Likely extension of the lockdown is a bad idea; the PM and the CMs got trapped in flattening-the-curve rhetoric
Going by news reports of the PM and CMs meeting, in all probability, the lockdown will continue after May 3 — in some form or another — with most states in favour of extending it; some have said that, in any case, there can be few relaxations in hotspot areas like Mumbai and Pune, for instance. This is most unfortunate and crores of workers will suffer as job losses mount; as firms go bust, in the absence of a central government relief package, bank NPAs will rise dramatically. The governments, sadly, have got trapped in the flattening-the-curve rhetoric and it is not clear if they know how to get out, especially since, in all likelihood, there can be fresh outbreaks of the virus as is happening in China.
The initial lockdown—and its extension—had a specific goal, and that has been achieved. Had the number of infected been doubling every three days, as it was before the lockdown, India’s flailing healthcare system would have been completely overwhelmed. But, with the doubling now occurring every 10 days, hospitals haven’t been overrun with Covid patients; it helps that other patients are being kept out, but for how long can this carry on? Nor have intensive care facilities had to turn away the dying. Indeed, there have been several breakthroughs in the meanwhile, like the production of low-cost ventilators, cheaper and quicker antibody testing kits, more production of masks and PPE, etc. An even bigger ramp-up in testing is now easier and, going by government data, hospital bed facilities have been increased significantly.
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New findings make it clear that flattening-the-curve is no longer as relevant; having scored a big victory in containing the contagion, India must move on. A week ago, ICMR talked of 80% of the infected being asymptomatic. If it still hasn’t changed its testing protocol to include asymptomatic people unless they have been exposed to an infected person, this is because there aren’t enough kits to test everyone; but it is obvious that if so many people are asymptomatic, the testing protocol is inadequate.
Similar reports are emerging from other parts of the world using antibody tests. In a homeless shelter in Boston, 146 of the 397 tested were infected, suggesting an infection rate many times greater than that thought to be the case until then. And, in Santa Clara, a study found the number of infected was 50+ times more than previously estimated using the conventional antigen (RT-PCR) tests. A later study using antibody tests in Los Angeles, PHFI president Srinath Reddy says, found infection levels were 28-55 times higher than previous estimates.
Reddy uses this to make a distinction between the Case Fatality Rate—885 people of the 28,055 detected in India have died so far—and the Infection Fatality Rate for the entire population. Anyone hearing that India has 2.8 million infected as against 28,055 right now—assuming the antibody tests reveal a 100-fold hike in infection levels — will be frightened enough to order an even longer lockdown but, as professor at JNU’s Special Centre for Molecular Medicine Anand Ranganathan points out, this is actually good news. From a case fatality rate of 3.2%—which is really high, considering that at some point, a much larger proportion of Indians will get infected—this rapidly drops to a much more acceptable 0.03% at the level of the population. Knowing this number also makes planning for the pandemic — and opening up the economy — more manageable. Since, by and large, the number of deaths being reported hasn’t shot up dramatically, a 100-fold increase in the number of people infected — from 28,055 to 2.8 million — means the fatality rate has fallen off dramatically to around 0.03%.
Indeed, Ranganathan points out that measuring the curve—its trajectory, actually—is really a mug’s game as it all depends on how much you test. If India had ramped up testing several times over and found 100,000 cases a week ago, just by way of an example, it is possible that the cases could be falling if the next week showed that 80,000 more people were infected. When you don’t even know the shape of the curve, to quote Ranganathan, how do you know if it is flattening?
Given this, and the fact that the human consequences of the lockdown are very serious since crores will be rendered jobless and hungry—and NPAs will also soar as firms go belly up—India’s best bet is to ramp up antibody testing to know where the infection has spread, and to what extent, so as to be able to plan the rollout of health infrastructure and also to decide which areas to open up fully. Also, for the economy to recover, a more nuanced approach is critical in even areas with infections. If the RT-PCR tests — or a rise in the number of hospitalisations or deaths — show the emergence of more hotspots, the governments must not use that to completely stop industrial production or service activity. Instead, cordon off the area/building where this happened and take local action, including disinfection/fumigation of the facilities. A vaccine is at least a year away, and it is not clear when one of the several treatment regimes being tried, including plasma therapy, will work. But waiting for the curve to flatten isn’t going to help; this is truly Abhimanyu’s chakravyuh.