Coronavirus: Why it is better for India (and you) to overreact now than regret it later

Compared to the immense spread and high casualty count due to coronavirus in many parts of the world, India currently seems relatively fortunate. As of Friday, the country had fewer that 80 cases and just one death due to Covid-19, the disease caused by the new coronavirus that has seen more than 120,000 cases confirmed world wide and more than 4,500 deaths.

India’s lower numbers are causing many to claim that the country will weather this storm, offering untested claims about Indians having better immunity or an unexplained history of faring better when it comes to flu viruses. Some people are convinced that the calls for excessive caution – canceling travel, limiting crowds, prohibiting large-scale spectator sports – are just the product of paranoia.

Drastic measures

Yet despite these beliefs, India has taken some drastic measures.

Earlier this week, it suspended all visas for foreigners traveling to the country for an entire month, with a few exceptions. The travel ban was even extended to those who hold Overseas Citizen of India cards, who can normally travel to India without visas. As several newspapers put it, India was placing itself in quarantine.

Meanwhile, a number of states have declared coronavirus an epidemic, a policy move that gives governments power to take stronger action to prevent the spread of the disease.

Delhi, for example, has ordered all schools, universities and movie theaters shut and banned all big events, conferences and sports gatherings until the end of the month. The state of Kerala had done the same earlier, with the government even assuring individuals that mid-day meals – a daily free provision of food given to students at government schools – would be home-delivered so that family budgets are not suddenly upended.

These moves are enormously disruptive. Shutting India off to foreigners for a whole month will have a tremendous economic impact. Keeping students at home and canceling major events will also hit local economies. The government will have to figure out how to address these problems.

Stop the spread

Yet there is a simple idea behind such efforts: the new coronavirus seems to spread very easily.

Italy went from around 10 cases to 10,000 in less than 20 days. It is not an outlier. Countries as far apart as Iran, South Korea and Spain seem to follow the same trajectory, with cases spiking in the matter of days.

However, as the chart below from the Financial Times shows, there have been some exceptions.

Researchers at the University of Southampton have put out some of the earliest scholarly work looking at how the virus spread, and what measures have worked. The research, which has yet to be peer-reviewed, looked at three major policy interventions and what effect they had on the spread of Covid-19.

“Sophisticated modelling of the outbreak suggests that China had 114,325 cases by the end of February 2020, a figure that would have been 67 times higher without interventions such as early detection, isolation of the infected, and travel restrictions,” said the Guardian’s report on the study. “But if the interventions could have been brought in a week earlier, 66% fewer people would have been infected, the analysis found.”

Social distancing

Of the interventions, the most impactful was early detection and isolation of cases. India appears to have focused on tracing all those who arrived in the country from places where there have been outbreaks, as well as those they may have been in touch with.

Questions have been asked about whether India has been testing enough for cases to be detected quickly, and whether the approach to testing has been too focused on only those with a travel history. But at least the policy on this is clear.

The next most successful intervention is social distancing.

That is the idea that societies need to work to limiting the number of contacts people have with each other, so as to prevent the easy spread of the disease. Crucially, these efforts – which would involve cutting down on going to restaurants or shops, working from home if possible, canceling family get-togethers, postponing holidays and staying away from crowded places in general – have to happen before the epidemic feels like one.

Indeed, it is the sort of policy that can easily be labeled paranoia because it is meant to be carried out early, even though the Indian government claims that there have been no cases of “community transmission”, i.e. cases where there is no contact with someone who traveled to an infected part of the world.

Why should you practice social distancing?

First, you don’t know if you have Covid-19

Its symptoms are the same as the common cold, and you may well be infected without showing any symptoms. Several researchers have estimated that 40%-70% of the world’s population will eventually be infected. That might be fine if you are not elderly or at risk because of a pre-existing condition. But if you ignore your infection, you risk spreading the disease to someone who is vulnerable – parents, grandparents, elderly neighbours or diabetic friends.

Second, don’t panic, but don’t be complacent

It is true that Covid-19 will be like a common flu for the vast majority of those who get it. As has been pointed out, the mortality rate is only about 3.4%. But think of what that number means for a place like India – millions and millions of people dead, if a large section of the population gets infected.

Moreover, it is important to remember that there is a midway point between “just a cold” and “dead because of coronavirus”. That midway could potentially be tens of thousands who are sick and need treatment in a hospital, and could apply to any one of us, not just those who are most vulnerable. At times like that we will need access to good healthcare.

If everyone gets the disease at the same time, where will you go?

India has just 2.3 critical care beds per 100,000 people, according to a paper in the Critical Care Medicine journal, compared to 12.5 in Italy (which is currently being overrun by the disease) and 10.6 in South Korea, where authorities had to take unprecedented measures to bring situation under control. Iran, another country struggling to handle the virus, has double India’s capacity per person.

This is where social distancing comes in. The idea is not to panic, but to take pragmatic measures that could slow down the spread of the virus.

The policy has been boiled down to a simple concept, based on an easy-to-understand graph: #FlattenTheCurve.

If enough people stay apart, they can slow down the spread of the virus even before cases spike massively, and so reduce the burden on the healthcare system. People are despearately calling for such actions in countries like the United States and Australia, where the healthcare capacity far exceeds India’s.

Practicing social distancing may be much harder in India than it is in some of those places too. Many of us live in joint families or in extremely dense neighbourhoods, travel on public transport and have people from outside working in or around our houses.

Cancel everything

But it is folly to believe that we can just go about as before, when there is a virus out there that has infected people in 100 countries and cause a huge number of casualties. As one writer put it, we need to cancel everything.

Work from home if you can. Go to the markets when there are likely to be fewer people there. Stock up, particularly on dry rations, soap and sanitiser. If you can afford it, give your household workers an extra allowance so they don’t have to use public transport to reach your place. Tip businesses that you might have to avoid for a while if you are social distancing. Remember that if your idea of distancing involves relying on delivery personnel, they are the ones who are taking the risk on your behalf. Consider these do’s and dont’s of distancing.

Think of others. Tell your neighbours about the importance of hand washing and social distancing. Remind your family, particularly the elderly, about the need to stay away from crowds. Ensure everyone around you knows what they need to do if they feel unwell. (All government information is here) Don’t believe in random forwards on WhatsApp. Verify information before you pass it along to WhatsApp groups.

Remember that there are social impacts to distancing also. Find ways to mitigate the loneliness that may come from distancing.

If all of these sound like prescriptions from a post-apocalyptic Hollywood movie, remember the idea is to prevent that from coming about.

“I was pretty annoyed when school was canceled here for several weeks,” wrote Ben Thompson, an analyst who lives in Taiwan, this week. “Now Taiwan is being praised for its uber-aggressive response. Indeed, when we look all over the world, there is no country that regrets their overreaction, and plenty that regret not acting soon enough.”