When decision-makers have to choose between alternatives in uncertain situations, they often fall prey to what psychologists refer to as ‘cognitive biases’. One of the most common biases is the availability bias, where decision-makers overweight information that is readily available and highly salient (such as through recent media reporting) and underweight or even disregard other information that may be equally important, but is more disperse and less salient. The frequency of exposure to particular events, such as the Covid-19 pandemic, can lead us to significantly overweight their risks relative to others to which we have received less exposure. Research has shown that subject matter experts are as susceptible to cognitive biases as the common man.
We are constantly being reminded of the costs of Covid-19, through information that is readily available, but we do not seem to be aware of the costs of repeated lockdowns, which may have already imposed much higher health costs on India than Covid-19.
The evidence to date suggests that the lockdowns, particularly the first one, have been successful in slowing the spread of infections in India and buying us time to prepare ourselves. We also know more about how to treat the disease today than we did at the end of March. However, it is not clear whether continued lockdowns will be effective. The Prime Minister and the Chief Ministers of Delhi and Maharashtra have resisted prolonging the lockdowns through June. All such States will inevitably come under pressure during the coming days to go back on their word, as confirmed cases keep rising (for example, the opposition parties on June 24 called for a 20-day lockdown in Bengaluru). Those who will pressure them will most likely be suffering from the availability bias, and will tend to overweight data such as the growth in confirmed Covid-19 cases and disregard the costs of lockdowns.
In order to resist the pressure, our leaders need to think carefully about the costs that our singular focus on Covid-19 is imposing on our country. Below are three ways in which India is incurring these costs, which are more difficult to calculate than the costs of Covid-19, but are not any less real.
Quality of life
First, there are clear signs that the Indian healthcare system, with its singular focus on Covid-19, is neglecting patients with other illnesses, who are routinely being turned away from hospitals. Richard Cash and Vikram Patel, writing in The Lancet , reported that in March 2020, compared to March 2019, there was a 69 per cent reduction in measles, mumps and rubella (MMR) vaccinations in children, a 21 per cent reduction in institutional deliveries, a 50 per cent reduction in clinic visits for acute cardiac care and a 32 per cent reduction in pulmonary care visits.
We know a lot about preventing and treating these diseases. Early detection is a crucial factor in effective treatment, and it is worrying that prevention (through vaccinations) and early detection and treatment have been compromised due to the obsession with Covid-19 over several months. We will pay a heavy price for this neglect in the coming months and years.
Second, the lockdown has already imposed a huge economic cost on the country, which will inevitably lead to significant health costs. Sectors critical to the economy, such as travel and tourism, have been at a virtual standstill for three months. The MSME sector is in a state of desperation and it is not clear how many units continue to be operational even after the easing of the lockdown. Those that are will take several weeks to return to full capacity. Unemployment has risen sharply the world over and India is no exception. While the Centre for Monitoring Indian Economy has reported the good news that employment has risen sharply after restrictions were lifted, it is still not at the pre-lockdown levels. Daily-wage earners with no financial reserves are the most affected. The World Food Programme has warned that the number of people facing acute hunger in the world will double to 265 million by the end of 2020.
The link between financial distress and mortality is undeniable: Deepa Mani and Shashwat Alok of the Indian School of Business estimate that a 5 per cent drop in GDP can lead to 42,000-67,000 additional deaths in India, assuming economic recovery in a year, whereas a drop of 30 per cent can lead to 3,30,000-4,30,000 additional deaths.
Third, mental health is the elephant in the room that nobody seems to be talking about. When individuals lose jobs, they suffer loss of self-esteem and start worrying about how they will provide for their families. Forcing them to stay indoors for long periods can aggravate their mental health condition, leading to anxiety and depression. Families, many with young children, have been cooped up in tiny living quarters for three months. Many housing societies have not allowed residents to even leave their apartments for months.
Stephen Reicher, an advisor to the UK government, has warned that the physical and mental effects of isolation are as detrimental as smoking 15 cigarettes a day. One way of estimating the impact of lockdowns on mental health is to obtain data on the sale of sleep, anxiety and depression medications during April-June 2020.
Finally, there is a fear psychosis building up in India, partly due to indiscriminate and sensationalist reporting of Covid-19 data by the media. People with ailments other than Covid-19 are choosing not to go for check-ups for fear of becoming infected.
Many restaurants chose not to open in Chennai even after they were allowed to do so. Some may have chosen to remain shut due to shortage of working capital, others due to shortage of labour, but there were probably many simply too scared to open and risk infection.
It is clear that this is no longer a lives versus livelihoods trade-off but rather one of lives lost to Covid-19 versus those lost to lockdowns.
Time to open up
Unlocking the economy has its own risks and must be done carefully. Many countries have deemed these risks to be worth taking because the longer the lockdowns continue, the more their costs seem to outweigh their benefits. The US, the UK, Spain, Germany and Italy have all unlocked their economies to varying degrees. India’s death rate is 10 per million, compared to 837 for Belgium, 628 for the UK, 606 for Spain, 573 for Italy, 370 for the US, and 106 for Germany. India’s cases are still rising, so the gap will narrow over the coming weeks and months, but we should continue to carefully open up because lockdowns have clearly outlived their usefulness.
It would also be helpful if the Central government could persuade State governments to agree to a coordinated opening up. Currently, each State seems to be doing its own thing. Nowhere is this more apparent than in air travel, where every State seems to have its own quarantine rules, which are acting as a serious disincentive for travel.
To conclude, Covid-19 is a formidable enemy about which much is still to be known and understood. The decisions that our leaders have made and will have to make in dealing with it are not easy. Trade-offs will be necessary. In order to make the right trade-offs, they will need to avoid falling prey to the availability bias. They will need to carefully balance the health costs of Covid-19 with the health costs of preventive measures such as further lockdowns. Repeatedly locking down cities that are major hubs of economic activity may lead to a remedy that is worse than the disease.
The writer is the Chengwei Ventures Professor of Entrepreneurship at the China Europe International Business School
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