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Coronavirus | Enforcing lockdown indefinitely too disruptive, say public health experts

Migrant workers are being provided food and water by volunteers and police near the Dr. MGR Central Railway station, in Chennai on May 31, 2020.

Migrant workers are being provided food and water by volunteers and police near the Dr. MGR Central Railway station, in Chennai on May 31, 2020.   | Photo Credit: R. Ragu

“Had the migrant persons been allowed to go home at the beginning of the epidemic when the disease spread was very low, the current situation could have been avoided,” says the joint letter by three public health organisations.

A group of public health experts, two of whom are part of a government-constituted advisory committee to contain the pandemic, has said enforcing the lockdown “indefinitely” would be too disruptive and “overtake lives saved due to lockdown mediated slowing of COVID-19 progression.”

“Had the migrant persons been allowed to go home at the beginning of the epidemic when the disease spread was very low, the current situation could have been avoided. The returning migrants are now taking infection to each and every corner of the country; mostly to rural and peri-urban areas, in districts with relatively weak public health systems ,” says the letter jointly authored by the Indian Public Health Association (IPHA), Indian Association of Preventive and Social Medicine (IAPSM) and Indian Association of Epidemiologists.

Second joint statement on COVID-19 by Indian Public Health Association, Indian Association of Preventive and Social Medicine and Indian Association of Epidemiologists

The government on Friday announced a series of relaxations called Unlock 1 that limits lockdown only to containment zones until June 30 and a spate of relaxations after June 8.

The government relied on modellers, or theoreticians, rather than field-level epidemiologists who are better acquainted with disease transmission dynamics. “From the limited information available in the public domain, it seems that the government was primarily advised by clinicians and academic epidemiologists with limited field training and skills,” the letter underlines.

India was paying a heavy price both in terms of humanitarian crisis and disease spread, the experts said. The “incoherent” and often rapidly shifting strategies and policies especially at the national level were more a reflection of “afterthought” and “catching up” phenomenon on part of the policy makers rather than a well-thought, cogent strategy with an epidemiological basis, they said.

Dr. D.C.S. Reddy, former Professor & Head, Community Medicine, IMS, BHU and Dr. Sanjay Zodpey, President, IAPSM and Vice-President-Academics, Public Health were among those who were advising the government and signatories to the letter.

Also read | Ministry of Home Affairs (MHA) order dated May 30, 2020

The Associations were invited by Prime Minister Narendra Modi on March 24, after the lockdown had already been imposed.

As of Sunday, India had 1,82,000 cases and over 5,000 deaths. Added to that was the “humanitarian crisis” that saw 114 million job losses (91 million daily wage earners and 17 million salary earners who have been laid off), across 271,000 factories and 65-70 million small and micro enterprises that have come to a halt, the letter noted.

While the lockdown slowed the transmission of disease, open and transparent data sharing with scientists, public health professionals and indeed the public at large, were “conspicuous by its absence”. The experts blamed India's response for over-relying on a “modelling exercise from an influential institution which was a ‘worst-case simulation’. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark.

Had the government consulted epidemiologists who had better grasp of disease transmission dynamics, it would have perhaps been better served, the letter said. The Hindu couldn't independently verify which particular model the letter referred to.

The experts add that it was “unrealistic” to expect that COVID-19 pandemic could be eliminated at this stage given that “community transmission” was already well-established across large sections or sub-populations in the country.

The expected benefit of this stringent nationwide lockdown was to spread out the disease over an extended period of time and effectively plan and manage so that the healthcare delivery system is not overwhelmed. This seems to have been achieved albeit after fourth lockdown with extraordinary inconvenience and disruption of the economy and life of the general public. The case fatality rate in India has been relatively on the lower side, and mostly limited to the high risk groups or those with elderly population and pre-existing co-morbidities etc.

Among its suggestion the group notes that the government should rapidly scale up public health and allocate 5% of GDP to health expenditure at the Centre and State level.

Full coverage| Lockdown displaces lakhs of migrants

Dr. D.C.S. Reddy, former Professor & Head, Community Medicine, IMS, BHU and Dr. Sanjay Zodpey, President, IAPSM and Vice-President-Academics, Public Health were among those who were advising the government and signatories to the letter.

The Associations were invited by Prime Minister Narendra Modi on March 24, after the lockdown had already been imposed.

As of Sunday, India had 1,82,000 cases and over 5,000 deaths. Added to that was the “humanitarian crisis” that saw 114 million job losses (91 million daily wage earners and 17 million salary earners who have been laid off), across 271,000 factories and 65-70 million small and micro enterprises that have come to a halt, the letter noted.

While the lockdown slowed the transmission of disease, open and transparent data sharing with scientists, public health professionals and indeed the public at large, were “conspicuous by its absence”. The experts blamed India's response for over-relying on a “modelling exercise from an influential institution which was a ‘worst-case simulation’. The model had come up with an estimated 2.2 million deaths globally. Subsequent events have proved that the predictions of this model were way off the mark.

Had the government consulted epidemiologists who had better grasp of disease transmission dynamics, it would have perhaps been better served, the letter said. The Hindu couldn't independently verify which particular model the letter referred to.

The experts add that it was “unrealistic” to expect that COVID-19 pandemic could be eliminated at this stage given that “community transmission” was already well-established across large sections or sub-populations in the country.

The expected benefit of this stringent nationwide lockdown was to spread out the disease over an extended period of time and effectively plan and manage so that the healthcare delivery system is not overwhelmed. This seems to have been achieved albeit after fourth lockdown with extraordinary inconvenience and disruption of the economy and life of the general public. The case fatality rate in India has been relatively on the lower side, and mostly limited to the high risk groups or those with elderly population and pre-existing co-morbidities etc.

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Printable version | Jul 8, 2020 8:49:05 AM | https://www.thehindu.com/news/national/coronavirus-indefinite-lockdown-more-harmful-say-public-health-experts/article31715670.ece

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