India : Implications of early reopening

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Dear Readers,

In a few days we would bid adieu to July and enter August with a sense of anxiety that the worst is yet to come. At the start of the Pandemic no one had imagined that it would persist for this long period, not even policy makers envisioned. People had questioned the imposition of restrictions on their freedom of movement and joy of intermingling with one another. Economists had warned about the cost of lockdown and the damage to the economy. Citizens were initially told that the Pandemic can be restricted with lockdowns and people grudgingly accepted it. Obviously it was not a water tight implementation in every country.

There are several countries particularly in Europe which faced the brunt of it in March-May period and now are in a way back to normalcy. There are others such as India, U.S, Brazil and many more, which relaxed the norms earlier than the situation warranted and paid heavily with massive spikes in cases. Their plans to balance lives and livelihood has so far not been successful as it is increasingly becoming clear that economic activity can only be done at pre-pandemic level if there is no pandemic or an effective vaccine tool.

This brings me to discuss the timing of the reopening. When can be the right time to lift restrictions and allow the animal spirits to lift the economy?

“R0” number:

Epidemiologists answer the above question by explaining about the reproduction rate “R0” number pronounced as “R-naught”, which is an indicator of how contagious a disease is, or how easily it spreads from person to person in a community. The number is important because government health policy makers are using R0 as a proxy for determining whether their respective country COVID-19 outbreaks are rising or flattening.

If R0 is 1, each infected person infects just one other person, on average. Over time, the number of infected people will remain the same.

If R0 is less than 1, each sick person infects fewer than one person, on average, so the number of infected individuals will shrink over time.

If R0 is greater than 1, each sick person is infecting more than one person, on average, so the outbreak will grow.

Measles, which is one of the most infectious diseases that scientists know has an R0 between 12 and 18. Similarly the Spanish Flu of 1918-20 which killed millions had a R0 between 1.4 and 2.8. Epidemiologists have calculated the COVID-19 pandemic to have a R0 between 2 and 3.

An R number below one, scientists explained, could be achieved much faster with tighter restrictions, effective testing and contact tracing to isolate positive cases. In locations where quarantine orders and other measures have been followed religiously, outbreaks have been stabilized, and the R number has dropped. For example New Zealand, China and Italy which have successfully overcome the challenge after several months of lockdown.

New Zealand (R0 < 0.5):

Before New Zealand went in lockdown, for instance, researchers estimated the R0 value was 1.8 – and had been quashed to just 0.35 as a result of it, leading to its effective elimination in the country.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
New Zealand                   1,556          1,513            22

Data Source: Worldometers  and NZ Herald

China (R0~0.9):

The Covid-19 positive cases were first reported in December 2019 in Wuhan in the Hubei province. The Government imposed a strict lockdown on January 23 and by third week of March the number of daily cases had reduced to double digits. China was successful in retaining it to 1 province. The China R0 number reduced from over 3 to reduced below 1 currently.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
China          83,784   78,889  4,634

Data Source: Covid-19 projections.comWorldometer and Ourworldindata

Italy (R0 ~0.9):

Italy was the first major country in the western world which was severely hit by the Pandemic. The country’s medical infrastructure got overwhelmed by the sheer number of cases which along with other factors such as the profile of the people who were affected led to an unprecedented level of fatalities. The Government introduced restrictions during the period and only relaxed them when the R0 number was close to 1. Currently the R0 number of Italy is around 0.93. If this trend continues for couple of months, Italy would be more or less be out of the woods.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
Italy          245,864   198,320   35,102

Source: Covid-19 projections.comWorldometer and Ourworldindata

Now let’s take three countries U.S, Brazil and India which reopened at a wrong time due to one or the other reason and paid dearly for the misadventure.

