Exiting the lockdown

A version of this article was in Outlook’s online edition in early April. This piece was written in collaboration with Dr M.I. Sahadulla, Chairman and Managing Director, KIMS Healthcare Group and the author of Vital Signs: Reflections on a Life in Medicine and Management.

Pandemics are not particularly new. In fact, Covid-19 is simply the latest in a long line of pandemics. But this one has a rather modern streak. For the SARS-CoV-2 virus that causes Covid-19 has used the connectedness of our globalised world to spread. And spread with such speed and stealth, that containment — keeping the virus out — has proved to be almost impossible.

Clouds of uncertainty, but rays of hope in the distance...

Most nations have largely turned to variations of a shutdown — what Singapore’s Prime Minister, Lee Hsien Loong, evocatively called “a circuit breaker” — to reduce the spread of Covid-19. The intention behind these shutdowns is to try and prevent, or at least curtail, the spread of the virus by limiting social interactions. This is because social interaction typically influences the rate at which a pandemic, especially a respiratory virus pandemic, spreads.

In India, the 21-day shutdown that began at midnight on 24 March has involved closing workplaces, shutting most public transport systems, shutting educational institutions, severely curtailing movements and gatherings of people and asking everyone to stay at home. But effectively implementing a shutdown in a country of over 1.2 billion people, from diverse socio-economic conditions, comes with its own set of challenges. Overcoming these challenges calls for coordinated, empathetic action by governments across the country, even as we throw everything we have at controlling the virus.

Yet, we also need to think about the future — not just medium or long term, but also the next few weeks and months. We need an exit strategy or post-shutdown plan that protects our wellbeing even as it bolsters our economy. Here are some options to consider:

Continue mobilising public health resources: Over the coming weeks — during the lockdown and even after it’s eased — we must use all our public health resources, including more testing, to curtail the spread of Covid-19 and ensure that the infection rate stays very low. At the same time, we need to recognise that the virus could probably linger in pockets for some time to come. Therefore, we must be part of the global effort to develop preventive vaccines or medicines that treat Covid-19. 

Launch a massive education campaign: It’s not easy to change our behaviour in the best of times. But at this moment, behavioural changes such as adopting basic hygiene practices or staying away from one another are vital to control the spread of Covid-19. Of course, given the conditions that large sections of our population live in, adopting these practices isn’t easy; so we need to create alternatives where possible. But adopt them we must.

This is why we need to invest more in campaigns to advocate responsible practices — cleaning hands, physical distancing from other people, staying at home when asked to and so on. Such behaviour needs to become second nature; something we all do on our own, without any coercion. While governments have already launched such campaigns fronted by celebrities, perhaps it’s time we considered innovative options including applying behavioural insights to these initiatives.  

Gradual easing of the shutdown: India’s national lockdown is scheduled to end on 14 April. Even if all goes well and the number of Covid-19 cases in the country stays relatively low, it makes better sense for the government to lift restrictions only gradually and cautiously. This is important to ensure there is no immediate resurgence of the virus from increased social interactions.

Controlled resumption of economic activity: The pandemic’s impact on the global economy is already being felt. Some of us can work from home. But India has millions of people who do not have that option. So in the weeks ahead, it’s important to consider ‘reopening’ key sectors of the economy ­—with strict physical distancing, hygiene norms and other controls in place. This reopening has to be carefully planned and even more carefully executed.

Make public health a focus area: Any investment in public health helps to prevent diseases and leads to the improved overall health of the population. But in India, healthcare, and public health in particular, has not received the governmental attention and financial support it merits. This must change immediately. India needs to view public health not as crisis management, but as a long-term priority.

We also need to make the ‘one health’ approach an integral part of our public health strategy. This involves recognising that our health is connected to the health of animals, plants and the environment that we all share. It, therefore, emphasises that efforts to prevent disease should focus not just on human, but also on animal, plant and environmental health. We really can’t afford to ignore this idea, given that SARS-CoV-2 is believed to have animal origins.

Pay special attention to mental health: The upheavals caused by Covid-19 are affecting every aspect of our lives. All of us are, understandably, beset by worries about money and about our own health and that of our loved ones. Bereft of our usual coping mechanisms such as social gatherings or even regular work routines, this anxiety could very easily spiral into mental health issues. So we need to allocate resources to mental wellness programmes.