India’s COVID Conundrum: To Lockdown or Not to Lockdown

By SOMALARAM VENKATESH, MD

 In “Asterix and the Roman Agent”, Julius Caesar deploys Tortuous Convolvulus to cause internal conflict among the Indomitable Gauls. Until then, the only fights the peaceful Gaulish village witnessed were between Unhygienix, the fishmonger and Fulliautomatix, the village smith. The Gauls always stood united against the Roman army and in spite of the occasional free-for-all, would always come together at the end for a boisterous feast. 

In the new millennium, India – like many other countries – has exhibited deep fault lines circumscribing hardened ideologies. It is that time in India’s history that Government’s economic and administrative actions are either inherently partisan, or projected to be divisive by its detractors. If SARS-Cov2 were to be an insidious single-stranded helical malware designed to sneakily break societal monoliths, there couldn’t have been a more opportune time than this. This pandemic has become an administrative nightmare. 

The first case of Corona Virus Disease (COVID-19) in India was detected on January 30th. After a lull for the next two weeks, stray reports of Covid-positive cases started from mid-February. A surreal calm descended across the country even as the COVID deaths climbed rapidly elsewhere in China, Italy & Iran. The nation went through a phase of wishful denial & unfounded bravado that tropical heat will protect Indians & that a younger, innately immune population will be somehow spared. 

That was until March 10th. And then the first COVID death happened. It quickly dawned upon Indians that the country will be catapulted on to the now-familiar exponential curve of COVID case numbers. WhatsApp groups launched into existential discussions; private citizens, inspired by twitter & other social media, populated hashtags on Social Distancing & took to hand-washing challenges. On 22nd March, Prime Minister Narendra Modi asked the country to observe a ‘voluntary’ 14-hour curfew on Mar 22nd preparing the public mood for the ominous times ahead. Following a substantial success of this curfew, and possibly getting wind of the looming avalanche of the pandemic, the Indian Government announced a lockdown in 75 of the 800-odd districts of the country. And on 24th March, the Prime Minister went on national television to announce a 21-day lockdown of the whole nation starting 4 hours from the beginning of his speech. 

By this time, many privileged Indians on social media – some doctors included – were keyed in on the contagiousness, the merciless paralysis of healthcare systems and the rapidly climbing death toll around the world. For them, the ineffectiveness of government’s messaging about Social Distancing, wilful violation of self-quarantine by Indians who had returned from China, Europe & the Middle-east (and by their contacts) were frustrating. This class of people lauded the Indian Government’s decision to lockdown the country. 

However, within hours of announcement of the lockdown, mainstream and social media were fired up about the possible impact on the poor. Survival of India’s migrant rural laborers working in the metros and daily wagers depends on an up-and-running economy. Shutting it down would jeopardise livelihoods exposing them to starvation. It is estimated that nearly 200 million people lack adequate food security. A lockdown will also limit movement of essential supplies and bring misery especially to these underprivileged. Visuals showing exodus of migrant workers, some setting out on foot with children on journeys of hundreds of 

kilometres went viral. Criticism that incumbent Central Government should have put a systematic plan in place – to address imminent needs of hungry millions – before announcing a hard lockdown, became widespread. The narrative that the lockdown is for the privileged at the cost of ignoring a sixth of population who will starve to death. Some even went on demand lifting of the lockdown with the theory that widespread COVID infection would lead to development of herd immunity in the community even if it comes at the cost of SOME Covid-related mortality. This, they argue, is preferable to the bigger tragedy of widespread starvation deaths. Even after the United Kingdom abandoned – after realising that it was based on a flawed statistical model – its famous strategy of No-lockdown and ‘Social Eugenics’ & shut the society down, this approach finds its proponents among some Indians. 

What is not understood is that the choice between Lockdown & Eugenics is not a binary. If cities and towns are not shut down, it is among poor, who live in overcrowded districts & use public transport, that COVID will spread like wildfire. Social distancing is the prerogative of the privileged in India: families that live in one room tenements and share toilets with several others can’t dream of self-isolation. In the absence of lockdown, India will ride on a dual time-scale of the pandemic: a steep early peak consisting of the poor and a gentler longer drawn curve consisting of the upper classes that can afford to practice social distancing. Of course, there will be an overlap, but the important point is that poorer patients will cluster around the time when Indian hospitals and healthcare professionals haven’t yet figured out the best Covid practices, PPE and ventilator production/imports have not yet been optimised and the vaccine has not yet been discovered. Therefore, case fatality rate among the poor will be disproportionately high, and as Saurabh Jha tweeted ‘India, particularly its slums, will be in corona flames’. The more affluent who will ride the flatter curve, will experience a lower case fatality, as long as there is enough surviving medical workforce from the first wave. 

Meanwhile, because the virus has wreaked havoc, the economy will be shut anyway & the migrant labourers & daily wagers will again be out of jobs & have their food security will be threatened. 

Asking to end the lockdown will thus subject the poor to a double whammy. 

Once this crisis settles, either with the country in ruins or having weathered the storm relatively unscathed, the Narendra Modi administration will stand to trial whether it should have ordered the lockdown earlier. Regardless of that, the path ahead seems to be clear: 

1. Strengthen the lock down & intensify humanitarian efforts: Many individual and groups have still not understood the magnitude of the disaster standing at their threshold. They continue to violate the lockdown. This has to be curbed by force if necessary. 

If not now, at the first sign of relaxation of restrictions, exodus of daily wagers seems inevitable. Testing this migratory population, quarantining the positive cases with dignity, rehabilitating the rest methodically in tranches so that the transport vehicles are not overcrowded after educating them about social distancing is the way to go. 

Hunger alleviation & prevention of starvation deaths among urban and rural poor will be a big challenge but needed urgently to avert a humanitarian disaster. The administrative machinery from the central, state and local government bodies should make war-like efforts in this direction. 

Dr Somalaram Venkatesh is Senior Interventional Cardiologist & Head of Cardiac Cath Lab at the Fortis Hospital, Bangalore, India and heads the Cardiology fellowship (DNB) program at his hospital. 

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