Published in Dhaka Tribune | May 13, 2020
Photos by Mahmud Hossain Opu
Dhaka’s streets are no longer empty. Shops are slowly reopening. There are rickshaws and cars. Traffic is beginning to pile on. Emerging out of a 43-day “lockdown”, some are calling the country’s guidelines in limiting public interactions a “new normal”. Most people, including myself, understand that the coronavirus is neither new nor temporary. When a vaccine eventually becomes available – perhaps in 12 to 18 months if clinical trials are successful – distribution inequity delays when countries like Bangladesh will get our fair share and will likely have to wait another year. Although research is preliminary, many experts anticipate COVID-19 to circulate in regular intervals worldwide. At this stage, herd immunity has mixed, largely inconclusive “results”.
Going into the lockdown, we knew it will be an astronomically expensive way to buy time. Time that we hoped the government can use to reorganize over burdened health systems to serve COVID-19 patients and provide routine care. Time that can be used to build strong partnerships to design and implement localized, frugal and scalable solutions.
However, much of this time was spent debating between protecting lives against the virus and safeguarding income, especially of some 10 million informally employed day laborers. This debate on reopening the economy unfortunately has become dangerously polarising and counter productive.
We have all seen the data on economic loss. There was nothing surprising about it. When any economy shuts down, it is inevitable people will lose jobs, experience financial shocks and will go into starvation if state welfare is not transferred to them quickly and widely. The only useful signal in the data is the magnitude of loss, which is challenging to accurately estimate in absence of nationally representative household surveys. Irrespective, the signal buys time for the government to come up with a more inclusive restart plan. Depending on the duration of the lockdown, countries with wider fiscal space will likely restart faster than others, although estimates from the International Monetary Fund suggest the “Great Lockdown” will reduce global GDP by at least 3 percent.
These data that we are seeing is incomplete at best. Simply put, household level surveys are asking individuals whether they have experienced income shocks and if they support the lockdown. Unlike rich countries, Bangladesh cannot entirely rely on confirmed cases and deaths because we will never have enough testing to get a fuller picture. Systemic discrimination persistently risks leaving disenfranchised people behind. Policies cannot be based on age-specific variations (or weather) because the data has shown no universal trend and is yet to be rigorously vetted. And most importantly, we still do not have any publicly available systems level data to compliment what we are witnessing inside homes.
In fact, we are still missing significant data on health capacity and consumer demand – both of which should influence any policy measures on reopening and estimating the efficacy (or lack thereof) of shutting down the economy. Has there been in an increase in hospital beds? What is the geographical allocation of recently recruited doctors and nurses? Where are the hotspots and what steps are being adopted to protect and support communities within these hotspots? How are routine services like child immunisation and maternal health (that we know typically and abruptly drop during outbreaks) faring over the past few weeks? What is the number of people with flu or pneumonia symptoms coming to health facilities and if this is more than the well-established seasonal trends? What is the lag time between asking for tests and getting one? What is the testing prioritisation protocol? What is the transmission rate? If many countries are justifying reopening only because they have experienced a sustained rate of decline, where do we fall in the equation with our exponential growth of infections?
The disconnect in the debate on reopening the economy is based on two fundamental assumptions: one, that those supporting lockdowns should be pitted against those who do not, and two, we will go “back to normal” eventually.
Many people say reopening the economy is undermining the value of people’s lives. Continuously staying at home is selfish and privileged – and shows some people have no regard for the economy. This choice between lives and livelihoods is a false dilemma. The goal has always been to safely reopen. The lockdown is intended for governments, especially if they are as resource constrained as we are, to ramp up capabilities and transition to effective case management. The question has always been how and when to reopen, never about if we will reopen. There is universal agreement on how: test-trace-isolate. And when we have that in place, we can re-introduce low-risk, essential activities and move up. In the reopening process, the government should want to avoid recreating conditions that forced the country to go into lockdown in the first place – and reopening hastily risks exactly that.
When experts are put through economic versus public health debates, we miss the opportunity to have a deeper discussion on how we can do both safely. We fail to notice important local interventions, such as setting up sample collection kiosks to makes COVID-19 testing more accessible or creating micro economies by cordoning off entire villages. If reopening can be staggered, we should instead by discussing what are the most essential services and where are we seeing the most demand. What tradeoffs – economic, political and health – need to made between opening shopping malls before Eid to save small businesses and allowing to congregate in mosques during Ramadan so people can feel spiritually united? Which businesses can be stretched to transition to e-commerce – cashless and contactless – and which ones need retail outlets to survive?
In post-pandemic world, “business as usual” is a concept of the past. If 0 is Wuhan-style, continued lockdown and 100 is pre-COVID lifestyle, the future does not promise 100. Therefore, in thinking about choices, it is important to not set our goal at 100. The new normal might be 50, or more realistically, 30.
Categorically, the questions we should be more interested to ask are:
(1) To what extent has the country used this lockdown to prepare for the “new normal”? Have existing health capacities been sufficiently repurposed? What measures need to be implemented to achieve a sustained rate of decline in infections? What policies, bills or regulations need to be passed in the parliament to enforce the “new normal” and how can people be nudged and incentivized to adopt them? Are governments ready for the next outbreak, or if things go haywire, for a second wave of this outbreak?
(2) What does Bangladesh’s new economy at 50 or 30 entail? What industries need to operate exactly as they had done before to still function and which ones can afford change? If change is the new constant, what measures need to be in place – not on a 3 to 6-month basis, rather for a sustained period of time? What are the cultural, social and behavioral nudges that need to be applied for this to work?
In light of the pandemic, how we choose to answer these questions will determine our generation’s history. I am optimistic, if we try, that we can emerge out of this stronger. The crisis has given us an important, rate opportunity to make the right choices, to overhaul fragile, inefficient systems and build more inclusive ones. The pandemic should not end with band aid solutions or quick wins. We should instead be rapidly increasing investments into building expansive public goods: social safety net, sanitation, education and health – and more transparent governments. We need to stop using the poor as scapegoats in an exhausting either-or debate on reopening the economy, and instead, focus our very limited resources on policy innovations that do not disproportionately harm any group. In doing this, we need to accept that the data we will be looking at is very noisy and we are learning almost everything on the fly. And as long as we are holding ourselves accountable to doing more, not one versus the other, we can safely start counting the lives we can save.