fatality rates of European countries. If we apply this rate, then the number of Indians who might have been infected may be as high as 56,500 and not the reported infected number of about 7,000. This is because a large number of infected patients are asymptomatic. This has been proven in Iceland, where 50% of coronavirus cases have no symptoms. When we take a randomised survey and it shows that a large percentage is already infected but is asymptomatic, we can start winding down the lockdown in phases with confidence.
(The writer is former governing council member of Manipal Institute of Technology, and an international oil expert)