Lockdown cannot be a cure for coronavirus

Indian scientists have recently developed a novel Covid-19 test kit that is cheaper and provides much faster results using CRISPR technology, and named it “Feluda” after the famous detective of Satyajit Ray’s novels. But Ray also created another equally famous character, Professor Shonku, who had among his repertoire of inventions the drug Miracurall. As the name signifies, this drug could have come in handy during the present crisis. If only real-life scientists could match the scintillating brilliance of their fictional counterparts and make one.

Sadly, scientific inventions don’t happen that way anymore. Actually never did, notwithstanding the hagiography surrounding the lives of famous scientists. But such fictional characters create myths that are hard to break. They have an élan that makes real-world scientists look dreary and insipid. Deep down, we still hanker for the arrival of the lone eccentric genius who will be our salvation. So one is always hoping and waiting for the brilliant invention of Miracurall, which in one shot will solve everything.

This inability to see the world in shades of grey, the complexity of real-life problems, the messy and patchwork nature of optimum solutions — that is the real problem. It creates an environment where charlatans flourish with their tempting offers of Miracuralls. Remember the early days, when the whole country was breathing a very specific ecclesiastical air and providing solutions based on novel strategies, like banging utensils and ingesting bovine secretions? Fortunately, pragmatism and a healthy fear of the disease have relegated such “Miracuralls” to the background, but it is important to remember them as illustrative examples of the ease with which rationality is trumped by the emotional appeal of quick-fix solutions.

Effectiveness of the lockdown

The policy version of the Miracurall drug is the lockdown. This is the wonderful one-stop solution to all our problems. India has been praised for its swift and decisive action in announcing an early lockdown, even before the count had reached high values. Authorities have painted an alarming picture of the number of cases that would surely have occurred had it not been for this intervention. But let us dig a bit deeper. These numbers that have been used to paint such a grim alternative scenario to justify the very visible costs of this lockdown have now been questioned, based on their rather shaky assumptions. Comparisons with the growth rates of the epidemic in European countries are clearly not valid, given the rather large variations observed between countries. A much better control group is to look within the country specifically to the days before lockdown.

Even here, the dates chosen to prove high growth rates are three days before the lockdown. This is an extremely egregious, because just three days before the ICMR had enlarged the scope of testing and with higher tests found many more positive cases. It is the equivalent of discovering unreported cases as happened in countries like France or Ecuador, and claiming that the growth rate was 1,000 per cent.

We keep hearing in the news that the growth rates are falling, but unfortunately, this standard method of measuring growth rates is fundamentally flawed. We simply borrow the standard practice of reporting growth as a percentage of the base amount, like economists do with the GDP or demographers with population. But while the GDP or population growth does indeed depend on the base numbers, why should the rate of increase of infection depend on total numbers who are infected. Some among this total, are cured and a small fraction are unfortunately dead; surely they are not spreading the infection. Even the active cases are quarantined in hospitals or at home, and are not the cause of spread.

Then why divide the growth rate of the virus by the total number of persons who got infected to obtain a percentage of growth rate? The math is simple — you usually have a growth rate where the time required for the number of infections to double (doubling time) is slowly increasing. And the percentage growth rate is therefore obviously falling, but, and here is the nub — you could still have a continuously increasing growth rate per day, as is the case in India. Our neighbours, Pakistan and Bangladesh, are also in the same boat. Pakistan especially, with its patchy and poorly-implemented lockdown, has an even higher rate of new infections compared to India, if we correct for population size. Truly, we are one nation, and the Covid epidemic has finally proved the incorrectness of the two-nation theory.

Tracking the growth rate

Faulty methodologies to prove or disprove the efficacy of lockdown can be chosen, a priori depending on what you wish to conclude. As an illustration, let’s chose Sweden, where there was no lockdown, as a control. On March 25, when the lockdown began, India had 657 cases, while Sweden had 2,526. Today, the situation is reversed and India has more than 1,12,000 cases while Sweden has around 31,000 — this difference is growing every day.

