India’s economy was shut down on March 24, the collateral damage of the precipitous lockdown to control Covid-19. It was extended to May 3, with interim plans to relax restrictions to mitigate human hardship and initiate economic recovery.
No relaxation is envisaged in districts identified as COVID-19 ‘red zone’ hotspots, based on the number and clustering of infected persons. They may be redesignated to non-hotspot ‘orange zones’ if no new infections occur over 14 days, or ‘green zones’ if this lasts 28 days. Even Kerala, well ahead of other states in reducing new infections while alleviating economic distress, has six hotspot districts, illustrating the value of zoning.
Public participation is critical to prevent new hotspots and expedite phased restarting of lockdown-restricted economic activity. Averting further lockdowns is essential for sustained economic and social recovery. Effective social mobilisation is a powerful antidote to the lack of control that citizens under lockdown perceive over their lives and livelihood. It is a catalyst for facilitating and expediting mitigation measures and government-driven post-lockdown economic recovery plans. It is most effective when society owns and drives it, hence the benefits must make sense to everyone.
Everybody needs to understand that the SARS-CoV-2 virus is highly infectious. Many infected people are asymptomatic, and hence unlikely to be tested. They infect others (for up to three weeks) and contaminate commonly used objects through coughing, sneezing, or even talking. Infected people develop immunity as they recover; currently, it is unclear how robust and durable immunity is. Most people who develop COVID-19 symptoms recover. Some with severe symptoms need intensive care. Around 2% to 3% die, especially if they are elderly and/or have coexisting medical conditions. Co-morbid conditions associated with COVID-19 deaths (obesity, diabetes, hypertension, chronic cardiovascular and respiratory diseases) are common among younger adults in India. Most young people without co-morbidity recover, but potentially after infecting others.
Preventing infections requires everybody to: maintain physical distance from others; wear face masks in public; avoid touching eyes, nose and mouth; wash hands with soap and water or use hand sanitiser after touching potentially contaminated objects or surfaces, and regularly disinfect surroundings.
A sustained decrease in new infections will save lives and permit the resumption of economic activities until effective treatments (that reduce viral loads, prevent deaths, reduce further infections) or a preventive vaccine become available.
Government-designated colour-coded zones are district-wise infection control areas. It follows that infection control measures have to be part of everyday life in villages, towns and cities, across each district, for the foreseeable future. If not, when new infections emerge, the locality and district could be re-designated as hotspots and have severe restrictions or a total lockdown reimposed. It is in everyone’s best interest to ensure that neighbourhoods and districts remain infection-free ‘green zones’.
The private sector (formal and non-formal) is the backbone of the Indian economy, accounting for the vast majority of India’s workforce. Its enormous potential must be unshackled and harnessed effectively in government-citizen partnerships to combat this ‘epidemic of economic downturn’ and restart sustainable economic recovery.
Since hotspots and containment zones are district-level designations, each district urgently needs a Covid-19 Task Force with representatives of: district administration, civil society, health, educational, agricultural, business and industry establishments, and NGOs. This task force (aided by implementation units at taluk, block, municipality, panchayat, township and even neighbourhood levels) should identify and collaborate with institutions planning to resume activities (whenever permitted) that cannot be done online or by working from home, to formulate a strategic plan and have standard operating procedures in place at the earliest.
Directives for establishments permitted to currently function are provided in the Ministry of Home Affairs order (No. 40-3/2020-DM-I(A)) dated April 15. Infection-control measures are also embedded in the operating guidelines provided to industries for the post-lockdown resumption of activities by the Confederation of Indian Industry (CII). They should be incorporated in all SOPs.
Establishments wishing to resume operations early could repurpose some or all of their activities to those considered essential or permitted by the MHA order. Innovative use of manpower and technology can be directed to developing affordable, reliable and efficient ways to: disseminate accurate information; counter misinformation; aid case detection and contact tracing; test for infection and immunity; ensure infection-control directives are not breached; protect frontline workers and the public; ensure treatment of critically ill patients; continue routine immunisation and antenatal care; ensure financial and food security, particularly for the vulnerable. Such a collaborative endeavour has huge potential for immediate and long-term economic and social benefits.
Every establishment needs to identify facilitators and barriers to adopting safe practices, to ensure employees have the knowledge and resources to observe recommended infection-control measures at work and outside, and to keep their families and neighbourhoods infection-free. This requires district-wide coordinated action and collaboration with contiguous districts, where some of their workforces may reside and supply chains may be located.
Rotary, Lions and other service groups are invaluable partners to disseminate accurate information and facilitate welfare measures. They can involve people from all sections of society in their spheres of influence, to ensure the ‘greening’ of affected India, district by district.
District-level government-civil society collaborative platforms have the potential to shape the narrative regarding the nature of future economic activities: redressing socio-economic inequity and any communal disharmony, and mitigating even the deleterious effects of climate change and future pandemics. These collaborations are vital for a salubrious social revolution.
Dr Prathap Tharyan
Adjunct Professor, Clinical Epidemiology Unit, CMC, Vellore
Dr T Jacob John
Retired Professor of Virology
(Email IDs: prathaptharyan@mail.com, tjacobjohn@yahoo.co.in)