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Resilience to COVID-19: Impact Analysis and Successful Interventions in a Pandemic World

Collaboratively written by Rhiddhit Paul, Debeshi Ghosh and Hamza Abdullah

Illustration by : Abhranil Munsi

India is the second-most populous country in the world. Lying within geographical proximity to the epicentre of the coronavirus outbreak, China, a response to the spread of the virus was implemented by the enforcement of stringent movement restrictions through a lockdown. In a gargantuan effort to develop infrastructure to cope with an unforeseen peril, the country has witnessed innovations along with huge challenges to augment defensive strategies to curb the spread of the novel coronavirus, which has now taken hold of almost the entire world.

The COVID-19 Virus: How prepared have we been?

In just a matter of months, the COVID-19 virus has escalated from being an outbreak of a novel strain of coronaviruses emerging from a market in Wuhan, China to being declared a global pandemic, forcing a global lock-down with almost a third of the world’s population arrested inside their homes.

Source: Freepik

However, The US healthcare system, widely believed to be the best in the world, is under enormous pressure due to the outbreak with medical professionals catering to thousands of patients in need of urgent care every day, while stadiums, convention centres, horse racetracks and other gathering spaces are swiftly being converted into makeshift hospitals. The trends are similar across the world, pointing towards the inability of countries, even with the best healthcare systems, to cope with a pandemic of a scale unimaginable to the world.

In many ways, the current COVID-19 pandemic is a prime example of a ‘Black Swan’ event – a term coined by the writer Nassim Nicholas Taleb to refer to extremely high impact events that often are inconceivable before they happen.

But the relevant question arising is:

Did this pandemic have to be a Black Swan event?

Over the decades, Epidemiologists like Dr Anthony Fauci had been warning that a pandemic of a novel flu strain was inevitable. There have been a number of incidents over the last 20 years, such as the SARS outbreak in 2002-04, which was concentrated in southern China and Hong Kong, the H1N1 swine flu pandemic originating in Mexico in 2009, and H5N1 avian flu in the 2000s. Yet the global economic and political leaders continued to look the other way, focusing on other priorities, which were perceived to be having greater attention, partly due to the smaller scales of the said pandemics of the recent past. One of the prime examples being the US administration cutting funding to disease security programs as recently as 2018. The World Health Organisation has been criticised across the spectrum for its delayed response to the COVID-19 outbreak. This criticism is rooted in the fact that the organisation waited until March 11th to declare the outbreak as a ‘pandemic’ and by that time, the virus had already taken hold of Europe, which replaced Asia as the next epicentre of the disease.

In the sequence of the events, the first case of COVID-19 was witnessed in India on January 30th 2020, and in spite of the deadly consequences, India was assuring its people that coronavirus is not a health emergency on March 13th, two days after the outbreak was declared a pandemic. On March 24th, Narendra Modi had declared a nation-wide lockdown across the country, which was further extended in mid-April for another two weeks, owing to a continuous hike in the positive cases. The intent of the lockdown was to prevent an outbreak in India, a densely populated country having a lack of healthcare resources. The lockdown had been quite a success in containing the spread of the disease. However, this success is woven together with a great amount of misery that with some foresight and early preparation, could have been mitigated—if not averted all in all. The sudden exodus of millions of Indians, mostly dependent on informal livelihoods, making desperate efforts to reach their distant villages across India, even walking for hundreds of kilometres with their vulnerable families, speaks of the failure of the administration, despite having ample time in hands to jump into an emergency-response mode.

It is also noteworthy here that in the present times, India has one of the countries having the lowest spending in healthcare if compared with national and global benchmarks. The current Indian spending remains at 1.6% of the country’s GDP while the government’s own National Health Policy 2017 envisages increasing the health budget to 2.5% of the GDP. The lack of capital investment in healthcare infrastructure is proving to be detrimental in the fight against the COVID-19, as the country struggles to take on the offensive measures to tackle the spread and is unable to provide mass-testing and contract tracing facilities to its people.

