However, the lockdown was a necessity. The keyword in the ongoing corona episode is social distancing. The virus spread through person-to-person contact, and the only way to limit its spread is to identify the people who got affected. With proper screening and lockdown of the affected person, the virus can be eradicated within 14 days.

The reason why South Korea is successful is because testing and isolation of the affected are done at a rapid speed. Latest figures from Our World in Data suggest as on 27 March 2020, South Korea tested 376961 people in comparison to Italy testing 394079, UK testing 113777, and the US testing 626633 people. However, on 1 March, Italy tested 21127, UK tested 11750, and the US tested 1129 people, in comparison to South Korea testing 96985 people. This points out to the importance of testing and isolation in controlling the spread. Italy, UK, and the US have learnt in a hard way.

In India, we do not have adequate number of testing kits. As on 27 March, India tested only 26798 people in spite of having a much higher population than UK, South Korea, and the US. One can assume India is under-reporting actual number of affected persons.

Neither other health infrastructures are in great shape. There are shortages of N-95 masks, ventilators, and other personal protective equipment (PPE) used by the doctors and health workers. India has 0.9 hospital beds and 0.7 doctors for every 1000 people, against the WHO mandate of 1.9 hospital beds and 1 doctor per 1000 population. Per-capita expenditure on health is less than $75 per year in comparison to $9536 for the US, and $4396 for the United Kingdom.

80% of the Out of Pocket expenditure (OOP) is on medicines. Few private sector players have launched insurance products related to coronavirus. However, the sum insured amount is low, around $575 and do not cover citizens above 65 years of age. Historically, the insurance coverage in India for both indoor and outdoor treatments continues to be narrow, despite the recent rise in the public-private partnerships (PPP) in health insurance, explaining why people have to rely on OOP. People meet their OOP – some 47% of the cost of hospital admissions in rural areas and 31% in urban areas – by borrowing and the sale of personal goods and assets.

Given the current state of affairs, the government allocating $2000 million funds in containing the spread of coronavirus may not be that enough. The policymakers are mindful about this and therefore the first-best solution, which is a 21 days nation-wide lockdown to implement social distancing and contain the spread of the virus.

Few other additional steps are necessary to make this successful.

1. Implementation: Lockdown should be universal and complete except for food, medicines, and other essential supplies. Instead of publicity-hungry politicians roaming the street and handing over the goodies, the army should step in to monitor the security and safety of the nation. Migrant laborers, unemployed people, and beggars should be broken down into small groups and given shelter and food in large convention halls, schools, parks, and stadiums. For this group the level of awareness is low, and economically they are the most vulnerable. India has 30.97 million metric tons of rice and 27.52 million metric tons of wheat, enough to feeds it population for a year. Each camp should have a medical center or clinic nearby to pick up cases as fast as possible. Alternatively, the places of residence of the migrant workers in their native areas should be identified, and the local district magistrate should be held accountable in case anyone breaks the rule of self-quarantine.

2. Screening: Given our huge population and stigma associated with coronavirus, there are instances of under-reporting. It is essential that central government make it mandatory for any person having upper respiratory tract infection, and history of travel undertake rapid tests for protective antibodies in a finger prick. This test is both cost effective, scalable, and can be used for initial screening. All the data can be collected via a mobile application. This data then can be analyzed by Artificial Intelligence to detect high-risk areas.

3. Profiling: High-risk areas should be tested first followed by universal screening to detect community spread. Once screened, areas can be demarcated into 3 zones red, orange and green depending on the number of positive cases. These zones will be transitional as the recovery rates increase with time. Localized travel and relaxation of lockdown can be done in the green zones whenever they attain that status. Drones can be used to monitor the zones.

4. Treatment: Hospital care will depend upon the initial triage of the patients. Hospitals should be separated into 3 categories - with ventilators and Intensive Care Units, without ventilators but high flow oxygen devices, and the ones with moderate care to quarantine patients only. Already railway coaches have been turned into isolation wards.

5. Infrastructure: Drug trials and vaccine development should be the priority of all biomedical companies. 3D printing of PPE should be done at all automobile and defense equipment manufacturing companies. At times, when there is a shortage of PPE, government should refrain to send these essential medical kits to other countries (read, Serbia). Instead, there should be a way to bring back API from China in larger quantities. Drugs manufacturing are drying up and many medical stores are running short of supply as the distributors are not able to reach the retailers. The supply chain involving medicine has to be up and running on a priority basis.

Lockdown was essential, however, given economic priority for the majority and also keeping in mind the importance of social distancing lockdown has to be eased out in a phased manner. Innovative awareness spread such as telecasting movies, in the likes of Contagion, may be more effective in building the awareness. The government may also want to put aside some big ticket purchase deal, such as Rafale, to meet the immediate fiscal requirement. (IPA Service)