Friday, May 1, 2020

What Is Our End-Game To COVID-19?

Last week, University of Malaya Law Review published my article on the effects of lockdown from a human rights perspective. The question posed is a practical but uneasy one: are lockdowns doing more harm than good? Here's a layman version stripped of legal jargon (with updated facts and figures):

The COVID-19 pandemic is truly a scourge to humanity. The death toll exceeds 200,000. A billion more are infected. Fatalities continue to mount. The virus is especially vicious against the elderly and those with pre-existing conditions (mercifully leaving the young largely unharmed). From Wuhan to Lombardy to New York, any corner of the world can be the next epicenter.

​Even now, medical experts are still in the dark on its potency (with modelling estimates ranging from conservatism to optimism):
  • How many people are infected? (half of our population may have already contracted the virus)
  • Can our bodies naturally develop immunity? (some recovered patients may have succumbed to reinfection)
  • When will a vaccine be ready for mass production? (likely not until late 2021)

Thou shalt not pass

Photo by cottonbro

Meantime, governments are struggling to contain the lethal pandemic. The immediate goal is to ‘flatten the curve’ i.e. slow the spread of viral infection to prevent hospitals from being overwhelmed (suppression). By the end of March 2020, one third of the global population — over 100 countries worldwide — have been put under full or partial lockdown.

However, lockdowns disrupt many facets of our lives. International travel is restricted. Offices, schools and shops are closed. Everyone must hole up at home. Anyone tested positive is quarantined for 14 days, even if healthy and asymptomatic. Disobedience entails fine or imprisonment. This inevitably raises an uncomfortable moral dilemma — to what extent should the majority suffer to protect the minority?

The stark reality is that not every society can afford to endure a prolonged lockdown. What if a vaccine comes too late? What if the fallout leaves a far more devastating impact? Fragile economies may collapse. Destitute masses may take to the streets. Sparks of civil war may catch fire.

* * *

The starting point is to ask: are lockdowns necessary in the first place?

It goes without saying that public health is at stake. On 3 March 2020, the WHO declared COVID-19 as a pandemic (the first time ever for a coronavirus) and a ‘public health crisis.

Also, COVID-19 kills. Governments have a positive duty to protect life i.e. taking appropriate measures to address the prevalence of life threatening diseases (e.g. AIDS, tuberculosis, or malaria). Such duty includes ensuring immediate access to essential goods and healthcare services (e.g. food, water, shelter, sanitation, and emergency health services and response operations)

But the question of necessity does not end there. A direct causal nexus between the measure and harm must be established.

Ultimately, the critical question is this — are lockdowns necessary to contain the spread of the outbreak?

Not necessarily so. State practice reveal divergent policies, driven by socioeconomic factors.

So far, some States still refrain from imposing nationwide lockdowns. A prime outlier is Sweden. Unlike its Nordic neighbours, the Swedish government merely exhorts people to practise social-distancing, with minimal restrictions. Such soft approach is perhaps workable in a high-trust society. In the East-Asian region — China, South Korea, Taiwan and Japan — governments have adopted a targeted approach i.e. rigorously tracking, testing, and treating the infected. Also, their good hygiene habits — such as wearing masks in public whenever ill — provide a natural defence.

For less developed States, lockdowns may not be a viable option. A standstill of economic activities would push people into poverty and starvation. Their shallow debt-laden coffers cannot afford a stimulus. Fortuitously, the outbreak has not ravaged fragile regions like Africa (perhaps due to their young demographic). Further, lockdowns may even be counter-productive. During the Ebola epidemic in 2014, Liberia’s lockdown of its capital, Monrovia, was lifted a few days later due to lack of public support and failure to stop transmission.

In short, a blanket lockdown is not a one-size-fits-all solution to contain the COVID-19 outbreak.

* * *

Even if the criterion of necessity is met, governments should next consider the possible far-reaching unintended consequences arising from a lockdown. The next criterion is proportionality: are lockdowns the most appropriate and least intrusive measure to save lives and protect public health?

