01 Aug Coronavirus: An Interim Verdict
By Anjum Altaf
While the pandemic has months to run, enough time has passed since its inception to render an interim judgement on its management in Pakistan and India. Despite giving the governments as much benefit of doubt as I possibly can, I am afraid I have to assign both a failing grade. The governments would no doubt contest this award so let me justify my verdict.
As always, the proof of the pudding is in the eating so let us look at the actual situation at this time. Both countries are reporting the highest number of deaths per day to date — Pakistan over a 100 and India close to 400. Despite everything they have thrown at it, the graph of new cases continues to rise and their number exceeds the number of new recoveries so the load on hospitals continues to grow. Unlike most other countries, where the outbreak was much more severe, the curve of new cases in India and Pakistan has not even flattened let alone reversed which is the only real marker of success.
Despite what the governments might say, this is the stark reality and if only more people in each country could read charts, the failing grade would need little further justification. In fact, this inability of the majority to make sense of charts is the real failure in both countries for which all their governments are responsible. This failure makes dealing with the pandemic a lot more difficult than it should be otherwise.
But let’s begin from the beginning. Both countries were late in closing their borders and in adequately screening arrivals there and at airports after news of the epidemic broke in January. Both then imposed lockdowns around March 24 when the number of deaths were less than ten. One can give them the benefit of doubt for this intervention based on the state of knowledge at that time. The epidemic had ripped through Wuhan, Milan, and New York and there was genuine fear it might do the same in South Asia. Thus the first reaction to hit the brakes hard could be justified especially given the political risk of being accused ex-post of not doing enough.
But very early on, it became clear that the behaviour of the infection was quite different in South Asia than elsewhere with its spread being much slower. The one big factor on which there was near consensus was that fatalities in the badly-hit locations were overwhelmingly concentrated in people above the age of eighty. It also became known that a lot of deaths were occurring in old people’s homes run on a for-profit basis. And finally, from the US it emerged that ethnic minorities with a history of deprivation were disproportionately affected.
None of these conditions applied to South Asia in quite the same way so there was need to review the decision to impose the total lockdowns. To do so, the lockdown needed to be disaggregated into two distinct components: closure of activities where large numbers of people could assemble together (e.g., colleges, stadiums, etc.) and the stay-at-home orders. While the first was manageable with some adjustments, the latter was completely infeasible in India and Pakistan. This was made obvious in India by the terrible uprooting of millions of migrant workers and in Pakistan by the population’s rejection of the component and its non-enforcement by the authorities.
The stay-at-home component revealed a startling lack of awareness on the part of the authorities of the reality of life in their countries. There was simply no ability to feed the households who were asked to lock themselves up nor the ability to transfer cash into their accounts to enable them to buy essentials needed to survive. It was only the fortuitous inability to implement the component that saved Pakistan from the humanitarian disaster that occurred in India.
This inability to think for themselves and the knee-jerk copying of a measure that was not at all sustainable in their countries contributes largely to the award of the failing grade. In academic parlance this would fall in the category of mindless plagiarism. Even the contention that the stay-at-home measure slowed the spread of infections is not borne out because there is hardly any difference in the pattern of spread in the two countries one of which implemented it very stringently and the other where it was completely absent. And even if the pace has been slowed, the harsh fact is that the number of cases continues growing. Even with a doubling rate of 15 days, the numbers mount fairly quickly. Pakistan now has about 125,000 cases, India 310,000; both exceed China where the total is 83,000 despite much more explosive growth at the outset.
Both Pakistan and India are now faced with a situation they are unable to defend. While most countries are relaxing lockdowns after the spread of the virus has been contained, Pakistan and India are doing so while the infections and deaths per day are recording ever higher numbers. This is a clear indicator that their response strategies have failed and giving the reversal fancy names like smart lockdowns or holistic approaches cannot mask the failure. In essence, there is now no strategy left to contain the virus.
Given the fragile nature of economies in which the vast majority of workers were employed in the informal sector and survived on what they earned that day, even the first component of the lockdown needed to have been more nuanced. Many schools and factories could have been reopened on a two-day-a-week rotation with adequate physical distancing and many places could have been given the incentive to become COVID-ready in order to be allowed to resume operations. For example, private construction in which workers are in any case separated from each other, could have continued with minimal adjustments enabling a very large number of people to continue earning their living.
