India needs a calibrated approach to tighten or relax controls at a local level depending on data from expanded testing
This is from The Intersection column that appears every other Monday in Mint.
As India decides what next after the 21-day national lockdown ends on 14 April, opinions are divided among those who want a phased lifting and those who want to extend it. This reflects underlying differences between those who believe it is worth taking calculated risks to forestall widespread suffering on account of lost livelihoods, and those who are concerned taking such risks could cause the pandemic to spiral out of control.
Bold as it was, Prime Minister Narendra Modi’s decision to impose a lockdown on 24 March was easier compared to what he has on his plate now. At that time, the consequences of the pandemic were clear, whereas those of the lockdown both unknown and in the future. It is almost the opposite now, and the moral dilemma appears far more acute. The prime minister has to weigh the real suffering of hundreds of millions of people caught in the lockdown against the millions who might catch the disease if the lockdown is lifted and the pandemic spreads. It’s not an easy decision, but there are ways to make it less difficult.
One reason India’s Union and state governments are caught in a bind is because of their instinctive binary mental model. The question is conceptualized as Hamletesque: to lift the lockdown (albeit phase by phase), or not. Unfortunately, this mental frame is unsuited to the radical uncertainty that the pandemic poses. If arguments for extending the lockdown do not answer how long it should continue, proposals for its phased lifting sidestep the possibility that the outbreak could get worse, or return in second and subsequent waves.
We need a different approach. We must be prepared for the disease to rise and subside at different times and in different parts of the country until everyone can be vaccinated, or the population acquires herd immunity. We need to be able to tighten restrictions when the risk of transmission increases and relax them when it recedes. We must have the capacity to lockdown and tighten control at hotspots while relaxing them where things are under control. We will have to insist on the use of masks, hand hygiene and physical as well as social distancing to reduce transmission risks. This is the way we can carry on with our lives and livelihoods even as we battle the viral pandemic as a nation.
The good news is that India’s constitutional structure enables such an approach. Public health is a state subject and state governments are best suited to decide what needs to be done given the situation within their boundaries. They, in turn, must consider the situation on a district-by-district basis, and at the level of municipalities and gram panchayats. If they have the capacity to isolate and quarantine geographical hotspots, they could relax controls elsewhere in the state. Similar to what has been adopted in Bhilwara, a targeted approach would let the government do both, control the outbreak and allow economic activity to take place where possible. Not all states have the same administrative capacity and social conditions, which is yet another reason to let them decide what is best for them.
That said, there is a case for consistency and coordination of policy measures across states. Over the past three weeks, many states have set up expert committees to recommend what to do after the lockdown. To my knowledge, there has been little consultation among these committees. While administrators are in informal contact with their counterparts in other states, there needs to be better coordination among them. States could agree on a common threat assessment system where each locality is assigned a colour code, from green to red, based on the risk profile. For instance, a “red” taluka anywhere in the country would mean the same thing, allowing for consistency in resource planning, allocation and operational procedures.
During the Cold War, the US adopted an alert state system called Defcon (defence readiness condition) that now has five levels, with the highest, Defcon 1, applicable to nuclear war. Singapore, having learnt from its bruises from the Severe Acute Respiratory Syndrome, or Sars, outbreak in 2004, put in place a framework for infectious diseases modelled on this. Called Dorscon (Disease Outbreak Response System Condition), it has four levels—from green to red—with preparedness, prevention and response plans that can be activated accordingly.
The advantage of alert-level-based systems is that everyone knows what to expect and what to do. People will understand when and why tighter control measures are called for, instead of being shocked and surprised. Administrators follow set procedures instead of waiting for instructions from their higher ups. Above all, political leaders will find it easier to decide and communicate, as they only have to explain their judgement calls.
But an alert system is only as good as the data that feeds it—which means we will need to expand testing for covid-19 beyond suspected cases to the general population. More and better data will then allow the government to tighten or relax controls gradually and discriminately.
There are many more The Intersection columns here
Whatever the government decides for 15 April onwards, it is inescapable that we will have to resume economic activity under the shadow of the covid pandemic. Beyond lifting or extending the lockdown, we need a policy framework for calibrated control.
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