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Why a total shutdown in response to the Covid-19 pandemic is a moral imperative for India

Why a total shutdown is a moral imperative in India 

There is a viral whatsapp text going on in India about the Protagoras paradox (where both sides have equally valid arguments) being applied to the total shutdown in India (http://www.citypeopleonline.com/covid-19-protagoras-paradox/).

As per this, on the one hand, the argument is that without the shutdown, our health systems MAY be overwhelmed and millions COULD potentially die in India. On the other hand, the increase in poverty that this shutdown WILL exacerbate may lead to a lot more misery and (paraphrasing the great modern philosopher Trump), "the cure may be worse than the disease".  

Before we get into the argument and counterarguments, let us remember 2 rules:
Rule number 1 : Statistics in the science of large numbers. So any analysis based on early trends when numbers are small may not sustain. 
Rule number 2: correlation does not mean causation. What it means that just because 2 things seem to move in tandem does not mean that one is causing the other. A third unexplained factor may in fact be responsible for both. 

Also remember, each virus is unique. Like software viruses , just because your system got attacked by "iloveyou" did not mean it was safer from attack from "cryptolocker" or "MyDoom", which attacked a completely different vulnerability. 

Lets look at the contra arguments against a total shut down:

Argument number 1: This is not a disease for hot and humid climates. Most of the deaths have happened above the tropic of cancer and between 0-20 degree Celsius temperatures.

Iran completely disproves this hypothesis. One data point is enough to disprove a theory (as Nassem Taleb says  - your belief that all swans are white can only last till you see ONE black swan). Iran is in the same latitude and pretty much a geographical mirror image of Pakistan and Afghanistan combined and in the same zone as north India. If a correlation has to be found on where the virus spread in phase 1, it should be trade intensity with China. 30% of all of Iran’s exports go to China. China is Iran’s (and South Korea’s) largest trading partner. Similarly, the EU is China’s largest trading partner followed closely by the US. After inter EU trade, China is Italy’s largest trading partner for both imports and exports and Italy signed up to the "one belt one road" initiative of China in 2019.  The trade route thesis easily explains why the top 15 countries are where the problems have started (China, USA+ Canada, UK+ 9 EU, South Korea, Iran) and grown the most to begin with. 
As the second order spreads are happening (in India’s case from Italy, middle east and UK), this hypothesis may be sorely tested in my view.  At the moment, this argument fails both the above rules above. 
There is some hope that like the Influenza virus, which has a proven less effectiveness in warmer weather, maybe Covid-19 will behave similarly. However, at the moment, there are no empirical studies to back that hope and as we say in business, relying on hope alone is not a good strategy. 

Argument number 2 : We are naturally immune to viruses because of the sheer dirt  / pathogens we are exposed to. 

This is a fairly primitive argument, and not been really advanced by anyone who understands how viruses work. This is truly new virus which humans haven’t faced till now and have no immunity against.  

A somewhat more sophisticated argument of the same type is a 2 step argument: that the antimalarial drug Chloroquine works against Covid-19 and most tropical countries have been exposed to malaria and therefore residents MAY have antibodies that MAY work against Covid-19. 
This is pure speculation and hope at the moment with no scientific basis.  That’s not how medicines work. 
Chloroquine is being tested by the WHO as a potential cure (along with a rolling list of 3 other pre-existing drugs) but its early days yet. 

Argument number3: The “herd immunity” argument by Boris Johnson, who is now infected himself. Good luck to him to achieve herd immunity. For the herd to get immunity, close to half the herd has to get infected first! The chief proponent of that argument has himself changed his mind when he realized that he would be trampled by the herd of exponentially increasing cases. 
First off, lets look at the data at the top 15 countries by number of cases as on Saturday the 29th




If you really want to appreciate the mortality rate, you have to look at cases 2 weeks ago, since today’s mortality reflects a past case. However, at the same, time, due to lack of adequate testing, the number of reported cases may be much smaller than the total actual cases (many of which remain unknown). 

