What next for India after the 21 day lockdown ends?
On Mar 24 2020, 8PM IST, The prime minister of India, announced a 21 day countrywide lockdown forcing a population of 1.3B in their homes who can go out only if they provide essential services or need essential goods.
The government’s hand was forced by the pandemic outbreak in India which has reached the community transmission stage. The latest ICMR 25th March morning update puts the confirmed positive case count at 539 Individuals. While this number in itself is small relative to the western countries, it’s important to note the denominator here — a total test count of just 22,038 individuals.
So, where do we go from here?
Lets start with the following ground assumptions
- The virus has spread to most of the states as of this moment
2. A lot of the carriers (especially youth) remain asymptomatic (do not show symptoms) for lengthy periods of time, or shed virus without ever showing symptoms. While the jury is still out on exact proportions, an article published in world economic forum, claims that around 60% of the population with SARS-COV-2 might show mild or no symptoms at all (src)
3. According to CDC, the quarantine period for an affected individual is at the minimum, 14 days (src), while there are few pre-printed journals that claim we might need to extend it up-to 24 days (src)
4. The virus like any other, continues to survive and spread as long as it can find a susceptible non-immune host
5. Its financially impossible for India to test each and every individual of the 1.3B populace. Tests are costly as it is, and producing a billion+tests in a small (few months to an year) timeframe will rapidly increase the costs including building new supply chain and manufacturing infrastructure
6. Each time India goes through a lockdown, there is an insane economic cost that the poor as well as regular taxpayers will have to bear
What might happen after the 21-day lockdown
Scenario 1: Break the chain
We track and contain every single affected individual(carrier) showing symptoms. Further, any carrier not showing symptoms ensures to not transmit the virus in this period to any other host, thereby breaking the chain. This is the best case scenario that the government is hoping for. We would have rid India of the virus if we can get here. Life can get back to normal and the economy, although hit badly by then, can recuperate.
To know for sure that the chain is broken, we will need to not have any new cases reported after the lockdown ends. There is no research to positively claim the length of time before we can successfully claim the spread is contained. (virus jumping from one asymptomatic carrier to another can hide in plain sight for quite a long time)
Scenario 2: A flattened curve that continues post lockdown
In this scenario, although we do not positively get rid of the virus, we likely would have stopped its rate of spread. By the time the lockdown ends, we would have built the medical infrastructure and awareness necessary to slow the spread further.
In this situation, new cases will keep popping up, but masks, social distancing and hygiene awareness, will slow the rate of spread. We would have enough ICU tech and Ventilators to support the critical cases, thereby reducing the death count significantly.
In this situation, the only way India will get rid of the virus completely is
- A vaccine is found — the chance of this are really low in the immediate few months, but I will continue to believe in the power of the scientific community at large.
- We have luck on our side — due to forces unseen, the virus dies on its own. Possibly due to the higher summer temperatures, a stronger immune system of a population used to diseases at large, etc
- We build herd immunity — This will take many months to an year. The idea of herd immunity is when majority of the population (>60%), get the virus and build immunity, the virus won’t find new hosts easily to spread and dies off
going by the data, the chances of options 1 and 2 are pretty low, but we can be quite certain, option 3, will possibly happen.
But what is the cost we are looking at for option 3?
An economic and medical disaster
- Regular lockdowns: In order to keep the curve flat till we reach herd immunity, we will have to go under lockdown every few weeks, in order to not stress the newly built fragile medical infrastructure. This will obviously destroy the economy and might end up becoming a bigger problem than the virus itself
- Massive death toll everywhere: Even if the mortality rate is under 1% (the jury is still out on this), we are looking at hundreds of thousands of deaths pan India. The ethical and moral cost here is unimaginable. Not to mention, the massive spike in medical costs that the government and in turn, regular taxpayers will have to bear.
- Ban on travel to and from India and a possible supply-chain disaster: As long as we continue to have community transmitted virus, and the rate of transmission in rest of the world is different from ours, we cannot let people in or out. If this extends to an year, we are looking at problems never encountered in our lifetimes. I cannot predict if the travel ban will impact supply chain, but its safe to assume, international supply chains won’t work as usual.
Scenario 3: The curve is not flattened and millions die
This will happen when people do not follow lockdown to its word. Interactions continue, at the grocery shop, through delivery agents and so on. Government fails to build rapid medical infrastructure. We can’t procure enough ICU Tech, Ventilators, PPEs (personal protective equipments). Test counts remain low and we get to know the severity of this only as we near the lockdown or post lockdown ends. The economy comes to a grinding halt. The medical infrastructure crumbles and cannot even function to support non covid-19 cases. Western countries might try and help us, but that will require them to solve the problem themselves first, which in itself might take many months.
Mind you, as long as there are asymptomatic carriers interacting with new susceptible hosts, the virus will keep spreading. The percentage and rate of spread will decide if we will fall under scenario 2 or scenario 3.
The next 21 days will decide which of the above scenarios will emerge.
The government has taken a lot of strong and urgent steps which gives us a slim but fighting chance to escape scenario 3. However, what it does in these 21 days will truly determine if we end up in scenario 2 or scenario 3.
The government will need to implement rapid and widespread testing to ensure we have full knowledge of the situation as we near the end of the lockdown. We will need to pre-emptively build and procure many multipliers of medical infrastructure in order to continue flattening the curve post lockdown. And government will need to build many contingencies to ensure the supply chain of essentials will not get disrupted in the coming many months.
But why not aim for scenario 1 and get rid of the virus?
That is not up-to the government, but its the populace who will truly need to step up if we need to pull this off! This is going to be very tough, but we have a chance now, and if we don’t act today, tomorrow is going to be very very grim!
And all it takes is for everyone to follow just two very important steps!
- Do not, at any cost interact with any new individuals or new surfaces for the next 21 days unless its an absolute emergency. Even if this means you need to let go of your newspaper, or your evening jog is at risk.
Ensuring that the virus doesn’t get any new susceptible hosts for the next 21 days, gives us a strong and perhaps the only chance of killing the virus spread in its bud.
2. If you or someone you know shows symptoms, call 104 compulsorily and immediately
This is the only way, the government can track and contain the virus. Everyone will need to compulsorily inform the government, not only to get treated, but also to ensure that government can track the asymptomatic carriers who were in contact with the patient and contain the spread.
To reiterate, this is not about one person or one family anymore. If the virus is not contained, the economy will be destroyed, and you, me and all the taxpayers will have to bear the fallout. Not to mention, the millions of lives at stake here. The government cannot do much here and at best, they can only soften the blow. This will have to be a collective effort in the order of a billion population, and the next 21 days will decide what country we will choose to live in.
