As lockdown fatigue sets in, we ask, “What is the big fuss over this Covid-19 pandemic?” After all, the number of deaths in Bangladesh, at the time of writing, are only into a few hundreds. In contrast, other diseases such as dengue, diabetes, hypertension, etc, decimate far more lives each year.
I shall endeavour to provide a succinct answer, but only in exchange for a small reward, which is described as follows: Take a chess board and place one grain of rice on the first square. Then place two grains on the next square. In other words, keep doubling the number of grains until all 64 squares are filled.
Sounds like a fair deal, right? Actually, it’s not, because assuming 55,000 grains in 1-kg of rice, you have just promised me approximately 335 billion tons of rice.
Therein lies the deceptive nature of exponential growth. It is a monstrosity which humans are not naturally predisposed to fathom.
Covid-19 is a highly contagious disease. The number of people infected can double in a matter of days. Hence, unless nipped in the bud, the number of patients can be overwhelming. Returning to the chessboard example, it is better to stop the grains of rice from doubling early on, rather than later.
The purpose of lockdown and social-distancing is to keep the initial numbers down. Taking a simple example, if there are only 10 cases, then doubling implies just 20 cases. However, if there are 10,000 infected persons, then doubling leads to 20,000 patients, which if it happens within a very short span of time can overwhelm hospital resources.
In fact, we are seeing hospital resources severely stretched all over the world due to the surge of Covid-19. Patients with other medical concerns are not getting the care they need.
A recent article in the Lancet, drawing on public health data from India, reported that there have been alarming reductions in essential public health and clinical interventions. Specifically, there has been a 69% reduction in measles, mumps, and rubella vaccination in children, a 21% reduction in institutional deliveries, a 50% reduction in clinic attendance for acute cardiac events and, surprisingly, a 32% fall in inpatient care for pulmonary conditions in March, 2020, compared with March, 2019.
It is therefore understandable, why experts around the world place so much emphasis on flattening the exponential curve.
Herd immunity is easier said than done
However, many of the chattering cognoscenti, armed with their latest field of expertise -- epidemiology, point out that the chessboard example is invalid because of “herd-immunity.” Viruses cannot replicate without a foreign host body. So, if many people fall sick and subsequently become immune, then the Covid-19 virus will not be able to attach itself to a viable host and therefore die out. In essence, herd-immunity makes lockdowns superfluous.
This concept, while attractive in theory, comes at a heavy price -- deaths. Despite the fact that Covid-19 is now the leading cause of death in many territories, studies show that not even Wuhan, Italy, Spain, the UK, and New York, are anywhere close to achieving herd-immunity.
In fact, the consensus among epidemiologists is that a strategy of pursuing herd-immunity is inadvisable when there is a high risk of mortality.
One of the reasons why expert advice has not gone unchallenged is because of the wild variations in the death predictions by the epidemiological models. Presently, the most talked about model is the IMHE.
There are legitimate criticisms of the model. In the early days of Covid-19, IHME was an oversimplified empirical model. Since then, it has undergone massive changes to the point that the original model is now unrecognizable.
Now, it is considered to be both an empirical and mechanistic construction. Moreover, there are criticisms regarding the lack of transparency in the way mathematical updates have been applied to the model.
Nevertheless, it must be recognized that models undergo significant changes as the environment changes. Just because some predictions have missed the mark does not devalue the main impetus for lockdown.
In fact, opening up too soon can undo the precautionary measures taken earlier. Singapore is a case in point.
Researchers at the Massachusetts Institute of Technology (MIT) trained a neural network model on data that predicted the spread of the coronavirus from late January to early March, including information on how countries implemented quarantine measures. They have issued a dire warning, viz, reopening the US too early would lead to a catastrophe.
Of course, lockdowns can be devastating for any economy. Hence, there are legitimate concerns relating to severe shortages of goods and essential services, hunger, drastic loss of wealth, and so on.
Moreover, the impact of Covid-19 on livelihoods is far worse for people on the lower rungs of the economic strata. According to a report by the US Bureau of Labour Statistics, of the top 25% of income earners, 60% can stay at home and do their jobs. Yet, for the bottom quarter, only 10% can work from home.
Sadly, much of this extremely important issue is discussed under the intellectually pretentious epithet, “lives versus livelihoods.” This distinction is largely illusory.
How will the economy change?
In a recent Financial Times article, Martin Wolf points to a cross-country analysis of predicted growth versus the severity of their lockdown strategies. The data showed almost no correlation between the two variables.
A study by the Institute of Fiscal Studies (IFS) in the UK shed light on why there is such a weak relationship between expected economic growth and the severity of lockdowns.
In fact, the reasons are quite obvious. First, a great deal of uncertainty remains about how this disease may evolve over time. This uncertainty means that even after opening up the economy, transactions that require face-to-face interaction will be affected far more than those that do not.
Second, because the elderly are likely to be more affected than the young, some people will resume normal lives sooner than others.
Third, the impact from the rest of the world-economy on a national economy is likely to be complex.
However, lockdowns cannot be continued indefinitely without damaging the world economy for many years, perhaps decades. Even the most optimistic predictions are simply frightening.
So, what is the alternative to lockdowns? Surely, the clarion call must be for innovative solutions. In this regard, recall some famous examples of creativity flourishing during isolation.
Sir Issac Newton made some of his greatest discoveries when he was in isolation after being sent down from Cambridge University. Apparently, Shakespeare wrote King Lear, Macbeth, and Anthony and Cleopatra while in quarantine due to the Great Plague. Composer Guillaume de Machaut wrote “Messe de Nostre Dame” while he took measures to avoid society during the Bubonic Plague in the 14th century.
The world has indeed changed. Creativity must be the driving force behind safely operating in this new environment.
Yet, given the nature of the contagion, creativity can only flourish if there is respect for social-distancing in an ecosystem characterized by extensive testing and efficient track and-trace. Countries such as Taiwan, South Korea, Iceland, New Zealand, and so on provide best practices in this regard.
In the absence of widespread testing, a variety of digital track-and trace methods have proved remarkably effective in Vietnam and Kerala.
Lockdowns all over the world have pointed to ways an economy may be gradually opened up. For example,
• Working from home is a viable option for many job descriptions. Facebook and Google have shown that it is possible
• Working patterns can change. Introducing extra shifts at work reduces the number of people at any given time, making social distancing easier. Moreover, weekends need not be similar for all employees. Some pharmaceutical companies in Bangladesh have adopted this approach
• Manufacturing processes may need to be altered to reduce the risk of disease. Where such alterations are not possible, workers must be issued protective clothing
• After the main lockdown is relaxed, staggered lockdowns may minimize transmission risk. Preliminary studies from India suggest that a staggered resumption of work following the end of the nationwide lockdown may reduce peak hospitalizations by almost 50%, as compared to total resumption
• Arts, culture, education can take place over the internet
• Delivery services can bring restaurants and stores home to people
In addition to the above, companies must recognize that the composition of aggregate demand shall most likely change. They have to be prepared to modify their product lines accordingly. There are numerous examples of such transformations taking place across the world.
Moreover, in order to make rapid changes to business models, there has to be widespread sharing of design technology across companies. This impetus suggests that there might be an enhanced role for open-source technology.
Of course, there must also be a cohesive strategy to provide food and cash transfers to those who cannot participate in the post-lockdown economy due to structural shifts in aggregate demand, insolvency, or poor health.
Microbes have changed our world and we must respond intelligently to this change. Apart from ditching assumptions that are now obsolete, we have to embrace the novel. Creativity, rather than experience, shall be the modus vivendi.
Kaiser Kabir is the CEO of Renata Limited.