10-fold strategy that India needs to adopt for exiting from ongoing lockdown4 min read . Updated: 13 Apr 2020, 01:00 AM IST
In some states/districts, curbs on gatherings, public transport, opening of malls, hotels, schools should continue
NEW DELHI : India scores high on a stringency index that has been developed to gauge cross-country government responses to covid-19. The slope of India’s case growth curve is flatter than some countries, but steeper than others. Ten states account for around 81% of cases. More than 80% of cases reported positive are in 62 districts, almost reminiscent of Pareto’s 80/20 rule. There has been no community transmission yet.
As models go, subject to their assumptions and impact of heat/humidity/herd immunity, India’s peak might be in June/July, with a final tapering in September. Ipso facto, no flattening is likely by the end of April and a call will have to be taken when there is a spike, despite extension of lockdown.
However, the economic costs of the lockdown are mounting. With a range of 6% to 6.5% gross domestic product (GDP) growth rate pre-epidemic, real growth for 2020-21 is unlikely to be more than 2%, perhaps lower. This suggests that, at least in the short-term, anything between 40 million and 50 million jobs are at stake.
As a prolonged lockdown till June/July cannot be realistically contemplated, on 1 May, one will therefore have to think of a calibrated and staggered exit strategy, with safeguards in high-vulnerability states and district hotspots.
In such states, districts, and clusters, the focus will be on averting community transmission, reducing mortality/morbidity, and averting a possible “second wave".
Ten principles suggest themselves for such a differential risk strategy.
# Enable full participation of states/districts and key stakeholders in decisions regarding a calibrated and staggered exit plan. An illustrative example is Kerala, which has constituted a state experts panel that has proposed an evaluation of districts by risk-assessment and a three-phase staggered plan. Rajasthan has also constituted a state-level committee.
# Districts have already been mandated to prepare district micro plans/crisis management plans, using a template provided by the ministry of health and family welfare and the Bhilwara model. The add-on to this district plan needs to be economic revival and a social protection package, including monitoring PM Garib Kalyan Yojana and other welfare measures.
# States can be put into five groups, based on risk assessment. A composite index or matrix for districts may be developed using key indicators related to covid-19 case load and trend dips/stability; mortality; population density; proportion of asymptomatic cases; proportion of higher risk over-60 years population and other local risk factors (disease profile, labour migration).
# The response has to be local and dynamic, responding to tracking and monitoring. The unit of assessment should go from the national, to state level, all the way to the district. One can categorize districts by “risk perception"—high risk, medium risk, and low risk (red, amber, green)—based on a combination of criteria. The high-risk districts can continue to see a near-complete lockdown till risk assessments are lowered, with assessments reviewed every week. Districts with lower risk can see a “calibrated opening".
# Some uniform principles should be applicable in districts where there is a calibrated opening. Those who can work from home should be advised to do so. There should be norms on office capacity (office capacity can only be X% to start with) to ensure adequate social distancing norms are maintained within office spaces, and there is no crowding on local transport facilities in denser urban areas, which would increase probability of re-proliferation. Everyone who leaves homes must mandatorily wear masks. Old and vulnerable populations must be advised to continue with a de facto lockdown.
# Even with calibrated opening, in some states/districts, there should be restrictions on large gatherings, public transport, opening of shopping malls, restaurants/hotels and educational institutions.
# District borders must be sealed in high and medium-risk districts. If some districts are unable to manage the virus well and there are people crossing district borders, this increases the risk for neighbouring districts. It is imperative that district borders are sealed in high and medium-risk districts.
# A staggered exit plan entails re-emergence of workers and possible resurgence of inter-state migration, implying that unified procedures for such migration will be needed.
# If supply chains are cut across districts, there will have to be exceptions. That’s why some protocols need to be standardized across the country: how much testing is done per capita and audits around this testing. This is because local officials may have an incentive to under-report the number of cases/deaths and may resist adequate levels of testing. There must be a consistent communication strategy across the country about hygiene, adequate precautions, debunking myths and fears and emphasizing the importance of avoiding stigmatization.
# Finally, a differentiated risk-based containment strategy across districts is only possible if there is enough testing to distinguish districts by risk-type. India will have to ramp up testing capacity, which is still below global norms. More generally, there are other supply side issues, with regard to personal protective equipment, masks, ventilators, fever camps, and surge in hospital capacity.
We have suggested these principles using the example of districts. However, in practice, it needs to be decentralized further down, such as hotspots within districts. Bhilwara and Dilshad Garden (Delhi) are instances where containment seems to have worked.
The covid-19 pandemic is not just a medical issue. It is a humanitarian one too, where livelihoods are at stake. That’s why the speed of economic recovery is contingent on a staggered exit.
Bibek Debroy and Ratan Watal are respectively chairman and member-secretary, Economic Advisory Council to the Prime Minister (EAC-PM). Views expressed are personal and not those of EAC-PM.
Tomorrow: How to revive the economy