The enemy is still lurking: Prevention from fallout via better preparedness post-lockdown

The outbreak of COVID-19, the Novel Coronavirus has challenged the entire world with an unparalleled situation. And that is what makes the nature and scale of COVID-19 one of its kind, even though, we human beings are not totally unaware of disastrous outbreaks of diseases in the past.

On Tuesday, 24 March 2020, the Prime Minister of India Mr. Narendra Modi announced a 21-day nation-wide lockdown to prevent the further spread of COVID-19, making it the first country to institute a lockdown in the absence of community transmission of the disease (Kulkarni, 2020). While the country has been lauded for this decision and has received solidarity for the same, experts such as Professor Ramanan Laxminarayan of the University of Washington’s Department of Global Health are of the view that this drastic lockdown was motivated by a realization that its health system is weak, beyond the consideration for comparison with countries like Italy and China (Chotiner, 2020). In this context, China, where the Novel Coronavirus first emerged, did not impose any such lockdown, with an exception of only Hubei province, followed by several restrictions in the same place (Daniyal, 2020).

India has now entered the third and final week of its lockdown. At this point, it becomes relevant to take a deep dive into the progress that the spread of the disease has managed to make in India.

After the first case was reported on 30 January 2020 in the state of Kerala when three students returned from Wuhan, China (TWC India Edict Team, 2020), the number remained fairly constant until towards the end of March when it shot up exponentially. As of 7 April 2020, the number of total reported cases has hit an estimated total of 4,911, as recorded by Worldometers’ database on COVID-19 [1], with the states of Maharashtra, Tamil Nadu and Delhi leading, at 690, 571, and 503, respectively, as shown on COVID19 Monitor of CRRP [2] depicting Growth of COVID Cases in India (as of 6th April, 2020). Given the current pace of growth, other than wondering where the cases can be expected to reach in the next 7 days, what is also thought-provoking is the concern about what external factors have been instrumental in posing challenge in controlling this situation, until now. Some of the challenges can be understood as follow:

Better immediate response

For the starters, India was still at a better position in the battle against the pandemic, because it had enough breathing space to institute a rather phase-wise and structured lockdown after the first three cases were reported. Identifying the hotspots or the truly affected areas could have aided this approach. This would have created a better space for people as compared to the sudden shutdown which left many citizens with very few hours to stock up on daily supplies or travel back home from one place to the other. Not only did this put several households under a sudden financial stress, but the risk of people getting exposed to crowded places increased in a time when social distancing was already a norm.

While the aforementioned is one angle of looking at the situation, what is also to be understood is the thought that a pandemic, like any other disaster, comes with close to none or very narrow window to allow any country a sufficient amount of preparedness. In case of COVID-19 in India, the number of cases in the initial few days were very low and the situation appeared to have been under control with the Government of India rightly issuing travel advisory to China (Indo-Asian News Service for India Today, 2020), heeding to the need of the context. In such a scenario it was difficult to foresee the shock that the country experienced towards the end of March with sudden rise in the number of cases. And not long after the situation began worsening, the prevalent lockdown was issued, according to the need of the hour. At this point, the choice of phase-wise lockdown was nowhere in the radar of consideration (and correctly so), in order to garner the required amount of seriousness, not only among the concerned authorities, but especially among the citizens of India. It was keeping in view the heat of the situation at that point of time that the Government of India also invoked the National Disaster Management Act (2005) to deal with the crisis by enabling the Government to access funds from the National Disaster Response Fund, to enhance the medical facilities and research (Prabhu, 2020).

Over-burdened government machinery

With a better planned lockdown, the country could have experienced better effectiveness, as well efficiency, with people not defying the need of social distancing. Consequently, this would also not have burdened the government machinery constituted by the security personnel, and different ministries and departments for example, under such heavy burden to ensure compliance by the citizens.

Peeping again into the flip side of this concern, as the citizens of a country dealing with a health emergency of an unprecedented capacity, the onus of responding to this disaster is not only on the National and the State Governments, but it is also on the citizens. Once the Disaster Management Act was invoked, the violation of its provisions was considered to be an offense criminal in nature. This means that, any sort of mass movements on the roads was subject to arrest (FE Online, 2020). This is because, such movements were identified as a serious threat to the country’s fight against the Novel Coronavirus. This move of the Government is appreciated for possessing a sense of uniformity in action with a coherence in the line of command.

