What to do with a problem like Covid-19?
Lockdown is the answer and that is where our debate remains stuck it seems. Few of us delved deeper into how a lockdown is or can be imposed and whether we could tweak the idea to suit our circumstances. As a health specialist, Mishal Sameer Khan, wrote in The News on Sunday over the weekend, the debate over the lockdown has paralysed the country, adding that each country uses different strategies to control population movement and mixing.
But it seems that three and a half months later, this nuance in the debate is beyond us. It should not be, for every success story around the world has included a home-grown solution, which has differed in each case, based on each state’s strengths and weaknesses.
Consider Vietnam, which continues to be quoted by us as the example of a country with few resources that has managed the virus well. But this success has many aspects to it. Perhaps one of the most important was that it took aggressive steps very early on. And this was because the country had already experienced SARS and avian flu in the past.
According to reports, it seems the country took measures early in 2020, months before other countries — from travel restrictions to closing the border with China and increasing health checks at borders and other vulnerable places. They had closed schools by end January and initiated a contact-tracing operation.
In some countries, successful efforts seem to have been built around local solutions.
By February, they were sealing hotspots, as we call them. For example, it also sealed an area with 10,000 people north of Hanoi. (It never went for a general, national-level lockdown.) Communication was also effective and began early — the government said it was ‘declaring war’ on the coronavirus at a time when the virus was still limited to China.
But perhaps one of Vietnam’s ‘biggest strengths’ has been its single-party rule and authoritarian system. Its ability to effectively lock down areas and to monitor its citizens has been possible due to its large number of neighbourhood wardens and public security officers who keep a constant watch — and are seldom disobeyed. The state keeps an eye on people’s movements as well as their social media accounts. (Some reports suggest that people are also encouraged to report on each other.)
For example, one media report mentioned that when a hospital reported a high number of infections, police and local officials were ordered to visit every household in the relevant neighbourhoods and ask if they had gone to the hospital.
Similarly, the law-enforcement agencies have censored hundreds of thousands of posts about Covid-19 and taken action against ‘fake news’ and even ‘sanctioned’ people. However, many have argued that others, with less authoritarian systems may find it difficult to emulate Vietnam.
It’s not just Southeast Asia where one finds innovation.
In terms of Covid-19 numbers, Africa is behind South Asia — but both regions have similar problems such as high poverty levels, fragile healthcare systems and little space for social distancing in the poorer residential areas.
But here too, successful efforts seem to have been built around local solutions.
Sierra Leone has past experience of Ebola which was declared an epidemic in the country and lasted from 2014 to 2015. As a result, the country acted early and declared a state of emergency even before it registered a single case of the virus. It followed by imposing three-day lockdowns to allow contact tracers to track down possibly infected people. The contact-tracing teams were put in place during the Ebola outbreak.
The country has been successful with its public messaging, as it has been working on it since the Ebola outbreak and in the years in between; it has figured out what works and what doesn’t. One report mentioned that earlier it tried broadcasting messages from military vehicles but this didn’t prove successful. With its experience of civil war, people are obviously wary of state actors. As a result, the government was compelled to modify its message to appeal to specific local communities and win over the local-level leadership such as village leaders, religious leaders and local councils.
For instance, one effort, it seems, involved traditional healers, who are rather popular with the people. They were asked to refer people to medical facilities instead of treating them. It took time, said one report, but saw some success.
But most importantly, the poor country didn’t just accept that nothing could be done about the water shortage in the poorer settlements. As in Pakistan, water is a precious commodity and not easily available in the poorer areas of the countries. But Sierra Leone didn’t just stop at public messaging about the importance of handwashing. It provided simple basins, water and soap at police checkpoints; inside remote villages and in urban areas. At places, buildings could only be entered once hands had been washed.
Even in the developed West, strategies have varied. Iceland, like New Zealand, has quashed the virus and has done so without a general lockdown. However, it did ban gatherings and also closed high schools and universities, while primary schools and day-care centres remained open. Places such as night clubs and hair salons were closed and masks are not encouraged. But more interestingly, Iceland put in place a contact-tracing team which included cops, nurses, and a criminologist. The country’s testing is among the highest in the world.
In addition, Iceland’s response was led by the country’s director of emergency management, its chief epidemiologist and its director of health. Every afternoon, these three gave a joint briefing to discuss the virus, occasionally inviting guests to join them. An article (on which most of this information is based) in the New Yorker says that three quarters of Icelanders listen to the briefing at one point or the other. The politicians stayed away!
Perhaps it’s time we also discussed more local, home-grown strategies rather than simply debating the merits and demerits of a general lockdown. Perhaps the washbasins could be a start.
The writer is a journalist.
Published in Dawn, June 23rd, 2020