Trade-off between COVID-19 & the lockdown

It has been more than a month since the government enforced lockdown amidst the COVID-19 crisis. To begin with, any sensible person would have understood that dealing with the crisis in Indian context would be complex and will need stringent measures as opposed to those taken by western world. It was pretty evident by the end of February that the virus strain has reached India and we are lagging by 2 weeks on how the virus has spread in other countries. In such a scenario it is obvious that we will consider the response of western world as a benchmark to judge our efforts. However, during each such comparison we miss out on where Indian stands vis-à-vis western world in term of medical infrastructure and health capacity.

The response each country was dependent a trade-off between the population, capacity of healthcare system and obviously the market and economic impact that a decision may cause.

Does high number of cases in western world reflects poor response of government?

Numbers are one of the basic yardstick we often use to determine success and failure of a system. We have been conditioned to think in that manner. But numbers cannot be compared absolutely without involving intricacies of context in which those numbers make sense. The other argument is that the high number of cases are attributed to the lockdown measure which the western world did not take or took too late. Let us look at these scenarios.

As far as the high number of cases in western world is considered we need to look at how the healthcare system functions.

Medical Infrastructure –

The number of doctors per thousand people in United States is 2.6 whereas the number comes down to 0.8 for India. That simply translates to USA can afford to give attention to at least three times more patients than India.

Another fact is that healthcare system in India is majorly privately owned. Even if you are poor, you would want to get treated in a private hospital. As we all know, the private system runs on profits and incentives. The number of beds in a private hospital are always kept at an optimal numbers depending upon the demand in the market. Thus, they have already be running at a near full capacity. The situation of government hospitals is even more dismal and they have been running beyond their capacity. There are instances of people coming to the All India Institute of Medical Sciences in Delhi, they just want to get treated there even if they have to bring their own beds and sleep on roads. The mentioned situation is about the general ailments. Now look at the nature of illness caused by COVID-19. It causes respiratory issues and the extreme cases where people need hospitalization because of the disease (this is different from being quarantined) are to be kept on ventilators. India has a meager 40,000 ventilators. To manufacture new ventilators we are dependent on imports. In contrast, USA has no such constraint of imports to ramp up the ventilator manufacturing. Another factor that will enable to afford to get high people infected and treated.

While aforementioned points about state capacity there is a side story about how the western country was first hit and had not the time to understand how the epidemic will play out. We, on the other hand, had examples of the western world and their response to the pandemic. We were two weeks behind on the curve and we understood that we cannot afford to get people infected considering our state capacity. The number of tests being done and the number of cases reported is another aspect that one can consider. The number of testing kits available is also a matter of state capacity and how much of the population can afford the test and whether it is government’s responsibility to subsidize the tests is another argument that can be put forth.

Population always remains a bottleneck in case of most of the problems our nation is grappling with. While more population density means the disease will spread at a much faster rate in India than it would have in any other country.

The Trade off

As mentioned in the beginning, the response of each state was based on the trade-off between health of people and the economic health of the nation. It is evident that how lockdown has affected varied group of people from students to migrant labors. Since the USA and other developed countries can afford to take care of more of their population thus they can afford to get more population infected than India and keep the economic activity running. All of the world’s choices are related to economics. While USA could afford to keep it’s economy functioning for a longer duration while using rapid testing and isolation as the key to tackle pandemic. India had no other option to shutdown the economic activity and lockdown people to tackle the spread of disease. The consequences of different types of response will only be revealed in time.