Another piece of information is based on a study as on Feb 28th (https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/)
, which surmised that for the world as a whole , as on THAT DAY, this seemed like a disease for the OLD and the INFIRM
As per this study, for those above the ages of 60,70 and 80 the risk of death was close to 4%, 8% and 15% and for people with pre-existing conditions such as heart, diabetes, respiratory, BP etc, it was 8-14%.

However, this data is not yet updated for a month while cases have multipled by 10X since then and I strongly suspect Chinese numbers anyway since  their system is not designed to report accurate numbers specially in the case of bad news but to under report bad news. 

 What does all this data mean for India? 2 conclusions: 

1.   We have terrible health infrastructure when we look at doctors / bed availability per person (see table above for comparison). The countries that have been hit so far have on average 4X better health infrastructure than us and even then, THEY HAVE BEEN SWAMPED.  

2.     While we may not be old on AVERAGE, we are definitely a very unhealthy country with an expected 107 million people suffering from pre diabetes and heart conditions (https://www.healthcarentsickcare.com/status-of-major-health-problems-of-india ). Add the 50 million old (70+), we are talking about a high risk population of close to 160 million people which based on the above analysis, would have an approximate 10% mortality rate. For the balance "fit / low risk" population, lets assume that we took the blas√© (herd mentality) approach and only 0.5% were at risk, even that is a staggering 6 million people.   

Any rational person when faced with the prospect of 10% of 160 mn and 0.5% of the balance 1.2 billion or overall 22 million (2.2 Crore) people being at very high risk of mortality, would have to take the approach that has been taken – ie; complete lockdown. There is simply NO OTHER ALTERNATIVE. 

Democracies can’t leave so many people behind to their fate. That can happen in Mao’s China or Stalin’s Russia or Hitler’s Germany, but it can’t happen in a functioning democracy. Specially knowing that in the absence of a cure or a vaccine (the world hasn’t found a vaccine for AIDS or even malaria yet), the only thing that SEEMS to have worked is total shutdown in China. 

How do we mitigate the impact of this on the bottom of the pyramid. India has one of the most widespread digital infrastructure reaching out to the bottom of the pyramid through the India stack, aadhar, jan dhan accounts and direct benefit transfers. In many aspects, it is better than many developed countries. It has been stress tested during demonetization. Push comes to shove , through direct benefit transfers, enough money can be directly send into poor people’s jan dhan accounts. Our granaries are overflowing with food and as Amartya Sen pointed out – there are no famines in democracies. An active civil society and media ensures that problem pockets can be identified and addressed. This is NOT the time to bother about fiscal deficits. If more money is required to send through DBT, that should be a priority. 

However, it is critical that we use this borrowed time (where we are trying to reduce transmission though social distancing) to quickly create an aggressive testing, contact tracing and isolation protocol and infrastructure. Otherwise the lockdown will only create concentrated pockets of outbreaks that can again get us back to ground zero when restrictions are lifted. India is the software capital of the world. I am certain that if they put their resources to this, the TCS’ and Infosys’ of India can deliver the system needed for contract tracing (which has been delivered in some of the other nations already) quite rapidly.  Quick testing kits are rapidly coming into the market and the focus on using this breathing space to create a longer term solution is absolutely critical. 

Let us hope and pray and leave no person behind and stop debating whether it would have been a good idea to let nature take its course. Let us focus on the task at hand. This is pretty much war (and at least 22 million lives are at stake) and the country has to come together to ensure that the sacrifice that we are all collectively making economically to buy time is used productively. 

Also, a request to those reading this article. You are clearly the fortunate lot. Please remember the people at the bottom of the pyramid. We cannot allow them to collapse. 10 families per person who can support is just about right. That's about INR 50,000 for supporting them for 2 months purely in terms of food. please donate generously without bothering about the "leakage". Let's not have the tail (25% leakage if that) wag the dog (the 75% that gets through). One credible place to begin could be www.prabhaavfoundation.org




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