Page 23 - ES 2020-21_Volume-1-2 [28-01-21]

6 Economic Survey 2020-21 Volume 1

If individuals and communities take appropriate steps to reduce R and slow the spread of
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the virus, the cases would be stretched out across a longer period of time, thereby flattening
the curve and avoiding overburden of the existing healthcare systems. It also buys time to
potentially develop newer drugs and vaccines targeted at the virus.

RESEARCH-DRIVEN POLICY RESPONSE AMIDST UNPRECEDENTED
UNCERTAINTY

1.8 Two fundamental strategies to combat an epidemic are possible: (a) mitigation, which
focuses on slowing the epidemic spread by reducing R , and (b) suppression, which aims
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to reverse epidemic growth by reducing R below 1. Each policy has major challenges.
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Ferguson et al, 2020 show that optimal mitigation policies (combining home isolation of
suspect cases, home quarantine of those living in the same household as suspect cases,
social distancing of the elderly and others at most risk of severe disease and use of masks,
sanitization & handwashing) might reduce peak healthcare demand by two-thirds and deaths
by half. In this scenario, population immunity builds up through the epidemic, leading to an
eventual rapid decline in case numbers and transmission dropping to low levels. However,
the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths
and health systems (most notably intensive care units) being overwhelmed many times over
– given that CFR for COVID-19 was high. The death toll of COVID-19 is dreadful, both
for those who lose their lives and for their family, friends, colleagues and all whom their
lives touched. It would have an adverse impact on economic activity too in terms of loss of
productive lives.
1.9 Suppression in the form of national lockdowns carries with it enormous social and
economic costs, which may themselves have significant impact on health and well-being in
the short and longer-term. Evidence shows that population-wide social distancing would have
the largest impact; and in combination with other interventions – notably home isolation of
cases and school and university closure – has the potential to suppress transmission below the
threshold of R =1 required to rapidly reduce case incidence.
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Uncertain COVID-19 Parameters in March 2020
1.10 In Epidemiology, two factors are particularly important for evaluating the severity of a
contagious disease: first, CFR or the fraction of individuals infected who lose their life due
to the disease; second, the basic reproduction number R - the expected number of new cases
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of the disease caused by a single individual. However, both the indicators were uncertain at
the onset of the pandemic and showed wide variation. The CFR was as high as 12 per cent
in Italy while the world average was 6 per cent in March, 2020 (Figure 3a). Various studies
showed that COVID-19 had a higher range of R , than many recent viruses, which aggravated
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the risk of its contagion (Figure 3b). Another key factor regarding uncertainty in both the CFR
and R was the fact that many cases were initially asymptomatic. This made it very difficult
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to ascertain the true number of individuals infected with COVID-19, and hence determine the
CFR and R .
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