Over the past 18 months, Sri Lanka saw several lockdowns, of varying periods. Except for the very first lockdown in the initial phase of the pandemic, which came into effect during the latter part of March 2020, other ‘lockdowns’ never ended without being criticised with, regard to their value.
More recently, the word ‘scientific’ has been prefixed to the term ‘lockdown’. Hence, the concept of ‘Scientific Lockdown’ featured in more recent discussions. Therefore, it is worth looking at the feasibility of implementing so-called ‘perfect’ 100% scientific lockdowns. The all-important question is: Is it practically possible to have the ‘perfect scientific lockdown’ to the satisfaction of all concerned?
Despite being in a lockdown state, the country needs all essential services to be carried out (health services, food production and distribution, maintenance of law and order including judicial work, national security, etc.). Further, the maintenance of electric supply, water supply and attending to its urgent breakdowns, fuel distribution, activities in ports, bank services, cleaning services, etc. are not less important. Even to work on a shift basis, one can understand that any country needs a significant workforce to carry out such a huge quantum of work on a daily basis, endlessly. In order to look after the essential needs of this workforce (e.g. their transport, food, health, welfare etc.), the country has to be active and as a result, it will invariably create a lot of human activity.
Hence, it is quite understandable that a ‘perfect’ curtailment of human activity is never achievable. In this difficult endeavour, responsible public/community behaviour is extremely important, by way of adhering to essential basic health advice. People are always trying to find out reasons and excuses to go out of their homes for non-essential matters, instead of staying at their homes. Hence, it gives the impression that in spite of all these Covid deaths around us, people still do not seem to have taken the matter in due seriousness. In fact, it is a common feature worldwide (I must appreciate the fact that given the circumstances, the behaviour of our people is better than that of most ‘advanced’ countries). Perhaps, health education and messages have reached its saturation point where such methods no longer penetrate the masses.
Therefore, it is more than obvious that like in any country, the Ministry of Health and allied services or the government alone cannot carry out preventive measures, unless the people exhibit more responsible behaviour and commitment.
Exposure load factor: Similar to the virus load in a patient, the exposure load can also be worked out. For example, when a 1000 people are exposed to five hours of a high degree of human activity in a city, it will result in 5000 hours of exposure load. But, if 100 people are exposed to 5 hours of the same degree of human activity, it will result in only 500 hours of exposure load. The group with higher exposure load has the higher probability of contracting the disease. Therefore, the enforcement of a lockdown is indeed likely to reduce the exposure load in a society.
The law of all-or-none, meaning adoption of either perfect scientific lockdown or no lockdown at all, is not acceptable, as such perfect scientific lockdowns are never achievable.
Importance of lockdowns: When a lockdown is in force, human activity becomes restricted (may not be to the desired extent), and as a result, there is always a reduction of caseload and its deaths, as we experienced in the past. This reduction, though temporary, is very important to keep the numbers of Covid patients and deaths within manageable levels for the health system and its workers. If lockdowns are not enforced, it is very likely that the numbers will increase, and peak in a short period. This is a very dangerous state; as such a situation will exceed the capacity of the health system of a country. This can lead to exhaustion of the healthcare workers and the total breakdown of the healthcare delivery system. Should it happen it can easily cause chaos and anarchy, where the revival of the system can be most challenging. Therefore, at all times every step must be taken to prevent such an eventuality.
Hence in summary, though the present lockdowns have deficiencies and shortcomings (and the fact that a perfect lockdown is not even a theoretical possibility), they are important in order to keep the health system and its workers healthy. More importantly, people should find out reasons and excuses to stay at home.
Prof ANANDA JAYASINGHE
Professor in Community Medicine
Faculty of Medicine
University of Peradeniya.