Showing posts with label Social Distancing. Show all posts
Showing posts with label Social Distancing. Show all posts

Thursday, April 9, 2020

Lock-Down is Shock Therapy: Move to Next Stage


   Lock-Down is shock Therapy. It has served its purpose if use the time to prepare for alternatives which meet the Objective and Goals for which it was introduced.  Our Objective is to Slow the transmission of SARS Corona Virus 2. The Goal is to Reduce Contact between potential carriers and the uninfected. The key question is how to do this at least cost to the public? This requires us to understand what has worked and not worked Globally, but also our own special conditions and limitations.
     Comprehensive testing of population in a large, poor country is impossible. Ideally, all those with suspicious symptoms and clinical appraisal by the local doctor/clinic, would isolate themselves at home and those with international travel history or contacts with same would be tested & those confirmed as infected, be isolated in special facilities.  This has not worked even for those who seem too have brought the virus from abroad through air/sea travel to and from India (Indian & foreigners). Therefore, home isolation must be made more stringent through use of mobile Apps or GPS enabled electronic wrist bands/anklets. International travel & tourism must be banned till the Pandemic has passed world-wide. Domestic travel for tourist purposes will also have to be controlled till Epidemic has passed in India.
      Wearing of Masks (even home-made ones) helps reduce transmission of virus from infected persons and must be made compulsory for 3-6 months. It must be encouraged even inside the home if there are suspected cases of Corona Virus Infection in the family and for those coming into the home from outside. Hand washing with soap has been recognized and accepted as a method for slowing transmission.  Free distribution of soap and washable, triple layered, cloth, masks can help promote their use by the relatively less well-off sections of society.
    Socio-Spatial (Social) Distancing is a critical measure for slowing transmission while engaging in essential economic activities. With exception of factories and workplaces, no gathering of more than four adults must be allowed till the Virus has been tamed. This includes religious gatherings, festivals, celebrations, conferences, seminars and private parties in restaurants, hotels or homes. Consumer Activities in which more than four adults are normally present in a confined space, less than 2-3 meters apart (e.g. Airlines, Malls, Markets, trains) must be carefully controlled and phased, for the duration of the Pandemic. Spatial distancing of 1-2 meters must be enforced compulsorily in all permitted activities, including the Workplace.
For Public policy purposes, it's useful to consider three different sets of Districts: (1) Those which are completely free of virus. (2) Those which are heavily infected. (3) Districts with small number of cases. Govt should consider banning entry of people into the set of Virus free districts and exit out of heavily infected Districts for a few months.
  My colleague Rattan Chand at The Foundation for Economic Growth and Welfare, finds that, "in 50% of ~700 districts there's no Corona positive case. 75 have 1 corona positive case each and 40 districts have 2 positive cases each.  60 districts have 3-5 positive cases, while only 175 districts have more than 5 cases. Govt should define a Contiguous Zone of virus free districts & low infected (1-5 case) districts which are contiguous to them, into which entry from outside is banned.  Similarly exit out of heavily infected Districts could be banned for a few months. Normalization can be phased in at a different pace in each set of districts.
The second aspect is the distinction between production & trading of goods and their support services (e.g. transport, delivery) and Services in which production and consumption occur simultaneous to many people, or in the presence of many other people (eg Airlines, Markets/shops, cinemas, hotels, restaurants). We (+ Karan Bhasin) have estimated that about 45-50% of GDP is in the former and about 15-20% in the latter. (e.g. hospitality). Though production cannot resume without export demand or domestic consumption, it is possible to differentiate between the two when phasing out controls. Much Quicker freeing of the former is desirable and feasible. It should also be assured that the remaining 35% is GDP from essential goods and services, which is formally free even under Lock-down, is not hampered by administrative constraints and limitations.
The third important aspect of Public policy in India, is that, the living spaces are worse than the work-spaces, for those living in one room tenements and Urban/semi-urban slums (30% of population, say). Consequently, confining everyone to their homes, can accelerate transmission of the Virus, for this segment of population, instead of slowing it down. We should therefore be very wary of mechanical suggestions to extend Lock-down, without careful analysis of Benefits and Costs.

