The lockdown conundrum

After a thorough review of the Covid-19 lockdown in the country, the Government of Pakistan has extended the unpopular measure for another two weeks. The restrictions will now be lifted on May 9, 2020. This is a measured and well thought-out official response to a potentially volatile situation. The government indeed did well to take into account the huge personal, social and economic distress the people are experiencing as a result of the virtual home incarceration the lockdown has thrust upon them, but it did even better by not allowing mass anxiety to sully its decision-making capability. In once-in-a-lifetime perilous situations like the one that has been created by this pandemic, it is not prudent for governments to embrace normalcy at the cost of terrifying human misery.

Like sundry other countries, social confinement protocols have been put in place in Pakistan as a standard procedure to slow down the spread of the virus. While there is tremendous pressure on the authorities to lift the lockdown primarily due to the economic ravages it has brought in its wake, decision-makers are caught in a classic Catch-22 situation. If the lockdown is lifted prematurely, Covid-19 could spread exponentially killing thousands of people and overwhelming the rickety health infrastructure of the country, rendering it useless for others too. However, if it remains in place for long, it could pave the way for economic meltdown, dwindling exports, mass unemployment, substantial increase in poverty rates and burgeoning national debt. All this could result in social turmoil that could snowball into a cataclysmic public upheaval.

Axiomatically, and in line with the customary global epidemiological practices, the lockdown cannot be lifted unless certain goals have been achieved. The first one is extensive testing done as per a meaningful plan. This would tell the experts about the mosaic of infections they are dealing with. Taking a cue from this mosaic and before relaxing restrictions, federal and provincial governments must revitalise and improve their respective health departments. Hospitals, quarantine locations and isolation spaces should be suitably equipped to handle the inflow of infectees. Trained manpower must be in place to handle them professionally.

Similarly, the requisite Personal Protective Equipment (PPE) should be made available and the users should employ it optimally. The economic crunch we are experiencing dictates that a methodology based on cogent quantification models should be developed to procure PPE that could ensure rational supply chains. A centralised, need-driven mechanism should be devised by the federal government to procure the PPE intelligently so that wastage, stock disorders, duplication enigmas, and distribution issues could be avoided. WHO’s recommendations contained in its Interim Guidance document could be consulted in this regard.

Before the lockdown is lifted, there must be a significant decline in the number of infections and the connected fatalities creating what is known as a flattened curve. Data from China published in the famous English peer-reviewed medical journal The Lancet shows that for those who could not survive, the average time between the onset of symptoms and death was 18.5 days with a range of 15 to 22 days. This period is the minimum that the lockdown must remain in place. This would also lead to a drop in ‘Ro’ or the reproductive rate of Covid-19 which could guide the experts as to when it would be safe to lift the restrictions. Currently it is 2.3 and it would be suicidal to allow social intermingling. Once it drops below 1, the authorities would have the wiggle room to make a decision.

However, the lockdown would not disappear overnight. A gradual, multi-tiered exit strategy would have to be applied to different regions. Old, weak, and physically vulnerable people could be asked to remain sequestered even after the lockdown has been lifted. After the removal of the restrictions, doctors would make fresh assessment about the spread of Covid-19. The future strategy would depend on that particular assessment.

Published in The Express Tribune, April 26^th, 2020.

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