Co-authored by Tarun Sharma and Yutika Vora
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Many viruses have come and gone (though not fully), but COVID-19 has affected our daily lives like nothing else has, in many of our lifetimes. The spectre of this virus is still unfolding and the stories of its onslaught and the response of various countries are rapidly emerging. Lessons from this human-virus conflict will certainly shape a lot of thought and decisions in the way humanity deals with public health emergencies including responses of governments and citizens. Some such observations are instructive for all of us: citizens and city governments.
Role of citizens is critical
The frontlines of this virus war are in the cities. In this case, the soldiers at the frontlines are all citizens, including the patients, the deceased, the doctors, the lab technicians, the government personnel as well as those who are socially distancing each other.
Given this central role that we all have, we need to be active soldiers in this war against the common enemy: COVID-19. Our actions need to be deliberate and strategic, instead of being casual. Things that we may have taken for granted our entire lifetimes or even in the lifetimes of two of our previous generations can not be taken for granted now.
Ban on all kinds of travel, students being promoted without exams en masse, central bank redrawing its financial year, cancellation of sporting events, and so much more has happened in a period of two weeks which is unprecedented for all of us. The scale of the progression is unprecedented too. It took 67 days from the 1st reported case to reach the first 100,000 cases, 11 days for the second 100,000 & just 4 days for the third 100,000.
The choices made by citizens are going to determine the outcomes we see in the coming weeks. 60% of the cases in South Korea were reported to have come from just one person. In the current situation, there is mass movement of people from various cities to their hometowns. Those returning from impacted districts need to know that instead of being a soldier, they could be a landmine if they do not practice the scientific advice being shared on the conduct including social and physical distancing with their family members.
Pivotal role of city governments
The current narrative of the news around COVID’s expansion has established our nation states as the main actor and countries as the main battleground. However, the cities have been the epicenters of the action. Wuhan, the capital of Hubei province in China is agreed to be the origin of the outbreak of the Coronavirus and the global spread was seeded by residents of Wuhan who travelled to various cities outside China. Wuhan had 83% of total infected cases and 96% of total deaths in China. It was in Wuhan that the now famous temporary hospitals were constructed in a record number of days. Now as China declares its success against the virus, what we know is that makeshift hospitals in Wuhan are being closed or doctors are removing their masks.
In South Korea, the country being praised for aggressive testing that led to timely containment, the war theatre was in Daegu, the third biggest metropolitan city of South Korea. Daegu saw the largest number of infected cases and deaths, which was at 72% of the total cases as well as deaths in the country.
In Italy, the country with maximum deaths due to Corona, it is the city of Bergamo where the images of army carrying coffins made headlines.
In India, the responses of the city governments so far have been commensurate with the powers that they hold; a large part of the decision making has been done at national and state levels. Some of the city governments were able to identify municipal hospitals to set up isolation wards. Many others who do not have hospitals under their jurisdiction are concentrating on sanitation and awareness drives, something in which they have built capacity as well as expertise, as a result of the Swachh Bharat Mission.
At a minimum, city governments are trying to raise awareness amongst the people regarding safety etiquette and providing support to state or district-level initiatives.
Given the magnitude of the current crises, it will be necessary for these governments to be enabled to take on more and ensure the health of their residents. It is imperative that the role played by our city governments builds on their competitive advantage of being the closest to citizens. Some of the measures could be:
- Leveraging knowledge networks: Most city governments have core staff in their health departments that make daily visits to households and have created deep knowledge networks about the citizens and neighbourhoods. These networks can play an important role in implementation of preventive and curative measures.
- Swift decision: In situations like the present crisis where it is essential to respond fast, the city governments need to be able to take swift decisions and if needed, without waiting for the state government’s instructions or permissions. The Commissioner and the Mayor, as the administrative and elected heads of the local government respectively, should be able to take executive decisions pertaining to public health of their cities. Globally there are cities whose capacity to handle this crises have been compromised because of waiting for instructions or resources from national governments.
- Swift Action: There can be circumstances where cities may feel the need to take decisions to close down restaurants, bars, and other establishments to prevent the spread without waiting for higher levels of administrations. City governments are responsible for providing licenses to many of these establishments and can be trusted to make such decisions in future.
Coordination between various actors in private and public sector
It is abundantly clear that the success of the efforts in the countries where they have been able to deal with COVID-19 has not been because of one actor. In South Korea, the aggressive testing that tested almost 300,000 people, and hence identified and isolated the spread of the virus, was made possible by the proactive action of biotech companies and swift approval by the Korean Centre for Disease Control & Prevention.
In various countries, the private labs have provided critical support to the national health machineries to test and identify cases and stall the potential spread. The Government of India has also recently started allowing accredited private labs to conduct tests for Covid-19. It will be increasingly important to augment the number of testing facilities.
For almost 8000 urban settlements, India currently has 116 labs for COVID-19 testing. With due regards to the caution needed to avoid panic or false alarms and hence the prudence with which new testing facilities are added, the cities should be able to identify the demand for such facilities and mobilise the supply by coordinating with the concerned authorities such as ICMR or state health departments.
Knowledge is Power
Truth in the form of verified authentic knowledge is the tool that ordinary citizens need to be equipped with. Hence, it is important that the efforts, the successes, the failures, the challenges in our collective ongoing battle are shared with citizens. The level of authentic knowledge and information sharing being witnessed right now should become the new norm for communication between citizens and their governments, between citizens themselves as well as between governments of all levels.
Various ministries and government departments are putting out information on a daily basis on the number of cases being reported. There are incredible platforms that have come up at the national as well as global level, that are doing real time tracking of the cases as they emerge. People are tirelessly piecing information from various sources on the web to present comprehensive information about the pandemic at national and subnational levels.
There is widespread knowledge being created and shared regarding the public health guidelines to deal with the crises; the government actions as they happen; the dilemmas governments are facing; the community efforts that are springing up voluntarily to support the vulnerables.
While this information sharing is unprecedented, there are still knowledge gaps that are impacting the way citizens or governments make decisions. Various states were dealing with the same crises in different ways in the initial stages, before the situation escalated and a nation-wide lockdown was clamped. Some imposed voluntary lock downs while others imposed curfews. Some focused their efforts on impacted cities while others locked down entire states.
Different approaches were adopted at different points of time to stop people from crossing their borders. With citizens living across state boundaries, these restrictions created panic as well as confusion, with many trying to go back to their hometowns voluntarily or involuntarily.
In future, it will be useful to have standard protocols and SOPs of communication and knowledge sharing in national emergencies such as this, so that the impact of not only the diseases but the knowledge gap is also minimised. Such protocols are already being shared between the medical fraternity regarding the testing, diagnosis and treatment of COVID-19.
Trusting the people
Global discourse suggests that containment of COVID-19 has worked in the countries which have used state surveillance. It implies a trade-off between individual liberties and state authority. As a nation, we can create a model which replaces authority with influence, and liberties with responsibilities to not just deal with this crisis but also define a social contract between citizens and their nation. A social contract with its foundations on trust and truth.
Abraham Lincoln said, “I am a firm believer in the people. If given the truth, they can be depended upon to meet any national crisis. The great point is to bring them the real facts.” It is during a crisis that we can see things in a new light and the things that shine the most is ‘truth’. It is the time for all of us to redefine the relationships which bind us together – between individuals, between citizens and their governments, or between humans and nature. It is the time to trust people with truth.
Research assistance: Pallab Deb and Aastha Negi