A policeman wearing a facemask stops a commuter beside a closed mosque during Friday prayers in Karachi. — AFP

The Analytical Angle: How smart containment, along with active learning, can help mitigate the Covid-19 crisis

Policymakers must be empowered down to the district levels to respond differentially based on local data.
Published April 18, 2020

Governments across the world face a near impossible choice in tackling the Covid-19 virus — lockdown and prevent spread, but risk economic collapse and potentially many dying of non-Covid-19 reasons, or remain (mostly) open to minimise the socio-economic fallout, but risk many dying of Covid-19.

To make matters worse, there is little data to base a policy response on. Our knowledge of this new virus (transmission mechanisms, environmental triggers, immunity, etc) is still nascent and fast evolving. We also don’t know enough about the potential adverse socio-economic and health impacts of the proposed public health policies. While many countries in the developed world have gone down the route of blanket lockdowns, for others, the choice is harder to make.

Physical distancing and locking down will be particularly damaging for the developing world. In Pakistan, much of the economy is informal. According to the Labour Force Survey 2017-18, the informal sector accounts for 72 per cent of non-agricultural employment. This makes it harder to target and provide financial assistance to those who may need it most.

Loss of livelihood and severe financial hardships may be accompanied by food shortages. In South Asia, food supply chains are dominated by labour-intensive SMEs. This means that extended lockdowns and quarantines may result in food supply disruptions especially in midstream and downstream segments — retail, food service, distribution.

Health issues which require regular care are widely prevalent in Pakistan. The World Health Organisation characterises Pakistan as a TB high-burden country with the fourth highest prevalence of multi-drug resistant TB globally. In young children, diarrhoea is still a major killer, and malnutrition and stunting are persistent problems. Maternal deaths due to preventable causes prevail and half of women of reproductive age are anaemic.

The impact of Covid-19 policies on an already weak and over-stressed healthcare system must be well thought out. Managing health conditions in a lockdown may be difficult. Conversely, easing distancing measures may be too risky as the high prevalence of these health conditions in some populations makes them highly vulnerable to the Covid-19 virus.

Fiscal space is severely limited for adequate relief measures and countercyclical policies which will be required as the economy comes to a grinding halt. Weak state capacity may also make it nearly impossible to implement and enforce a country-wide lockdown, while ensuring all citizens are taken care of.

Women queue up outside the bank branch in Hyderabad to get financial assistance under PM’s Ehsas Emergency Cash Programme. — File
Women queue up outside the bank branch in Hyderabad to get financial assistance under PM’s Ehsas Emergency Cash Programme. — File

Understandably, these are very tough decisions to make. While the fear of uncontrolled spread and mortality eventually pushed the government out of paralysis, at times it also led to panic and poorly thought out decisions. The decision to expand the Ehsaas programme, for example, was a good one but the execution was poorly thought out with massive crowding outside distribution points.

The decision to ease the lockdown and open up some industries is also a controversial one — especially with little transparency on the criteria being used to strengthen or ease the lockdowns.

In Pakistan this crisis has also become politicised resulting in misalignment of strategies across government tiers. The enormity of this challenge requires cooperation rather than tribalism. Our leaders need to work together to save lives and build resilient systems for the long-term.

Up till now the choice has largely been presented as a binary: Lockdown and prevent spread but risk economic collapse, loss of livelihoods, and deaths from other preventable reasons; or remain open to minimise this socioeconomic disaster, but risk health systems buckling and thousands dying from the virus.

Read: A better response to the Covid-19 challenge lies in smart lockdown strategies

Given the dearth of data, however, we are driving blind: we just don’t know enough about the health and economic impact to figure out the trade-offs between these choices. How can we make better decisions in the face of such great uncertainty?

The crux of our approach is the importance of learning. Governments must draw on a well-developed and well-tested machinery for how to make decisions under uncertainty. Policy actions should inform our learning so that policies are tested and refined in real-time. This is what we call smart containment with active learning.

While some decisions must be made immediately (such as, increasing testing capacity and personal protective equipment for health workers), others may be better made after collecting some information (such as, socio-economic data to better target the relief response). Many decisions may also be refined over time as more information comes in (such as, which specific aspects of distancing and lockdown strategies are most effective).

The smart containment approach allows for a locally heterogeneous policy response — each area may have different prevalence, and different needs based on demographic, economic and other characteristics. For example, areas with high population densities or areas with high-risk health characteristics such as high incidence of TB, may need to be treated differently.

Policymakers must be empowered down to the district and local levels to respond differentially based on local data and ground realities. These ground realities then translate into differential and graded decisions on smart testing strategies, physical distancing and lockdown measures, relief measures, public messaging, health sector capacity, and so on.

The active learning aspect calls for re-evaluating policy measures regularly based on data and evidence. This will help us better understand the benefits and costs of each policy and refine accordingly. This process of continuous re-evaluation can provide a roadmap for the next 18 months that is fully guided by the evidence.

The roadmap should inform the design of physical distancing measures and enable better targeting of support measures to rebuild the economy and society.

Consider the two contrasting policy choices — (a) a weaker lockdown where there is isolation, contact tracing and care for those who are sick but there is also a degree of freedom of movement to allow essential workers, such as food producers and distributors, to continue their work, or (b) strict quarantines and physical isolation which will require massive investments in maintaining food chains, ensuring necessities for every family and providing critical care for those who need it.

Up till now, decisions have been made in the face of substantial uncertainty without any clear guidelines for how those decisions should be made to resolve the uncertainty as rapidly as possible. The approach we recommend incorporates prior information and multidisciplinary expertise in a structured fashion and enables real-time data responsiveness.

The Analytical Angle is a monthly column where top researchers bring rigorous evidence to policy debates in Pakistan. The series is a collaboration between the Centre for Economic Research in Pakistan and Dawn.com. The views expressed are the authors’ alone.