Lockdowns when not needed, Unlocking when Lockdowns are really needed !!!

A spree of lockdowns all over the world and a weak health care system probably made India impose a Nation wide lockdown in the wake of rising corona virus numbers in March. Let us see the numbers today!!!

Lockdown was imposed when the numbers were very low and was imposed in a condition when the growth of the cases were not exponential.

So clearly India imposed a lockdown at a point when the numbers were very low and the daily cases were just 49 and that too when the cases were there only in few cities like Mumbai, Delhi, Chennai etc.

Lockdowns were imposed through out the country, when 90% of India had no cases or very few cases. Lockdowns in Mumbai, Delhi, Chennai probably were warranted because of Travel related importation.

Was a lockdown really required in Arunachala Pradesh, a place very close to Himalayas is my question!!!

Whether Lakshadweep surrounded by water on four sides needed a lockdown?

Whether Bangalore which had only 10 to 20 cases needed a lockdown then ?

Lockdowns have worked globally and are like gold standard in reducing the transmission rates. Lockdowns restricted the infection to just 5% in Newyork, Spain and many other hard hit places. There is no question that Lockdowns work. But lockdowns also needs to be imposed only when there is a clear cut indication that other techniques like contact tracing and other methods don’t work.

Lockdowns are really not required if there are very few cases, cases are not rising exponentially and there is sufficient medical resources in terms of ICU/Ventilators in handling the numbers .

Let us look at how other countries have build there models to combat COVID. A alert system has been designed to impose lockdowns according to the need of the situation.

Alert System followed in many countries in all over the world for imposing lockdowns!!!

The above system, clearly shows that the different parts of the country have different covid risk at different times. For example, if the cases are rising exponentially, the ICU capacity is limited and Contact tracing cannot be done in most of the cases, then Lockdowns have to be imposed. While at Level 3 and 2, other social distancing measures may work allowing economy to function again.

By this standard, a uniform lockdown for the entire country when the cases were rising exponentially only in Mumbai, Delhi and Chennai appears to be not scientific with the various scientific disease management models followed all over the world.

Let us look at what is the position in various states as on today

Comparison of cases as on July State wise (Statista : Source)

Now clearly from the above there are atleast a dozen states like Kerala, Punjab, Puducherry, Tripura, Nagaland, Himachal Pradesh, Meghalaya, Dadra, Arunchal Pradesh, Ladakh, Chandigarh, Mizoram, Sikkim, Andaman and Nicobar Islands did not have any cases even in June 2020. Then whether a lockdown was really needed in March -April 2020 in these states!!!

Take the example of Karnataka.

Karnataka numbers were not there and the test positivity rate was very less in the initial period

Lockdowns were imposed when there were few cases, low test positivity rates, lower deaths.

Now when the cases are growing exponentially, the unlocking was done, clearly showing that disease forecasting and surveillance were never used in imposing or taking out lockdowns in many states.

There were no cases in Bangalore in March-April 2020 and there was no evidence of any exponential growth in Bangalore or even Karnataka State. Now because of a nation wide lockdown, the state had to suffer such economic damages, that now when the cases are actually going beyond 100000+, the state has taken a step not to impose a lockdown.

Economic effects of the March Lockdown is so severe that the state finances are badly hit and there are huge economic effects in terms of unemployment, social unrest etc.

As a result there are no lockdowns and the new normal of exponential growth of virus and unlocking economy is seen everywhere in India.

Lockdowns were imposed when they were not required, but unlocking is happening when the Lockdowns are really required.

As mentioned before, a mapping of the entire country to the granular level to the above risk matrix (Level 1 to Level 4) should be done.

For example, if the cases are rising only in few wards of Bangalore, only those places will be on red, while the remaining cases will be on other risk levels. Only if the risk level is going to Level 1, the lockdowns should be imposed.

In this regard, a early warning system on lines of New York is the need of the hour. This system should be maintained in all cities and districts

A similar early warning system can help cities combat the disease at a local level instead of really placing a nationwide lockdowns.

