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Lockdown or not? Covid-19 raises key questions on decision-making in a democracy, like India

A pandemic such as Covid-19 also challenges the processes involved in decision-making and their prioritising in a democracy, like India.

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Is the coronavirus lockdown justified? One school of thought holds that any societal cost is worth paying to save a life. This seems sensible at first, but we do not honor this dictum in normal times, either in India or globally. We tolerate people dying for lack of resources, often on a mass scale, in developing countries.

A pandemic raises questions about the processes of decision-making and prioritising in a democracy, such as India.

Rough estimates suggest that India has at best a similar number of ventilators as does the United States, but it has four times the population. A high proportion of these ventilators were very likely being used already before the pandemic struck. Even if there is a massive increase in hospital capacity, the case for slowing the spread of Covid-19 in India must be centered on preventing serious illnesses rather than on ensuring the availability of ventilators by spreading their use over time.

But suppressing the virus temporarily may not prevent it from becoming widespread later. The absence of a vaccine coupled with the limitations of poor health infrastructure in India will make doing so challenging. Hence, a lockdown may be less successful than anticipated. Twenty one days is insufficient to ensure the exhaustion of the virus within households. Even with perfect compliance with the lockdown, it may well resume its spread, unless arrested by climatic or other factors (such as a vigorous mass testing and quarantine program, for which India presently has little capacity).

Also read: ‘Mishti essential for Bengalis’: After appeal to Mamata, sweet shops to run for 4 hrs daily

Need higher health spending

India’s average expenditure on health is far below that of other developing countries, showing it to be a relatively low governmental priority.

Health expenditure in India amounts to 3.7 per cent of the GDP, of which only around a quarter is government expenditure. This is substantially below the low- and middle- income country average of 5.4 per cent, of which nearly half comes from the government.

Moreover, those who die are often young.  This is one reason that India’s life expectancy of 68.5 years, despite rapid increases in recent years, is still 10 years less than in the US and 17 years less than in Spain. There were roughly 1 crore deaths in India in 2018 of which more than 12 per cent are attributable to air pollution. Nearly 7 per cent were caused by diarrheal diseases, 5 per cent by tuberculosis and more than 2 per cent by road injuries.

In each of these cases, there was considerable room for public policy efforts to reduce deaths further, through prevention as well as cure.

The risk of death, in particular from preventable diseases, is unevenly distributed by class, caste, region, and gender. But Covid-19, as a highly infectious disease, seems to threaten people, especially the elderly, of all classes. Some of the other causes of death are known to be disproportionately experienced by those who are poor or socially disadvantaged.

Also read: Italy on the verge of losing grip in south as fears of looting & riots amid lockdown grow

Lockdowns alone won’t do the job

Against this background, it is not easy to make full sense of the coronavirus lockdown. It’s not that we should not try to avoid premature deaths due to the current pandemic. But if we care so much about avoiding deaths, we should have done, and should do, a great deal more to avoid those that arise from other sources too.

The cost of installing a single ventilator to save a life in India is likely to be much higher than the cost of saving lives in other ways. This is not a reason for not installing ventilators, but for doing things that can save and extend lives in more ways, even in normal times. Planned increases in public expenditure on health can take India in the right direction. An improved health infrastructure would also help in the monitoring of, and response to, public health emergencies such as the coronavirus.

The lockdown-induced economic and social disruption will have consequences for health and well-being because restrictions on freedom of movement make it hard to maintain health programmes, to run schools, to ensure that people are nourished, or that they avoid domestic violence. A state that claims to value equally all lives, or years lived by different people, must express that commitment in its actions. It should do so at the least by designing measures to safeguard the public health which do not worsen it.

Also read: Modi tells Indian envoys to ‘mobilise’ funds for PM-CARES fund to tackle Covid-19

Lockdown implementation lacks foresight

The discrepancy between the stated aim of promoting the public health and its pursuit is stark. It is underlined by the implementation of measures, announced with apparent haste and decisiveness, which reveal a lack of foresight about the most basic issues.

The decision-makers appear to have paid little or no attention to the difficulty that people would face in maintaining livelihoods and gaining access to food. These sudden restrictions have triggered mass movements and brought about crowding in neighbourhoods, increasing the potential for disease transmission. They also appear to have overlooked the prospect that the police forces charged with enforcement of the ban would implement it with untargeted brutality, thereby themselves becoming a danger to the public health.

Prime Minister Narendra Modi’s declaration that no one needs to worry about the supply of food and adequacy of income, was belied by the reality that turning a market economy into a centrally planned one would take more than 21 days, even if it were a good idea. Many other countries that implemented a lockdown announced clear exceptions for essential services and allowed them to function much as before.

The avoidance of natural calamity, however desirable, cannot be a warrant for the creation of an avoidable societal calamity. Although countries are dealing with similar disruptions of supply and demand, caused by state responses to the pandemic, India’s action is perhaps the most draconian in the world, and its consequences perhaps the most perverse. Today, the Modi government must deal with a challenging situation created in part by its own conceit of power. Its actions have caused the entire society to live in a purgatory, between anarchy and totalitarianism, combining the worst of both worlds, even if for seemingly sound reasons.

Also read: China is good at many things, just not propaganda. This Covid-19 story about India proves it

Are we asking the right questions?

The pandemic does not merely demand an answer, but it also raises a question: What exactly is public health? Taking sensible decisions in the presence of deep uncertainty requires more than decisiveness. It requires rational evaluation of the difficult choices to be made. And in a democracy, it also demands efforts at justification, before and after the actions are taken, informed by different societal perspectives.

Whatever the trajectory of the disease, one should ask that choices made in the name of the public are justifiable to them, including the most vulnerable.

