Lockdown arguments and possible unfolding
Dr. Prajjwal Pyakurel
Lockdown is the security measures taken during an emergency to prevent people leaving or entering their buildings or places. During lockdown only essential services are allowed and rest remains closed. Most of the countries in the world adopted lockdown measures to prevent the spread of coronavirus. The logic behind lockdown was to break the chain of transmission of the disease and prevent further spread of the virus. I am writing this opinion piece sitting in my room on a table, watching various news channel in television and thinking if lockdown was the possible solution.
I will try to argue the lockdown measures by comparing the difference between countries who adopted lockdown and those which did not. For those countries who adopted lockdown implementing a science-based lockdown strategy was essential to sustain containment of coronavirus. However, most of the countries did not have robust data before they took evidence-based measures. At present a fifth of the world’s population is still under lockdown in the global fight against coronavirus. This has helped to reduce the chain of transmission of the disease. Wuhan in China had 76 days of lockdowns before the residents started their normal life. To stop the transmission of the virus, they adopted aggressive public health interventions, such as early detection of cases, contact tracing and population behavioral change. However, European countries like the Netherlands and Sweden had different pathways. In the Netherlands they thought of creating herd immunity. Their strategy was to control the spread of the virus and protect vulnerable groups including the elderly and people with underlying health conditions. By striking the balance rather than instituting a national lockdown they thought of protection post-lock down aftermath. They thought that when society returns to normal it would be exposed to the danger of a new outbreak as too few people would have been infected and therefore immune. In Sweden they prioritized their economy as important as the health of citizens and hence lockdown was not imposed.
Arguing from the perspective of Nepal measures taken by the government to enforce lockdown was an appropriate nip. However, its scientific validation could still be debated. Now on the 4th week of lockdown majority of people in Nepal are thinking of what will happen next. Will the lockdown open after the stipulated timeline? Will the disease spread if the lockdown opens? Will my child get infected if I send him/her to school? Should I go to the workplace to work and many more things? We must find some sort of solutions to stop this buzz.
As a community physician and public health expert, I feel that the situation in India is crucial for the coronavirus spread in Nepal. The reason being the open border between two countries and free movement across the borders. Vigilantly assessing the situation in India and strictly monitor the border areas and some unofficial channels is very imperative. Data scientists should be observant enough to assess the situation in the country and perform data mapping, statistical modelling, and prediction of cases and inform the higher authorities as needed. This will help to make appropriate strategies for prevention. We should not go by the notion “Prevention is Cure'' but by the notion that “Prevention is only the cure”.
Similarly, all the people entering from Indian and China border should be compulsorily tested. The reason being the transmission of the virus from asymptomatic as well as from pre-symptomatic cases. Tracing of the contacts of the confirmed cases should be done and a field epidemiology team comprising epidemiologists, public health officers, statisticians and social scientists should be kept standby for contact tracing. Strict quarantine and isolation measures with strong monitoring mechanisms should be developed for needy ones as per diagnostic testing. Facility based quarantine should be encouraged for suspected cases. Treatment of COVID-19 confirmed cases should be done in dedicated corona hospitals.
Additionally, hotspots for suspected cases should be identified and mass testing performed with appropriate diagnostic kits and essential services should be accessible to the public and non-essential services that could be delayed meanwhile for e.g school and colleges should be closed. Movement of people at ward level, municipal level and provincial level should be strictly monitored and suspected cases should be immediately tested. Hand hygiene measures and behavioural change message should be communicated to the public through media. Female Community Health Volunteer (FCHV) who are the pillars for successful community health programs in Nepal should be utilized for community awareness with a robust incentivize scheme. Furthermore, innovative ideas should be created suitable for local context. These all measures should be supported by strong communication and coordinating mechanisms at local, provincial, and federal government with appropriate policy changes.
Economy of the country is equally important as the health of the citizen. The effect of this lockdown had direct effect on those daily wage workers who worked and earn their livelihood. Hence the country top think tank should think of opening the lockdown by taking the above measures and thinking from the broader perspective for sustainable economy and taking care of those who are underprivileged.
Dr. Pyakurel is an Executive Member of Nepalese Society of Community Medicine of Nepal (NESCOM)