21 Apr 2020 21:38 IST

Flattening the curve doesn’t mean that the virus is conquered

It stems the tide when medical resources are scarce but it’s just an early milestone on a long road

Everyone these days is talking about flattening the curve. Indians overwhelmingly support Modi’s extremely strict lockdown measures as a patriotic act and rattle off statistics of people infected, tested, succumbed, and recovered. The average Indian appears to have embraced mathematics skills that would have made Aryabhata proud.

On social media, flattening the curve appears to be the final goal. The thinking goes that May 3 is a date that we can all wait out because things will be fine afterwards.

Except that things won’t be. What we gain by flattening the curve is that we all don’t get sick at the same time and rush to seek medical care when resources are scarce. Lockdowns preserve scarce facilities to treat the really sick. This approach — although prohibitively expensive because of the economic impact — is helpful in India which has among the fewest hospital and ICU beds per 10,000 people, and lacks advanced equipment like PCR machines and ventilators.

But flattening the curve doesn’t mean that normal life can resume and the virus has been defeated. That can only occur when a cure is found and better yet, a vaccine is readily available, both of which experts say are at least a year away.

Unknowns and uncertainties

Covid-19 is not like any other virus. For one thing, it can transmit when people are asymptomatic. It also appears to suppress immune systems even in recovered patients. According to the South China Morning Post, when researchers analysed 175 patients who had been released from a Shanghai hospital, nearly a third had low levels of antibodies and some had no antibodies at all. If the report is confirmed, it delivers a serious blow to antibody tests that labs around the world are rushing to develop.

Many viruses can’t be detected directly, but the presence of antibodies to the viruses can be. If antibodies are found in a person, it means that the body has triggered a fight with the virus — and the finding could flag a potential infection even if the person shows no symptoms. But what if the person has the virus, is asymptomatic, and worse, has no antibodies? The test would clear the person when, in fact, he actually has the virus. The world does not need false-negative tests, those which incorrectly indicate that a particular condition or attribute is absent.

So, as the Indian economy struggles with an extended lockdown and the government, already deprived of billions in tax revenue, can at best announce a stimulus package of about 1 per cent of GDP to help the struggling economy (compared to western nations that are spending 10-15 per cent of GDP), many questions remain.

New infections post lockdown

What happens when India restarts the economy, people start going out, and infections start again? Because we only need one infected person to somehow leak through the net and begin transmitting the virus. Tragically, this has been the experience of the wealthy city-state of Singapore which took aggressive measures initially to contain the virus. But The New York Times reported that Singapore’s coronavirus caseload has more than doubled, with more than 8,000 cases confirmed as of Monday, the highest in South-East Asia. “Most of the new infections are within crowded dormitories where migrant labourers live, unnoticed by many of the country’s richer residents and, it turns out, the government itself,” the paper said, drawing an eerie similarity with India as a whole after May 3.

Modi has embraced nearly-draconian lockdown measures because he understands well that in a country with high population densities, maintaining social distancing is nearly impossible. Even contact tracing, which the government is doing admirably well, works largely when everyone is at home, the tracing is local, and there are few infections — but fails when people begin moving about and dissipate. How could officials possibly contact-trace on a crowded train or bus? Even if they do, what would we do with all those individuals who came into contact with the infected? Quarantine them? Where? We don’t have the hospital beds set up to isolate lakhs of people. So do we order them to self-quarantine? If so, how do we enforce compliance?

Difficulties ahead

Clearly, we cannot afford to shut the economy down again. The World Economic Forum already predicts that Covid-19 could worsen hunger in the developing world. Pakistani PM Imran Khan said in an NPR radio interview on March 17, “If we close down the country, what will happen to the poor? People will die of hunger here.” India’s situation thankfully is not so dire, but, with trade expected to be down a third and global economic growth shrinking three per cent, the IMF predicts that the world will ‘very likely’ experience the worst recession since the 1930s.

Few political leaders either know enough to answer these questions or are willing to. But an important first step is to prepare our nation that life after May 3 will likely be painful. And that May 3 is just one mile-marker along a long road.