On 19th March 2020 at 8pm, PM Narendra Modi in his address to the nation besides driving the serious nature of Coronavirus, made a particular request to the citizens of the country: to observe a janata curfew or self-imposed confinement to their homes between 7am and 9pm on coming Sunday. He also requested all citizens to give him few weeks.
The two statements together convey a strategy which is likely to shape up in the coming days. Before going to explain the same, let’s discuss what the intentions of the self-imposed curfew are: it’s to gauge the levels of public cooperation for his request. It’s also to instill a common cause of social distancing. But is it all ?
To delve into the matter one has to look at a seminal work published last weekend viz., by the Imperial College London which thrashes out the best non-Pharma policies for containing Corona virus effectively viz., Mitigation and Suppression.
Now, let’s understand the two terms. Under mitigation, governments simply allow the virus to run its course, while try and reduce the peak of infections. The idea is to flatten the curve a bit to make it more manageable for the healthcare system.
Above chart published by the Imperial College London’s impact was so obvious that the UK and US governments were compelled to make a course correction in dealing with the disease.
In the above graph, the “Do Nothing” situation is the black curve. Each one of the other curves are what would happen if tougher and tougher social distancing measures were implemented. The blue one shows the toughest social distancing measures: isolating infected people, quarantining people who might be infected, and secluding old people.
The blue line is broadly the current UK coronavirus strategy, the red line is the capacity for ICUs, this time in the UK which is very close to the bottom. All the area of the curve on top of the red line represents coronavirus patients who would mostly die because of the lack of ICU resources.
By flattening the curve, there will be many deaths with the ICUs collapsed, increasing collateral damage.
Doing some mitigation strategy is akeen to knowingly overwhelm the healthcare system, driving the fatality rate up by several notches.
The devil in the Mitigation Strategy lies in one of its key assumptions alled the “Herd Immunity”.
The idea is that all people who are infected and then recover are now immune to the virus.
The tacit assumption in this is that the virus doesn’t change too much. However, its unlikely as the virus has already mutated.
China had two strains of the virus: the S and the L. The S was focused in Hubei and deadlier, but the L was the one that spread through the world, because it had a higher transmission rate. Also this virus continues to mutate.
This is only natural since RNA-based viruses like the coronavirus or the flu tend to mutate several 100 times faster than DNA-based ones. The coronavirus, like the flu, is an RNA-based, so it’s much more likely to mutate.
The best way for this virus to mutate is to have millions of opportunities to do so, which is exactly what a mitigation strategy would provide: hundreds of millions of people infected.
In other words, the mitigation strategy not only assumes millions of deaths. It also gambles on the fact that the virus won’t mutate too much which isn’t true. And this strategy will give it the opportunity to mutate. So after a few million deaths, there could be a few million more – every year. This corona virus could become a recurring fact of life, like the flu, but many times deadlier.
So if doing nothing and mitigation won’t work, the alternative is called suppression.
The Suppression Strategy tries to apply heavy measures to quickly get the epidemic under control. Specifically:
1. Go hard right now. Order heavy social distancing.
2. Then, release the measures, so that people can gradually get back their freedoms and something approaching normal social and economic life can resume.
Under a suppression strategy, after the first wave is done, the death toll is in the thousands, and not in the millions.
Reason: not only the exponential growth of cases is cut but also the fatality rate since the healthcare system is not stressed beyond capacity.
So the Supression Strategy though is a no-brainer, governments hesitate on the following counts:
1. This first lockdown will last for months, which seems unacceptable for many people.
2. A month long lockdown would destroy the economy
3. It wouldn’t even solve the problem, because the epidemic would only be postponed: later on, once the social distancing measures are released, people will still get infected in the millions and die.
Below please find the Imperial College team modeled suppressions. The green and yellow lines are different scenarios of Suppression. There are still huge peaks, so why bother ?
Presented like these, the two options of Mitigation and Suppression, side by side, don’t look very appealing. Either a lot of people die soon and the economy stays unscathed today, or the economy is hurt today, just to postpone the deaths. However, what this ignores is the “value of time”.
Suppression would get the following viz.,
1. Fewer total cases of Coronavirus
2. Immediate relief of the healthcare system and those who run it
3. Reduction in fatality rate
4. Reduction of collateral damage
5. Ability for infected, isolated and quarantined healthcare workers to get better and back to work
6. Setting up a tracing operation as in China or East Asian countries for identifying all the people that every sick person met and put them in quarantine helpful in providing intelligence regarding the social distancing measures used (testing and tracing single handedly brought South Korea under control without resort to too much social distancing methods).
7. More time to buy equipments for a future wave of the disease
8. Ramp up procurement of masks, PPE’s, ventilators, ECMO’s and other critical device
With the above research backing and explanations in place, my perception is that very soon PM Narendramodi will be going for a “Hammer” approach by locking down the country for a couple of weeks to a month in April which is liable to drive the economy southwards, but allow to get the disease effectively under control by not overwhelming the current healthcare system. The “hammer” strategy can be supplemented by a “dance” phase where the virus may flare up in few places but the idea is to keep the transmission rate down so that it does become exponential. In either case it will allow the country valuable time to recoup resources and source a potential vaccine for cure.
The country and all citizens must unequivocally rally round and support the PM if such an approach is what he asks for going forward since this has been scientifically established as the best method for containing a pandemic of the nature of Covid-19. The country needs to look at supporting daily wage earners, non-organized businesses and also those living from paycheque to paycheque. Once that is taken care of, let’s bring on the lockdown Mr PM !
3. Graphs, adaptation in lines of Tomas Pueyo’s article (2.)
Author’s Brief – Devamalya De (Dev)
A Civil Engineer and Project Manager by professional, Dev shuttles between Mumbai and Bahrain. A voracious reader and an occasional writer, Dev has published write-ups for several web portals (DBpost and Mynation.com) besides being a published co-author for Amazon.com listed best seller : Living a Wealthy Life. He also maintains several FB pages with curated content besides his own page for short stories: Stories123