COVID-19 Response: allow the non-infectious and non-vulnerable people to work

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 was first reported in China in late December, 2019, and has since evolved into a global pandemic. As of 12 May 2020, data compiled by the John Hopkins University indicates that COVID-19 has been confirmed in more than 4 million individuals in 185 countries and regions, with close to 300,000 deaths, a mortality rate of more than 6%. Severe disease involves bilateral interstitial pneumonia requiring intensive care unit (ICU) ventilatory support and can evolve into adult respiratory distress syndrome with high mortality. The largest study of 1591 ICU patients by Italian medics led by Giacomo Grasseli reported a median age of 63 years, with only 203 patients (13%) younger than 51 years. Common co-morbidities are hypertension, cardiovascular disease, type 2 diabetes, and, more rarely (4%), obstructive pulmonary disease. Similar data have been reported from China.

There is no known pharmaceutical treatment for COVID-19. The dynamics of this novel disease are such that in absence of non-pharmaceutical interventions, it can overwhelm the capacity of health care system, as media have reported the situation in Europe and America. Malawi’s first case COVID-19 patient was reported on 2 April 2020, and the caseload has since grown to 58 with 24 recoveries and 3 deaths as of 12 May 2020. In an attempt to contain the spread of the COVID-19 pandemic rather than to wait for patients to clog the hospitals, the Government of Malawi (GoM) decided to implement a population-wide lockdown. The GoM announced a three-week lockdown period, almost similar to what has been implemented in other countries, starting the night of 18^th April 2020. A lockdown can control the spread of COVID-19 because it limits contacts among people. Prevention is a preferred measure because of a fact that the Malawian health care system is very ill-prepared to handle extra burden posed by a sudden surge of acute COVI-19 patients. The GoM's population-wide lockdown policy has, however, become a sticky policy to implement, the summit of which was the court injunction by Human Rights Defenders Coalition (HRDC) that was granted and sustained until this day by the Malawi High Court. I hereby present my input on the current debate on the Malawi’s COVID-19 response.

A summary of my critique of the Malawi’s approach to COVID-19 that on one hand, GoM failed to implement stringent prevention measures at the country’s border entry points for new arrivals, stringent management of infectious people who test positive to COVID-19, and, also failed to support a stay-at-home of all potentially vulnerable people, but instead GoM opted for a population-wide lockdown. As other critics have argued, the lockdowns impose a disproportionately high economic and social costs at both household and national levels. Lockdown implies a slowdown or complete halt for an uncertain period of time of production and consumption activities leading to closure of businesses, job losses and deepened poverty, in the absence of palliative policies to protect or substitute income flows to the vulnerable groups.

With a population-wide lockdown, GoM will face a loss of revenue in taxes, fees, levies, etc, while at the same time, GoM will continue to face also increasing public expenditures to procure additional ventilation devices, personal protective equipment (PPE) for health workers, and to cushion incomes of the poor households to protect them from total consumption failure. This is especially worrisome for Malawi where COVID-19 crisis interacts with pre-existing poverties including high levels of household income poverty, a weak health care system and a fragile national economy. The foregoing means that Malawians will either die of the COVID-19 in the absence of effective action, or die of poverty-related causes including hunger, if the population-wide lockdown is implemented. This, therefore, calls for a careful calculated policy measures.

With a nation-wide lockdown, the revenue-starved Malawi Government will be forced to slash budgets and public services vital for the poor, while at the same time the poor will lose their jobs and often their health and lives, disproportionately more than the non-poor.  My four-point advice is that government should implement:
i) Implement a 14-day compulsory institutional quarantine at the country’s border entry points of new arrivals;
ii) Impleent a 14-day compulsory institutional quarantine at designated treatment sites for infectious people who test positive to COVID-19;
iii) Implement a generous income support for a compulsory stay-at-home to all those most likely to end up in a hospital once if attacked, including the elderly citizens and those people with hypertension, cardiovascular disease, type 2 diabetes, and obstructive pulmonary disease; and
iv) Allow the less vulnerable individuals to move and work with eased up measures.

This mimics the strategy that was practised in the ancient communes where human settlements (cities) were physically protected outside military invasion, disease outbreaks, etc., by gated walls, and if one of their own community members catches a strange disease he or she was quarantined for the safety of the wider community.