In a widespread disease with a proven infection fatality rate below 0.1 per cent, like Covid-19 in India, it is unscientific and futile to impose lockdowns in a bid to limit the increase in case counts.

Lockdown measures cannot permanently control the spread of the virus, as is evident from the widespread prevalence of the disease in India despite the lockdown. At best, lockdowns delay the onset of the disease to after the lockdown is lifted, rather than preventing disease altogether. Lockdowns themselves cause severe damage to both lives and livelihoods, as people delay required healthcare and lose their jobs.

Widespread pandemic is good news

As there is substantial global data and experience now available, the progress of the disease is known more clearly. It is clear that India has reached a stage where in many cities, the prevalence is in double digits (more than 10 per cent) while the countryside is relatively less exposed.

However, the best part is that the number of deaths in India due to Covid-19 infection is quite low relative to the experience of other countries. In the end, Covid-19 infections will have a relatively small effect on India’s annual death count of nearly ten million.

India’s daily burden of ischemic heart disease alone is approximately 4,000 deaths. If the lockdown is continued, it is possible that more people will die from neglected treatment of other diseases than from Covid-19 itself.

The lockdown encourages mismanagement of medical services by delaying or eliminating needed care for patients with other conditions that are not specifically Covid-19. It is a wrong and self-defeating policy to count deaths only due to Covid-19 on a day-to-day basis, while ignoring deaths and other malign outcomes from other diseases as a result of lockdowns. The daily death and health incidence data should be published for all causes and not just Covid-19, to put things into perspective.

Publicising only reported Covid-19 cases and deaths is a form of misinformation, inducing fear in the population, including in the medical community. The reported case counts present a false picture of the epidemic, greatly underestimating its true spread. In fact, the actual number of cases is tens of times higher if unreported cases are also counted.

Remember, a widespread epidemic is good news, since it implies a low infection fatality rate. So, it is better to recognise and publicise the vast number of cases that recover on their own, to rightly project the relative lethality of Covid-19 and address the disproportionate scare from the early days of the epidemic.

Also read: With rising cases, India far from flattening curve but low death rate a silver lining

The approach India should take

In view of the above evidence, a liberalised Swedish approach is the best course for India. This simply means emphasising public education, individual risk-taking and responsibility. The desirable, and, perhaps, unavoidable, outcome will be slow or natural exposure of the not-so-vulnerable segment of the population, while the capacity to handle severe cases is built up.

The more vulnerable (say persons of age 60-plus and with comorbid conditions) should receive special protection, including testing, close monitoring, and perhaps isolation.

The strategy of testing and tracing all asymptomatic or mild cases in order to isolate them will now be impossible, given the widespread nature of the epidemic. Waiting in lockdown for a vaccine is also risky, as the harms from the lockdown multiply. A heroic level of ‘trace, test and isolate’ will only further stigmatise the disease as it has already done, clog institutional capacity, and increase viral load all around, including on the medical personnel and on the asymptomatic or mild cases. This will make institutions hotbeds of avoidable nosocomial viral load (i.e. hospital-acquired infections) and result in more deaths.

By contrast, a decentralised approach involving all levels of primary, secondary and tertiary medical infrastructure, like any other communicable disease, will be more suited to manage the pandemic.

The ‘trace, test and isolate’ doctrine raises significant human rights issues in terms of unequal treatment and freedom of the individual, as the tested asymptomatic or mild patients are forcibly exposed to additional viral loads on not only themselves but all around, leading to more deaths, while those untested (and hence not quarantined), develop natural immunity and live.

To sum up, disease projection models should be updated to account for the serological evidence of widespread disease prevalence and low infection fatality rates. Wherever the revised projection suggests that hospitals will not be overwhelmed, lockdowns must be lifted, boldly and confidently, but with special provisions to protect the vulnerable.

It is important to handle the epidemic as a public health issue and not a disaster or law and order issue. Police forces must be taken off completely, the Disaster Management Act should be lifted, and constitutional liberties fully restored. There must be a transparent disclosure of the widespread nature but very low true mortality of this disease, quite like many other diseases we live with in our day-to-day lives.

Dr Jay Bhattacharya is a professor of medicine at Stanford University, USA.

Sanjiv Agarwal is the founder of the Good Governance India Foundation, Mumbai. The GGIF is launching Rational Health Response to Covid-19, RHRC-19.com, for a collaborative response with medical practitioners in India.

Also read: Stopping traffic, discipline, ‘braking’ Covid spread — why states are bringing back lockdowns

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