The new normal

June 10, 2020 0 By S Harachand

Many countries are reopening their economies, albeit cautiously, after finding that the lockdowns imposed as a response to the pandemic have helped to significantly bring down key metrics of the viral spread, such as the number of people newly infected each day. The absolute number of deaths due to the infection also shows a declining trend, flattening the epidemic curve. At least a few among these nations seem to believe that the first wave of the viral onslaught is now behind them. 

India too is on its way out of what has been described as one of the toughest and longest lockdowns, which started on 25th of March and was extended multiple times.

But contrary to the situation in other countries, India started easing the stay-at-home orders at a time when the graph on its every day new infections was setting new records with each passing day. The number of fresh cases reported each day rose to more than 7,000 by late May, when the lockdown was, for all practical purposes, lifted. 

Active COVID-19 cases across the country were limited to a few hundred when India entered the lockdown and stopped all human and vehicle movements, and suspended all business activities.

The government has tried to portray the lockdown as a success, arguing that it was never intended to stamp out the infection, but to give it time to put processes and infrastructure in place to deal with a full-scale onslaught.

According to India’s health ministry, the timely announcement of the lockdown measures has effectively contained the number of infections and deaths which would otherwise have been much, much higher.

Evidence and experience from elsewhere also underscore this viewpoint. A recent estimate from Columbia University disease modellers concludes that delays in bringing restrictions cost at least 36,000 lives in the US. 

Even small differences in timing would have prevented the worst exponential growth, which by April had subsumed New York City, New Orleans and other major metropolises, data from the disease modellers show. 

If the lockdown had started one week earlier, the US could have averted this many deaths, researchers said.

India claims a better fight

It is in this context that the public life of India’s 1.3 billion people came to a grinding halt with the announcement of stay-at-home orders in late March. Schools, offices and shops were closed. All modes of transportations stopped and borders sealed. Social distancing norms were introduced and gatherings of more than two people in public places were prohibited.

People were allowed outside only if vitally necessary. Many of the states went further, closing their borders with neighbouring states tightly and even blocking inter-state highways, which put the movement of emergency patients and food grains in jeopardy.

The chief minister of Telangana went one step further, slapping restrictions by threatening to issue “shoot on sight” orders if people did not take the lockdown seriously.

In the interim, the health ministry continued to add to the number of testing centres capable of detecting the infection and to augment facilities dedicated to the treatment of COVID-19 patients.

As of May, India has developed capacities to test more than one lakh samples per day, according to the Indian Council of Medical Research (ICMR)

The government has put in place 3,027 dedicated COVID-19 hospitals and health centres besides 7,013 COVID-19 care centres. Together, they have 281,000 isolation beds, 31,250 intensive care unit (ICU) beds, and 11,387 beds with oxygen support for patients.

The recovery rate of COVID-19 patients in India has steadily been increasing to touch 42% mark in May. The death rate from the new coronavirus disease has remained below 3%, according to the health ministry.

Today, Indian companies produce nearly 300,000 PPE coveralls and 300,000 N-95 masks each day. This is being touted as a big achievement as the country had no domestic manufacturing and it used to import most of the PPE components before lockdown.

The country has managed to put up a better fight against COVID-19 as compared to many other developed and developing countries, claimed India’s health minister Dr Harsh Vardhan. 

According to him, India is returning to a new normal, following simple hygiene measures like washing hands with soap frequently for at least twenty seconds or using alcohol-based sanitisers; not spitting in public; sanitise one’s workplace, regularly touched surfaces like tabletops; using face covers in public places to ensure other’s safety and ensuring proper respiratory hygiene.

Cases soar as barriers fall 

After nearly eight weeks of stringent lockdown, India began the process of relaxing the curbs as part of a total exit from the country-wide shut down, starting from regions with fewer host spots.

As on May 30, more than two-thirds of states have gone on with significant relaxations in restrictions imposed on travel and other business activities even as the virus spreads its tentacles to newer and newer regions of the country.

India has re-started inter-state rail services and has also opened its air space too for domestic travel.

Meanwhile, Indian states of Maharashtra, Gujarat, West Bengal, Tamil Nadu continue to report higher and higher numbers of infections, while fresh cases are being recorded from places which were once-deemed safe “green zones” with few or nil active cases.

The reverse exodus of migrants, which is playing out across the country on a huge scale, is spreading the virus farther and wider.

Even as widespread concerns prevail on the possibility of a jump in the number of cases and fatalities post-lockdown, some experts think that most of the cases could be mild and self-limiting.

“Till now, legal measures like lockdown and curfew have just slowed down the spread of the virus. However, post the lockdown, we do expect a surge in cases and the only measure we have is to follow social distancing as well as practice safe hygiene,” comments an epidemiologist who doesn’t want to be on the record. Measures like travel restrictions as well as avoiding crowds would be helpful to some extent.

However, most of these cases would be mild and self-limiting and would need only isolation. For moderate to severe cases, we need to strengthen our health system as well as open up the private sector to take care of these cases, he opines. 

Restoration at a higher cost

The way out of lockdown, however, need not be a smooth process. It can be just as hard as the way into the stay-at-home orders. In fact, it can be harder.

Reopening could lead to thousands to new infections and more deaths, warn epidemiologists. 

At the same time, it may also save thousands of jobs. In a country like India, where a vast section of the population live in penury, a revival of economic activities could save them from further impoverishment and possible deaths from sheer starvation. Hence, in the trade-off, the pendulum has swung to favour the reopening of businesses. 

A protracted lockdown must have not only burned big holes in the pockets of Indian citizens but caused irreparable damage to their country’s economy.

It is, however, not just India that is facing the dilemma. Fears of an enduring slowdown is forcing economies to reopen. Soaring unemployment and bankruptcy announced by businesses escalate the crisis.

At the same time, the threat of a fresh resurgence of the coronavirus hangs like the sword of Damocles. 

Health authorities in India, however, maintain that they are better prepared now for a possible increase in cases, with more testing capacity, stockpiles of medicines and protective equipment.

In the post-lockdown phase, the approach they are looking at is more targeted, characterized by “surgical precision” rather than a “sledgehammer” approach.

Restoration of livelihoods, everyone knows, comes with a hefty price. Even the business community recognizes that reopened businesses pose an increased threat for themselves and to their workers.

No bells ‘unrung’

Since restrictions were intended to fight the coronavirus pandemic, even the simplest outdoor activities after the reopening seem fraught with a thousand questions and calculations, said Dr Michael Ryan, a top WHO official, recently.

There is a long, long way to go, before there is going to be any bells unrung in this response. This virus may become just another endemic virus in communities, and may never go away, he pointed out.

The earlier societies realise these facts, the better placed they will be to deal with the emerging scenario.

In addition, it is also equally worthwhile to let go of any notion that lockdowns are the final phase in the COVID-19 crisis. Lockdowns are only a measure to slow the spread of the infection and the states that open up might need to clamp down again as the virus spreads. Guidelines on public gatherings could change anytime without notice. 

Places like South Korea, Taiwan and Hong Kong were able to flatten the curve and restore a semblance of normalcy via effective suppression strategies, including mass testing, contact tracing and isolating people who get sick.

So, the writing on the wall is clear. The days after lockdown could well be tough. People should prepare themselves for an uncertain future. What this crisis has also highlighted is the important part played by awareness and cooperation on the part of the citizens, as distinct from government interventions, in overcoming such a pandemic.

On the other hand, critics argue that the economic fallout of the shutdown is more while corresponding benefits to public health is rather less. The harder you push the lockdown, the more unintended consequences you get, they warn.