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A sustainable lockdown strategy

The coronavirus pandemic is the gravest crisis Pakistan has faced. The virus is spreading exponentially worldwide, and once it infects the chances of serious illness and even death are quite alarming.

Unlike what our misinformed prime minister told the nation a few days ago – only to backtrack later – the virus can be lethal for all, including the young and the healthy.

This pandemic has devastated the public health systems of advanced countries and its effect can only be imagined in Pakistan. Fortunately, so far the death and devastation in Pakistan are not at the level suffered elsewhere. But this shouldn’t make us lower our guard. We may be just a few days behind other countries and end up worse off than them if we don’t continue our focus on slowing the spread of the virus.

Unfortunately, the current government has failed to deal with this crisis, especially in its initial containment efforts. Its first failure was in not ordering enough ventilators, protective equipment and testing kits between January and mid-March, or planning to add emergency healthcare capacity in the country. In essence, the government wanted us to fight this war but without any weapons. Next, it spectacularly failed in containing the virus at Taftan. Our health adviser himself visited Taftan yet somehow the government turned the quarantine facility into an incubation centre and then released the infected.

The failure continued at airports where thousands were allowed to come in without proper screening. And it continued when the Tableegi Jamaat was allowed to hold its Ijtema. The ijtema ended sooner-than-scheduled but only after other institutions intervened. Likewise, it was due to such intervention that the Punjab government enforced a lockdown in the face of obstinate and misguided opposition from the prime minister, who to this day has failed to own the lockdown and articulate an integrated national strategy to face this crisis. His initial dithering has cost the nation precious time in this fight.

Now weeks into the lockdown we are seeing some positive results as Pakistan hasn’t climbed a steep curve either on infections or deaths. It seems, however, that the slow growth in confirmed cases is due both to the lockdown and also limited testing. For low coronavirus deaths too, scanty testing is partially responsible as patients who weren’t tested when alive aren’t reported as coronavirus fatalities. However, things are likely to get worse as infections continue to creep up.

Since there is no cure or vaccine, one strategy is to let the virus spread and achieve ‘herd immunity’, the notion that when enough people within a population get infected and gain immunity then further spread of the virus becomes slow. Great Britain pursued herd immunity for a time before changing course once it was understood that it may suffer up to a million deaths before herd immunity is achieved.

Most countries in the world are trying to contain the virus with various types of lockdowns as the only viable strategy. We have to follow the same course. However, we must be honest with the nation. This pandemic will likely get worse before it gets better and thus lockdowns might be in place, off and on, for quite some time. But since this battle must be fought until a vaccine is discovered, the lockdown has to be economically sustainable and culturally appropriate.

A lockdown has four principal advantages. First is to slow the spread of the virus, what is referred to as ‘flattening the curve’ of infection, so that a large proportion of the population doesn’t get sick at the same time and public healthcare systems are not inundated with millions of people getting sick simultaneously and competing for limited medical resources including hospital beds, ventilators, etc.

Slowing the spread of the virus has an enormous impact on the number of infections and fatalities. The New York Times estimated that in America a no lockdown situation would have led to more than 150 million infections and 1.8 million deaths but a 60-day lockdown would lead to 13.9 million infections and 82,300 deaths. So ‘flattening the curve’ is crucial to saving lives.

A second advantage is to gain time to build infrastructure to contain the virus and fight the disease. This means building field hospitals tailored specifically to tend to Covid-19 patients, creating quarantine and isolation centres, and even temporary shelters for people most at-risk. We also need to procure ventilators and protective gear for medical personals and the public.

A third advantage is getting time to test as many at-risk people as possible and where appropriate isolating them and tracking and testing their contacts. The main reason South Korea and Singapore have been so successful in containing the virus has been their ability to track, test, isolate the infected.

Finally, the fourth advantage is to gain time in the hope that a cure is soon found. Research is ongoing and it is possible that a vaccine or a cure can be found in the coming months. Our effort to slow the spread now and buy time can save millions of precious lives.

Lockdowns have enormous economic costs but we can reduce these by certain mitigating measures. It goes without saying that large gatherings should be banned everywhere. But economic activity that is vital and can be carried out with minimal risk may continue. Authorities should expeditiously come up with protocols of how factories and businesses can protect their workforce and customers by minimising the risk of infection. Only those factories that meet the requirement may then be allowed to re-open.

Businesses that can result in spreading the virus, such as restaurants, salons, gyms, etc must remain closed. But other shops could be allowed to open, perhaps on alternate days to ease traffic and congestion in the markets. Similarly, public transport like busses could be allowed but with passenger capacity truncated. People selling things on pushcarts or small kiosks should be allowed to conduct their business, but again with restrictions such as a limit on how many can park their pushcarts in the same area, etc. These measures minimise the risk yet provide employment opportunities for our people.

While people are making sacrifices, our governments must do their part. At this time of economic crisis, our monetary policy should be geared towards providing liquidity for businesses, especially small and medium enterprises, so good businesses don’t go bankrupt due to a liquidity crunch. This will permanently reduce our national income. More importantly, our fiscal policy should primarily focus on helping the poor through this crisis. Cash transfer to the poor has been a good start. Much more needs to be done.

No strategy can be successful if it is not universally accepted and fully implemented. This is not to say that the lockdown specifics should be the same in, say Faisalabad and Pasni, but it does mean that the principles and rationale of the strategy should be the same and implemented uniformly. The government must take ownership of the situation and come up with an integrated national strategy.

Miftah Ismail, "A sustainable lockdown strategy," The News. 2020-04-15.
Keywords: Health sciences , National strategy , National Crises , National income , Economic crises , corona virus , Employment opportunities , Economic costs , Healthcare system , Protective equipment , Medical resources