Lockdowns across the world have the potential to do more harm than good. Well-meaning policies from Geneva may not be as applicable to lower-resourced countries.
734 million people live on less than $2 per day. The median household income across the world is less than $10,000.
There are dozens of countries across the world which have no critical care facilities; many others have limited or poor quality equipment, few trained staff, and no realistic possibility of acquiring such facilities.
If someone contracts severe COVID19, they will not be able to afford several weeks in an ICU, even if they belong to one of the fortunate new global “middle classes”. Even in economically developed countries, Level-3 care is not affordable for most; only in those countries with a national health system or good medical insurance schemes have patients hope of acquiring ICU care.
Even before the pandemic, most countries were not in a position to rapidly increase hospital capacity in a crisis. The latter is now compounded by worsening economic recessions; rapid price inflation of medical equipment; large scale procurement of medical equipment by richer governments; healthcare staff becoming sick or refusing labour due to safety issues; and no effective, coordinated strategies or funding from IGOs, NGOs or individual national governments.
Lockdown means different things across the world
The rationale for lockdown, to buy time to increase healthcare capacity, is not valid for most of the world.
What does lockdown mean across the world?
In Cairo, lockdown means not leaving the house on Friday or Saturday, or at night; otherwise it’s ok.
In Atlanta, lockdown means that one can still get tattoos completed because it is considered an essential service.
Even in enlightened Germany and the UK, to help pick the harvest, governments can relax rules on lockdown to transport workers from Eastern Europe in their hundreds on packed buses or airplanes.
For the majority of the world, in dense urban settings like slums (where 100,000 can easily live in the same square mile) and rural villages (where sanitation is already a premium, open air toilets are the norm) staying home cannot prevent the virus from spreading.
Lockdown means little in Khayelitsha.
If European workers who are unable to work have not already been furloughed, then the vast majority can fall back on the benefit system.
But for most people in the world, if you do not work, you do not get paid; if you do not get paid, you cannot feed your family. Food insecurity is real for those who do not live in the West’s socio-economic bubble.
Because of the lockdown, food supply chains have become more precarious. Whereas in Europe this might mean limited food choices, in poorer countries it can lead to starvation. As people cannot grow or harvest food because of lockdowns, almost a billion people across the world are facing a decrease in calorific intake or outright famine.
Malnutrition and starvation due to lockdowns may kill more people than the pandemic. Furthermore, water scarcity is also worsened by lack of machinery to maintain pumps and to transport water; and lack of clean water for sanitation exacerbates all communicable diseases.
In an informal economy, needing to work every day to feed one’s family remains the priority, and impeding economic activity rapidly becomes disastrous.
If someone’s family is starving because of denial to work, it is understandable that they are not going to stay at home and listen to official government advice - they are going to get on their bike and go out to find work: the threat of a possible ‘virus from China’ is not going to be at the forefront of the mind.
When states have limited budgets and capacity to support their locked-down populations, lockdowns result in widespread starvation and civil unrest. And all the while, the poorer countries debt burden (with its implications for long-term health outcomes) increases.
As with other national emergencies, governments are using fear to roll out executive powers to restrict populations.
Minorities, already facing discrimination and oppression, are being scapegoated as the locus of infection. Freedom of expression is being curtailed.
Government surveillance and information control has intensified. Rule by diktat is becoming normalised. People are being arbitrarily arrested, fined or imprisoned, even executed, on the pretext of public health. Populations are in effect imprisoned in their own homes.
Lockdowns don’t work if people aren’t locked down. People will not be able to tolerate being shut in their houses for long periods. With economic imperatives, ignorance and misinformation surrounding the virus, people will flout the lockdown.
A more nuanced approach to lockdown and social distancing is required across the world, one that takes into account the daily lived realities of those who we seek to protect.