4/9/2021 Why Lockdown is Not an Absolute Panacea for Coronavirus Spread in India

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NEWS18 » NEWS » BUZZ » WHY LOCKDOWN IS NOT AN ABSOLUTE PANACEA FOR CORONAVIRUS SPREAD IN INDIA 8-MIN READ

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Why Lockdown is Not an Absolute Panacea for
Coronavirus Spread in India
Lockdown is not an absolute panacea for COVID-19
spread. It should not be applied out of context and cannot
be maintained inde nitely. Though the measure is
extreme, it only results in postponing the eventual spread.

NEWS18.COM
LAST UPDATED: MARCH 22, 2020, 19:48 IST
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DR MANJUNATH SHANKAR AND DR ANANT BHAN

PHOTOGALLERY

Image for representation

P
rime Minister Narendra Modi while addressing the nation on Friday, 20th March 2020 urged Indians to
face the COVID-19 pandemic with collective determination and patience. He also called for a “Janta Janhvi Kapoor Looks
19
Curfew”, a voluntary 14-hour lockdown on 22nd March 2020 from 7 am to 9 pm: by the public, for the Sexy In A Bikini During PHOT

Her Maldives Vacation;

public. See Her Hot Photos Here

Though largely symbolic from a public health perspective (do not trust the social media forwards which tell you
such a small period can help vanquish the virus), this serves as a useful drill. This will give Indians an insight
into what it would mean to go in for an extended potential future lockdown. Some states like Odisha,
Rajasthan, and Punjab have already announced lockdowns of varying geographical coverage for a week or
longer. As of 22nd March 2020 afternoon, lockdown with only essential services operational was further
announced for 75 districts.
Priyanka Chopra Shares 10
This list will probably grow over the next couple of days. This has led several to ask a question: what is the use Radiant Photo From Sets, PHOT

See The Diva's Drop-

of a lockdown and how long should it go on for: a day, a week, two weeks, or even longer?
Dead Gorgeous Pics

These lockdowns are the latest in an expanding COVID-19 government response which included travel
restrictions, issuing protocols, guidelines, and advisories, providing testing, establishing isolation and
quarantine centers and setting aside hospital and ICU beds. While the initiative is commendable, there have
been concerns around decisional delays and a lack of clear communication and transparency.

We have had a proliferation of usage of terms, often inter-changeably: social distancing, mass gatherings,
lockdowns, shutdowns, curfew, prohibition, stay at home, shelter-in-place, home isolation, quarantine to
denote some or all the actions. This has ended up confusing people; added to this is misunderstanding even
among government of cials with regards to the use of ‘Local transmission’ to denote Stage 2 and ‘Community
transmission’ for Stage 3.

The main and only difference between Stage 2 and 3 is the ‘Known’ vs ‘Unknown’ chain of transmission. This is
a crucial difference that will dictate the response strategy. In Stage 2, incoming infected travellers are spreading
the infection further at home, workplace, or in social settings i.e. among known contacts, and a chain of
transmission through contact tracing can be established. Therefore in ‘Local Transmission’ all chains of
transmission are known, accounted for and under observation. Only when a new case is discovered which

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4/9/2021 Why Lockdown is Not an Absolute Panacea for Coronavirus Spread in India

cannot be connected
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to a known
CORONAVIRUS
travellerINDIA
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or theirENTERTAINMENT
contacts, can we say
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‘Community
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is happening
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(Stage 3). This is an unknown transmission because we do not know from whom the infected individual
acquired COVID-1

Due to stringent ICMR testing guidelines till March 20th, which many found irrational, only a person who was
an incoming foreign traveler with symptoms OR a contact of a con rmed positive individual OR a small group
of individuals from the community with speci c respiratory symptoms were tested for COVID-19. This probably
gave us a false sense of security, only broken when the reports from Tamil Nadu, Pune, and Delhi about
potential community transmission came through. Reassuringly, the ICMR has now relaxed the testing eligibility
also allowing for symptomatic health care workers, and all hospitalized patients with Severe Acute Respiratory
Illness (SARI) to be tested.

When this article was written, the of cial stand of the Government was that India still does not have any
Community (unknown) transmission. However, as described earlier, many states and cities have initiated
‘lockdowns’ of varying degrees (with respect to mass gatherings, closed schools, pubs, theaters and function
halls) for different durations as if we are already in Stage 3.

The steady increase in the number of positive cases in multiple states since March 3rd after a lull in February in
combination with the rapid global spread especially in Europe, Iran, and the US has probably created fear
among (especially state level) policymakers, and the public, that unknown transmissions are happening in India
and cases will continue to climb, and it’s politically expedient to act. The Union government has neither itself
or through directives to states required that stringent measures should not be taken unnecessarily, without a
clear rationale outlined and communicated to the public.

For example, Odisha with only 2 cases reported, has announced putting 40% of the state under lockdown.
Rajasthan and Punjab soon followed. These actions appear to be ad-hoc knee jerk reactions rather than a well
thought out strategy. We should avoid a lockdown competition among Chief Ministers and following the herd
mentality (because Italy, France Spain, US, UK, and others are doing it).

While preserving the health of populations is crucial, it’s important to remember that lockdowns have severe
economic and social impacts. The ensuing economic disruption could spell disaster for many small businesses,
travel and hospitality industry, daily wage earners and other economically vulnerable groups unless
compensatory support is provided.

As such, these measures must be judiciously exercised based on real-time local data. It should balance public
health goals with economic and social stability. The most appalling lapse on the part of the response has been
its failure to clearly de ne the current goal- is it containment or mitigation?

If we can nd and break all known chains of transmission, then containment must be the goal i.e. to isolate
suspects, test, treat infected individuals and trace contacts to suppress the virus transmission. But if there are
multiple unmanageable unknown chains of transmission in the community, then mitigation becomes the goal.

