Suppression to mitigate Covid-19: Govt’s approach is right It should stick to it to the end

From Oceania to the Americas, country after country is grinding to a halt by the coronavirus global pandemic.   Less than a month ago, US President Donald Trump pooh-poohed that “it’s going to disappear.

One day, like a miracle, it will disappear”. 
Now, there is a grim realisation that this is just the beginning. According to a study by Imperial College, London, it would take 18 months and repeated lock-downs to beat the virus. 

By then hopefully,  a vaccine may have been developed. In the meanwhile, if nothing is done, 2.2 million Americans and half a million Britons would die. Even with short term mitigation strategies like social distancing now in place, the death toll would only halve. Poorer countries and especially those with rundown healthcare services would take a heavier toll. 

The global pandemic is spreading fast -- the infection is assumed to be doubling every five days from early January 2020, according to the same study.  Those numbers tally with the exponential growth of the number of patients and fatalities over the past week; the global coronavirus cases doubled from 165,000 to 335,000 between March 16 and March 22 while the death toll doubled to 13,500.

Governments around the world are grudgingly putting in place measures that would have been unthinkable -- and unpopular -- barely a week ago. Italy, the worst-hit has announced an internal travel ban. Germany banned the public gathering of more than two people. New patients and the dead are piling up in Europe. In America, the mayor of New York has warned about needless deaths due to the lack of healthcare facilities.  Health systems in advanced developed states, from Italy to America are overloaded. Essential life-saving equipment and test kits are in short supply. Studies predict 30x excess demand for ICU beds in America during the peak time of the pandemic.   

Where does Sri Lanka stand in the global outbreak? The number of coronavirus cases in the country more than doubled during the week. Nearly 86 cases were reported as of yesterday noon. The lion share of the infected people are returnees from Italy and other European countries and those who have come in close contact with them.  

The relatively low number of local cases might be due to the early mitigation measures. Sri Lanka imposed the mandatory quarantining of returnees from Korea, Italy and Iran on March 11, and banned  travellers from high-risk countries in mid-March. Low numbers could also be due to limited testing. 
There are two main approaches to combat the virus.

The first approach is known as mitigation. It is aimed at reducing the health impact of an epidemic, ‘flattening the curve,’ (but not necessarily interrupting the transmission completely) through measures such as a two-week quarantining of infected households, self-isolation and other social distancing measures.   That would prevent a large influx of new cases from overwhelming health services, and also help buy time to develop a vaccine.   

The second approach is known as suppression where the aim is to reduce the reproduction number (the average number of secondary cases each case generates), to below one and effectively eliminate human-to-human transmission. These measures are broad-based and often indiscriminate such as complete lock-downs of cities, universities, colleges and entire countries. The flip side is that they should be maintained, at least intermittently, for more than 18 months. 

China’s success so far in fighting back the virus is a classic example of the effectiveness of a broad range of suppression measures. Wuhan, the epi-centre of the virus, Hubei Province and much of neighbouring provinces were placed under varying degrees of lock-downs. Factories, universities and offices were closed. Vehicles, except officially sanctioned ones, were taken off the road.  House to house temperature checking was instituted. Neighbourhood volunteers guarding housing units chased away unwelcome visitors. 

All but one case that was reported from China during the weekend was locally transmitted while   imported cases kept rising (44 new cases were reported on Sunday). However, the challenge for China would be avoiding the revival of the virus spread.  Many experts warn that the virus would make a come back soon after the suppression strategies are relaxed. 

China has so far weathered that eventuality -- it might even prevail in the long run. 
Sri Lanka’s emphasis until last week has been on mitigation.  During the early weeks, travellers returning from abroad were asked to self isolate for two weeks. Later, mandatory quarantining was introduced for visitors from Italy, Korea and Iran. 

Mandatory quarantine measures saved a country from a major spread of the virus. The largest number of coronavirus cases were found at quarantine centres. However, there are serious concerns whether these measures were introduced too late. 

Also, early measures such as self-isolation require self-discipline. That was probably lacking in some quarters. The government is now calling on those who arrived from March 1 to 15 to contact a health hotline. Any leakage of the virus to the society during that period would trigger a new phase of local/community transmission. As evidence suggests, we are not yet there.

Social distancing measures have shown their limits too. On one instance, a pastor from Switzerland who conducted a service on March 15 in a church in Jaffna has been tested positive for Covid-19 on his return to Europe. He reportedly hugged and embraced each of the some 120 members of the congregation in the Philadelphia Church in Jaffna. Elsewhere, an attendee of the Royal-Thomian big match was tested positive for the virus, effectively sending all members of the Turf Club to self-isolation.

The government’s limits on imposing social distancing measures were also increasingly clear and were also understandable.  The President himself complained that the Siripada Chief Incumbent had refused to suspend pilgrimages and that the organisers of the Royal-Thomian big match went ahead despite his warnings -- though he himself  was seen at the Ananda-Nalanda big match a week before. 
Last Friday, the government shifted gears to the more forceful second approach: Suppression of the virus.

It announced a countrywide three-day curfew,  which was lifted in some parts of the country yesterday at  6.00 a.m. and reimposed at 2.00 p.m. In the Colombo, Gampaha and Puttalam Districts the curfew was extended till 6.00 am today (24th)  and will be reimposed at 2 pm the same day.  

It is a hard pill for most people to swallow but that is the right strategy. The difference between the outcome of mitigation and a more forceful approach of suppression is evident in the contrast between the trajectory of the pandemic in China and Europe. 

China’s decisive approach was aimed at stopping the virus on its track while Europe through half-hearted social distancing measures tried only to contain it, with little success. America has not done any better either. Political vacillation and a subtle clash between social liberties and combating the coronavirus has prevented Europe from adopting a more decisive strategy though China’s one-party state has no such encumbrances. 

Now, when the European governments are slowly and reluctantly adopting a host of forceful methods, it seems like they are too late and too little. In the meantime, the elderly and the weak are dying.  
Not all states have near-absolute political autonomy over its society, however, at times of extreme vulnerability of its people the governments should act boldly and decisively. In the end, the primary role of the government is to govern. The failure to do so at a time of crisis defeats the very purpose of governance. 

Sri Lanka had its own moments of dilly dallying and political grandstanding in the battle against coronavirus. We hope it were legitimate economic concerns and not the partisan calculations of holding a general election come hell or high water that prevented the government from enforcing more forceful methods earlier in the day. 

However, Sri Lanka still has the time and space to prevent a communal transmission. To that end, the country should go through a full cycle of nationwide lock-downs while making sure that absconding returnees are accounted for.  The government’s strategy is right. It should stick to it to the end.
 

Follow @RangaJayasuriya on Twitter