As India reaches the 20th day of a nationwide lockdown, positive cases of coronavirus infection crossed the 9,000-mark on Monday (9152 with 308 deaths according to government data and 9205 with 331 deaths according to Johns Hopkins University).
To put things in perspective, India, a nation of 1.3 billion people, has so far been able to keep the infection under 10,000. With positive cases doubling in roughly seven days, India’s coronavirus curve is less steep compared to the US or some European nations. It is even showing signs of a mild tapering.
In comparison, the US already has well over 5 million positive cases and over 22,000 deaths. Since the third week of March, its graph of positive cases has shown an exponential growth. Though New York, the epicenter, is showing signs of contraction, researchers have warned that the worst is yet to come in states such as Texas and Florida.
Europe paints a similar picture. Italy, Spain, France or Germany, despite showing signs of plateauing, are still way above the danger mark in terms of daily new cases. Europe’s combined death toll crossed 75,000 on Sunday. Some in Britain believe UK could be the worst affected country in Europe.
Representational image. Image by Manuel Darío Fuentes Hernández from Pixabay.
Bear in mind that India’s ramshackle public health infrastructure is light years away from the health systems in these nations. To arrest the spread to the extent it has so far, therefore, implies that there are certain things India did right.
To begin with, India took the pandemic more seriously than the developed world did. The pandemic presents nations with a policy choice. It pits the economy against a nation’s health system and dares the government to gamble.
Some governments, like those in the US and Europe, refused to be drawn into making this choice for as long as they could, and ended up being robbed of any choice. Had Donald Trump listened to advice from policymakers and scientists within the establishment and announced lockdown measures earlier instead of trying to protect economic gains, America’s story could well have been different. Damning reports are emerging from the US that Trump ignored public health at the cost of economic and political considerations.
The Narendra Modi government deserves credit for implementing tough measures and taking those decisions quickly. Some of these steps, such as travel and visa restrictions, were imposed preemptively. The 21-day lockdown was announced when India’s positive case count hadn’t touched 1000. The period will likely get extended. The economic costs of these steps are enormous, but India has chosen to save human lives instead of economy.
The pandemic, however, poses tougher questions still. No nation can remain locked down indefinitely. So, the key question is, will the lockdown measures be enough? If not, what may India do? Let’s return to data briefly to assess this question.
Though India’s positive cases count is doubling roughly in seven days, the death count is doubling faster. Data from Worldometers shows a sharp rise in India’s daily new cases from April with 759 confirmed cases on 12 April. According to some assessments, India may have over20,000 cases in the next 7-8 days. This may pose tough challenges to our rickety public health network. Since the lockdown is already in place, India will have to rethink implementation of non-pharmaceutical interventions (NPIs).
This is where some of India’s east Asian peers offer some lessons. South Korea, Hong Kong, Singapore or Taiwan have shown the way in battling the contagion with measures that have been quick and effective despite the proximity of some of these nations to China, the origin of coronavirus. South Korea continues its downtrend in positive cases, Taiwan reported just three new cases on Sunday, Hong Kong had just one more positive case compared to Taiwan while Singapore, that had done reasonably well in containing the virus early, is battling a second wave of infections ostensibly due to premature relaxing of social distancing measures.
Taiwan, Hong Kong and South Korea’s responses have drawn global attention and all-round praise. It may seem that their superior health system (compared to India’s) played a part in their success in flattening the curve but when nations with world-class infrastructure like the US or Italy have been struggling, it seems likely that there’s something else at work.
These nations possibly did some of the things differently than the rest of the world. Can India do what South Korea, Taiwan or Hong Kong did? To what extent can their best practices be emulated elsewhere? What role does culture play in battling the pandemic?
The answers to these questions demand a better understanding of the trade-offs at work. For instance, it is well known that contact tracing and isolation are two of the most effective policies in containing the contagion. South Korea’s success has received wide publicity in India. Critics have panned the Modi government for failing to emulate Seoul’s practices. However, a huge part of South Korea’s response has been shaped by its move to prioritize public safety over individual privacy. These have been formalized within a legal framework.
In a country where an almighty storm was kicked up over an identification document meant for better distribution of subsidies and entitlements — Aadhaar was touted as pure evil by privacy warriors in India — can a government really implement the kind of intrusive privacy measures that South Korea did for contact tracing and isolation of coronavirus patients?
Surveillance is just one of the three broad lessons that inform the responses of some of these east Asian nations against the pandemic. The moot point is, are these steps transferable?
1. The privacy versus public health debate
One of the key reasons behind South Korea’s or Taiwan’s effective response was their ability to conduct extensive and affordable tests. Lifting of this strategy straightway is impossible for a nation as populous and at this stage of development such as India. However, can we import their contract tracing and isolation policies, given the fact that cluster outbreaks often happen due to inadequate information or hiding of travel practices by individuals? Turns out this is not a straightforward issue.
The SARS outbreak in 2003 and the MERS outbreak a decade later — that had ravaged many of these east Asian nations — have largely shaped the South Korean, Taiwanese or Hong Kong’s responses. In Hong Kong, for instance, those who arrive from abroad must wear a special bracelet that tracks their movements, while those self-isolating in Singapore must send photographic proof of their whereabouts and send hourly updates to administrators.
Some of South Korea’s contact-tracing efforts are so intrusive that it throws open every movement of those suffering from coronavirus to the wider public. A series of mobile phone alerts about a patient lets the public know where the infected person has been in the last fortnight — whether it was bar, a sexual harassment class, or a ‘love motel’, pay-by-hour accommodations favoured by couples. This, quite obviously, creates a stigma. As a BBC report points out, public even decided whether “two of the infected were having an affair.”
