COVID Spike: Should Govts Be Doing ‘What People Want Them To’?

No point blaming govts, as democratic govts do what the people want; people clearly don’t care about their health.

“It’s the economy, stupid,” said US President Bill Clinton during his 1992 election, which now seems to be a bygone era. But there is no mantra today that is more telling of our life and times than this quotable quote, be it in India or the US.

In politics, it boils down to what is the value ascribed to one’s citizens and the cost to the economy. Maybe even more importantly, what does it do to your chances of getting re-elected?

A whole pandemic year later, as many parts of the world including India grapple with a second and even a third wave of COVID-19, governments are again scrambling to figure out containment measures and get on with their vaccination drives, to bring things back to a semblance of normalcy.

This is made considerably more difficult with the emergence and rapid spread of variants and mutant strains which are not only more infectious but also far more deadly and potentially more resistant to the current vaccination and COVID treatment efforts.

Choice Before Govts: Death & Sickness or a Devastated Economy & Starvation

Now, normalcy is exactly what a lockdown is not — being stuck in your home with your favourite cactus and pets and humans for company for an entire month (or longer, in some cases). And if that sounds bad, it’s even worse for businesses like hospitality that depend on the daily buzz of regular life to keep things going. There appears to be a direct correlation between death rate and unemployment, according to this report, with a 370 percent increase in chances of death if one is unemployed.

So, it comes down to this: death and morbidity due to COVID-19 or slow starvation — of not only yourself but your entire family and all those who depend on you. And that is the cold hard mathematics that governments across the world are doing.

How much can they shut down, that will reasonably slow down the spread of COVID-19 and keep the death rate low, without wiping out the economy and forcing tens of millions into poverty and destitution?

As you can imagine, there is no scenario where this has been tried out or even tested before, and different countries have different metrics. In Western European countries, where the health system is predominantly public, social security systems are well-funded and have enjoyed a large and favourable trade balance, the burden of healthcare is primarily on the State, and hence, they have tended to be far more in favour of comprehensive national lockdowns — which results in a far more effective suppression of transmitting COVID-19 and thus reduces the number of cases.

India Can Neither Afford a Full Lockdown Nor Widespread COVID-19 Infections

The US is a curious case: it’s the richest country in the world but with an almost completely private healthcare system and mediocre social security net. The US, for much of the COVID-19 pandemic, saw completely inept central leadership sending out mixed messages, and responses that were left to provincial and local leadership. It is indeed astonishing that the United States, with 1/20th of the world’s population, had almost 1/4th of the world’s total COVID-19 cases. But with the onset of vaccination and a change of leadership, there seems to be some light at the end of the tunnel.

Countries such as India, Brazil and other middle-income countries usually attempt a more hybrid solution, with containment zones that locally suppress virus replication while keeping as much of the economy running as possible.

With a poor social security net, underfunded health systems and large population near or under the poverty line, lockdowns are not just an option — neither is widespread disease-spread which would push the healthcare system beyond capacity.

Despite a second COVID-19 wave, with elections around the corner in five Indian states, the virus is no longer just in the minds of the people or for that matter the government’s thought process.

For, if your locality goes into lockdown, you have admitted ‘defeat’ and your own ineffectiveness.

An opponent not acknowledged is an opponent that does not exist. Kind of like an Ostrich’s head in the sand, until said opponent eats you alive.

COVID Infections Are a ‘Lagging’ Indicator: What This Means

So, here in India, we are at the precipice of an abyss. Our vaccination coverage thus far is 3 percent of the population, largely among the high-risk categories such as the elderly, the vulnerable (in a certain age group), and frontline workers.

There is a new variant in town, one that has devastated most of the western world and is the enemy at the gate. The population is its own worst enemy with scarcely any physical distancing, use of masks or sanitisation.

To get a sense of the latest spike’s rapid increase in numbers, let’s consider a few facts. Remember, infections are a lagging indicator. People getting sick is due to exposure or infections that have happened about 3-5 days prior. Also, the death rate is a lagging indicator because once people get sick and go to the hospital for treatment, it usually takes about 10-14 days before they succumb to the disease.

And finally, the virus’s progress through the population is an exponential growth. For example, if a lotus doubles in number in a pond every day, and it takes 30 days to fill the pond with lotuses, when is the pond half full? And the answer is the 29th day.

So, with exponential growth, you do not even realise the wave is upon you until the water is already above your head.

Will Partial Lockdowns & Night Curfews Help In Cities Like Delhi & Mumbai?

With at least 5100/day cases in Delhi, 10,000/ day in Mumbai (at the time of writing this article), half-measures such as weekend lockdowns and night curfews will not be as effective as we hope they will be, because cities are already partially shut down at these timings. However, this is certainly effective in getting the message out and conveying the seriousness of the situation.

The percentage of the population that parties and goes out to restaurants is small and inconsequential to the actual number of COVID cases.

Actual enforcement of physical distancing measures, masks, preventing crowding of public transport and public spaces will be far more effective in curtailing the pandemic and controlling the latest wave.

Remember, most of us believe that this will not happen to us, but Statistics is a cold hard beast and plays by the rules. It is simply a matter of when — not if — someone we know who gets severely sick, and then finally it is us who will also have to pay the price. No point in blaming governments then, because governments in democracies do what the people want, and it is clear that the people do not care about their health or that of others.

COVID & the ‘New Normal’: Why ‘Resistance’ is Futile

In the final analysis, what does it come down to? To quote Mahatma Gandhi: “You must be the change you want to see in the world”. Strict and proper mask-wearing, mass vaccinations, physical distancing, avoiding social gatherings and as far as possible not using crowded spaces or markets will be the antidote in some ways. There will need to be real change — not only in behaviour but also in the processes employed to keep countries running. The world, as we have known it, has changed, and irrevocably so, and the faster we and our elected representatives acknowledge this, the easier it will be to come to terms with COVID-19, and live in harmony with it.

The new normal, intermittent lockdowns, revised global supply chains that are more resilient, increased domestic manufacturing of essential goods for pandemics, greater coordination among governments for pandemic-control is the life we must adopt.

Those who do not — simply — will not survive, both literally and figuratively.

Only the tough survive — so, adapt or perish. And to quote Star Trek: “Resistance is futile.”

(Dr Aviral Roy is a consultant with MEDICA Superspecialty Hospital, Kolkata, in the Department of Internal Medicine & Critical Care. His areas of expertise include H1N1 pneumonia, dengue fever, ARDS, septic shock, heart failure, use of ECMO for lung failure and neuro-critical care. He can be found as @aviralroy, on Twitter and Instagram. This is an opinion piece, and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)