The Covid-19 pandemic has triggered debates between economists and health specialists. I found myself engaged in a conversation with my childhood friend Imtiaz Husain Chowdhry, MD, who is a physician in the USA with a successful practice and long career behind him. He strongly sided with the lockdown policy since according to him, "lockdown is the standard of care unless you have effective treatment and vaccines and drugs."
Imtiaz has been in the USA since 1975, where he came after finishing his medical studies in King Edward Medical College (KEMC), Lahore, Pakistan. We both took our SSC from Government Laboratory High School and passed our HSC from Dhaka College. Our roads parted after we finished HSC and he was awarded the Inter-Wing scholarship to do his MBBS in KEMC. I went on to study Economics at Dhaka University and came to the USA for graduate studies. Imtiaz Husain Chowdhry (IHC) has been in private practice in a suburb of Washington, DC, specialising in cardiology, while his younger brother, Imran Chowdhury, MD, is an infectious diseases specialist with the same group.
Since the Covid-19 pandemic began in March, IHC and I discussed the issues relating to the treatment of Covid-19 and the global response to the crisis. He saw my last op-ed on Covid-19 in this newspaper ("How 'facts' influenced Covid policy", July 5, 2020) where I argued that wholesale lockdown is a severe blow to the economy. Subsequently, we exchanged several SMS messages which brought to sharper relief how much the medical profession and the economists disagree about the need for a lockdown policy as was followed in many countries. I will use the initials IHC and AS to indicate the views that Imtiaz and I, respectively, conveyed to each other, over two days of a "virtual" dialogue.
"Yes, total lockdown is probably not necessary. If only everyone followed the CDC guidelines of social distancing, wearing masks, and hand washing. However, we still need to avoid super spreader situations (e.g. large indoor gathering, bars without distancing and face masks). Going forward, there ought to be enhanced testing, along with isolating positive cases, contact tracing and quarantine of contacts. That is the way to go. We have failed pretty bad in this country so far because of a crazy, lying, incompetent, bigoted, racist, divisive president who is only interested in winning the next election." (IHC)
In response to his argument in favour of a lockdown, I reiterated my view that while I agreed with IHC on the clinical view for mitigating Covid-19, from a cost-benefit perspective, shutting down the economy has been very damaging, even for the average person. My question was, "couldn't many countries achieve the same outcomes, i.e., preventing the spread and protecting lives, without resorting to large-scale and indiscriminate quarantine and business closing?"
"Lockdown is very important. For most places it was done to prevent infected people from leaving the area to infect people in other areas. That is how it spread initially from Wuhan to Europe and then from Europe to America. It is necessary to contain the virus in each country as well. It was done successfully in China and many other countries". (IHC)
I pushed back by arguing that lockdown could be executed swiftly only in totalitarian states such as China and Vietnam, but it would have been difficult to enforce a lockdown without causing a civilian uprising in Italy, UK and the USA, particularly in the USA with a federal system. I offered a hypothetical scenario in the following terms: "Why can't people who are not sick go about their regular business while those who have symptoms or have pre-existing conditions be ordered to stay in quarantine?"
Imtiaz, the physician still appeared not to be convinced by the economist's viewpoint. "Keep it in mind that many patients with Covid have mild and no symptoms (about 30 percent). With a successful lockdown, once you flatten the curve and it's going down, the lockdown can be lifted. Other measures, such as social distancing, masks and hand washing have to continue during and after lockdown." (IHC)
"As far as lockdown is concerned, the duration and whether it is a limited or generalised lockdown is adopted in a country will depend on the problem at hand and how virulent the bug is. Policymakers can get all the information online from CDC and WHO, but it is evolving. Incidentally, lockdown is nothing new and has been done to contain pandemics for a long time. It is estimated that by April, half of the world population had been under some form of lockdown. You think half of all the world population was in lockdown with no evidence?" (IHC)
It now appeared that in the debate my friend and I were not going to reach an agreement on the best form of lockdown policy. I gave it a final try by arguing that, "There is a distinction between dumb lockdown and smart lockdown. The latter involves identifying the hotbeds (also known as clusters) and quarantining the locality, and is being used very effectively now. Most lockdowns were dictated by panic created by some Imperial College epidemiologists who used faulty models. As an economist, I would always consider the cost-benefit aspect of any policy. As I argue in my op-ed, the effect of a dumb lockdown on the livelihood of poor people has been enormous. Limited lockdowns are just as effective, and the rest of the country must be spared the trauma of a blanket lockdown." (AS)
He shot back, "Of course there are downsides to lockdowns but, as you suggest, it is a matter of risk benefit calculation. Masks were not initially necessary; now, of course, it is necessary outside of your home and should be mandatory. Incidentally, two drugs, remdesivir and dexamethasone have been effective in reducing death but is not a magic bullet."
I let him have the final say since he knew more about the disease and its effect on the afflicted. "It is an unusual virus that can attack multiple organs. However, we've seen early promising results with vaccines. With an effective vaccine, some viral diseases have been eliminated completely like smallpox and polio. Others have been controlled like flu (with yearly shots). With effective antiviral agents, some viral diseases have been controlled like AIDS while others have been cured like hepatitis C. So we have, potentially, a lot of future treatments." (IHC)
Dr Abdullah Shibli is an economist and works in information technology. He is Senior Research Fellow, International Sustainable Development Institute (ISDI), a think-tank in Boston, USA.
The article was written in collaboration with Imtiaz Husain Chowdhry, MD, a cardiologist with a private practice in the USA.