So during this lockdown period, the number of infected persons increased 170-fold in India while a country without lockdown had a 13-fold increase. Does this prove that lockdowns enhance growth rates of the virus? Clearly not. So, before we undertake such kinds of data analysis, we need to be extremely cautious and understand the limitations and underlying assumptions behind every such exercise. That is why the most praiseworthy statement came from Sweden’s chief epidemiologist Anders Tegnell, who with a rare combination of humility and honesty said that he was not convinced of the correctness of his own decision and his team was constantly reviewing the data.

Anyway, the effectiveness of relying solely on lockdown methods is questionable, since it does not halt the micro-propagation of the virus within households and poor communities which do not have the privilege of practicing social distancing in their cramped living conditions. So we simply cordon off the slums and deny their existence. This simply leads to geographical inhomogeneity in the spread, and sooner or later, this virus pool will spread via vegetable markets and the ubiquitous household help into middle-class neighborhoods.

The lockdown has simply driven the infection deep underground with people refusing or unable to come to hospitals even for treatment of other diseases; often with tragic consequences. It has broken the back of both the common man and the already precarious economy. So the question that should really be asked is this “Was such a strict lockdown necessary?” Or would a more humane approach which could have avoided such needless suffering been adequate to slow the spread of this virus?

It is really a question of tradeoffs, where if the objective is maximise social good, then a single-point focus on halting the epidemic is indeed poor governance. Let us be clear. This is not an argument supporting a free-for-all lifting of restrictions as advocated by some fringe elements in the US, with their hallowed demands of freedom and entertainment.

In India, the demands for lifting restrictions fulfils a more prosaic need. How to avoid hunger? Can we even begin to imagine the state of mass panic and helplessness, which has prompted millions of people to trudge hundreds of miles to their villages, where they will inevitably face near starvation conditions, instead of staying in the cities?

Government claims notwithstanding, we have no way of knowing whether the virus has ridden piggyback on some of the thousands of persons who are making their long and weary way back home. I suppose it will manifest itself soon enough. What is known is that the peak levels of infection lie somewhere in the future. What those numbers will be and when it will happen is uncertain. Some functionaries in the establishment have put this date as end of June, though the crystal ball they have used for this future gazing is definitely not available to mere mortals. And what about the second wave of infections whose advent is as assured as the arrival of the next Indian businessman to Bahamas after defaulting on his bank loan.

Vaccine hopes

But wait, hope is at hand — another Miracurall waiting to take centre-stage. US President Donald Trump has announced that the vaccine for this virus will be ready before he comes up for re-election this winter. Alas, if only it was as easy as the distribution of freebies and handouts so effectively carried out by our politicians before elections. As the largest democracy in the world to the greatest democracy in the world, we can only say: “You have much to learn from our venerable traditions”. Just pause and reflect for a moment. If making a vaccine was such a sure-fire exercise, then why are there around 50 vaccine candidates in early research phase, pre-clinical stage, phase 1, 2 and 3 trials? As a matter of fact, the only vaccine candidate in phase 2/3 is the BCG vaccine, since it is already established and is sought to be repurposed. Clearly, the companies and institutes developing them know that most of these candidates will ultimately fail, and they are optimistic that luck will favour them.

But optimism and luck are not guarantees and though it is possible that this pool will generate one or two successful vaccines, we do not know which ones, and how long it will take. Experience shows that developing a reasonably efficient vaccine takes anything between 2-5 years. But not to worry we have faith. Another rather minor but troubling question is whether the developed vaccine will ever reach India. If history is any guide, it won’t. The swine flu vaccine never did, and the company that developed it was clear that it was justified in putting a high price-tag, since it took a huge risk when investing research funds on a vaccine candidate that could well have failed. As Salvador Hardin, a character in Isaac Asimov’s book says: “Never let your sense of morals prevent you from doing what is right”. An aphorism that has been taken to heart by our rulers as well.

The writer is retired professor, School of Biotechnology, JNU