To lockdown or not to lockdown is the big question

Discussions on a lockdown exit strategy have started as we approach the last week of the 21-day national lockdown. Politicians, health experts and administrators are discussing whether to extend the lockdown, continue in ‘hotspot’ areas, give breaks between lockdowns or lift it in a staggered manner. There are no easy solutions. We need to let science and data guide our actions instead of political expediency. It does not make sense to lift the lockdown when testing is not yet available widely.

It should also not be lifted if the count keeps increasing daily, and our health system’s preparedness is inadequate. Lifting it early might open us to rapid rebound of infection. Future lockdowns should be guided by “Start where you are, Use what you have, Do what you can” triumvirate. Decentralisation is key because it does not make sense for a whole state or a large part of the state to go into lockdown when cases are coming from one district.

Start where you are Factoring in population, growth rate and other assumptions, COVID models provide an estimated number of ICU beds or ventilators needed. We could flip the equation and begin with how many ICU beds and ventilators are available and then extrapolate it with the number of serious COVID-19 cases the district can handle.

Use what you can If testing is not available widely or if the results have a long turnaround time, it might be wise to come up with a case definition for syndromic surveillance.

Do what you can Use data on new cases to build a simple mathematical tool to project future cases. The administration should have a data lag of 14 days, that is, once a lockdown is initiated, the remaining bed capacity should last next 14 days. From ICMR, MOHFW and state health authorities, try to get data. Reduce lockdown uncertainty by fixing the duration beforehand, so that people can stock up.

Create an easy-to-understand dashboard and publish it through SMS, WhatsApp, social media, websites and billboards. There is a Kannada adage ‘Hasige idashtu kalu chachu’ which translates to ‘Stretch your leg to the size of bed’ that is live within your means. For COVID-19, we might adapt it to stretch the epidemic to match the health system’s capacity. Dr Manjunath Shankar is a public health specialist. He participated in the US CDC Emergency Response (Modelling Task Force) to the West African Ebola outbreak in 2014-15. Dr Anant Bhan is a researcher in global health, bioethics and health policy.