'Lockdowns not sustainable, come at high costs'

As Indian states like Maharashtra, Tamil Nadu and Assam announce lockdown extensions, one of UK’s most vocal lockdown critics, Sunetra Gupta, a professor of theoretical epidemiology at Oxford University, spoke to TOI on why stringent curbs like these are not sustainable and how the costs are too high — as evident by the migrant workers’ exodus in India. The 55-year-old, who has also won Sahitya Akademi award for her novels, also believes the structure of the Indian population could be a reason the country has a lower mortality rate and that there is an urgent need to bolster the health system.Q: You are one of the few scientists who have opposed lockdown…A: I have been worried about the effects of lockdown in a nation like the UK, but my main motivation for getting drawn into this debate in countries like India — where I was born — is the fact that it is going to cause immense harm and untold damage. In the UK it is a privilege that is accorded to those who have a steady income and large houses. One can immediately see the inequality highlighted by a lockdown. If someone does not have much you can’t tell them to stay at home during lockdown. This is true for the UK, but it also holds true for Dharavi.Q: One of the interesting arguments that have been put forward is that the lockdown period could have been used to prepare health infrastructure. But the moment the lockdown was lifted, the cases increased. What can developing countries do?A: This is just one disease. We don’t have the infrastructure in place to prevent the deaths that are occurring from tuberculosis, diarroheal disease and from other respiratory infections. What is being highlighted by this pandemic is a fundamental problem. In the developing world, such healthcare extends to the middle classes mostly. But this is also true for the UK and other countries which have a disastrous deficit in the healthcare systems. One can certainly make an argument that you can buy time with lockdown. It is possible that the UK could have sustained a lockdown that lasted up to three weeks, simply to get its act together…But the truth about lockdown is that it is not sustainable. It is not a solution at any level and in India the costs were felt extensively with migrant workers moving out. medium76743016Q: But some of the states like Assam and Tamil Nadu have reimposed lockdown. Why are countries continuing with lockdown when it hasn't emerged as a very effective strategy?A: In the UK, quite a few academics are against lifting lockdown. There are two reasons why they think so. They believe it may lead to a surge in cases, so that’s my primary point of disagreement with them. I think there is enough evidence to suggest that lifting lockdown in the UK will not lead to a massive surge of cases. But, my argument has been that we cannot look at this epidemic as a single axis of how many people are going to become infected. We have to weigh it against the cost of lockdown.Q: So a vaccine could be the only answer?A: A vaccine will be very useful in protecting vulnerable people. Studies have made it clear that the deaths are occurring in the elderly or frail. One of the things about India and sub-Saharan Africa is the age factor. Percentage of population in the category of old and frail is considerably smaller than in the UK. But in sheer numbers, it is quite high. One could protect them with the vaccine much as one does with flu.Q: But hospitals are already running out of beds in places like Delhi…A- That is a real concern. It is the same here, the National Health Service (NHS) looked like it was about to be overwhelmed and they built hospitals. By then, the pandemic was on its way out. And as it is, we have not been able to prevent deaths from TB and other diseases. So many children die of vaccine-preventable diseases and this year the numbers will be higher because many have not been vaccinated due to the crisis. I think the only thing we can do is to bolster the healthcare system. That is the long-term solution. With lockdowns, you are only deferring the epidemic, we have seen this in places that had successful lockdowns. Places like Sweden where they haven’t locked down and simply moved the vulnerable groups have had higher deaths but they are now in a sturdy position to go forward. Q: You mentioned that the virus is on its way out. What do you mean?A: The virus is obviously not on its way out in Mexico, Brazil or even the southern states of the US. So there are places where the virus is on its way or plateauing. In the UK, in many parts of Europe, the pandemic has peaked and then come down in my opinion. medium76743000Q: In India, the Covid-19 cases were predicted to peak around July.A: The thing about India is that it is very large and cases may have peaked in places like Mumbai. When India went into lockdown, I was of the opinion that the virus had already spread and that it had not caused too many deaths because of the age structure of the Indian population.Q: Why do you think there are so few women epidemiologists in India? A: Epidemiology by itself is a new subject. There are different types of epidemiologists. I work in an emerging field where we use mathematical models to try and understand the spread of diseases. I think we have a healthy representation of women in the physical sciences relative to the population in India. I always tell people that when I was growing up in India, no one made me feel that I should not study sciences because I was a woman. So in many respects were are further behind. In cultures like India, it is far more conducive for women to study sciences.