The concern about the movement of migrants

In terms of the intensity and the nature, the neighbouring country of Bangladesh too had announced a lockdown of 10 days, preferring to use the term ‘holidays’ over ‘lockdown’. However, there was one difference, which was a major one, in fact. On 20 March 2020, the government of Bangladesh warned its citizens that buses, trains, and ferry services too could be halted in the heat of the Novel Coronavirus outbreak. This move allowed the migrant workers in Bangladesh, a large enough window to move back to their villages (Daniyal, India is enforcing the harshest and the most extensive COVID-19 lockdown in the world, 2020). Resultantly, by the time the Prime Minister of Bangladesh Ms. Sheikh Hasina addressed the nation on 25 March 2020, the migrant workers had gone back home, despite which, two more days were permitted for such movement, until 27 March 2020, when the transport services were finally halted. While India has denied community transmission of the virus so far, the lack of public awareness, and dearth of appropriate measures for the migrant workers is not helping in generation of sufficient amount of seriousness to deal with this situation. And this gap is also showing up when reports of large religious gatherings hit the headlines.

While the above mentioned is true, what is also true is the point that the responsibility of exercising vigilance and required amount and type of checks on the movement of migrants and daily wage labourers was assigned to the local administration. Expressing care and duty towards such workers, the Centre issued directives to all the respective district administrations to make arrangements for those who got stranded on the roads, after the borders of the states were sealed.

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Healthcare facilities

The former governor of the Reserve Bank of India Dr. Raghuram Rajan has noted, “It is said that India reforms only in crisis. Hopefully, this otherwise unmitigated tragedy will help us see how weakened we have become as a society, and will focus our politics on the critical economic and healthcare reforms we sorely need.” (Nair, 2020)

India is recognized to have a highly overstretched healthcare system with difficulty in providing appropriate care even in ‘normal’ times. According to a report compiled by the World Bank, the number of hospital beds per 1000 people in India is only 0.7, compared to 4.2 in China and 3.4 in Italy [3]. Taking from this, it is but foreseeable that should there be any greater surge in the number of COVID-19 cases in India, it will be close to impossible for the healthcare providers in India to support the sheer volume of cases.

The ongoing lockdown in the country does not put an end to the pandemic. What it instead does is buy the country some time to improve its preparedness strategies and measures. The government is already looking up for all possible resources from different sectors of the country- public, private, and defence. However, this should not and does not understate the fact that the pace of the actions has to manifold. This means that, the number of tests being conducted have to multiply to reduce uncertainty, for one. This will ease the identification of hotspots across different states in the country. Also, learning from one of the best practices implemented in Hubei, the assigning of volunteers, especially from the youth can be beneficial to be rushed to areas where shortages of medical supplies are acute.

Up until now, the Government of India has already been taking several measures to bring the situation under control. In order to retain this vigour and build further on it, utilization of the remaining period of lockdown in strategic disaster preparedness planning is the need of the hour. So far, the country has denied any community transmission of the disease. In future too, if this is to be prevented, despite the lockdown being lifted, it is recommended that the resuming of inter-state transportation services is avoided for at least a month more, and the travel between different countries is avoided for three more months. This is to suggest that, while the inter-city transportation services and the local movement of the people can be considered to ply, the borders of the state should remain closed. This will allow the state governments ample amount of time, space and ease of control in monitoring the situation and taking necessary actions as per the requirement. This will also ensure that any scope of transmission of the disease between states is completely snapped, thus reflecting an inter-state cooperative approach. Consequently, as afore discussed while the lockdown could not be instituted in a phased manner, it can be lifted in that way, gradually, especially in a scenario when the state governments are still hoping for the extension of the lockdown.

Further, like in other affected countries, in India, COVID-19 can be understood to have entered mainly because of airline traffic. However, it was not majorly because of travellers from China because they were all quarantined in the initial stages (Sharma, 2020). It was, in fact, likely because of people travelling from Italy initially, followed by people coming from other countries. At that point of time, the idea about how the disease was progressing and spreading was largely unknown. Standing in the middle of this battle with at least the ability to guess the seriousness, intensity, and the pace of the spread of the disease, restricting inter-country travels comes across as another necessity, especially when the disease has spread across several countries of the world. In this context, this move can usher in a measure of prevention, in a situation where everyone is learning from everyone else.

 

While we are preparing for the potential new challenges post the lockdown, we, as the country, are already in the response phase in the outbreak, where intellectual agility is demanded. It is only with quickness in actions that the hopes of several citizens and the concerned authorities can be realized in reality.