Exit strategy for Lockdown

Risk optimization between the health threat and economic survival.

As of any Risk management, even for this situation of pandemic; application of resources to minimize, monitor, and control the probability or impact of unfortunate events and maximizing the realization of opportunities available for minimal damage is the aim. Uncertainty is core to risk management and so addressing the assumptions and uncertainty explicitly is very important at this juncture.

Living with Corona-

 Assumptions and approach on which these suggestions are based:

• The pandemic has spread its net from Jan to march 15^th and might erupt at unprecedented quarters. The present zones are being altered after  detection of cases in that area.The cases have been there for some  amount of time; before they got detected.
• We entered in the battle of Corona at a stage where possibility of existence of community transmission in some way,has already happened. It is evident in the socio-economic pattern of red zone localities. Breaking the chain is not completely possible even by extending the lockdown, as we are fighting to trace a non-traceable major chunk of asymptomatic patients.
• Though the lockdown has certainly helped in flattening the curve.
•  Considering the deaths occurred till date, despite difficult living conditions in slums and immigrant camps and high density of population; we can say that COVID19 has not affected our country severely compared to few western countries.
• The core purpose of the lockdown was to buy time to implement a strategy to tackle the virus, to prepare for the final lifting of the lockdown and to prepare for a 'new normal' till the vaccine or medicine becomes available.
•  Creating systems to arrest the criticality of symptomatic patients well before it arises and saving critical patients by providing state of art health care services,will prove the important and impact creating intervention.
• The further waves of pandemic may surprise us if they occur at unexpected districts or mutation happens in an unprecedented way or the patients grow in large numbers during monsoon.
• Yet, we cannot wait to start economic activities as almost everyone is affected economically during the pandemic, and no phasing out would be required for rolling out economic activities.
•  We may give option to people whether they want to be part of the workforce, taking risk in favor of earning or they would like to be at home without salary and provide them some Income protection scheme as suggested by WHO.
• We may give them subsistence allowance for six months or till the time when the medicine or vaccine is available whichever is earlier (3000 in urban areas, 2000 in rural areas)
• The same allowance may be given to those who were working before lockdown and are falling under vulnerable categories and would not be working during this period.
• Opening of the lockdown should be without conditions except the general corona care, to make governance simple.
• The economy is facing many problems, at this stage and it needs support from government. It should not be burdened by more and more permissions/restrictions and unnecessary monitoring for COVID19.
• Passage of transportation of goods should be allowed without any restriction as the economy needs seamless entry. 
• Based on this zoning government may stop the activities for flimsy reasons of any area becoming red zone. This should be avoided at all costs.
• Doctors and medical staff are the warriors of the disaster. They must be protected, comforted, equipped, trained and provided with right system. A PPP model incorporating strengths and efficiency of private medical sector may be banked upon for making the health care system vibrant and responsive.
• The total approach should be made consultative and participative. We need to shift from policing and regulating to consent based policies. WHO recognizes the lockdown and other restrictive tools are blunt and have major socio-economic costs.Any further restrictive measures may be imposed with consent and participation of community.
• Government need not take the whole risk of decision making of lifting lockdown. Employees may share the risk if they want to opt for joining duties by giving consent to the employer. The  employer may cover its employees with corona defined benefit insurance. The government should take the responsibility of building an effective CORONA care system and treat the patients with utmost care and diligence. Create credibility and trust in the minds of people about the health care system so that they enter into economic arena without much fear.
• Government should do some awareness advertising for creating an environment about movement for purposes other than economic reasons. This would create social shaming for even smaller parties and gatherings and may be avoided by people.
• As the people have learnt the seriousness of the disease and will follow the coughing/ masking /hand washing and distancing protocol.
• Health department may handle the Corona crisis strongly and government should work on preparedness for monsoons and monitoring and preparedness for spikes