   Next, we need to consider some of the facts and data available to us about the Global spread of Corona Virus Pandemic. The cross-country average (185 countries), of Corona virus related Deaths (CVD) to detected Corona virus cases (CVC) is ~0.027 or 2.7%. India's death rate is exactly equal to this average. There is little reason to believe that this is biased, compared to other countries. The average number of cases per thousand of population for the same set of countries is 0.267. This compares with normal death rates in countries like India and USA of 6 to 8 per thousand.
   The number of corona virus cases in India is ~ 0.001 per thousand of population. There is a combination of likely reasons for this; (a) Early action to reduce travel from China and other infected countries to India. (b) One of the most stringent lockdowns in the world, perhaps the 5th country to impose a national lockdown. (c) Lower levels of testing than richer countries and consequent lower rate of detection of confirmed cases. (d) Higher ambient temperatures then most developed countries, except those like Singapore which are near the equator. (e) Lower mobility internationally and domestically than richer countries, (f) Higher percentage (70%) of population in Rural & semi-rural areas with lower population density and consequent natural Socio-spatial (Social) Distancing, and (g) social practice of women covering faces with “Chunni”, “Saree-Pallu” or Burqa, when outside the house.
However, we should expect and prepare for, a rise in the number of CV cases, closer to the World average, before the pandemic is controlled. We expect the infection rate to creep up closer to the international average but is highly unlikely to exceed it.
        Finally consider the effect of the Lock-down on GDP. The current lock down exempts essential commodities. According to our estimates about 35% of the Economy is therefore exempt. The rest of the economy (65%) is virtually shut down, with no production and no consumption of the goods and services it produces. We estimate that the Lock-down has reduced GDP by 2.8% of what it otherwise would have been. If the nationwide Lock-down is extended to end of April the cost will go up to 5% of GDP and to 9% of GDP if it continues till end May.
   In my view the Lock-down has served its purpose of national shock therapy. There are now better alternatives available to replace it and get the Nation progressively back to work.  Therefore, a lifting of the Lock-down with the personal, public, sub-regional and Sectoral safeguards, along the lines analysed above, is recommended.
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The author, Dr Virmani, is Chairman of the Foundation For Economic Growth and Welfare (EGROW).

