With four deaths due to coronavirus in India as on 19 March, everyone is wondering about the same thing.
Will India shutdown or not?
The Quint reached out to experts, including former bureaucrats like Shailaja Chandra, public policy experts like Nitin Pai and Oomen C Kurien, and health economist Amir Ullah Khan to bring to you a wide range of opinions.
‘Yes, The Govt Should Shutdown’
Amir Ullah Khan, Professor of Health Economics at Manipal Institute of Technology
Yes, the government should shutdown, but only if the government can ensure cash support for those who are going to lose their daily wages. It is good and important to do a shutdown, cause every indication is that we are moving towards a big calamity. However, the economic impact of this move is going to be huge. It will be huge for those in the informal sector.
The lockdown is necessary, we are moving towards a critical take off stage.
If you look at all countries which have been badly impacted, Iran and Italy, the pattern is clear that as soon as COVID-19 positive cases cross 150-200, we have seen the trend double every three days. The point is that it is far better to be safe, so we should not take any chances on that.
India has enough money and the necessary infrastructure to do this. Lots of people through Jana Dhana Yojana and even otherwise, have bank accounts. The transfer of funds to support them during this time must be digital. There will definitely be people who are left out, so it is critical to include them in the system, but there is no choice now. I think the government has to do this.
India could have isolated only certain areas, like China did, but they could do that as the outbreak was localised to certain provinces. In India now we have cases in many states. Hence localised lockdowns will not help.
‘Impose Serious Restrictions on Movement’
Nitin Pai, Director of The Takshashila Institution
One of the biggest unknowns right now is the extent of the outbreak in India — with testing being limited to a few thousand people with travel or contact histories, we do not have a good sense of what the actual situation is. Even a conservative estimate under the current rate suggests we can have a few thousand cases in a few weeks time. It is important to arrest these numbers to the extent possible, to prevent a massive outbreak.
So it would be wise and prudent to impose serious restrictions on movement of people for a few weeks; while massively expanding testing, robust quarantining, contact tracing and information sharing. I do not know what a “lockdown” means, but we do need actions to reduce risk of mass transmission. At this time this means closing schools & religious places, prohibiting mass events & public transport including trains and buses. We could review these control measures on a weekly basis.
‘Preparedness of States Must Receive Highest Priority’
Shehlaja Chandra, Former health secretary at Ministry of Health and Family Welfare and former Delhi chief secretary
Experience of public health, knowing how the country is administered and common-sense are today needed more than ever. Following the trajectory of countries like Hong Kong, Singapore and Taiwan which seem to have managed the spread of Covid-19 well needs to be analysed. How did they do it? At a National level India has already done two out of three things – long ago.
(1) They reduced the arrival of new cases into the community through travel restrictions. India did that early on and after cancelling foreign visas also put an embargo on Indian passport holders returning from EU and some other countries.
(2) These countries prevented possible transmission between known cases (suspected or in quarantine) which has been adopted here too.
(3) To guard against silent transmission in the community contact between individuals through encouraging self-isolation and community distancing. Some cities starting with Delhi, have closed clubs, restaurants, cinemas and schools but it is far from uniform. It is not easy e.g. to shut down public transport. The most extreme case is of more than 8 million people travelling on Mumbai’s suburban trains. Even if the trains are staggered, distancing of tens of thousands that travel next to each other in a congested space cannot be overcome.
Individual chief ministers and state Governments would need to take a call by identifying places where social distancing may not be feasible but has to be managed.
It is time that the states started mapping the districts and undertake limited random testing in specific high-risk communities to see whether the virus is spreading. Only if prevalence data is available can one forecast future trends. The District Magistrates, Municipal and Public Health authorities must expand surveillance and strategic sampling of the community. The district CMHOs and the Municipal staff all have a fairly good idea of their territory. They have always used informers like the RMPs, school teachers, postmen and market associations to encourage reporting. Such information needs to be shared through a common protocol as unlike other diseases COVID -19 is highly contagious, and being one step ahead is the only way of containing the situation going awry.
There is a need for a common protocol for sharing news intra and inter-state followed by regular monitoring as we have no possibility of shutting down national and state highways and things can spread very fast.
Communication will help being prepared. While it is too early to say who has done well, by and large in the area of public health management Kerala, Tamil Nadu and Maharashtra perform well. The Northern states are usually slow in the beginning and tend to learn from the southern states.The Health Ministry and the State Health Secretaries always review things and areas where red or orange flags need to go up follows. But at the state level nothing works like the Chief Minister reviewing things, talking to the residents of the state on Television, sharing decisions and showing immediate concern for those in need. The situation needs political leadership backed by professionalism, random testing and a strong sense of anticipation. One is not hearing enough of those things happening.
‘Shutdown of Major Urban Centres is Inevitable’
Oommen C Kurian, Senior Fellow & Head of Health Initiative at ORF
Given that we are seeing increased number of patients even when we are using very restrictive testing criteria, strong measures are needed to tackle the challenge. A shutdown of at least the major urban centres is inevitable, if we want to slow the spread, identify the pockets of infection and suppress the spread. I hope the lockdown will be followed by more focused, aggressive testing.
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