How Do We Solve a Problem Like Corona

Feedback from those who responded to my last blog, “COVID Lockdown; India’s Biggest Economic Blunder”, was on expected lines. All, without exception, felt that lives were far more important than the economy and it was correct for the government to prefer a save lives approach to a save economy approach. I wish to clarify that it is not my opinion that lives be sacrificed to save the economy, both are precious and need to be saved.

There have been many communicable diseases in the past, some with significantly higher rates of fatalities than Covid-19, and our response to them has been muted. For the first time, in the last 75 years, we are responding to an outbreak of a communicable disease with a great sense of foreboding. Genesis of the COVID panic can be traced back to China’s handling of the epidemic breakout in Wuhan and to the several mathematical projections, predicting millions of deaths, that emerged from various corners of the Globe.

China was the first to panic: When China sets its mind on something it goes into mission mode and nothing, least of all “trifling” concepts such as human rights, citizen’s freedoms and individual suffering, can make it dither …and so it was with the Novel Corona virus breakout in Wuhan. The aggression in approach and the extreme restrictions it imposed conveyed an impression that Corona was deadly.

Whatever the holy books may lead you to believe, life is precious and once lost, cannot be resurrected. However, life is not cheap. We are routinely forced to choose between what we want and what we can afford. Sadly, it is true with life too. We may be reluctant to acknowledge it, but each one of is willing to spend that much and no more to keep a life going.

Whatever the stock market rallies over the past 2 weeks may lead you to believe, the economy is in big trouble and needs all the stimulus that is possible. While most Asian countries’ GDPs are expected to grow between 1% to 2.8%, and that includes our neighbours Bangladesh, Sri Lanka and Nepal, India’s GDP is projected to contract by 3.2%.

The implication of a contracting economy, without getting into numbers, is a fall in demand resulting in lower tax revenues to the government, lower profits or higher losses to the private sector, job losses to the common man, slow down or stagnation in fresh investments, increase in banking sector NPAs, lower offtake of credit, fall in interest rates, erosion of savings, etc.

How much is a life worth? Consider the following hypothetical situation. A member of the family suffers from a rare form of cancer. Experimental drugs in the West have shown remarkable results with 100% of the cancers treated going into remission. The drugs are still experimental, are not mass manufactured and therefore the entire treatment costs about Rs. 50 crores. A few hospitals in India offer treatment for this form of cancer. The results are less promising as compared to the West. In about 50% of cases they have been able to stem the growth. The Indian treatment is 98% cheaper at just Rs. 1 crore.

What course of treatment would these people choose?

  • A. Family is amongst the 100 richest families in India.
  • B. Family is upper middle class and well to do.
  • C. Family, with home and car loans, has an annual income of Rs. 15 lakhs.

Family A will spend Rs. 50 crores, without blinking an eye. Family C will probably opt for palliative care as even Rs. 1 crore is way above what they can afford. Only family B has a decision on their hands. If, the 5 acre farm, the luxury apartment, the 20,000 sq. ft. commercial space generating an handsome monthly rental and the Rs. 5 crore portfolio comprising of blue-chip stocks are all disposed off, they could raise the Rs. 50 crores required for the treatment. They would still retain their 4 bedrooms house and business. What treatment would family B opt for?

Individuals don’t always get to put life ahead of livelihood. Our decisions are often a battle between the heart and the mind. Whatever be our decision, we are most definitely going to be left carrying emotional baggage for the rest of our lives. A fine balance between life and livelihood is not easily achieved by individuals. An engineer, on the other hand, can set aside emotions and apply the principles of Operations Research to arrive at a quantitative basis for making complex decisions. Complex mathematics involving data are not for all so, we’ll keep it simple and fallback upon good old common sense to answer the question, how do we solve a problem like Corona?

Define our goal: Our goal is to minimise the loss of lives. No known cure or vaccines are available as on date and the government deployed the only weapon it believed it had in its arsenal, lockdowns. Since 25th March we went through 4 phases of lockdowns, with the first two being severe and total and the latter two offering some relaxations.

The lockdowns kept us indoors and business shut. Normal way of life was denied to all of us. Plans, some made months ago, had to be cancelled. People had to even delay elective surgeries and treatment of chronic ailments. To understand the actual impact of a lockdown on saving lives, we have to consider not only loss of lives directly attributable to Corona but, also increase in fatalities due to restrictions on movement due to the lockdown.   

