Economy, or health?

Bangladesh is now standing between a rock and a hard place – to continue the lockdown and face the punishing economic disaster, or to return to normal life and face the onslaught of the coronavirus, two equally dangerous extremes leading inevitably to disaster.

None of the choices can now be discounted summarily no matter how unsavoury they are.

The World Bank report on South Asian economy released on Sunday showed the economic perils if the lockdown were to continue – Bangladesh's GDP would crash to between 2 and 3 percent this year depending on how long the lockdown continues.

Employment loss would be unbearably huge in numbers and some of the jobs cannot be brought back with fiscal stimulus if the lockdown continues.

In other words, the country would be revisited by the old spectre of pervasive poverty and food crisis, the cost of which we still do not know.

Stacked against the World Bank's grim outlook is the World Health Organization's recent (April 10) warning that if countries withdrew their lockdowns, the virus would spiral into massive spread of infection, killing more people than now.

World Health Organization chief Dr Tedros Adhanom Ghebreyesus said countries should be cautious about easing restrictions, even as some struggle with the economic impact.

When the current lockdown ends on April 25, and if the detected cases continue at the current trend, by the time the lockdown ends, Bangladesh would hardly have 1,500 confirmed cases. That is just a fraction of the total population.

Taking it to a logical extension, if we ran massive tests and conducted tests on one crore citizens, six lakh or more cases may be detected at the present rate of 6.4 percent.

So if the lockdown is lifted, this huge population will be at risk.

According to a study published in the reputed medical journal The Lancet, lockdowns regarding coronavirus across the globe should not be completely lifted until a vaccine is found.

And when does a vaccine arrive? Nobody is sure, but it may be ready by September according to a scientist leading one of Britain's most advanced teams.

Sarah Gilbert, professor of vaccinology at Oxford University, told The Times on Saturday that she is "80% confident" the vaccine would work, and could be ready by September.

Experts have warned the public that vaccines typically take years to develop, and one for the coronavirus could take between 12 to 18 months at best.

That raises the question: is it at all feasible to lock down Bangladesh for that long? The clear answer is no.

But then, the WHO's warnings are reflected in the Covid-19 pandemic history of Singapore, Japan, Hong Kong and South Korea.

For months, Singapore, Hong Kong, Taiwan and South Korea were lauded for their deft handling of the coronavirus. 

But Singapore is now facing a new wave of infections. Total infections in the city-state jumped more than 80 percent in the past week. 

The government has closed beaches, and some areas of parks and nature reserves, saying "tougher measures" are necessary as safe-distancing measures aren't being strictly followed. It is also making it mandatory for commuters to wear masks on public transport even after the end of a partial lockdown period.

Hong Kong too is facing the same kind of rise in infections.

A partial lockdown has seen the closure of schools, fitness centres, bars and other entertainment venues. The shutdowns have piled greater pressure on Hong Kong's fragile economy but Hong Kong has warned that the strictures might last for years.

Japan, which seemed to have beaten the virus without extreme isolation measures, is seeing cases increase alarmingly, and Japan's prime minister has declared a one-month state of emergency in Tokyo and surrounding regions.

Ways to ease restrictions

So what can be done in such a conundrum?

It seems that until a vaccine is invented, the virus will lurk around us and keep infection rising until all of us have it and develop some immunity. The only thing we can do during this time is to shield the vulnerable groups like the old and sick people. A tough proposal no doubt, but that now seems the best way, as epidemiologists say.

Meantime, a tough quarantine for international passengers has to be ensured unlike the most relaxed one Bangladesh put in place in the early days of the coronavirus infection in the country.

Side by side, a massive increase in testing for the virus allows for a strategy called "seek and destroy".

You identify cases. Test anybody they came in contact with. And isolate them before they become infectious.

This is possible if social interaction can be reduced to about 70 percent. Then the situation becomes much more manageable.

But for Bangladesh to come out of lockdown, it first needs a better estimate of detected infected persons. For that it needs to ramp up testing, the current rate of testing is too small to reach a reliable number. And once we have a credible infection number only then the flattening of the curve, the daily number of disease cases at manageable level so that fewer people need to seek treatment, will give us the signal to relax but not end social distancing.

To come out of lockdown, countries firstly need to have a flat curve. Secondly, their health care systems need to be robust to deal with new outbreaks. Thirdly, they need a system in place for mass testing, contact tracing and isolation.

Unfortunately Bangladesh lags behind on all counts.

So right now, a World Bank-WHO middle ground has to be found out by Bangladesh. Not a complete WHO diktat, not an economy-centric WB approach.

Bangladesh has already lost crucial time in ramping up testing, maybe because of the global unavailability of kits. But it needs to find its own credible curve and then flatten it to get out of the lockdown soon.