The Best Practices observed in India

and across the Globe

Across the globe, countries that have had a traumatic experience in previous pandemics (SARS, MERS) are mostly implementing the offensive strategies and supplementing that with the defensive ones. This, to a great extent, has helped in flattening the curve. While most of the other countries in the world are implementing it in the opposite order. The problem greatly lies in the availability of testing kits and medical infrastructure as a result of a lack of preparedness for such pandemics.

In India, some of the defensive measures implemented by the government are hygiene, social distancing, and expansion of isolation and quarantine infrastructure. Re-interpreting the age-old practice of demarcating playgrounds with chalk, in Bengal, streets and public spaces were demarcated to maintain social distancing. A translation of the idea of demarcation could be seen in Singapore where the tape had been used as a “pandemic architectural element”.

The suspended railway services have aided in the conversion of several railway coaches into isolation wards. Apart fromt the railway coaches, India did resort to converting sports complex turning them into quaratine centres and temporary hospitals.

Railway coaches turned into isolation wards in India | Source: The Economic Times – Indiatimes

The Ministry of Defence, Government of India developed special tents, with a floor area of 9.55 square meters, and equipped with 2 beds and medical equipment, have been developed for use during medical emergencies. The Kerala response Model has been one of the best examples to showcase timely interventions towards the migrant labourers flooding onto the streets, by introducing measures such as community kitchens, masks and sanitisers, counseling, 24-hour control rooms and efforts by the local police force.

In the rural context, India has shown the way ahead with some best practices observed in the villages. The Indian village of Khalilpur in Dhubri, Assam has been practising offensive and defensive measures simultaneously with a five-point agenda that includes sanitisation of the village premises, distribution of food, medical protection equipment and masks, social distancing and availability of medical assistance and doctors. The whole process has been largely facilitated by the women volunteers from the village and the villagers plan to develop their technique further as a Standard Operating Procedure for rural resilience to the virus.

Photo Credits: Binoy Bhattacharjee | NECARDO

However, as claimed by the World Health Organization, restriction of movement and lockdown is only instrumental in buying more time to switch from “a defensive mode into an offensive mode”. In preparation for the switch, India is proceeding to acquire test kits, and expand infrastructure to facilitate contact tracing, mass testing and treatment – the offensive mode. However, medical facilities and the shortage is an inevitable consequence.

The first epicentre of the virus, China, dealt with the consequence of the outbreak – overwhelmed medical facilities – through technological advancements and constructed a 1000 bedded makeshift hospital within 10 days using prefabricated units. Examples have also been set by Hong Kong, Vietnam, Taiwan and South Korea, that are positioned at an uncomfortable proximity to China.

Construction of the temporary medical facility in China | Source: BBC News

A lot of Non-pharmaceutical interventions in Hong Kong have contributed in limiting the spread of COVID-19 through public health measures and public behaviour changes.

In South Korea, self-diagnosis apps and geo-tagging patients who test positive to send social distancing alerts to people in the vicinity through phone apps helped in early tracing. Drive through testing facilities allowed thousands to be tested in a single day, in the safe confines of their cars. At the same time, “phone booth” testing, where a glass-walled booth with built-in rubber gloves for collecting swabs separated a medical worker from a potential patient, prevented direct exposure of medical staff. For treatment, ‘designated site’ was a reasonable solution that earmarked medical facilities that handled COVID-19 cases, to ensure efficiency and prevent contamination.

Vietnam held daily press conferences conveying honest information to the citizens. They set up mobile disinfection booths fitted with ramps in public areas that were capable of sanitizing the entire body, removing 90% of viruses on surfaces in 30 seconds.

Mobile disinfection booth located in public places | Source: Vietnam Times

In Taiwan, Chen Chien-Jen, the Vice President and a noted epidemiologist, gave regular briefings on the importance of hygiene, handwashing and wearing masks. Through border controls, screening of passengers, quarantine orders and suspension of schools, Taiwan had an early implementation of defensive strategies since December 31, 2019. Testing was then enhanced through proactive diagnosis and contact tracing. Psychological distress, like disease stigma, which serves as a major roadblock in the identification of cases was addressed.

In developed nations, COVID-19 has altered perspectives of spatial usage, proximity and commute. The “tactical urbanism” is ensuring pedestrianization to facilitate social distancing. Government policies are being framed in New Zealand to improve the public realm temporarily. Sidewalks are being widened into motorways temporarily in the form of pop-up cycle tracks. Cycles are being promoted in the United Kingdom as key transportation during the lockdown.

