Our research estimates that India has approximately 19 lakh hospital beds, 95,000 ICU beds, and 48,000 ventilators. Most of these facilities are concentrated in a few states and cities. (Express Photo by Prashant Nadkar)

India is confronting two simultaneous crises. An economic crisis destroying our livelihoods and a health crisis which threatens our lives. The twin crises are deeply intertwined — our economy cannot be reopened without credibly addressing fears of infection and resurgence. The health crisis caused an economic crisis because people do not consume, work, or invest when there is visceral fear. Despite repeated assurances from governments, the unabated reverse exodus of migrants to their homes in the eastern states signals the fear and uncertainty that has gripped the nation. The immediate reaction of the government, an extended national lockdown, has been extremely successful in slowing the growth of the virus. However, we are yet to “flatten the curve” — that is reach the peak beyond which active cases decline steadily and total number of cases flatten with strong recoveries. It is also important to note that “flattening the curve”, doesn’t make the virus go away. There remain high chances of resurgence, as seen in Germany, South Korea and, more ominously, in Iran. We must, therefore, now shift to a plan that balances the need to protect our health and reopen our economy by locking down only those who are infectious.

This article presents a simple, scalable, and credible solution. One, introduce a comprehensive “test and isolate” policy across the country. Two, build testing laboratories in all 7,000 blocks across the country and three, build dedicated infectious diseases wards in every district hospital across the country. This will make it safe for Indians to return to work and help in keeping the infection rate below 0.5 per cent of the population (currently it is 0.007 per cent). Until a vaccine is developed and deployed, the simplest and safest path to this outcome is a national COVID management strategy of isolation combined with contact tracing and testing. This strategy is far less disruptive and cost-effective than our current policy. It does not rely on any technological breakthroughs and will work even in the worst-case scenario. This provides a roadmap for a future in which Indian citizens are confident that their health and the economy’s future are protected against the virus, and from future pandemics. It is the fastest path to an economic revival because it is the simplest and safest path. A strong commitment from the Centre to provide resources has already been signalled by the finance minister in her last stimulus announcement.

The solution outlined above is of long-term strategic interest, beyond the current virus outbreak, since infectious diseases are a major killer in India even in normal times. Tuberculosis alone accounts for over 4,00,000 deaths every year in the country. Let us look at required investments into different components of this COVID management strategy.

Our research estimates that India has approximately 19 lakh hospital beds, 95,000 ICU beds, and 48,000 ventilators. Most of these facilities are concentrated in a few states and cities. How can we optimise the scarce resource across states as the infection spreads eastwards and to rural areas? A critical piece in our public health architecture is the urgent upgradation of health and wellness centres (HWCs). This is an efficient gate-keeping mechanism for COVID management. These HWCs become points for early detection, contact tracing and testing of COVID cases. We estimate this expense to be Rs 30,000 crore.

We have to proactively adopt the following steps to overcome this pandemic and minimise its spread. One, testing: If all states were to match the testing rate of Tamil Nadu, it would allow us to cover 5 per cent of the population (7 crore tests/year) at a cost of Rs 21,000 crore (at Rs 3,000/test). Testing is critical to the detection and containment of the virus. Two, contact tracing: The most sustainable and effective way to scale up contact tracing and surveillance (besides using district police) would be to hire and train additional ASHA workers. India could double the number of ASHA workers for Rs 10,000 crore/year. Three, quarantine: Clean, safe and adequate isolation facilities are critical to managing this pandemic. This is particularly relevant for people living in high density housing. If an estimated 2.5 per cent of the population were to be kept in isolation for two weeks and some compensation was paid to the poor for involved income loss, this would cost Rs 30,000 crore. Four, masks for all: The government could make abundant masks available to the general population and incentivise firms to provide masks to its employees through tax subsidies. This would cost Rs10,000 crore.

The creation of public diagnostic labs at every block level has been announced by the finance minister in the final tranche of the economic package last week. It is important to keep in mind that approximately 1,00,000 diagnostic laboratories, which include pathology laboratories and radiology centres exist in India. Developing an efficient public-private-partnership model could be the way ahead to tide us over the current crisis and leverage the existing infrastructure at local levels. Blocks that do not currently have any labs should be prioritised for the creation of government labs.

Put together, these investments would cost around one lakh crore a year and will allow us to implement a COVID management model across the country. Since each week of the lockdown costs Rs 200,000 crore, these investments are obviously worthwhile. Right now, it may be difficult to envision a date when the number of infections drops to very low. Easing containment policies without a viable alternative like “test and isolate” in place would resume the exponential growth of the virus and very likely bring us back to our current situation. The strategy, once implemented, must continue for the next 18-24 months or until a vaccine is widely available.

Fear is driving a significant part of the current economic downturn. This includes fear for our own health as well as the uncertainty of future lockdowns. Our policy must be simple and feasible enough to instil confidence among people that the health crisis is being effectively managed by all tiers of the government along with the business and health communities, and that its implementation will prevent additional economic losses.

The writer is a former member of the Prime Minister’s Economic Advisory Council