Telangana government steadfastly rejected the need for clamping a lockdown only to do the same within two days. Nobody knows what factors guided the assertion not to declare lockdown and later announced a ten-day lockdown which is now further extended. Public health decisions should be based on scientific evaluation of the situation in a transparent manner to infuse public confidence in them. What criteria should be adopted to declare a lockdown or to unlock?
The ICMR guidelines earlier advised lockdown type restrictions if the test positivity rate (TPR) exceeds ten percent. The TPR is certainly an indicator of the severity of the problem. But, it cannot be the sole criteria. TPR reflects the testing capacity of the health system than the prevalence of infection in the community or the trajectory of the pandemic at a given point of time. The TPR depends on the number of tests done, the criteria of people on whom the tests are performed, and the method of testing used. Besides, no test is fully accurate. Even the RT-PCR test which is considered to be the most accurate test available can also miss 30 percent of cases. This is because of a host of reasons ranging from the timing of the test in relation to the person getting infected to the efficiency with which the sample is collected, stored, and transported.
Governments release data on daily new cases, daily deaths, etc. on regular basis. These can be useful indicators to judge the severity of the problem despite data loss due to low testing or inadequate death count.
Lockdown will not cure the pandemic. It is only a measure that helps to reduce undue stress on the health system. Therefore, countries across the world have been employing lockdown to ensure the infection rates within manageable limits. Therefore, the number of people admitted to hospitals, number of patients who require oxygen or ventilator support are also better indicators to understand the gravity of the problem even in comparison with the capacity of the health system.
At a time when governments are compelled to balance between lives and livelihoods, a combination of all the above factors with a relative weightage, perhaps, may be a better option to arrive at decisions on locking or unlocking. Even this can be a decentralized approach so that the public health response is more accurately data-driven. Such an approach encompassing a combination of criteria is much more useful given very weak data gathering, dissemination plaguing our health administration.
By Prof K Nageshwar