A Catch - 22 Situation

What is Protagoras Paradox? Everyone knows it’s a Ancient Greek legend about the lawyer, Protagoras and his pupil, Euthalos and their famous court battle. It is actually a counter dilemma or Catch 22 situation for the courts of law. In fact the Protagoras Paradox captures the dilemma of our times in a very concise manner. This paradox is such that whichever way you look, both sides have equally convincing arguments. We can go either way in supporting any one and still would not be wrong.

Those in medical practice often come across such situations, either in making a diagnostic or therapeutic decision. One physician can recommend a course of treatment based on scientific evidence and another can recommend a diametrically opposite course again based on medical evidence. Right or wrong, but some merit would exist on both sides. Often the physician himself is having an internal struggle to make a decision about the most appropriate course of action, as two different decisions are arguing in his mind, to do this or to do that. The horns of dilemma are tearing him apart.

You will be wondering as to what am I trying to say? Today many countries have an interesting paradox. Do they continue lockdown for a very long time and wipe out the economies or let a few million people die and keep the economies going.

May be this was the dilemma which prompted a tweet by Donald Trump, ‘hope the cure is not worse than the disease’. I hate to say, but I find some merit in this tweet. One only hopes that the global attempt to flatten the COVID curve, we do not flatten the global economy curve totally. The question is what’s the best way forward? One group recommends ‘total lockdown’ to break the transmission chain, based on evidence from China, who managed to control the spread of the virus by ruthless lockdown and 3 months later they are showing that disease is controlled in Wuhan. On the other hand, the other school of thought is graded isolation & protection of elderly and very young, but let it spread amongst the young and healthy. After all, the disease ultimately will be controlled when we achieve ‘herd immunity’. The medical community is divided in these two groups i.e. to enforce complete lockdown or graded isolation?

To complicate the issue, the epidemic experts have joined the bandwagon with different models of statistical analysis, from Rosy to Dooms day predictions. If we don’t do a complete lockdown, then a million people will die in 1 year. No no, some say more like 90 million will die in 1 year. Whose data analysis is correct? Some suggest do nothing, nature will take over in a few months and all will be well, they quote historical data to justify their recommendations. On whose inputs should we base our disaster management strategy?

Then there are economists with their doomsday predictions. If this continues till May end, our medical resources will be overwhelmed, agriculture will suffer, food shortages will occur, production will come to a standstill. There will be an economic crisis of the proportions that world has not seen ever. So, break this lockdown nonsense and let’s get back to work as usual.

You might argue what all this mean to India? So far we have been very proactive and have contained the virus spread admirably. Now it has been close to 40 days since the lockdown started. Till yesterday, the global figures for total active cases were 31 lakhs with 2.15 lakh deaths (7%) and recovered patients stood at 10 lakhs (30%). And what were the equivalent figures for India? Total cases 30000, deaths 950 (3%) and recoveries at 7500 (25%).

Now let’s look at Fatality Rates per Million of population across the Europe & US. The worst is Belgium at 621 followed by Spain 496, Italy 443, France 341, UK 311, Sweden 197, Finland 177, USA 152, Germany 82. (Mind you these are death figures). So can anyone of you guess what is that figure for India? Hold your breath, it is 0.065.

I am aware that there will be an argument that we are testing very little. Initially it was too low at round 4000 per day but today it is around 50000 to 60000 tests per day. Granted, for population size of India, even this figure should be higher. But the point to be considered here is that what is test positivity rate? This rate is hovering around 4.5% and it is not going up but in fact it’s consistent since the break-out. Then there are people who keep saying that the deaths are being overlooked. In today’s world with social & news media so active, it is practically impossible not to notice if the deaths were alarmingly high.

Here I would like to draw your attention to the fact that there are nearly 28000 deaths every day in India i.e. about 1.1 crores every year. The deaths occur due to various diseases or reasons which are Child Mortality, Cardiovascular diseases, other heart diseases, Respiratory problems, TB, Cancer, digestive & diarrhoea, accidents, malaria and suicide.

Another point which is being stressed is that the corona has still not reached the slums of say Mumbai, Delhi or Kolkata and if that happens the deaths will go up exponentially. Well, then what do we do? Wait? Till when? The virus is in India for more 2 months already and if it had to spread to slums, it would have by now. And what should people staying in these slums do till such time? They will die of starvation if not with Covid. Today there are 8-10 people crammed up in their tiniest shanties with nowhere to go. I have a genuine fear that there may be many psychological cases due to the lockdown.

The next point is fear of unknown. Nobody wants to take a chance. Why risk it? The results so far are indicating that government is successful to a large extent in containing the spread. So what will our political masters do now? Should they continue the lockdown? Generally the answer would be yes. May be that is the reason some states want the lockdown to continue. By the same logic, the elites eg. rich, upper middle class and middle class might wouldn't mind if the lockdown is extended. They would tend to believe that I am safe in my house. But my point is what is the percentage of such elites? My guess is less than 5%, say 3%, that’s about 4 crore people. But for vast majority of Indians, crores & crores, it deprives them of their livelihood. And the time frame for such extension of lockdown is not definitive and such limbo situation would further increase the anxieties of such people. These daily wage earners will start becoming desperate and I wouldn’t be surprised if that percolates into civil unrest if the lockdown continues any further. The government will have to make some provision for these people if they wish to return to their native place. Further there are 22 states in India who have less than 2% cases and there is no logic why they are subjected to such harsh lockdown. The government can not and should not have one size fits all approach.

Secondly today all the states are on a financial brink. The main sources of their income have totally dried up. The GST collection are near to nothing and no sale of petrol & diesel. The central government have also squeezed the only other source of their income, liquor. I somehow don't see the logic of this complete liquor ban.

Whatever one may argue, the vaccine for this virus is at least 18 to 24 months away. Does that mean that all of us are going to sit at home for this period? That’s ridiculous to even think.

Hence India has to plan to open up sooner than later. Because even the elite class will soon realise that their investments in markets are tumbling down by the day. The markets will improve only and only if the economy starts looking up. And that is possible only if we get over the lockdown.

Now the point is what course Modi government would adopt? Will they listen to medical experts, epidemiologists & economists? I think they will decide what course of action will ensure their survival, what will get them people’s votes and they will run with that. Further there is no clear cut formula to decide how to open up. At present ‘Lockdown” finds favour with them. As it is, the economy has not been doing well for last 1-2 years and now Corona virus will become the fall guy. Gradually people will get tired of lockdown and demand that let life go on. Then with equally convincing arguments, the government will say the time has now come to lift the blockade, as we have controlled the contagion, and we have won.

Unfortunately, the costs in either case will be huge, both in terms of lives and money!

Some of you might argue that I am overlooking the threats. And am I personally ready to take the risk? Well, I feel that only thing in our hand is to take necessary care & precautions and get on with life. The flip side of lockdown is too scary.

Incidentally the Protagoras Paradox has not been resolved till date. Students in Law school still hold mock trial and give arguments on both sides without any resolution of the dispute.

Really a perplexing situation. A real Catch-22.

(I had read about Protagoras Paradox earlier but when my friend, Prachi Bapat sent me a post on this paradox with global economic perspective, I got an idea to link the same to overall Indian context)

Yeshwant Marathe

yeshwant.marathe@gmail.com

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