Ironically, the enforcement of lockdowns may put people in the way of greater harm. First, makeshift quarantine centres are prone to overcrowding and lack sufficient food and proper sanitation, driving many occupants to escape. And who can blame them? The choice between ‘certainty of starvation’ and ‘lottery of infection’ is clear. Greater hardship awaits long-suffering migrants detained at immigration facilities notorious for deplorable conditions even during normal times, such as those in the EU.

Second, law enforcement authorities may resort to excessive force when arresting delinquents. In Kenya, a 13-year old boy was killed by a stray bullet, and three men were beaten to death by the police. In Uganda, women have been caned and forced to ‘swim in mud’, and a LGBT shelter was raided. Police brutality has been similarly reported in South Africa and Rwanda.

Third, danger lurks within households. Women are trapped together with abusive partners. Prolonged confinement heightens the volatility in relationships and level of stress. The murder of two young women in Spain and Italy has gripped international headlines. In France, calls to the national domestic violence hotline spiked by a third during the lockdown period.

Fourth, healthcare providers are faced with difficult choices indeed. Shortage of ventilators compel doctors to play God in deciding which patients to save, and which patients to be left for dead. Indirectly, non-COVID-19 patients bear the brunt of suffering, too. To reserve capacity for COVID-19 treatment and mitigate the risk of cross-infections, hospitals are scaling down their in-patient services and delaying elective treatment — even for cancer! In the long run, the overall quality of health may deteriorate.

Not another Zoom meeting...

Photo by Andrea Piacquadio

* * *

Aside from physical harm, lockdowns prevent us from enjoying many of our fundamental freedoms:
  • Movement: Restrictions to movement must be non-discriminatory. For instance, prohibiting entry of travelers due to ‘flight risk’ is arguably justified (e.g. the US blocking non-essential arrivals from Europe). In contrast, the mass expulsion and detention of African nationals in China appears motivated by stigma, especially considering Africa is hardly a COVID-19 hotspot. In short, measures aimed at people of specific ethnicity — regardless of their actual residence and travel history — is far likelier to be discriminatory.
  • Privacy: Data protection is part of privacy. To contain the COVID-19 outbreak, governments have resorted to mass surveillance - the most invasive tool being contact-tracing apps. For instance, South Korea and China are able to identify contacts crossing paths with those infected (whether friends or strangers) by analysing the digital footprints left in public places.
  • Religion: Generally, most religious communities are amenable with the temporary suspension of public worship. Friday prayers at mosque have ceased. The Pope delivered his Easter homily in an empty St Peter’s Basicila. Nevertheless, all over the world — from Israel to Iran to India — there will be ultra-orthodox sects hell-bent on flouting restrictions. Rational thought may not always prevail over religious zeal.
  • Assembly: Political activities in any area gravely stricken by COVID-19 will naturally grind to a halt. Where an entire nation is in lockdown, Parliament should go into recess (e.g. the UK). Nevertheless, some governments may seize this opportunity to bulldoze their political agenda. In Poland, the tabling of an anti-abortion bill sparked a brave street protest in defiance of lockdown restrictions (but with social-distancing). There is a genuine risk of governments blatantly extend and abuse their emergency powers to stifle political dissent.

* * *

Are lockdowns an effective cure to our short-term suffering?

Even if so, will lockdowns end up as a cure worse than the disease itself in the long run?

These are not abstract philosophical musings. Instead, they keep us vigilant for pitfalls, as we venture deeper into the unknown. A single misstep may scar societies for years, if not decades. The greatest tragedy is to step out of a pandemic, only to land into pandemonium.

Lives will be lost. Rights will be curtailed. Sacrifices will be made. The sooner we accept that trade-offs are inevitable, the sooner we can espy the safest escape route out of our painful predicament.

After all, lockdowns are only a stopgap measure, not an exit strategy. Once lifted, a second or third wave may hit our shores again. Lockdowns may be enforced, loosened, lifted, and reinstated – in a seemingly endless cycle. Vaccine or no vaccine, many developing States have little choice but to ride the wave, in order to avoid an economic shipwreck.

Ultimately, the remedy to COVID-19 comes down to two very simple questions.

What is the end-game?

How do we reach our end-game?

Lockdown or no lockdown, we need to start planning our end-game now.

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