Zoning & Our Path to Recovery
#3: Act as if real cases are rising ~10x every 10 days
COVID-19 is a grave health & economic crisis. But it is containable. It has been done in other countries and is replicable. Implemented well, it is a 5-7 week solution. Implemented incorrectly, this could drag on for months & cause thousands of casualties from the virus & the economic fallout.
Precautionary Principle: Act as if real cases are rising ~10x every 10 days
Nassim Taleb’s precautionary principle states that if an action or policy has a suspected risk of causing severe harm to the public domain (affecting general health), the action should NOT be taken in the absence of scientific near-certainty about its safety.
Once in community transmission, this applies to the decisions we make assuming confirmed case numbers reflect reality. The truth is testing lags real cases everywhere, and especially in India since our testing volume per-capita is one of the lowest in the world.
If our objective is to limit risk & prevent an uncontrollable breakout, we must assume that the real number of COVID-19 cases is growing ~10x every 10 days, even if official numbers don’t reflect it, since that’s the growth rate of the virus in other countries & we have no reason yet to believe that it’s behaving differently here.
3-Step Path to Recovery
Recognise that COVID-19 is not a healthcare capacity problem. No amount of healthcare capacity buildup can really keep up with biological exponential growth. Building healthcare capacity to treat is important. However, to end the outbreak, it’s crucial to stay focused on limiting transmission in tightly defined zones.
1. Zoning
For effective outbreak response identify Green, Yellow, Orange and Red Zones dynamically to help monitor the situation, to increase response effort where needed, and to release areas from constraints when possible.
Individual Yellow, Orange and Red Zones should be as small as practical (neighbourhoods, wards, districts, states) so that borders, checkpoints and travel restrictions are established to other Zones. Align this closely with administrative borders to minimize friction. Lockdown & limit all movement between zones.
2. Cut Transmission & assess Risk within Zone
Run a massive Test-Trace-Isolate protocol, especially at points of entry/ exit. If you’re running short on test-kits, check out the alternatives you can work with.
Build healthcare capacity (esp. PPE & isolation beds) to run the Test-Trace-Isolate protocol. Tightly monitor high-risk people & places. Monitor symptoms of all residents daily via a monitoring app to find brewing hotspots.
For every Zone, understand current & future R0 based on leading indicators of infection (not confirmed cases, as they are limited by testing) & assess risks on a near real-time basis.
3. Opening up after a Lockdown
Relax rules and regulations for situations & people that have a low risk of affecting Zone wide R0. Be nimble and proactive instead of waiting for a perfect solution.
Gradually open up activity in the Zones that are consistently Green. In the Yellow & Orange Zones allow varying levels of activity. In the Red Zones, keep everything shut until the situation improves. No questions asked. Direct resources to support the Red Zones.
As you open up, limit travel from region to region, requiring a COVID-19 test & a 14 day quarantine for those transferring from region to region. A divide and contain strategy is essential to protect & grow the Green Zones.
Check out our COVID-19 Recommendations for Policy Makers.
Sign your district up for the Outbreak Control Playbook. Know what Zone you are in.
Write to us at india@endcoronavirus.org
We’re writing to you from the India chapter of EndCoronavirus.org.
EndCoronavirus.org (non-profit) is the world’s largest organization fighting COVID-19, with 2000+ scientists, doctors, engineers & analysts, from NECSI / Harvard / MIT / IIT / IIM, monitoring the spread & control of COVID-19 since January. We have published the most effective set of guidelines for governments to fight the pandemic. Our efforts were critical in the US in banning flights from China in Jan & other early outbreak control measures.
Our mission is to end the outbreak in India with the least damage to our people & our economy. We work with governments to implement guidelines from our learnings in other countries that have stopped the outbreak. This includes guidelines for zoning, risk-assessment, healthcare prep, high risk institutions, grocery stores & essential services.