Only those cities/wards/districts/taluks which are at Level 1, lockdowns will be imposed to contain the spread of the virus.

In Level 3 and 2 cities/wards/districts/taluks non lockdown measures need to adapted which is listed below:

Firstly, Test sufficient number of people and keep the test positive ratio below 5%. Until and unless the test positive ratio crosses 10%, the risk for placing lockdowns is limited. So testing is important.

In all these places, pooled testing can be carried out in every household so that a estimate of incidence of the disease can be got. Even serosurvelliance can be carried out to understand the infection levels in the community.

Secondly, Build Contact tracers. Have QR code based contact tracing web apps similar to New York. Blue Tooth based apps are found to be ineffective because many don't use them.

Thirdly, All citizens who have symptoms like Fever, Cough, Sore throat, fatigue, Loss of Smell and Taste and below < 50 yrs to self isolate for 14 days and inform the authorities. Their family members to self isolate for 7 days. Isolation in this cases may be more important than speed of test.

So immediate announcement to public that they should self isolate and mandatory reporting will bring out all symptomatic people in the city out. Contact tracing them immediately will bring more on isolation.

Fourthly, All citizens > 50 yrs and those vulnerable ( cancer/kidney disease/heart disease and others ) to go for reverse quarantine where they will not meet more than one person and are given separate rooms and toilets with ventilated room.

Wherever it is not possible, at least mandate the use of N95 masks or Surgical Masks for such cases even with in the household. Cloth masks may not be effective for vulnerable( WHO guidelines)

Mandate all workplaces to give these age groups and vulnerable group to work from Home.

Fifthly, Restricting gatherings to only groups of 20 and maintain effective social distance. Restricting Public Transport and avoiding the spread to other district by reducing the mobility is key.

Sixthly, Identify clusters with in cities and continue the lockdown in regions with high test positive ratio, high deaths and also highest number of cases. These clusters should be sealed off and lockdown should be continued in this place, till the test positive ratio is below 5%, deaths are decreasing and cases are also decreasing.

Seventhly, Open Restaurants, Bars, Malls, Temples, Churches, Mosques and other places where high congregate settings cautiously with lot of precautions. Retail and Entertainment centers should be strictly regulated to maintain all the Name and Phone Numbers of the visiting persons for contact tracing.

Eightly, Mild Symptoms can go on home isolation. All patients with moderate breathing issues ( whether covid or non covid) should be given a first aid protocol in any hospitals like Oxygen Therapy and the first set of treatments like Remdesivir, Dexamethasone, Heparin to avoid the cases going into severe pneumonia cases. Quick action in this case by acting without waiting for the covid confirmation can save lives. The current problem of no reasonable care would also be solved if this approach is taken by the government.

Ninthly, Monitor Oxygen Bed Capacity, ICU Capacity and Ventilator Capacity. Avoiding ICU should be the primary strategy. Early treatments and Oxygen Therapy has reduced deaths in many places. Recruit large number of nurses and junior doctors to provide these services. If possible open 1000 bedded Viral Pneumonia Hospitals to tackle large number of people.

Lastly, Conduct Zone wise Fever Camps and do door to door screening for symptoms. In Chennai, 10 lakh door to door screening was done in 14 days. This can be achieved and symptom based isolation can work in this case.

Lockdowns should be imposed only based on scientific evidence that the cases are rising exponentially and the ICU cases cannot be managed because of overwhelmed medical services.

In, all other conditions, the above ten points listed would help contain the disease to a greater extent.

The key point is when to impose lockdowns and when not to impose them.

An independent Bio Security Council similar to the one in UK should be placed at the highest level(National/State), to advice which states/cities/wards should go on lockdown through a scientific forecasting and surveillance team.

Author is a B-Tech in Electrical Engineering from IIT -Madras and MBA from IIM-Bangalore. He is presently serving as an IRS officer with the Income Tax Department in Government of India. Views expressed in this article are personal. More than 10000+ people have read his in depth scientific analysis in the last one week alone. His Scientific In-depth analysis has been appreciated by Top Policy Makers, Politicians and thousands of citizens all over India !!!