Addressing Covid-19 pandemic in developing countries

by Anis Chowdhury | Published: 00:00, Apr 08,2020


Medical staff collect samples from people at newly set upped walk-in sample kiosk to test for the novel coronavirus at Ernakulam Medical College in Kerala on April 6. — Agence France-Presse/Arun Chandrabose

Governments and civil society leaders must help prepare the population for the ‘new normal’ after the lockdown period. ‘Business as usual’ is no longer an option, writes Anis Chowdhury

THE novel coronavirus that first appeared in humans in China’s Hubei province in December 2019 has quickly turned into a global pandemic, already infecting more than a million people and claiming more than 65,000 lives across the world.

Although the new coronavirus cases were slower to appear in developing economies, perhaps for lack of testing and under-reporting, almost nowhere has the pandemic escaped and it may prove disastrous for the world’s poorest people, especially those living in slums and refugee camps. Besides many thousands of deaths, there will be enormous socio-economic impact.

According to the UN secretary general’s report, ‘This is much more than a health crisis. It is a human crisis.’ Besides coordinated large-scale international supports, amounting to at least 10 per cent of global GDP, national solidarity is critical to avert a human catastrophe, economic collapse and social disaster, including human rights.


Panic response

IT SEEMS there were some complacencies in developing countries, seeing the virus jump from China to western Europe, and then to the United States, bypassing large part of Asia, Africa and Latin America. However, as the deadly nature of the virus became clear even in the world’s most advanced and rich countries, developing countries, almost in panic, are racing to contain its spread.

Unfortunately, most governments are implementing measures without taking into account their country specific circumstances. Besides obvious differences between developed and developing countries, especially in terms of resources, demography and institutions, there are significant differences among developing countries themselves.

Of course, governments in developing countries must do their best to impose physical distancing as the virus is known to infect exponentially through close contacts. But policymakers need to consider alternative measures, especially in densely populated countries while at the same time keep the economy running to minimise impacts on poor and vulnerable people who depend on daily work in the informal sector.


Are lockdowns necessary?

IN SOME circumstances, as in Wuhan, and developed countries following the ‘benign neglect’, a lockdown may well be needed to abruptly slow the virus spread if it has reached potentially catastrophic proportions. But in slums and villages, typically, three to five people share a room, with one toilet, common utensils and towels. Isolation is virtually impossible in those circumstances. Even basic hygiene, like washing hands, is not easy when clean running water is a rarity.

Thus, in some developing countries, the means have become ends in themselves, with the focus on enforcing the lockdown, often using harsh draconian and repressive methods, typically with insufficient attention to using the lockdown period for containment and preventive purposes.

Lockdowns are economically disruptive in various different ways and have permanent adverse effects, eg, by disrupting supply chains, nationally, but especially internationally, which many open developing countries have come to rely on, especially in recent decades.


Adverse impacts of lockdowns

GOVERNMENTS need to think carefully about how lockdowns will affect the economy and people’s livelihoods. The poorest — especially the unemployed, daily-rated labourers and the self-employed — will be hit hardest by economic lockdowns.

For the people living in slumps, lockdowns may mean painful deaths from either coronavirus or hunger. Thus, there could be violent protests as seen in some African countries.

Lockdowns in rural areas during cropping or harvesting seasons may mean a loss of crops and food insecurity for the rest of the year. India, thus, exempted some farm activities from the lockdown after farmers raised concerns.

Without sound understanding of the socio-economic features of society and effective means to reach adversely affected and vulnerable people with relief, government measures are unlikely to gain public or community support, which is vitally critical for their effectiveness.

A lockdown is a blunt measure with limited effects which may be better achieved through less disruptive means as careful comparative consideration of East Asian experiences suggests.


Learning from China?

EVEN in China, the lockdown was not really nationwide, with work unusually resuming two weeks after the lunar new year, instead of the usual week off during this season.

There is a tendency to generalise misleadingly from the Wuhan experience. The lockdown was mainly in Hubei and two neighbouring provinces around Wuhan, where epidemic proportions had been reached, but not the rest of the country. It was seen as the best way to bring the rapid spread under control.