Temporary bicycle lane in Berlin | Source: Forbes; Photo by Paul Zinken

A lot of tech-based companies and science centres across the globe have started working on dashboards to track the spread of the pandemic and regulate the updates for all the countries. A recent news by Bloomberg shared that Google and Apple would team up to bring contact-tracing to 3 Billion people.

The Impact of COVID-19

The virus has impacted the world in ways that one could only consider in hyperbolic and speculative. The effects on our daily lives cannot be merely classified into good or bad. In most cases, the impact has manifested itself in the grey areas of the spectrum, with the many negatives being balanced by a number of positives. From a spatial viewpoint, perspectives have been rewired not just for architects and designers but individuals and groups in various other sectors of work as well.

For example, being well connected to the rest of the country has always been seen in a positive light—better air connectivity, a number of highways to approach the city, the number of trains that can be availed and maybe even how well a train or bus station has been designed have all been common ways of judging the ease of living and getting around town. However, the onset of COVID-19 and its rapid spreading mechanism flips the advantages of better connectivity and mobility on their heads. It is in fact, the more isolated spaces—such as villages, and in urban areas—closed gated communities, for example, which have appeared to have the upper hand in fighting COVID -19. Within these isolated islands, life, while restricted, goes on as it did before. In villages, as people return from cities, it is only when someone is infected, does the village face a major problem. Otherwise, in a state of isolation, with enough food to sustain oneself, they are fortresses in the face of the pandemic.

As the virus forces regional and national lockdowns, with entire nations being quarantined, one of the most visible changes is nature returning to urban spaces. ‘Wilderness’ is no longer merely a concept for urban design and city planning. Animals are leaving their shelters in which they had been hiding in order to occupy parks, ponds and gardens that had been closed to the public as a precautionary measure against the disease. With factories being shut down, vehicular movement limited to essential activities and construction suspended too, the air quality has improved remarkably, with Delhi’s AQI turning ‘Good’ from ‘Hazardous’ in just a few days.

The suspension of factories and suspension of transportation, however, does have a detrimental effect on the world economy. With supply chains being disrupted, The IMF has projected the global economy to fall by 3% in 2020. It also forecasts that the Eurozone will face the economic strains and will contract by 7.5% in the current year, with Italy and Spain taking the biggest hits. The United States, currently the biggest epicentre of the pandemic, is also projected to have negative growth of 5.9%. However, India will be among the fastest-growing economies in the world in spite of a growth projection of 1.9%, against a projection of 5.8% in January 2020.

The lockdown has forced businesses around the world however, to rethink their workflow and the dynamics associated with a physical presence. Conveniences such as group video calls and screen sharing applications have become the new norm for millions of people. The new work-from-home culture has a few perks, however a time schedule that allows more flexibility, the comfort of working in one’s own personal space and of course spending time with one’s family, for those of us fortunate enough to be with them. More and more individuals are using the extra time that they save from the absence of a commute in order to pursue hobbies they had once forgotten and to try out new skills. And while for many of us, life at home seems to be doing just fine, these only the most fortunate have the liberty to see the silver lining. The less fortunate among us, are fighting for life and death - and not only because of COVID-19.

Source: Quartz India

With quite a large portion of India’s rural population travelling and migrating to cities to earn their living, COVID-19’s impact on mobility was largely felt by those less fortunate and trying to get back home. As trains, buses and other forms of transport are shut down, on foot is the only means available to return. While many choose to fight it out in the cities, staying put and rationing out food, others attempt the long journey back - quite a few of them dying of exhaustion before reaching home.

Back in the urban areas in India, people feel the brunt of the absence of their rural counterparts, mostly occupying the informal sector. In low and middle-income neighbourhoods, still functioning on the age-old caste system in order to address their waste management, the essential services of sanitation suffer as workers either stay indoors or head back to their hometowns. Streets begin to smell of neglect and hygiene at the most basic level and the lack of education, information and communication have also resulted in hazardous COVID-19 medical waste lying unattended and mixing with the municipal solid waste.