Friday, April 3, 2020

Socio-Spatial Distancing: Alternative to Lockdown


   Estimates made by Karan Bhasin and I suggest that the current lock-down (till April 15),  will cost 2.8% of GDP, over and above what it would be, given the effects of the Pandemic on Contact Sectors, particularly Hospitality, Airlines, Travel & Tourism.  If the lock-down is extended to end of April the cost goes up to 5% of GDP and if its extended to end May, the additional cost will be 9% of GDP.  This doesn’t include the bankruptcy cost of all the MSMEs, Tiny enterprises, Restaurants, Shops(retail & wholesale), which will go bankrupt because of inability to (a) lower wages or fire workers, (b) pay rent on premises and get evicted, and inability to repay loans.
    The mean Infection Rate from COVID19/Corona Virus 2 is estimated by author to be 0.2% of population and the mean Death rate is 2.2% of Infected cases, as of March 29th, 2020. The maximum Infection rate in any country in World today is 0.33% of population (0.6mi) in tiny Luxembourg. That is 1/3 of 1%. The next highest rate is 0.26% of population (0.4 mi) in even tinier Iceland. The maximum death rates per infected cases is 11% in Italy where an overwhelming majority were over 60 years of age with other medical conditions. The death rate in Italy for infected people under 50 years is ~2% and this reduces towards 1% if they don’t have another medical problem. Non peer-reviewed research suggests that overall rate in Italy could be lower.[1]
    It is therefore essential to explore intermediate possibilities between complete National lock-down and normal activity.   One such proposal is outlined below for consideration. It has the following elements:
  1. Nationwide Ban on assembly of more than 5 people in any Public place, including religious gatherings, should continue till end June. Family of 5 should be allowed on roads, parks & open air public spaces, as long as they are all wearing masks and keep 1-3 m distance from others.
  2. International Travel Ban (till 31/6/31): No international travel allowed by air, sea or road, except for those stranded away from home. Those allowed to travel for compassionate reasons, must be properly tested before being allowed to travel in or out of country.
  3. Severely affected Districts may have to continue with lock-down or quarantines till the infected cases have clearly peaked (with exemption for Essential Goods and services).
  4. Wearing of Masks must be made compulsory for all workers (including household workers) and all individuals outside the home. There are three broad Quality of Masks; N95 masks are needed only by doctors & those handling SARS Corona Virus 2 (COVID) cases. Surgical masks are necessary only for Health workers. Lowest quality masks are acceptable for the general public and can easily be manufactured in rural areas, villages and even at home.
  5. Factories, Mines, & Agriculture & allied production & trade and Non-contact Services can resume with compulsory Mask wearing. SocioSpatial distancing must be maintained to the extent possible in all Work Places. Establishment owners and workers would be liable to fines if masks are not worn.  Services which require Ques (eg Govt/Public Services, NGO Distribution of free food), must make arrangements for SocioSpatial distancing in such Ques. 
  6. Public Transport is essential for going to work. One seat must be empty between people, testing with thermal sensor before entry (<100.4 deg) of terminal/transport, compulsory wearing of masks. All those over 60 years old can be allowed to travel on compassionate grounds if they don't have any other medical condition, have tested negative on formal test and need to travel to work. Work related travel must be opened first, while Domestic Tourist travel may be restricted for some time and resumed gradually to ensure lower density on Airlines, Trains and Buses and at Tourist spots, to a level at which SocioSpatial distancing is a realistic possibility.
  7. Hotels, Restaurants: All govt restrictions on, and fees for, home delivery from these establishments, must be suspended for the duration of these restrictions. Restaurants with attached gardens or terraces could be allowed to serve customers, with min 3 m distance between tables and strict social distancing among patrons. Internal service could be limited to 1/4th of licensed capacity to enforce 3 m spacing between tables, provided air-conditioned premises use higher quality filters to minimize re-circulation of bacteria/virus for duration. Compulsory temp check of both workers & customers before entry into premises (+ other simple checks). Patrons must wear masks when not seated and eating/drinking at table.
  8. Malls & Large Retail Markets, Cinemas, House of Worship, Conference/Seminar Venues etc.: May have to be kept closed for several months and then opened gradually with appropriate safeguards and for younger, healthier folks with no other medical conditions. Small local markets, repair shops and shops selling consumables & non-durable could be allowed to open first.
  9. Urban slums & clusters of one room tenements need special measures; Even with best of intentions, it's very difficult to maintain clean hands, clean bathrooms and SocioSpatial distancing in Urban Slum clusters. One possibility is to shift those with rural/village home base, back to these villages for 3 months, after testing & ensuring they have masks.
  10. Infected persons: Mild cases must be home quarantined, modest cases in special facilities (including identified hotels) and serious cases sent to hospital. To ensure irresponsible people do not break Home quarantine they can either be Monitored through (a) a mobile app, with random physical checking to ensure they don't go out, leaving mobile home; or (b) An electronic anklet/ wrist band which sends warning if person moves out of range of locator inside house. If house has older people (>55yrs), infected person must either stay away from them or wear a mask in their vicinity.
  11. Older people above 50/55/60 years of age with other medical conditions, are most vulnerable to Corona Virus infection and mortality. They must be advised to stay at home and insist that anyone coming from outside wear a mask. They must also shun Hotels, Restaurants, Malls, retail markets and Public transport. Whether they should be compulsorily excluded from these places, is a difficult decision.
  12. Anyone caught violating the mask wearing regulations (listed above), should be quarantined at home for 1 week (say); The quarantine period should increase progressively for subsequent violations.
      Early announcement of these measures is essential for all concerned to start Planning for these measures immediately (Production & distribution of Masks, thermal scanners, test kits, protective clothing for health workers, ventilators).
      During a Lockdown it’s impossible to aid the poor through public works and production related subsidies. Even when Lock down is lifted it is difficult given stringent Socio-spatial distancing requirements. A mobile based Direct Cash transfer (DCT) system is ideal for getting transfers and subsidies to the vulnerable sections of the population. It is best for rural areas (70% of population) because people are dispersed and distance to Bank Branches and ATMs is large. It is also the best mechanism for migrants from rural to Urban areas. Women with minor children should get transfers separate from their spouses. This requires a mobile loaded with a Payment App, Aadhar & Voter ID numbers and few work/residence & family details. Rural/slum Women who don't have mobiles, should be given free preloaded ones.
     There are no easy solutions given the uncertainty surrounding the Pandemic, but policy must be based on data-based analysis. All feasible alternatives must be carefully considered, keeping in mind administrative weakness and limitations, variations across States/Districts, Rural/Urban dimensions and Sections of society.
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Source:  http://dravirmani.blogspot.com/2020/04/socio-spatial-distancing-alternative-to.html