Though the goals are different, there is a huge practical difference. Under mitigation, contact tracing is
deemphasized and lockdowns are initiated (see graphic). All other actions like personal hygiene (wash hands,
cover cough etc.) should be practiced for both the goals (another thing not communicated properly). Currently,
Singapore, Hong Kong, South Korea, and Taiwan are attempting containment; Italy, France, Spain UK and some
parts of the US are attempting mitigation.

Under mitigation, we accept that the virus will spread in the community and we can only slow it down and not
stop it. By slowing it down, we reduce the pressure on the health care system ( atten the curve). When a
lockdown is implemented, we are trying to reduce the interactions and exposures between strangers to slow the
transmission- we are indirectly saying everyone is a COVID-19 suspect and we need to maintain distance from
them all. This purpose might be defeated if it is not done in an orderly manner due to confusion and panic.

It will be counterproductive if people do compensatory rebound interactions before or after lockdown (panic
buying and hoarding in congested supermarkets) which increases exposure.

Lockdown is not an absolute panacea for COVID-19 spread. It should not be applied out of context and cannot
be maintained inde nitely. Though the measure is extreme, it only results in postponing the eventual spread. It
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4/9/2021 Why Lockdown is Not an Absolute Panacea for Coronavirus Spread in India

should be partCORONAVIRUS
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of a coordinated, coherentINDIA
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and sustainable COVID-19
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response
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strategy.
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Given the economic and social consequences, this arsenal should be used tactically as a last resort in localized
hot-spots of infection identi ed through quality surveillance to achieve a clearly de ned objective (reduce new
cases/hospital admissions or to do active case nding by the door to door survey).

The government should come up with clear guidelines for lockdown which is categorized and proportionate to
the perceived risk based on real-time local data and health system capacity. In a democracy like India, we
should adapt our own strategy on the extent of lockdown and have a graduated system of restrictions after
taking the public into con dence. These guidelines should be publicly communicated, and answer at a
minimum the following:

Why: The reason and immediate objective behind the lockdown.

When: The trigger for the lockdown based on near real-time local data considering lags. Is it a steep increase in
daily new cases for the past three days or concerns around stretched health system capacity or out of an
abundance of caution?

Where: The geographic areas and administrative borders that are going to be included in the lockdown

What: The level of lockdown. Is it minimal, moderate or at maximum? What businesses can be operational in
what manner under each of these levels? What actions are permitted and not permitted?

Who: Who/how many can come out, at what times and how frequently? Who should report regularly for work at
each activation level?

How: This consists of two parts- How long the lockdown (depending on the objective) for --this should be based
on scienti c evidence and public health advice; also how will it be carried out— how will we avoid panic? How
will sick people during the lockdown seek care? How will food be delivered to households which can’t buy and
store? How would old people in secluded homes be taken care of? How will people in transit or at borders be
advised? How will homeless, beggars and daily wage earners or small shop owners like tea stalls be
compensated? How will we monitor the lockdown? Will we police the lockdown, and ne/take legal action
against those who violate it, even for legitimate reasons (such as a family emergency)?

Lockdown might be thought of being akin to a nuclear strike option on a viral spread, but it is unchartered
territory in this regard for us as we have never used this strategy in India. Furthermore, it can at the most buy
us precious time. It might serve us better to be innovative, evolve contextually relevant models of lockdowns
and rede ne how these can be humanely implemented. We should not go into mass lockdown at the rst sign of
unknown (community) transmission.

We should try to contain COVID-19 transmission with maximum effort as this will have the least economic and
social impact. We should do extensive testing, recruit volunteer contact tracers and use India’s technological
strengths for ethical surveillance tool development to achieve this. When all chains of transmission are
seemingly known, even with a few exceptions, we should follow the adage “Don’t use an axe to cut a nail”.

But when there are unmanageable unknown transmissions happening in the community, ”Never bring a knife
to a gun ght” should be the guiding principle and the state should exercise full measures at its disposal,
including extended lockdowns to save lives.

We need the Government to come up with transparent and evidence-based criteria and guidelines for its own
approaches and policy actions, including lockdowns, to enable con dence in its COVID-19 response and enable
adherent participation of the public.

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4/9/2021 Why Lockdown is Not an Absolute Panacea for Coronavirus Spread in India

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Dr Manjunath Shankar is a public health specialist. He participated in the US CDC Emergency Response
(Modelling Task Force) to the West African Ebola outbreak in 2014-15.

Dr Anant Bhan is a researcher in global health, bioethics and health policy.

TAGS CORONAVIRS OUTBREAK CORONAVIRUS CORONAVIRUS DEATHS CORONAVIRUS LOCKDOWN CORONAVIRUS PANDEMIC LOCKDOWN
FIRST PUBLISHED: MARCH 22, 2020, 19:41 IST

NEWS18 » NEWS » BUZZ » HOW TWO RUSSIAN MEN SAVED A SCARED CAT FROM FALLING OFF 30 FEET-HIGH WINDOW 1-MIN READ

How Two Russian Men Saved a Scared Cat from Falling

off 30 Feet-high Window
Two locals in Russia went out of their way to help a scared
cat stuck outside a second- oor window.

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LAST UPDATED: APRIL 09, 2021, 20:07 IST
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PHOTOGALLERY

Feline luck | Image credit: Reuters

W
hat could possibly brighten up your day than a positive story of a cat rescued by fellow humans, Janhvi Kapoor Looks Sexy In A
restoring your faith in humanity? One such heart-melting news came from Russia when two locals Bikini During Her Maldives
Vacation; See Her Hot Photos
went out of their way to help a scared cat stuck outside a second- oor window. The scary clip took Here
a positive turn when two men came forward to help.

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