Should India maybe have taken an approach that was more contextual and sensitive to the collateral damage of the sudden 21-day (now extended) national halt?

Way Forward and Recommendations

  • As India, along with many other nations enters into the phase of community transmissions, the global concern must be to combine offensive as well as defensive measures to tackle the long-term and short-term repercussions of the virus spreading faster than its previous counterparts. The foremost area of improvement is to increase the testing and tracing capacity in the entire world, especially the less capacitated developing countries. Improved hygiene habits and behavioural change pertaining to waste management, especially the medical waste must be sought through a bottom-up approach.

  • The social isolation and the resultant shift towards digital media tools for education and communication must be incentivised, scaled and replicated. This shift also presents massive opportunities towards higher digital literacy in countries like India having a sharp hike in internet penetration over the last few years. The emergence of online education and working from home must also be encouraged to maintain social distancing, even after the lockdown ends until the risks related to the virus are non-existent.

  • The lockdown has affected badly on the informal economic sectors in India and many similar economies. The poor are finding it difficult to sustain their lives and livelihoods. Managing cash flows, especially in the informal sector, probably by the means of direct cash transfers, along with ensuring food security for the poor must be ensured by the governments. The example of Kerala must be cited where the government has ensured food security (in accordance with the regional food culture), entertainment and mobile recharging incentives among other things to ensure the migrant labourers don’t feel trapped and come out on streets protesting the food and income shortages.

  • However, some positive aspects of the lockdown are experienced by many, as people have more time to focus on things that otherwise seemed less important, such as more interaction with friends and family. Reflecting upon human relationships, empathy and collective living must be sought even after the pandemic ends.

  • One major challenge lying ahead for public spaces is to rethink their role in a post-COVID world. Traditionally regarded as the facilitators of human interaction, economic and social activities, the public space must now prepare themselves to be enablers of hygiene and social distancing for a while till the fight is over. In the short term, public engagements through semi-private spaces like balconies and terraces must be encouraged to keep the public sanity and mental health intact in these times of peril.

  • The cities have been swiftly emerging as the powerhouses of the economy in modern times. Density, coupled with the provision of facilities and employment results in greater prospects of improved quality of life in cities. However, in a post-pandemic world, cities must strive to decentralise the power dynamic and boost food production in rural areas. Most of the informal workforce losing out on livelihoods could be deployed to the agrarian sector. Incentivisation of the rural economy to decentralise and de-densify the cities should be ensured.

  • In terms of the level of preparedness to fight the current and future pandemics of such a scale, India and the world have to achieve more than they have right now. Preparedness for hygiene, food stock, waste management and medical infrastructure must be ensured by the governments.

  • It is about time the technology innovations like the IoT in the medical field were explored, where a range of machines interact with each other to provide essential healthcare facilities like testing using drones, aggregating precise and standardised data and predicting future pandemics using machine learning. Planning must be done to ensure a resilient supply chain management as a prophylactic measure across the globe. More healthcare spending is a necessity in a post-pandemic world and the priorities must be set straight now.

  • Another aspect to focus on is ensuring a sense of inclusion and solidarity across societies and countries. Blaming each other, be it on a community level or international level, will never yield constructive results. Questions must be asked and critique must be presented where it is due, but in today’s times of peril, solidarity, not isolationism and protectionism is the way forward. Racial and community-based stigma must be done away with, and steps must be taken to ensure international cooperation and greater awareness amongst the citizenry.

  • Lastly, the current crisis has presented a window of opportunity to reflect on our actions and their repercussions on nature. There have been numerous documented instances where nature and wildlife have reclaimed their due spaces and initiated the healing process. The air quality levels have improved across the world’s most polluted cities. River ecosystems are recovering and marine life is now returning to normal. So while the world is thrilled with clearer skies and dolphins, we should not forget that we, human beings, have created such systems of living that benefit from over-exploitation of nature. And unless we amend our ways, nature will strike back again, as it has a way to come around and the current crisis is an opportunity to understand that there is little we can do to bear the perils of nature's fury.

World Economic Forum Annual Meeting 2013 | Graphic Source: The Value Web

Note: The data source of the research is only till April 16th 2020.

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