Locking down with conditions

The advent of Covid-19 has pushed the world to a precipice: the twin crises of public health and economy can easily lead to both unforeseen and unpalatable changes in human society as we know it today.

It is certain that global economic growth will experience a serious decline as commercial and industrial activities go down in many parts of the world as a result of large-scale lockdowns. A visible change is also expected in the way states and citizens see public health – not so much as a service that can be bought and sold but as a collective good that must be available to all and sundry across socio-economic boundaries. The rest of the changes the two problems may bring about remain unpredictable and, therefore, ominous.

In Pakistan’s case, Covid-19 can cause an even greater uncertainty than it may do elsewhere. This is mainly because the country is already facing an economic crisis. The economy is growing sluggishly, inflation is high, tax collection remains subdued and foreign exchange reserves and rupee’s value are both under serious pressures.

To understand the impact the state of the economy may have on public health, consider this: researchers at the Imperial College, London, have estimated that coronavirus left to itself would infect more than 80 percent of the population in Britain and America. Without any “mitigation”, they predicted, Britain would experience half a million deaths by the end of this summer. This number could be as high as 2.2 million in the United States. Mitigation here refers to the isolation of the vulnerable and the sick, quarantine of infected individuals and households, social distancing but otherwise a normal society.

It is obvious that even these soft measures (mitigation) need a lot of financial resources – both to treat those infected by the virus and to protect others from being infected. Certainly, it is easier for stronger and faster growing economies to put in place effective and efficient mitigation measures than it is for those which are moving at a slower pace – just as Pakistan is doing now.

Even with mitigation, researchers warn, there could be as many as 1.1 million deaths in the United States if a prolonged lockdown or suppression of otherwise normal social and economic activities is not enforced. This, undoubtedly, is a highly costly proposition; its enforcement will require a lot of money and to counter unemployment and other economic effects will require a huge investment of public funds.

Can Pakistan’s economic managers arrange all the financial resources required for the lockdown without further burdening the economy with debts and deficits? This is a question that requires urgent attention. Otherwise, we arrive at the other end of Covid-19 with a much weaker economy and, consequently, an even greater inability to ensure public health for the future.

A high investment in public health is important because a strong healthcare system that can protect and immunise people against possible infections and epidemics is the only possible way to preempt and prevent the spread of diseases like Covid-19. Lockdowns do help but only temporarily. They help a government buy some time to prepare for a fight against a disease. But they cannot work in the absence of a well-oiled healthcare system that can simultaneously take care of the sick and safeguard the healthy but vulnerable. Things get further complicated in the case of a pandemic. If the world doesn't have a vaccine to cure Covid-19, the virus will rush back to hit the moment lockdowns are relaxed.

Pakistan, thus, faces a seemingly Hobbesian choice: between an unsustainable lockdown and the spread of a deadly pandemic. Here is why.

As disease and death spread, a lockdown becomes impossible to put off indefinitely. Italy has done that only to realise the folly of it after a lot of devastation. And, lockdown or no lockdown, the presence of a large number of sick people in any society is bound to bring down economic growth. The real choice, therefore, is between investing in a robust public healthcare system and letting people suffer due to its absence.

What gives this argument even greater urgency is that no country can impose a permanent lockdown. There has to be a time limit on them, otherwise they will cause social unrest and economic chaos. Even a partial lockdown will result in a huge economic shock in countries like Pakistan where up to 25 percent people live below the income poverty line, more than half of the labour force is either self-employed or works in the informal sector and a significant number of people are daily wagers. This points to just one direction: lockdowns (complete or partial) have to be accompanied by subsidies and financial support for the economically vulnerable sections of the society.

According to the World Bank, 25 countries are using cash transfers as part of their economic response to Covid-19. For instance, Brazil will give 200 reais (38 US dollars) each to informal workers, who make up roughly 40 percent of its labour force. It has also allowed small businesses to delay tax payments and provided year-end benefits early to pensioners. Australia, France, Germany, Japan, Britain and the US have announced fiscal packages worth billions to save their citizens and businesses from the likely economic consequences of Covid-19. The most conservative estimates of the total extra fiscal stimulus announced so far stands at two percent of global economic output.

Will – or can – Pakistan follow suit? Given its pre-corona economic crisis, it will certainly find it extremely difficult to provide economic relief to its people even during a brief lockdown.

But, while a lockdown is a necessary condition to start a fight against the diseases, the single most important condition to win this fight is helping people withstand economic shocks in the short run and improve the public healthcare system in the medium to long run.

It is, therefore, important to emphasise that a lockdown, whether partial or complete, must be enforced with clear objectives. It should be put in place in order for our medical infrastructure to be ready to treat the already infected. The second objective should be to protect the rest of society from the disease. To follow the advice of the head of the World Health Organization, Dr Tedros Adhanom Ghebreyesus: “Test, test, test. All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded.”

The good thing is that Pakistan is among those few countries which have developed their own testing kits. It should scale up production of those kits after imposing a partial or complete lockdown. The more clearly we can identify those who have the disease, the less we will have to depend upon indiscriminate restrictions on movement, commerce and industry.

The next logical step will be to use information and communication technology to identify hotspots, to round up the infected, administer quarantines and enforce effective social distancing. Both China and South Korea have made an effective use of big data to do exactly that. The travel history of international travellers, data collected from identity cards, passports, mobile phones and customer detail records should be used effectively for the purpose.

Admittedly, the use of such data would be a violation of the right to privacy but the urgency of the situation justifies it – though strict guidelines and safeguards should be laid down to avoid the misuse of this data by individuals as well as institutions.

Finally, everyone of us must realise that Covid-19 is too big a crisis to be left to the government alone. The need for social distancing should not absolve us from our social responsibilities. Rich individuals and philanthropic organisations should come forward in these troubled times to provide relief to those who will require it during a lockdown. This relief, however, should be channeled through a single government agency to ensure its targeted disbursement. Young people should be (online) trained immediately to work as volunteers to both enforce the lockdown and distribute rations and supplies.

The crisis facing Pakistan is unprecedented but we are lucky that we are not the first country to have been hit by Covid-19. We can sail to safety only if we do not repeat the mistakes made by those hit before us.

The writer heads the Sustainable Development Policy Institute.

Twitter: @abidsuleri