The 2015 MERS outbreak killed 38 in South Korea, but more than the number of deaths, the trauma it left on society compelled South Koreans to revise their laws and embark on aggressive contact tracing. Ki Mo-ran, an epidemiologist advising the government’s coronavirus response, was quoted as saying by The New York Times on the MERS experience, “We did our epidemiological investigations like police detectives… Later, we had laws revised to prioritize social security over individual privacy at times of infectious disease crises.”
It is obvious that South Koreans have accepted the trade off between privacy and public safety that led to better identification of positive cases. It is not a coincidence that countries that put a premium on individual liberty are the ones suffering the most.
2. The culture of wearing masks
After advising healthy individuals not to wear masks — a confusion created in no small measure by the bungling World Health Organization — governments around the world are now advising, even forcing people to cover their faces in public. With good reason.
In India, several states have made wearing of masks or a cloth-cover mandatory. The Indian government has even released a DIY guide on how to make these face covers at home — mindful of the fact that there’s an acute paucity of masks of any kind, leave alone medical gear such as N95 or N99 respirators that are needed by frontline health workers. But crucially, that tweet by Union ministry of health and family welfare was sent on 4 April, when the pandemic has already conquered the world, including India.
The Advisory and Manual Use of Homemade Protective Cover for Face and Mask can be seen at:https://t.co/Dj8ojLRfXQ@PMOIndia @drharshvardhan @AshwiniKChoubey @PIBFactCheck @COVIDNewsByMIB @MIB_India @DDNewslive @airnewsalerts @IndiaDST @PTI_News
— Ministry of Health 🇮🇳 #StayHome #StaySafe (@MoHFW_INDIA) April 4, 2020
And even when masks have been made mandatory, Indians are struggling to comply. They are being forced to comply. A quick venture out to the grocer’s or the markets make it apparent how onerous the task most Indians think wearing a mask is. Those who manage to wear one, keep in hanging below their chin, while most either use a loose handkerchief or nothing at all.
The situation is no better in the US or Europe. After reversing the course and advising people to wear masks, US president Trump struck a defiant note in saying that he won’t use one. Trump was not being headstrong — he was merely expressing the cultural unease of the West in wearing masks.
In contrast, nations like Singapore, Hong Kong, Taiwan, South Korea or Japan have naturalised masks as part of their culture. Once again, the SARS and MERS outbreaks had shaped in large part their responses to coronavirus. SARS had triggered enough research to support wearing of masks as a way to prevent respiratory diseases (see here and here).
The east Asian nations had a natural advantage. While the public needed no persuading to wear masks, the governments were proactively monitoring and controlling the flow of these equipment.
As Hilton Yip, a journalist from Taiwan, notes in Foreign Policy: “Recognizing that it had to ensure an adequate supply of medical equipment, including face masks, for health professionals and the public, Taiwan’s government stopped exports of surgical face masks on January 24 while requesting local companies to step up production. Daily production is set to reach 10 million soon, divided between the public, medical, and industrial sectors.”
A Seattle-based nurse, while recounting her experience in Hong Kong during coronavirus training, was quoted as saying by BBC that in Hong Kong, “occasionally people would avoid getting into a lift with her because she was not wearing a mask.”
Wearing of masks is a cultural and expresses different motivations. It could be to safeguard oneself from potential contagion as much as a sign of respect towards others. In hindsight, SARS and MERS better prepared these nations to handle Covid-19.
Chen Yih-chun, director of the National Taiwan University Hospital Center for Infection Control, was quoted as saying in VOA News that SARS outbreak was a major “turning point. Before that Taiwanese saw masks as a stigma marking them as severely ill.”
3. Collectivism and faith in administration
Some of the measures discussed already involves huge trade-offs on part of citizens. It includes taking decisions or implementing systems that are seemingly onerous for individuals. Part of the reason why European governments or the Trump administration hesitated in putting in place lockdown measures is that it restricts individual liberty. It has been said that China succeeded in reversing the trend in Wuhan due to very tough measures that would have been impossible in a democracy.
And yet, Taiwan or South Korea are vibrant democracies that have citizens willingly suspend their liberties for greater public good. In India, Aadhaar implementation triggers an almighty backlash from civil society whereas in places such as Singapore, Taiwan, South Korea or Hong Kong, citizens willingly comply with onerous measures at considerable inconvenience because they trust their governments to do the right thing. This is the case even in autocratic system like China’s where implementation of tough measures would have been impossible if the people at large were at variance with the Chinese Communist Party’s purpose. No amount of penal provisions can force revolting citizens to behave. In democracies such as South Korea or Taiwan, this sense of putting national goal above self comes out to the fore in a greater way.
Lee Tae-ho, Korea’s vice minister of foreign affairs, wasn’t far from truth in claiming that “public trust has resulted in a very high level of civic awareness and voluntary cooperation that strengthens our collective effort.” More to the point, the political will of the government taking tough steps in battling the pandemic, and ensuring that these steps are successful, flows from the public will, that in turn depends on the trust that citizens impose on their governments. In contrast, the government is touted as the “enemy” in western liberal democracies, leading to a huge trust deficit between the government and its people. In India, despite a huge mandate, the federal government (or even the ones in states) cannot claim to enjoy unmitigated trust from every strata of society.
Among many lessons, the pandemic has taught us that culture shapes, to a large extent, the battle against coronavirus.
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Updated Date: Apr 13, 2020 21:31:55 IST