Bureaucrat tells how to end lockdown, leash corona

 

ISLAMABAD: As decision-makers are weighing different options to contain the spread of coronavirus without slapping lockdown that entails economic cost, a strategy paper drafted by a bureaucrat offers an intelligent solution on how to keep more than 90% country open, substantially mitigating economic impact and simultaneously breaking the chain of infection.

 

Rashid Langrial, a Harvard graduate civil servant, has proposed corona zoning management of the entire country, as he warns that the virus isn’t going to go away anytime soon and nationwide lockdown isn’t a solution.
The zone should be demarcated in a manner that socio-economic needs of residents are catered for. This must follow random testing from each zone and he has suggested pool-testing (where swab samples of ten people could be examined together) in order to make it economically viable.
Zoning and testing can be done in two weeks, according to his calculation. The proposal in circulation among bureaucratic circles has been well-received in Punjab, Khyber Pakhtunkhwa and Sindh alike. “It is very good. He talks of a kind of evolving lockdown. We are implementing it a bit only whereas his idea is to link it to mass testing and so on,” said a well-placed bureaucrat in Punjab.
A provincial secretary in KP commented after reading: “[It] makes perfectsense and the most [of] things are in line with thinking in KP.” Sindh chief minister also echoed the proposal during a presser on late Wednesday.
“Given the uneven spread of the disease in spatial and temporal terms, only a differentiated approach can work. Different levels of lockdown will have to be defined, with varying severities….But a differentiated approach towards lockdown can only be applied if different areas can be categorized on the basis of disease incidence,” Langrial writes in his strategy paper published by the Pakistan Institute of Development Economics (PIDE). He has, therefore, suggested zoning as a corona management strategy on the basis of assumption that uneven transmission of the virus requires uneven approach for different areas.
Social distancing as a strategy depends on the cooperation of full neighborhood, he writes. Enforcing that in a zone is more practicable than uniform application at the country level.
Moving full zone or full neighborhood instead of households along the social distancing spectrum creates incentives for congruent households to exert pressure on delinquent households for compliance.
There are roughly 33 million households in Pakistan. Considering one zone has 16,000 households, there will be 2000 zones countrywide, he writes. Each of the corona management zones can further be divided into 10 corona management circles of roughly 1600 houses.
“What is important will be geographical contiguity, easily identifiable natural boundaries and socio-economic cohesiveness in determining a zone or a circle,” Langrial notes. The perimeter of the zone or circle should be a clearly demarcated boundary, one defined either by natural or man-made markers such as a road or a canal.
Economies are not organised on the basis of some arbitrary number of households but there is nonetheless the fundamental concept of a market town and its hinterland.
“If the relationship of the hinterland with the primary towns is respected while demarcating the perimeters, spillover effects of quarantining certain zones or aggregate of zones can be neatly minimised,” according to Langrial.
Commercial or industrial areas can either be included as part of such zones or can be separated into independent zones with limited access.
Testing comes next. Right now, tests are being conducted on people who either report symptoms or have come into contact with symptomatic people whereas approximately 30% of the infected population which is asymptomatic goes unchecked thus act as extremely potent viral vectors, Langrial explains.
Another 10% in the current testing regime are false negative. Combing them together, these 40% carriers are the mostly deadly weapon in the arsenal of COVID-19.
Without isolating them, relaxation in lockdown would defeat the entire social distancing strategy whereas testing kits are scarce and any diversion to asymptomatic testing will be viewed as wasteful. Langrial offers a solution: pool testing. Germany started testing pooled samples in order to overcome testing limitations. Swabs of ten individuals with different viral transportation mediums are collected, pooled into one and tested. If the pooled sample result is negatives then all ten people are cleared. If none are positive, you can save the cost of 9 additional tests. He has also laid out a strategy of carrying out random sampling.
This sample testing will be useful in informed social distancing strategy. Zones can be divided into four types depending on the number of corona patients.
A zone will be fully locked with curfew in the event of ten or above cases; partial lockdown where there are more than four and less than ten patients; quarantining of zone in case of more than two and less than five patients; and 90% opening of a zone having less than three cases in any circle. The question remains what if the data shows an infection in majority of circles. In this situation, Langrial suggests a complete lockdown of 14 days will be observed in the entire country.
Prior to the curfew-lockdown, ample time (a week or so) will be given for the population to prepare for a 14-day lockdown. People may travel back to their homes, with sufficient stocks for a long vacation to be spent with family alone.
“This lockdown may take place every quarter. Such lockdown will result in across-the-board suppression of disease, enabling us to have the luxury of targeted lockdowns for remaining 10 months,” he explains. At the end, Langrial warned that the lockdown must continue till we have reliable data on the incidence of COVID-19, collected through robust testing of households selected via representative sampling.
Zoning can be done in three days and if the state really moves into action, first round of testing can be conducted through pooled method within ten days because base GIS data at census block is already available, he explains. “Any other approach including incremental opening of the country may lead to disaster of a kind this country has never seen before,” he cautions.