Diagnostic Labs are shut: Diagnostic labs across the country remained shut. About 3,200 cancers are diagnosed daily. This means in 70 days we would have failed to diagnose around 2,25,000 new cancer cases. As we all know, cancer is curable if diagnosed and treated early. The lockdown has possibly endangered thousands of cancer patients. Not only cancers but, several other ailments too remain undetected as a result of the lockdown.

Hospitals shut too: Hospitals too witnessed near zero footfalls in the past 70 days. Doctors did not show at hospitals. Some doctors consulted over the phone or video calls. Patients too delayed visits to the hospital for fear of contracting the virus. In short, medical care was either not available or refused, by the patients themselves, during the 70 days of lockdown.

Lack of timely medical care and ambulance services to swiftly shift patients to hospitals will result increase in other causes of death. Currently, data on how many daily non COVID deaths took place during the 70 days lockdown is unavailable for India.  New York too was subjected a very severe lockdown, similar to the one in India. Data for New York city is available on the CDC website. As per the figures released for New York, there is a massive 31% increase in average number of deaths due to non COVID reasons during the period of the lockdown. We will not be entirely wrong to assume a similar phenomenon of increase in non COVID deaths happened in India too.

Around 25 lakh persons die of heart attack alone in India every year. The 70 days average for heart attack deaths would be 4.85 lakhs. 31% of that is, yes 1.5 lakhs. It can be argued that India has a younger population and better immunity and so on. It can further be argued that since for COVID was not 100%, some the 31% could include COVID related deaths too. Even if we are to take a lower number, say 5%, the incremental deaths due to denied medical facilities is 10 times the number of COVID deaths.

In 2017, figures for later years are not released as yet, 34% of Indians die due lack of medical care (please see chart below) largely because the facilities are either not available or beyond the reach of the poor. A majority of the patients who die without medical care would have suffered a heart attack, brain stroke or pregnancy related problems. According to experts, many people die due to lack of minor surgeries (Bell weather surgeries). A Lancet commission report says the deaths due to lack of access to medical care surpasses the number of deaths due to AIDS, Malaria and Tuberculosis. The lockdown has only succeeded in denying medical care to the middle class with health insurance too.

Across the board loss of jobs is most likely to push more people back into poverty. In the next 6 to 12 months, hunger and debt related deaths will show an increasing trend. Not just the poorest families, the middle class too will be under tremendous stress to meet their home and vehicle loan commitments sans a regular monthly pay-check.

The most fundamental question of all is, did the lockdown reduce COVID related deaths? From 25th March to 31st May we witnessed a steady increase of number of positive cases from 571 to 190,648. In the last 10 days we have added another 96,507 cases. The lockdown may have slowed rate of spread of the virus but failed to arrest it. It has not lowered the COVID peak but delayed by 2 months, right into the middle of the monsoon season.

The annual monsoon brings with it several diseases such as Malaria, Diarrhoea, Dengue, Chikungunya, viral fevers, Cholera and Typhoid. Even in the good old pre-COVID days, hospitals were pushed to capacity between July and October. The monsoon season is possibly the worst time to experience the COVID peak. With 50,000 new infections per day, both COVID and non COVID, we are sure to run out of hospitals beds. We also run the serious risk of cross infections, increasing the fatality of patients.

Lockdown has achieved the exact opposite of it was supposed to. More lives will be lost because of the lockdowns than would have been lost if the virus was allowed to run its natural course. The damage to the economy will take 2 to 3 years to repair. The one positive outcome of the lockdowns is that people have become aware, at huge personal cost to themselves and the nation, of the precautions they must take to reduce their risk of exposure.

A word on the title. You would have noticed that the title is a take on the popular song How Do You Solve a Problem like Maria from the film, The Sound of Music. There is a reason I chose this title. In the film, there is no problem with Maria, she did very well at the Von Trapp household. The problem was with the expectations the Church had of her. So, it is I feel with Corona and COVID. By locking ourselves at home and expecting the virus to go away, which it naturally refused to do, we have made a huge monster out of it. Treat it as a communicable disease with a low fatality rate, nothing more, nothing less. Test extensively, protect the most vulnerable, quarantine the infected, make available affordable ICU and ventilator support for those who need it and allow the healthy to get on with their lives.