A pandemic is a rare instance that seems to call for a strong executive, even in a democracy, but it also brings to the fore its potential weaknesses. An informed, reasoned and robust public discussion of what is right to do, at each phase of the crisis, must take place.

The author is an Economist at the New School for Social Research, New York. Follow him on twitter @sanjaygreddy. Views are personal.

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  1. Lockdown is against law of freedom liberty movement democracy… It support dictatorship ?? And all this modi is doing ?? And there should be amendments in disaster management law , national security law , sec 188 sec 144 all are being misused?? There should be also no govt Powe to acquire public property or public power for national benefit ?? Are public their property?? A big no …

  2. I think and highly recommend that lockdown has to be lifted. Otherwise it will us, kill all the poor and low income people and who have no their own house, job and money. Government only about busy in promising but no food , no essential things, no money to buy provided. No rent is given, landlords ask people to vacate and go their homes. Transport also totally shut and dropped. People in India die of hunger, sickness and without money , job and freedom to move out !!! This is most damaging than anything in the world. Government should provide all free medical facility, food and awareness and maintain disciplene . That’s all what is required !!!!
    No brutality please !!!! Lift the lockdown , help the poor, unemployed and suffering to live peacefully.

  3. Analysis is great! We understood the problems with the current plan and its implementation. We will like to read an analysis answering what is the best way to manage the situation 1-Apr-2020 onward. The analysis should be realistic and should take into account our administrative capacity, human behaviour, psychology and societal context in the account while charting the action plan. It’s okay if you make mistakes in your plan. Media should debate with alternate plans and proposals.

  4. no matter what decision the government takes, some person sitting somewhere will find a reason for the government to not have done it. The only sensible thing in this article is yes, increase public health expenditure during normal times.

  5. I agree somethings went wrong (see following) due to centralization of powers with PM Modi.

    Coronavirus time lines in India in the year 2020
    1. January 30 First patient discovered
    2. January 31 WHO declares coronavirus health emergency
    3. February 5 Coronavirus: Window of opportunity to act as per WHO
    4. February 12 Starting on Feb 12 onwards (March 3, 5 etc.) opposition leaders are asking PM to prepare for tsunami of coronavirus
    5. March 11 WHO on officially declared the coronavirus a global pandemic.
    6. March 12 Reports first death due coronavirus
    7. March 19 Janata Curfew speech by PM Modi
    8. March 22 Janata curfew on March 22
    9. March 24 Total lockdown speech by PM Modi on March 24 at 8 pm Indian time
    10. March 25 Total Lockdown in India starts after 4 hours at midnight of March 25
    11. March 26 Finance minister announces a Rs 1.7 Lakh Crore Package
    12. March 28 Start of reverse mass migration of poor people to villages in Bharat due to poor package and being abandoned
    13. March 28 PM Modi’s govt minister playing antakshari & watching TV and asking rich & well-off Indians in cities to join them
    14. March 31 Frontline health workers still don’t have required personal protection equipment and not enough testing.

  6. E-commerce is stopped. This one reason is enough this party doesn’t care about people. I saw huge crowds in vegetable market. Then they closed vegetable markets, the vendors started put shop anywhere they can and it attracted crowd. Supermarkets were crowded and then they were asked to put circles where people can be distanced. Nobody bothered. The govt announced free ration and all the ration shops were crowded. All this could hav3 been stopped with allowing e-commerce but no, even though by papers it’s allowed the ground reality is all the major players are afraid of thugs system.

    First of all, this is a job for govt that’s how south Korea and japan overcame the virus. Testing, isolating, curing the patients. But that means it’s hard work so they chose easy task, asking public to be compliant so if they can’t contain the virus they can just blame that the public didn’t follow the rules. If it worked Modi would brag he did it. Just research japan and south Korea you will know it’s govt responsibility

  7. “Lockdowns alone won’t do the job”. Correct. Government should lock up all librandus whose minds are working like corona virus. Along with lockdown of ordinary people, librandus need special lockdown in Andaman and Nicobar.

  8. For me, President Trump in Washington, Dr Anthony Fauci by his side, Governor Andrew Cuomo in New York are three – actually only two – facets of this problem. One represents what we all know, the other two calm professionalism, reliance on the best solutions that science and familiarity with actual governance can produce. The US spends $ 3.6 trillion on healthcare, more than India’s GDP. It has gone from almost Nil to 1.64 lac cases in March, an exploding graph that began when China, the source, had pretty much got things under control. More than democracy vs authoritarianism, it is leadership styles and competence that will differentiate how countries deal with Covid 19.

    • You have forgotten that USA has manyfold librandus as compared to India. More a country has the population of librandus, higher and higher that country will have infection rate of Corona Virus as librandus are always the bottleneck for implement any administrative measures for mass controlling. All countries should immediately lock up librandus otherwise they will face uphill task to control the corona virus. As per my analogy if a country can control its librandus, it can easily control the Corona virus.

  9. How many more such articles from these ‘experts?’ Battling corona alone is not enough?

  10. If COVID-19 has a rate of transmission(R0) of 2.4 it will infect 60% of the population and probably 5% of the infected will require hospitalization. It does not then matter whether you have one ventilator or a million ventilators. No country in the world, however strong in primary medical care or poor in medical care will be able to handle it. So 21 days time is not to stock more ventilators, but to see how testing and tracing could be improved. Now better and cheaper tests are emerging. India has developed own test kit. Also, masks are emerging as a major factor to control the spread. In 21 days a lot of clarity on the pandemic will there and probably the lock-down can be lifted.

  11. Sitting in New York talking about India is new Elitism .From when did economist become epidemiologist ? Can’t you guys shut up and bother about the city you are living in?

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