Thread by @naukarshah

Supporting a govt decision during crisis does not mean one should stop critical thinking process. A thought lockdown would lead to groupthink & thus sub-optimal decisions. So, indulge me as I pose some questions as to whether a 21 day lock-down is feasible or even desirable? 1/n

First is that we do not know the parameters used to take such a decision. Like why this decision now? Is it the number of cases, the rate of increase in spread, us moving towards community spread stage… what? But let us leave that for now. 2/n

For now the more crucial question is what happens after 21 days. What parameters are going to decide whether to continue the lockdown or withdraw it? I strongly believe govt needs to be transparent about this as it is the only way to know if lockdown has served its purpose. 3/n

A lockdown helps us to delay the spread, allowing us to use this time to
1. Identify/develop the drug combination & scale up production.
2. Ramp up the health infrastructure during the time
3. Scale up testing infra and then test, isolate and trace every single carrier. 4/n

Let us take it one by one. A drug being developed & produced in mass-scale during this period is the best scenario. WHO has already initiated megatrial for some promising treatments, sciencemag.org/news/2020/03/w…. But 21 days is unrealistic as most drug trials take months. 5/n

The next one, to use this time to ramp-up health infrastructure, would be a serious challenge considering the geographical spread of the disease in India. 25 states/UTs have confirmed cases as of today. Lack of ICU, ventilators & PPEs cannot be overcome in such a short time. 6/n

The third one, that is to trace, test and isolate under a city-wide containment strategy like what was done in Wuhan is the trickiest one as far as India is concerned due to again the geographical spread of the disease. bangkokpost.com/world/1883990/… 7/n

In Wuhan, China mobilised resources at the national level to tackle the crisis at the city level. A strategy we won't be able to replicate as almost every state has crippling health infrastructure and is going to scramble to fight its own battle. 8/n

Another reason why the Wuhan strategy is not possible is due to our vehement stand that we have not entered community spread stage. This assumption is dangerous as that leads us to a severely restrictive testing strategy/protocol. 9/n

Experiences in other countries and kind of cases being reported in India strongly points to a community spread. Without a near universal screening and testing strategy, we can never be sure if the virus remains in the community or not after the 21 days lockdown period. 10/n

This puts us in a difficult situation because if we don’t isolate every single case during this period, lifting of lockdown after 21 days would only put us back to square one. People with virus still present but undetected amongst us! Continue lockdown or not? 11/n

Lockdown is not without economic & social costs. But when applied nation-wide, without a plan for near universal screening & testing, to a country like India with poor safety net & social security, the whole exercise itself could become futile with negligible gain? 12/n

So, while advising social distancing, should we put the nation into a lock-down without a plan to ensure every single case to be tested, isolated & traced?

After 21 days, we could be as much in dark as we are today. Now with a large population under severe economic distress.

21 days lockdown - A critique. Compiled link at
medium.com/@naukarshah/21…
@drharshvardhan @narendramodi
@MoHFW_INDIA