Mexico can teach us COVID 19 management

Kahlon Sher Gill

Links are tenuous between India and Mexico. This marginally upper-middle-income economy (per capita income $10,500 about the same as China) with a population of 126 million (about the size of the state of Uttar Pradesh) doesn’t matter much geopolitically. It is tied at the hip to its powerful neighbour- the United States. No reason, therefore, for Indians to engage with it deeply- beyond the delectable Tacos. Or is there?

Twins

As it turns out, barring the language barrier, there are more similarities than differences. First, a colonial past has left behind feudalism and sharp class distinctions. Whiter skin is associated with upper-class folks. Mexicans are fiercely proud of their past glories and yet over-anxious to appear modern. Sounds exactly like India.

But the biggest and most topical similarity is that like India, Mexico is an outlier in the Covid-19 league tables of infections and deaths.

Against 3082 infections in India, it is 1608 in Mexico. Versus 86 dead in India it is 60 dead in Mexico.

So what you might ask? Many countries have similarly low rates of morbidity and mortality from The Virus. Also relative to population Mexico fares worse since our population is 10X of theirs. True.

But consider that Mexico shares a porous 3200 km long border with the US with an estimated 1 million crossing per day before the border was sealed on March 19 to non-essential travel. Also, consider that it is foreign visitors or returning citizens who imported the virus into Mexico and India.

Panic versus planned prevention

The first case was detected in Mexico on February 27 – a day after President Trump returned from his triumphal visit to Ahmedabad, India where he addressed a rally of 100,000 ecstatic Gujarati fans. The first case had already been detected in India on January 30 – an Indian returning from Wuhan. We did nothing for a month. After President Trump departed, the government had the time to think about the crisis. In the first week of March screening of international travellers was started and compulsory quarantine by mid-March after media exposed scandals of celebrity returnees flouting self-quarantine laws.

We started screening of international arrivals too late. But the compulsory quarantine was a judicious response taken after celebrity returnees had demonstrated that they might not be immune to Covid-19, but they were immune to the Indian restrictions.

Where we differ from Mexico is that we panicked in end-March. There were no evidenced statistical reasons for the panic. The infection and death rate justified only selective targeting of restrictions.

The tyranny of League Tables driven policy

But we wanted different. We wanted to be a global leader in dramatically stamping out Covid-19 – like China and most spectacularly South Korea. We like strong governments who in turn like low hanging fruit not a sustained public health services slog.
Also, we wanted to team up and beat the developed nations at their own game.

And what is their game? Rich countries with enough doctors, nurses and hospital care facilities and most importantly well- off families who do not live from day to day can afford a lockdown. Families will still get their wages, out-of-work income support plus easy access to good hospital facilities for free. For such economies the “stamping out” strategy makes sense.

Mexico closer in context to India than the G7

Mandi COVID

But the reality in India is completely different. The lockdown is 10 days old. But who is locked down? It is primarily the plotted urban areas where economic activity has been truncated. In rural areas, animals must be fed, and crops cared for or harvested. In urban villages and the farm markets on the outskirts of cities, where produce is sold and bought, bustling, boisterous commercial deals continue as normal. But “transaction costs” have increased because of the number of “control points” farmers have to navigate to reach the market and truckers to reach warehouses.

Orthodoxy and “lock down” don’t mix well

The Tablighi Jamaat case in Nazimuddin, Delhi where an international meeting of clerics was permitted and turned out to be a cesspool of imported infection, demonstrates what the “stamp out” approach misses entirely.

Unless you start screening early and unless you “lockdown” when the first arrival is detected, you will only be proliferating the infection in the community which has been locked down. This is what happened with the Tablighi clerics. They infected all those in the area where they lived and where they travelled subsequently. The Tablighi are obscurantists who believe that their faith can protect them and if not, then it is God’s will.

They are not alone. In Israel, orthodox Jewish communities are similarly courting disaster by privileging religious rituals and customs over the Covid-19 restrictions – much to the dismay of their Defense Minister, who early-on counselled that the old and the vulnerable should be isolated through self-quarantine.

Mexico’s takes an unorthodox “bet that’s technically sound”

But let’s get back to Mexico. The Washington Post reported March 31, 2020 that Mexico has followed an unorthodox strategy of not worrying too much about testing vast numbers – the standard Western strategy which uses their superior testing capacity to advantage. Instead they rely on their own disease modelling algo – developed during the 2009 Swine Flu epidemic.

Admittedly the novel strategy is a “bet that’s technically sound” says Mexico’s Coronavirus Czar – Hugo Lopez Gatell, which allows them to fine-tune their response.

They need an unorthodox strategy because they just do not have the technical resources of the US or Western Europe (neither do we). Also, 60% of the workers are in the informal economy (in India it is 90%) and these have little or no savings (just like ours). Locking down such people could cause “frightening damage”.

We “locked down” resulting in the barefooted exodus, last week, of migrant workers – walking with their families, hundreds of miles to get home to villages and collapsing on the way out of exhaustion.

So devastating was the negative impact that Prime Minister Modi – uncharacteristically but graciously – publicly apologized and asked for forgiveness for the misery he had unwittingly unleashed.

In Mexico too, the naysayers to their home-grown approach, many of them schooled in the US methodology of high tech, high cost solutions to public health problems, warn that leaving a lock down till too late will over burden the hospital capacities once the disease peaks.

It is professionally safe to stick to “herd analysis” but not very useful. Mexico’s disease control authorities have had the gumption to stand tall in delivering a contextual, home grown response with decent results.

Time to get to work

It is about time we got real and recognized that there is a big contextual element to COVID 19. Selective lock down of “hot spots”, as they emerge, is a good idea. Screening at all inter-city bus and train stations and airports with those detected being quarantined. will discourage people from unnecessary cross border travel.
What is not a good idea, is to constrain, any further, the production cycle and free cross-border movement of all goods. India needs to get to work quickest. We cannot afford an enforced holiday.

Also available at TOI Blogs April 4, 2019 https://timesofindia.indiatimes.com/blogs/opinion-india/mexico-can-teach-us-covid-19-management/

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