A Tale of two Lockdowns: see how two US cities Philadelphia and St Louis dealt with 1918 flue pandemic. It may also explains why the death rate in India is much less than most of the developed nations.

There have been much hue and cry on what was the benefit of early Lockdown in India, was it unnecessary? Could it have been avoided? Here is a documentary analysis on the benefits of early lockdown that may also explain why India reported less death rate than the world average or than that of developed nations which have better health facilities.

It is interesting to see how two US cities Philadelphia and St Louis handled the world’s worst known recorded pandemic to the word, 1918 flu also known as Spanish flu. It infected about 50 crore people (one-third of the world’s population that time) and killed between 1.7 crore to 5 crore people worldwide.

 

Philadelphia:

It Reported first death of Spanish flue on September 14, 1918 it took no measures for the first 20 days--by but that time it had already 400 daily deaths per million. On October 3, the state announced Lockdown, social distancing, closed schools and churches. But it had lost the battle against Spanish flue which continue to spread exponentially. Within a fortnight death rate reached its peak and reported nearly 2600 deaths per million on October 17-18. After this, it generated herd immunity and reduced substantially and in another on month death rate dropped to almost zero. The flue remained active for two and a half months.

St Louis

It reported its first death on October 4, within 3-4 days, it announced lockdown, asked for social distancing, closed school and churches, and the results were very positive. The death rate in St. Louis never crossed 700 daily death per million—this death rate was almost four times less than Philadelphia. Though the flue remained active for almost three months in St. Louis and curve flattened. A delay in lockdown by nearly 20 days in Philadelphia increased death rate by four times.

Observations:

By delaying lockdown by mere 10-12 days increased the peak death rate by almost four times (2600 deaths per million in Philadelphia, and 700 deaths per million in St Louis). Though it is difficult to say that the lockdown was the only reason… there were many reasons, St Louis (spread in 158 square Km) was less populated density wise, and

Philadelphia had more populated and spread in 367 Square Kms, but still the fact remains that the peak death rate tended to be lower in places that acted early, whereas those that waited a week or more saw higher spikes.

Early lockdown avoid unnecessary stress on Health Infrastructure, less death spike means doctors would get time to handle the cases. Similarly, the earlier cities acted, the lower their total death counts in general. Keeping peaks low likely kept health care systems from getting totally overwhelmed, and therefore enabled them to provide better care to each patient.

But then this is not the end of the story:

St Louis lifted the restrictions early considering that the worst has gone, but they were wrong, the virus hit back with the second wave.

"St. Louis and Denver city in the USA lifted the restrictions early thinking the danger was over. But the flu often rushed back as soon as interventions were lifted. Both cities saw spikes in cases after they lifted their bans. None of the cities that kept their bans in place saw the second wave. In some cases Third-wave as well," observes Popular Science magazine (an American quarterly magazine science magazine for the common man),  in its article "What the 1918 flu pandemic can teach us about COVID-19".

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In the Indian context:

India had announced its first Lockdown on March 23, when there were nearly daily reporting of 300. On March 223 the world was reporting about 41,000 cases a day and nearly 2200 deaths a day. The lockdown continued till the first week of June--perhaps the longest lockdown for a country with 138 crore population.

In the first week of June, Unlockdown process began. Then the daily deaths were less than 300 and 10,000 new cases every day. Whereas the world was reporting more than 1.14 lakh cases a day, and daily death of about 4300 people.

The daily death figure and reporting of new cases did not stop increasing despite the longest lockdown. Yet the situation is not as bad as we reported in Italy, Spain, UK or USA. It is managing with its dilapidated health infrastructure though not as efficiently as developed nations are doing, 

 Today the daily death toll has reached 600, and daily new cases to 40,000. The situation is still bad and the only silver lining is the better recovering rate and decreasing death toll.

Did Early Lockdown help India?:  

Yes, without any second doubt. 

Look at the death per million in developed cases USA 433/ Million; Spain and UK more than 600/ million; Italy 580/ million; Germany 109 per million. World over average death rate per million is 78.

Considering the fact that India only reports 20 death per million, one can say India’s position is much better than the world. Reasons could be Early lockdown, immunity, awareness, and late entering of Covid-19 the virus in India.

Did India perform better than other countries? 

Certainly not.

Well, we must question the way our government imposed the Lockdown in a hurry without any roadmap and proper discussion with states and health experts.

It could have been more effective and less painful to casual migratory labourers. The worst part of the Lockdown was suffering of poor migratory people who had no place to live, nowhere to go, and hardly anything to eat. It was a blunder of the Modi Government and it would pay its price in the coming elections.

The SOPs (standard operating procedures) was not clearly defined, officers working on the ground zero were mostly confused due to vague instructions from centre and State.

We should also question why effective measures were not taken at International Airports and on strict early checking (After Mid January, February and March) of people visiting India. Probably our policymakers fail to judge the veracity of the pandemic?

Lastly and most importantly, Centre and state governments did not take advantage of Lockdown to prepare itself for the possible increase in COVID-19 cases. Our health system and its COVID-19 preparations are still worse than some developing countries forget the developed nations.

Write is Vijay Thakur, Special Representative, The Statesman, who has covered health, Energy, Agriculture, and Internal security during the past 30 years.