COVID-19: What a lock-down does and doesn’t solve
Figuring the corona-algorithm to save humanity, thoughts from a computer scientist
Many countries around the world, including my own, India, have gone into a lock-down. China did this for the longest time and seem to be reopening now. On a starting note, I think the lock-down for India is absolutely the right step at this time. We have the advantage of getting into it early. But will that solve the problem, lock-stock and barrel?
Let us consider India’s 21 day lock down as an example. We will not let anyone meet anyone. People with infection will not be able to spread the infection. In parallel, aggressive testing of anyone with symptoms and isolating them will make sure we do not have new cases. The infection of the patients will go away in 15 days. When we come out after 21 days. There will be no one with infection and we would have eradicated the disease!
As good as it may sound, the problem is that even one untraced infection or infection coming from outside, as we open up to the world, can kickstart the pandemic again. I am unable to believe that in a country of India’s size and complexity, we can prevent a few undetected people to get infection again and restart the pandemic. We can have a rigorous monitoring, testing and isolation process, but the small sample size that may kickstart things again is scary. We will know in the next 2–3 weeks through the China experiment, if and how the complete shut-down and re-start strategy works.
If mass eradication is not the way, then what is our chance? We cannot be in a permanent lock-down. We cannot open up completely and let people die. We must find a more an algorithm to deal with such a pandemic to solve it for good.
What is that algorithm? We need to establish the objective of the algorithm and the levers that can meet the objectives.
Objectives of the corona-algorithm
a. Match the rate of the pandemic such that the local testing and hospital care can deal with the number of cases in the region. We need to slow-down the pandemic and increase testing/care facility, to match the rate. This will make sure we have the situation in control in all regions, our mortality rates are low and people who are affected can get the best medical care.
b. Keep the most vulnerable away for the longest. Today, we know the elderly people are most vulnerable and susceptible to death due to co-morbid conditions. We may learn so about more groups. We need to keep them away as much as we can.
c. Ensure socio-economic justice is delivered to all strands of people in the short and long term, given the loss to businesses, small and big, and the tremendous number of job losses.
If we are able to achieve the above, then we will be able to slow down the pandemic such that we can give good medical care to the affected, keep the mortality rates low, keep the vulnerable away and most importantly, keep getting everyone food and shelter. In the meantime, an external event such as discovery of a vaccine and/or better illness management through medication, will give us a way to both control the spread (like we can, for flu) and reduce the mortality rate. That will be the ultimate win! We will lose lives in this course, but we will be doing our best till we have a vaccine/cure.
Language of the corona-algorithm: The Levers
Once the objective is established, we can work out the details of the algorithm. What are the levers we have, which will define the language of the algorithm? I think we have six levers, currently established through scientific principles:
a. Social distancing: We know that the amount of people-to-people contact hugely affects the rate of spread. We cannot be in a lock-down forever. So rather than the 0–1 game, we will need to find ways to moderately or lightly lock-down. This would mean a new normal, where we no more function in our usual way — going to office, relatives, friends, partying, etc (and explaining these to people). As an example, it could be that we all go to office in rotation and international travel may have completely new norms and a totally new infrastructure at the airports. For different categories of workers, such as formal, informal, daily laborers, home-makers, dwelling in metros, cities, towns, villages, we will need to evolve new ways of work and social distancing. This would need quite a bit of thought and planning. More interestingly, the regions and frequencies of lockdowns must be modulated based on data on spread of infection.
b. Proven Preventive tools: We know that two things help: hand-washing and masks. More will come with time, as we innovate in a multi-disciplinary fasion. The question is how we institutionalize these. We need radical solutions — for instance, one can promote that the three layer cloth mask becomes part of one’s attire, like a shirt, a pant or a tie. Like all our other clothes, we have a permanent supply of them and they follow the wash routines like say one’s underwear!
c. Infection Testing: The third lever we have is testing people, isolating them and their contacts. This requires a full algorithm in itself on who to test, how to test fast, isolation time and a standard operating process for all of this. We need to figure testing capacity, supply chains and cost. A new normal for the government would be accepting a monthly cost towards testing in the budget and an army of designated health workers. One could learn from countries like South Korea, Singapore and Hongkong here, who used extensive testing to slow the spread.
d. Medical care facilities: We need standard-operating-process to handle impacted patients, with different levels of symptoms. We will need to build capacity in management drugs, ICUs, and ventilator, other than housing for the affected. One needs to make sure this capacity is over and above what we need for current volume of critical care patients.
e. Research and innovation: We need to continue to invest in research and innovation to find a vaccine, medicine for better management of the condition and preventive tools. We must understand that this needs to be a multi-disciplinary effort. Innovation can come from anywhere. We need to get people together to solve stuff, remotely! The governments across the world need to invest in this and work collaboratively as much as they can. Doesn’t harm having an Xprize for it!
f. Economic intervention: These are abnormal times and the state will have to intervene more than the usual, to help people with the job losses and choking of the supply chain. While doing our best to control the pandemic, the government will need to constantly work on lowering the economic distress, mostly on the economically lower strata of the society.
Using these levers, we must design an algorithm for handling the coronavirus pandemic. It is not straightforward to design such an algorithm. All stakeholders need to come together to do so. We will need models from system dynamics to test out the algorithm in simulation. Equally difficult is its implementation. We will need to try out interventions and change them progressively, adapting to the situation and as we learn new things about the virus.
The moot point is that the biggest objective of this 21 day lock-down is to take a call on the algorithm we as a country will try out and prep to implement it — by building the capacity and a taskforce to implement the algorithm.
The big question is not how we deal with our lives during the lockdown, as much as, what we will do next when we open up. That is the most important goal.
Founder of India Science Fest and CTO @ Aspiring Minds