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April 17, 2020

What to do when you don’t know the answer


April 17, 2020

The novel coronavirus confronts Pakistan with an enormous crisis. Like many other countries, we are caught between two evils: the only apparent way we have to deal with the coronavirus is to lock down the country. But the economic costs of a lockdown are so massive as to possibly cause a complete social breakdown. What then are we supposed to do?

The short answer is that we don’t know. And we need to decide on the basis that we don’t know. Let me explain.

As already stated, while the coronavirus pandemic is one of the most forecasted and anticipated disasters in history, there is still much that we do not know. We are not entirely sure yet as to how it spreads. We do not know if surviving the coronavirus renders one immune to further attacks, and if so, for how long. We do not know the fatality rate of the disease. We do not know what percentage of people are asymptomatic after infection. We don’t know why some people escape lightly and some people die horrible deaths. We do not know whether multiple rounds of lockdowns will be necessary. We do not know whether the economy will recover as and when this threat recedes.

We. Don’t. Know.

The problem is that it is very difficult for people, especially leaders and experts, to say that they don’t know. Think about it. If you have reached professional recognition on the basis of your ability to provide answers, then a declaration of ignorance is not that far removed from an admission of incompetence. The same goes for political leaders. When Donald Trump accepted the Republican nomination as president, he started by saying that the entire system was broken and that “I alone can fix it.” How is Donald Trump now supposed to say that he doesn’t know how to fix the coronavirus crisis?

The further problem is that attacking a known unknown (to use Rumsfeld’s phrase), as if it is some variation of a known problem, is counterproductive. History doesn’t give you mulligans: you only get the one chance to get it right.

So, given that we only have the one chance, and given that we don’t know much about the virus, what are we supposed to do?

The answer by Nassim Nicholas Taleb, the person who popularised the phrase “black swan event”, is to apply the “precautionary principle.”

In simple terms, the precautionary principle is an elaboration of the maxim, ‘better safe than sorry’. In the field of environmental law, the principle has driven decisions saying that new industrial technologies should only be allowed once proven safe because humanity cannot afford to take chances with the earth’s environment.

In terms of the coronavirus, Taleb’s analysis is that “The obvious policy left now is a lockdown, with overactive testing and contact tracing” in the manner pioneered by China and South Korea.

The response to Taleb (and other lockdown proponents) is the same as already noted above: how is the state supposed to deal with the economic consequences of a lockdown? What happens if supply chains break down? How are daily wagers supposed to feed themselves in the absence of economic activity? What happens if social order breaks down?

One very original answer based on “smart lockdowns” has been proposed by my friend, Rashid Langrial. His work builds on the insight that when faced with two terrifying choices, the best option is to try and “de-risk” the situation so that one is not faced with only binary options.

Smart lockdowns are based on graduated restrictions ranging from a complete curfew to relative freedom. More importantly, the restrictions would not be applied nationally, provincially or even across one particular city but only to those specific zones where infection is prevalent.

By Langrial’s estimate, a smart lockdown approach would allow 90 percent of the country to stay relatively open. The economy would not be unfettered. But it would survive.

But how does one implement smart lockdowns?

To begin with, Pakistan’s population of 210 million would be organised into economically independent zones using three principles. First, the boundaries would be clearly demarcated and easily communicable. Second, the boundaries would be demarcated to maintain the existing social fabric of the area. Third, the zones would be economically integrated so that at least 80 percent of a zone’s economic activity would be internal to that zone.

The second step is smart testing to differentiate the zones from each other. Testing is crucial because at least 30 percent of the people infected with the Covid-19 virus remain asymptomatic. Unfortunately, given the current cost per test of Rs5,500, Pakistan simply does not have the funds to adopt the aggressive testing approach adopted by East Asian countries like Singapore and South Korea.

Part of the solution is provided by the concept of pooled testing: ten people are swabbed and their samples are all tested in one go. If the pooled sample result is negative, then all 10 people are cleared. Not only does this serve as a cost-cutting measure but the testing coverage of the country can be increased ten times.

The second half of the solution is provided by an effective sampling strategy. The math is complicated, but the short version is that spending Rs35 billion rupees annually (upgrading labs and HR) allows one to test and map the entire population of Pakistan on a dynamic and periodic basis. Furthermore, the cost of testing is likely to fall once new testing methods reach the market.

The third step is to figure out the actual restrictions to be applied to different zones. As currently proposed, Green zones (90 percent) would be both internally and externally open, possibly including places of public gatherings (schools, mosques etc) with some public distancing/sanitary measures. Yellow zones (5 percent) would be internally open within the zone but externally quarantined from other zones. Brown zones (3 percent) would be similar to Yellow zones but with the addition of certain internal areas being completely locked down. Red zones (2 percent) would be fully locked down with curfew.

Establishing graduated restrictions would help promote a collective sense of responsibility as people would jointly suffer in case their zones have high infection rates. Similarly, communities would jointly benefit from relaxed restrictions if their zone or unit is disease free.

There are many other points which need to be carefully examined. How would interprovincial and international travel work? Would people who have recovered from Covid-19 be given special work and travel privileges? How would governments deal with high incidence locations like religious seminaries, congregations and jails? Langrial has tried to deal with these issues through a detailed paper which is available online. But, obviously, more work and more thought is required.

Covid-19 is a fearsome challenge, especially for developing countries like Pakistan. But we need to accept that the disease is not disappearing any time soon. What we need now is a strategy to manage it till a solution arrives. Langrial’s proposal gives us one such strategy.

The writer is an advocate of the Supreme Court of Pakistan.

Twitter: @laalshah