 Strategy for easing out the Lock down-

Type of intervention	Purpose	Strategy	Explanation
Health care by health dept.	Reducing COVID mortality cases	A strong hub and spoke system of corona care involving all GPs and a specialized COVID hospital to arrest / detect the Critical patient in advance	As the patients are connected to their General practitioners and the GPs know the health history of patients, they can be a more equipped to detect the criticality level of the patients. They could be convenient and effective point of reference due to their local acquaintance and social connect. GPs can be trained and equipped with safety gears and the criticality identification and handling  protocol for potential corona affected persons.
	Getting data of patients for targeting the COVID testing priority	GPs should be given a protocol of different stages of criticality, and work with them in PPP mode (like TB), reschedule the drugs for cough and fever like symptoms in H1 drug category, so the data is available with medical stores. Get the information of reasons of hospital deaths.	These can be tools to capture all the symptomatic patients by using an app developed for this purpose. Instead of sending people for tracing contacts of patients and travelers. This information can be monitored by call centers and control room by using their cell numbers.
	Control room	A vigilant control room and call Centre for making the system alert and responsive	The control room communication with right people will boost their confidence in the system
	Awareness and care for vulnerable patients	Create awareness about vulnerable categories and request them and those who are sick to home quarantine themselves.	The registration of vulnerable patients can be done by providing assistance of GPs. The control room may help them by calling them periodically and updating their health status
	Testing and digital monitoring	Will only culminate into home quarantine and hospital care. The app will be connected to all doctors/medical stores/ Hospitals/ and call center	This will help capture the data of person even if he buys a crocin/ paracetamol tablet.
Economy	Sharing risk with industry	Industry to maintain distance and masking protocol and hand-washing	The micro-planning may be done by each industry for maintaining protocol suggested by Govt, no government involvement will be there except on complaint.
	Insurance Scheme	Insuring  employees against Corona by employer and Govt can contribute in that	There are already corona special plans Insurance plans in Market
	Sharing risk with employees	Consent letter to employer for willingness to enter into the economic activity despite ongoing Corona pandemic. Those who opt for staying home may be considered for subsistence allowance.	The risk of opening of the economy may be shared by government by taking employee consent and insurance of the employee against corona treatment by the employer
	Normal operations without any kind of permission	As the red zone and green zone are interdependent for economic transactions, economy will only thrive if there is restriction of movement.	The movement will be allowed without conditions. Except health protocols, which are common to all.Especially Agriculture and industrial Cargo movement should be allowed freely across state/ country. The protocol can be given for handling Cargo like disinfection protocol.
	Malls or markets and hotels discouraged regular activities	They may go for digital marketing and home delivery mode	This may engage their staff in productive activities.
Other important activities	Schools and colleges	May work on digital mode as far as possible, consent of parents may be taken for attendance if any. As a contingency home schooling will be recognized for this year and the students may be allowed to take up exams and remedial classes after the real normal	Digital interventions may be encouraged. DD national may take up lectures on TV for Classes by experts on all subjects may be initiated on national TV as it can reach to the rural and remote areas too. The teachers will be in school preparing for alternative options
Risk mitigation by government	Monitoring present and potential Red zone localities /clusters for risks	Monitor these zones for vibrant interventions and quick remedies, by a special task force of government till the medicine or vaccine is found	Strengthening disaster risk governance to manage disastrous risk, Enhancing disaster preparedness for effective response. These zones will be monitored for better health services and not for movement.
	Monitor Contingencies	Contingencies like mutation of virus and response to monsoon weather may raise an alarm, work with specialists for devising right strategies	Team of Health experts and senior administrators could be set up to monitor and device the strategy
	Crowd control strategies	Regulate transport and other necessities like APMC markets for avoiding intimate contact.	As the social gathering and school colleges are not to start functioning, the crowd would be considerably reduced.
	Insurance scheme	May insure deaths due to Corona for persons travelling in Bombay locals	Mumbai Local may be an exception and it is a life line too so some innovative solution may be tried to come over this issue of starting local trains like opting Insurance schemes for passengers travelling from Locals
New normal	Individual care	Use mask compulsory when out of home and when around the vulnerable population at home.
	Societal restrictions	No social. Religious, entertainment gathering, meetings would be allowed	Create a media strategy to attach guilt around even small unnecessary social meeting during this time. We are opening economic activities without which we cannot fight with this Covid-19 situation for longer period of time. Any other unimportant gathering should be avoided at all cost.
Social assistance	Vulnerable people	Pregnant women, women with child upto the age of 10, people over the age of 50, people who are on medicine of BP/diabetes/heart disease for last 6 months. And working before the lockdown, with their aadhar and address proof.
	People who opt out for fear of Corona	Have denied the salary, option may be given subsistence allowance for shifting to other forms of employment which allows working from home or with less contact