Pakistan, but not India, would also get a failing grade on communications and management. The mixed messages, the waffling, the many spokespersons with little credibility, the number of decisionmakers with no domain knowledge, and the blatant political in-fighting, left the population completely confused about the seriousness of the problem and open to bizarre conspiracy theories. This debacle was made worse by the capitulation to clerics, the permission to allow Eid shopping, the long Eid holidays when people went home, and limiting the hours when shops could remain open instead of extending them to thin crowds. After all these oversights, to tell the people it was their responsibility to deal with the virus was the unkindest cut of all and an abdication of the trust reposed in a government by the people.
What was doable in India and Pakistan were the most low-cost measures that had a reasonable chance of acceptance — universal adoption of masks, frequent hand-washing, and physical distancing, where possible. Ignoring what was doable in favour of what much better endowed countries were doing when faced with runaway infections was a serious error of judgement.
The mistake that both India and Pakistan made was to fall into the trap of believing that the lockdown was a solution to the problem and entertaining the naive hope that the infection would somehow go away if the lockdowns were extended long enough. There was no basis for such a presumption; in fact, it was known from day one that a successful lockdown was only going to buy time to prepare for the inevitable load of infections and that time had to be used intelligently to do the other things that were needed to root out the virus. These included screening, testing, tracing, quarantining, and isolation, something that was quite feasible when the number of cases were very small and all coming from outside the country. The same task is well-nigh impossible now that the infection has spread within communities and travelled all over the country in trains and buses.
This mistake was compounded by turning the policy debate into one of lives versus livelihoods and taking a moral stance on the value of lives. In actuality, in countries like India and Pakistan, it was always going to be a case of lives versus lives, an assessment of whether more lives were to be lost to the virus or to the collateral damage caused by the policy response to it. In fact, this is what people were saying had anyone been listening: “We are not afraid of dying of the virus because we are going to die of something else anyway.” In Pakistan, there grew a great fear among people of going to hospitals even for non-COVID ailments out of concern of what might happen to them if they were tested and found positive or if they would be allowed proper burials if they died. There is still the real danger that excess non-COVID deaths caused by inattention and lack of medical care might exceed the deaths by COVID which are reportedly only of the order of 2,500 in Pakistan and 9,000 in India at this time.
Neither country employed the very simple and low-cost check of tracking excess deaths in a representative sample of urban graveyards and crematoria. Nor was this data made publicly available for use by analysts to provide an independent indicator of the impact of the pandemic. Anecdotal reports from India suggest a fair number of excess deaths in Mumbai and Delhi over comparable periods in previous years while none have been reported in Pakistan thus far. Had the reports from Pakistan been confirmed it would have supported the hypothesis that even if the prevalence of infections was high, most of those infected were recovering on their own. This would have allowed an intelligent re-orientation of the response strategy.
The optimistic scenarios now being offered by the governments that the infections would peak in July-August are just that. One cannot identify any measures in place that would effectively flatten the curve or reverse it. All talk of smart lockdowns etc. is just facesaving. The fact that both countries used up their most potent weapon right at the beginning and are being forced to relax the lockdowns now when the cases are mounting is an acknowledgement of policy failure. This does not mean that a return to total lockdowns is what is called for — that was an inappropriate policy response from the beginning and remains so now.
Despite all the uncertainty that remains, what seems most likely is that both countries are likely to see the worst case scenario that would have unfolded if nothing much had been done and that the pandemic would burn itself out when the threshold, whatever it is, for herd immunity is crossed. At best, the very stringent lockdown might have averted deaths of the order of 30,000 according to the most credible modelling exercise in India but the cost that the poor have had to pay for this gain has been extraordinarily high. And it is quite likely that in the final reckoning the excess non-COVID deaths might be more than the number of deaths averted.
Pakistan has been burdened with incompetent governments virtually throughout its history but it has taken an external shock of this magnitude to drive home the reality of the price that has to be paid for poor governance. This was a situation requiring real-time adjustments to policy as fresh evidence accumulated and new information became available almost by the day. Instead, there was a leaden-footed response by people lacking a scientific mindset and more attuned to scoring points and praying for divine interventions. India is less unfortunate in this regard but its governments are equally uncaring about the welfare of the poor and the present government’s preference for grand surprises illustrated by actions like demonetization and lockdown without notice have ended up inflicting very similar pain on its most vulnerable citizens.
This opinion was published in The News on Sunday on June 14, 2020 and is cross-posted here with the author’s permission. The writer was the Dean of the School of Humanities and Social Sciences at LUMS.