Mexico, India and Pakistan are among the countries that have hit record numbers of new coronavirus cases in recent days, as drastic regulations that kept streets empty and people apart are lifted. It's a similar story in U.S. states like Texas, Florida and California. In Beijing, a cluster of cases linked to a wholesale market has caused alarm over the weekend.
Should that mean a return to lockdowns? U.S. Treasury Secretary Steven Mnuchin says no. Reality will be less categorical.
Take Pakistan. Official numbers have soared so dramatically that now roughly one in five of those tested are infected, a worrying indication of both spread and inadequate testing volumes. An already-fragile health system is overwhelmed and running out of beds. The country is now registering well over 6,000 new cases a day, compared with less than 1,000 before restrictions began to ease in May. It's moving so fast, in fact, that the World Health Organization took the usual step of recommending officials reimpose shelter-in-place orders. Mindful of the financial realities of a crumbling economy, though, the global body suggests restrictions be applied two-weeks-on, two-weeks-off.
It's an unorthodox compromise. It's also just the sort of option many more countries will have to consider as they try to contain fresh waves of infection and keep fraying economies ticking over, with a vaccine not yet on the horizon.
A handful of European countries do appear to be returning to a semblance of normality relatively smoothly. For much of the world, though, it was never going to be a clean switch from lockdown back to pre-pandemic life. That doesn't mean that we can dismiss offhand the option of fresh restrictions if cases surge and hospital admissions need to be kept down, no matter what Mnuchin says. Officials in the Houston area, for example, said last week they would consider reimposing stay-at-home orders to deal with a situation described as "out of hand."
Each time they're imposed, strict, all-out lockdowns become more difficult, especially in emerging markets already badly damaged. Capital Economics estimates that real gross domestic product in South Asia, for example, will be as much as 9% smaller by the end of 2022, compared with virus-free estimates.
But can flexible alternatives, of the sort the WHO proposes, work in practice?
Consider again Pakistan, which has yet to act on the UN body's advice. There, the obstacles to making even a blunt on-off lockdown work are both clear and instructive - extreme versions of what other governments will need to tackle as they consider more pliable approaches second time around.
First, Islamabad has insufficient testing, detecting and contact tracing, meaning it isn't gathering the data needed to make adequate policy choices and keep clusters under control. Just as serious is public distrustin government and official warnings, compounded by a lack of cooperation from religious authorities. As with misinformation around polio, the consequences are dire.
To get the best economic and social outcome requires trust, clarity and plentiful data. Absent these, the government's proposed alternative to lockdown - "smart" selective tactics, shuttering hotspots - are even more unrealistic than the WHO's proposal. And of course, neither the lack of testing nor distrust of authority are currently unique to Pakistan.
None of this means that adapted lockdowns, as the WHO describes, aren't a credible suppression option.
Bhramar Mukherjee at the University of Michigan, who has been modeling the outbreak in India, points out that flexible, second-wave lockdowns aren't just necessary but may be desirable, in an environment where it's simply impossible to wait for zero cases before reopening, much less to reach Iceland's testing levels. That's especially true if, as with India, the initial restrictions were early and draconian.
Mukherjee, who has also worked on the dramatic state-level differences in India, suggests a potentially more workable alternative to the WHO's cycle. She points to Punjab, a relative success story among provinces, which has imposed weekend lockdowns - easier to apply and run over a long period, and with less economic impact. Places like Mumbai, which now has more cases than Wuhan at its peak, and Delhi, where the health system is under severe pressure, may need to follow suit.
Lockdowns are no panacea, especially when governments fail to utilize the time to prepare, or return to normal too swiftly. They are also not the only way to control the virus: Simple remedies like promoting cleanliness and restricting large gatherings can help, as in Mumbai's sprawling Dharavi slum. Lockdowns are also, in their more malleable version, one of few tools in the global kit to tackle a pandemic that may yet drag on for months.
Unfortunately, best execution requires data and trust. That means the states that need it most, like Pakistan, are those least able to deliver.
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