We should also learn from South Korea and Singapore, which have been among the most successful in containing the virus although neither have imposed lockdowns. Singapore has introduced lockdowns selectively only after detecting new cases in some specific areas/groups.

Trace, test, treat

KEY to Korea’s success has been mass testing, which helped prevent the spread of the virus by identifying and breaking the chain of transmission. The public policy objective is generally to ‘flatten the curve’ so that the health system can treat and otherwise cope with the infected.

The authorities traced and tested contacts of those already infected and others with suspicious symptoms for infection and immediately strictly quarantined and treated those infected.

As asymptomatic, but infected individuals are likely to be the most significant in spreading the virus, identifying those without symptoms is a major challenge.

Tracing, testing and treating are undoubtedly expensive, they are less costly than the economic disruption due to lockdowns.

Scientists are working to develop cheaper testing-kits, such at the Gonoshasthaya Kendra (People’s Health Centre) in Bangladesh


Kerala experience

KERALA was first to detect the presence of coronavirus in India. It, however, has successfully curbed the virus spread using only physical distancing and precautionary, especially sanitary measures, well before the disruptive and draconian lockdown imposed in the rest of India. Key features of Kerala’s response are:

Whole-of-society approach: wide community consultations, including with experts, to find the most appropriate, locally-suitable versions of transmission control, along with how to monitor and enforce them.

All-of-government approach: involved government agencies across ministries in designing measures to achieve consistency, better coordination and effective communication to avoid confusion.

No one is left behind: ensured supply of essential commodities, particularly food and medicines, to protect the vulnerable sections of society.

Social mobilisation: provided essential epidemiological facts to communities so that people understand, do not panic, and follow basic hygiene and other preventative measures.

Kerala’s approach has earned high level of trust and hence has proven to be less disruptive, less costly, and more effective. As of 5 April, it had only three deaths out of 131 nation-wide, according to the union ministry of health.


Physical distancing, social solidarity

ALTERNATIVE measures can improve ‘physical distancing’ and other precautionary measures, at work, at home and in the community. Wearing masks, even homemade face coverings, provide some protection, especially when many people who have the coronavirus show no symptoms and infectious aerosol droplets are commonly emitted by the infected in normal social interactions.

‘All of government’ approaches are urgently needed to provide meaningful and effective leadership to ‘whole of society’ efforts to contain the spread of virus infections. Only a whole of society mobilisation effort will be able to minimise the disruption and damage.

The public health authorities must provide better popular understanding of the threat and why particular policy responses are needed. Public appreciation and understanding of the challenges involved are crucial for acceptance and implementation of policy.

As we learnt from successful tackling of ebola and AIDS epidemics, the aim of public policy is the virus, not its carriers. So, measures against the virus must not stigmatise its carriers. Policies must be designed taking the context and socio-economic circumstances of policy implementation.


This time is really different

THIS crisis is unlike any previous crises. We cannot expect to return to the status quo ante soon, certainly not until a vaccine is developed and affordably available, which may take quite some time.

A ‘V-shaped’ quick recovery is also unlikely, given the deep and extensive disruptive effects on all of society, eg, including supply chains, international, national, regional and even local.

Hence, there need to be significant fiscal and monetary interventions by governments to keep businesses and industries going, retain employees and sustain consumer spending. This is certainly not the time for governments to be fiscally conservative in order to please credit rating companies and anonymous, faceless financial markets.


The ‘new normal’ can’t be ‘business as usual’

GOVERNMENTS and civil society leaders must help prepare the population for the ‘new normal’ after the lockdown period. ‘Business as usual’ is no longer an option.

We need to think of new ways to reorganise life, economy and society to ensure that people can live full lives with their wellbeing assured.

We need to accelerate investments in digitisation and digital transformations of certain industries and services to enable employees to work remotely.

People will also have to change their social lives to reduce physical contact, even proximity, and mass gatherings.


Anis Chowdhury, adjunct professor at the University of Western Sydney and the University of New South Wales (Australia), held senior United Nations positions in 2008–2015 in New York and Bangkok.

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