United States (U.S) (R0 ~1): 

Unfortunately in the U.S, popular outcry against restrictions and the alarming loss of jobs in an election year worried politicians and they started advocating relaxation of norms. It could not become worse than this, as soon as openings began, many people returned immediately to their old habits ignoring social distancing norms and hygienic recommendations such as avoiding crowds (especially indoors), wearing a mask, hand washing, and other preventive measures. Factories reopened, and many retail establishments and other services resumed operations, albeit at reduced capacity. For a short time, output and consumer spending rose significantly, and the unemployment rate started falling although still at high level. But in most cases, these reopenings started with an R number above one (1.24), which guaranteed that as soon as people started relaxing precautionary measures, the number of infections would begin to rise again. Current the U.S R0 number is around 0.97 which could easily shoot up if strict guidelines are not imposed.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
United States (U.S)          4,281,314   2,036,752   148,979

Data Source: CDC, Worldometers and Covid-19

 Brazil (R0 ~1):

The latin American giant was late to react to the Pandemic threat and thus missed crucial time in getting ready to prepare. It also reopened at a wrong moment when the “R0 number” was higher than 1 which meant that the transmission rate was high. As expected the virus numbers surged exponentially catapulting Brazil to the number 2 spot.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
Brazil          2,355,920   1,592,281  85,462

Data Source: Covid-19 projections.comWorldometer and Ourworldindata

India (R0>1):

On the contrary in India, the dilemma of protecting lives and livelihood forced the Government to relax norms much sooner than it would have liked. After the lockdown announcement in March 2020, millions were laid off by small businesses and factories. According to data published the unemployment rate shot up to 23.5% in April from 7.8% in February. The unemployment rate dropped to around 11% in June as the Government announced “Unlock1” or first phase of reopening.

As expected when the lockdown was relaxed, the number of cases started to shoot up as it was difficult to make the people follow the social distancing norms. As mentioned in the data below the number of daily cases shot up from less than 10,000 during May 2020 to more than 15,000 during the month of June. In July it has tripled that rate with current (July 23rd 2020) data showing more than 45,000 daily cases. No surprise India is now at the third position behind U.S and Brazil. The R0 number for India went down from 1.7 in March to 1.23 in June during the lock down. After reopening the R0 number has worryingly not gone down below 1, on the opposite it tends to stubbornly remain around 1.2 which if continued could add thousands of new cases on a daily basis.

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As of 25th July Confirmed Cases Recovered Deaths
Globally          16,075,406   9,821,866   645,221
India          1,383,854   884,659   32,089

Data Source: The Print , Worldometer and Ourworldindata

This brings me to the final question. What would be the implications for early opening in India?

The answer to this question lies on how the predictions could be for India in the coming months. There were different studies done which project very different outcomes. Some studies which had predicted earlier about India cases are revising their data. The uncertainty level are so high that no one can be certain that the predictions would come true. The predictions are based on behavior of virus but parameters such as Government response, community behavior etc do play a huge role. The tests conducted in India are still very low compared to the tests done in other countries who are in top 10 or have successfully neutralized the virus. This would have an impact as tests are ramped up.

Country Tests/1Million Pop
India 11,798
U.S 161,120
Brazil 23,093
Russia 184,339
South Africa 46,007
Italy 107,849
China 62,814
New Zealand 91,097

Data Source: Worldometer

Projection 1.

According to COVID-19 Projections  which did predictions in U.S, three possible scenarios are projected for India. The total number of deaths in India is projected as follows:

Aug 1 Sep 1 Oct 1 Nov 1
Worst Case           39,556          86,952        153,232         227,400
Most Likely           37,355          67,484        105,180         138,426
Best Case           35,151          47,240          56,681           64,057

Projection 2.

According to COVIDAnalytics done by MIT researchers, the following could be the COVID-19 related death prediction for India:

         Aug 1         Sep 1         Oct 1        Oct 15
        38,074         70,693       107,598       124,168

Conclusion & Recommendations:

  1. Any country which reopened quickly to get the economy back has seen a surge in cases.
  2. India currently has a worrying R0 number of 1.2 which shows cases could go up exponentially.
  3. India should ramp up tests even if this would show high number in the statistics.
  4. There is no need for further lockdown in India as the damage from a premature opening is done.
  5. Citizens, communities and civil societies have to solder the burden and take responsibility of their neighborhood.

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