‘Lockdown in India was early, far-sighted and courageous’: WHO envoy
New norms on the horizon as coronavirus has altered way of life, says Dr. Nabarro.
There is no evidence to suggest that the coronavirus disease (Covid-19) will disappear, says Dr David Nabarro, the World Health Organization’s (WHO) special envoy on the disease, adding that people may have to consider new norms for the foreseeable future. Declaring a lockdown when there was relatively a small number of cases in India gave the country time to come to terms with the new virus, he tells Sanchita Sharma in an interview. Edited excerpts:
Do you think Covid-19 can be stopped?
If you don’t get in early and the outbreaks grow, they get very, very big very quickly and then managing them is a massive and a very taxing task. So, where you have countries with not many cases and strong, robust responses at the community level supported by governments, we are most hopeful.
Everything starts at the community level, detecting people with disease and isolating them, finding their contacts and quarantining them, and maintaining, as far as possible, a ready state to respond to outbreaks very quickly, and widespread efforts to reduce opportunities of transmission through lockdowns. During a lockdown, you must build community capacity for interrupting transmission where its starts -- in local communities -- and I see it recognised in India.
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How would you rate India’s response?
The lockdown in India was quite early on, when there was relatively a small number of cases detected. This was really a far-sighted decision because it gave the whole country the opportunity to come to terms with the reality of this enemy. People understood that there is a virus in our midst. It gave time to develop capacities at the local level for interrupting transmission and sorting out hospitals.
Of course, there is a lot of debate and criticism, and inevitably with a lot of frustration and anger that life is being disturbed in this way. It is very, very upsetting. I think it is courageous of the government, honestly, to take this step and provoke this enormous public debate and let the frustration come out, to accept that there will be hundreds of millions of people whose lives are being disrupted. For poor people on daily wages, this is a massive sacrifice they are making. And to do it now at an early stage as opposed to waiting three or four weeks later when the virus is much more widespread, was very courageous.
Unlike in Europe and the United States?
Comparisons between governments are not very helpful, but I can say that there have been some countries where that kind of strong action was not taken early on and we see they now have to struggle with the most immense suffering. We are seeing health workers absolutely at the end of their tether, and getting infected because they are exhausted. We see long term lockdowns being talked about. For example, some people are talking about six weeks, eight weeks.
Is lockdown for three weeks enough?
That all depends on how well-organised the basic community-level public health services and hospitals are. And whether people can see it as a battle that requires solidarity right across society. I don’t make any kind of recommendation because I don’t know what is happening [on the ground].
India is looking very, very carefully to make sure that when the lockdown is lifted, there won’t be a windfall, with lots and lots of cases, hospitals overwhelmed and a national crisis. I think that strategy is right.
What about the people worst affected?
We need to save the lives of people who are badly affected. We must be looking after our hospitals, treating our health workers like they have to be treated considering they are on the front line, protecting them as much as we can and supporting them in society so they get looked after... really making sure they are secure and safe.
In imposing major lockdowns, all governments are having to juggle with the need to really get on top of outbreaks quickly and, at the same time, ensure that people through the lockdown are not experiencing extreme impoverishment or shortage of food.
There is growing recognition all across the world that we have to manage lockdowns very carefully. The size of some of these lockdowns is really massive, so having an integrated policy of lockdown management that deals with the social and economic consequences is always important. As far as I know, there are 70 countries and territories where lockdown is being applied, which is somewhere around one-third or half of the world’s population. So lockdown management is a key activity to get right alongside the response to the disease.
Will coronavirus go away or will it become a seasonal virus like the flu viruses?
We don’t know how this virus will behave over time and whether it will become less serious and whether it will have a particular distribution pattern. The virus is four months old, to our knowledge, and we are learning over time. I don’t know what will happen in hotter weather. I’m really very eagerly awaiting information from your country which is now going into the hot season to know whether or not there is the same level of transmission, or whether it is the same level of illness that we’ve seen in temperate climate. I’m really hoping that it won’t be quite so severe and that weather will be on our side.
We also don’t know how the virus will behave in communities where there is quite a lot of illness, like for example malaria or other infectious diseases.
Will social distancing be the new normal?
Let’s wait and see but let us plan for the virus to be with us in the world for the foreseeable future. There is no evidence to suggest it will suddenly disappear and let’s see what that means for how we organise our lives.
I believe the coming reality for the world will be one where we are always defending against this enemy, like a kind of fire brigade is needed in place. And within that defence, then have the recovery of social interaction and economic activity but done in a way that keeps us all as safe as much as possible. I don’t think we have an impossible task but if we call on our collective ingenuity to establish norms that will enable society and business to get on with what they do best, which is enterprise that creates wealth and enables people to have a decent standard of life.
I’m asking people to consider the new norms at the same time they are imposing lockdowns because the new norms are going to be key to exiting safely from lockdowns without exposing people to disease.