The recent COVID-19 pandemic has set a worldwide panic. Almost every government, whether national, state, or local is implementing some version of a lockdown strategy where people are either ordered or advised to stay indoors until further notice. This has resulted in the closure of public transport in some countries (like India), closure of non-essential businesses (almost in every country), loss of jobs, loss of public wealth (stock market, depreciation of assets due to recession in economy), and widespread uncertainty as there is no definite timeline about how long this may continue. One of the main arguments to justify this lockdown strategy is that this is the ONLY effective way to avoid or minimize public transmission of this extremely virulent pathogen which has the capacity to infect a large number of people if protocols of social distancing are not followed. No doubt, this is a very compelling and persuasive argument on its face. But the problem is, it is devoid of any credible evidence and without any cost-benefit analysis. Before people jump their guns for me mentioning "cost-benefit" analysis, I am not talking about determining the cost of human life and evaluating it against economic benefit or loss, I am talking about the analysis between various alternatives to this strategy, let's be clear about this.
It is not a secret that 100% compliance with any rule or policy is impossible. No matter how good implementation is there is bound to be a violation. Also, locking down the entire country is practically an impossible task. The most important factor that does not seem to be taken into consideration in this equation is that COVID-19 seems to be more dangerous for a particular age group and people with certain condition conditions. Numbers are displayed like reporting scores of an NBA, NFL, or cricket match without providing any further details about what these numbers really signify. Are these infections among high-risk people? What is the percentage of people from high-risk groups among reported deaths? What's the recovery rate among high-risk and low-risk people? These are only some of the questions that could be easily answered due to our increased speed and capacity to collect and process the data. All the efforts should have been directed towards protecting high-risk groups. Identify them, isolate them, and provide them with all essentials so that they don't have to mix with other low-risk populations without following strict social distancing protocols. It's easier to manage and control the behavior of a small group of people than putting an entire country in lockdown and expecting that everyone will obey it. Actually, the lockdown is an extremely inefficient, wasteful, resource-intensive, and expensive way of achieving the same goal, that is, to protect the high-risk people from infection of this virus. Only and only if this infection was extremely dangerous for everyone irrespective of their age or medical history the lockdown strategy in the way it is currently implemented would have made sense.
I wonder why these questions are not being asked in decision-making meetings? Why people are not proposing a more targeted approach than a one-size-fits-all approach? Why people are not able to see the self-inflicted damage on the economy and personal lives of the poor and marginalized? Why the number of infected people is important? What's the problem even if 90% of the country is infected if the death rate is within acceptable limits comparable to other similar infections? Imagine a scenario where 90% of a country is infected but only 0.1% of them are from the high-risk group. Is this better or worse than a complete lockdown where only 10% population is infected, but 10% of them are from the high-risk group? Why these models are not proposed or debated? Another thing to keep in mind is that any of these predictions based on modeling can be completely wrong. I worked in the area of structure-based drug design long enough to know that many times models fail to predict outcomes of complex problems. They are helpful, but they don't provide definitive answers and this should be a factor when considering predictions from any model.
As far as the lawmakers, national leaders, and other decision-makers are concerned, it is a win-win situation for all of them. If things get worse, more people die, they will claim, imagine the devastation without these precautionary measures. If things get better, and fewer people die, they will claim that this was the result of their aggressive measures. They win praise no matter what happens. Also, in hindsight, anything can be justified or criticized, this is called hindsight bias. The actual test is are these leaders willing to take steps that justify the cost they are inflicting on society or going to play safe and do what everyone is doing without analyzing if that's the best solution for their country or not? The answer is for everyone to see.
This crisis will also pass for sure. I hope some of the questions which I posed above will be asked and we will be better equipped to deal with such pandemics in the future. I hope that worldwide panic will not be touted as a universal solution when we face another world crisis. I also wish to thank all who are at the forefront of fighting this war and are working tirelessly to deal with this situation.
Thanks for reading and please share your opinion about this topic.
Hi Vinay,
ReplyDeleteI read your article and even I thought like you. But don't we need to think about the following as well?
True, we should also look at the stats and demographics like age and prior medical conditions and not just look at how many have died. But then is it really feasible to separate them from the others? Does a country like India have accurate data as to how many people have a precondition? If at all we decide to separate people, where would we arrange them to stay? It is already difficult to arrange for accommodating infected people. We are going for open grounds, trains and what not. If we also add the number of not affected but likely to be affected people imagine how much additional space we would require? And at what cost?
Secondly is it really affecting people of specific age group or medical condition? We have cases where even doctors and nurses have been infected.
Death rate may be low but transmission rate is high. If we don't go for a lockdown now more people will be infected unnecessarily. And if you keep offices and public places open it will spread so much and so fast that eventually many people will be at hospital than home. So lockdown I think would avoid that.
Naresh Mehendale, Pune
Hi Naresh,
DeleteThank you for sharing your views on this topic. You have asked great and relevant questions. I wish same questions are being asked to decision makers during the meetings which hopefully are conducted before taking decisions which are impacting massive population all across the world.
You are right, transmission rate is very high. But does that matter if people don't die because of that infection? Every year millions of people get infected with flu (influenza) and thousands die in each country, in Italy itself in 2017, around 24,000 people died because of flu. What matters is the rate of fatality and we do not have accurate numbers for it, so we cannot base such a major decision or incomplete, inconsistent, or inaccurate data.
As far as high-risk group is concerned, we have clear indication that this virus affects disproportionately to people with weak immune system or underlying conditions. Drs and nurses can have underlying conditions and vulnerable to this disease. Some of them are so passionate and committed to their profession that they work even after being in high-risk group assuming that precautions might protect them, but human errors happen an sometimes infection gets them.
No need to isolate people from their families, as infection rate is so high, no healthcare can take load of patients if every infected person shows up at the hospital. The good part is that not everyone need hospitalization, many can be treated at home and some even get away with mild or no symptoms.
Now the most important question, how long you keep this lock down? How long you can stop international travel? What if infection starts spreading again? Another lockdown? What if infection doesn't guarantee immunity? What if virus mutates? There are so many unanswered questions and reacting based on a worldwide panic is not a wise thing to do.
My only argument is, where is the data to support that this approach is saving lives? Why not to allow in a controlled manner to spread the infection among the healthy population and see if we can develop a herd immunity.
And as far as India specific problems you mentioned, Indian govt and Indian people have to come up with logistics and solutions. Govt need to be transparent in how much resources they have and how they plan to utilize them. This is why we elect them, right? Govt is supposed to inform us and serve us as best they can, not to dictate us.
These are just some of my views based on my readings and understanding of the current scenario, any further criticism or questions are welcome. Thanks again for your comment.