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Bridging a false dichotomy in the COVID-19 response: a public health approach to the ‘lockdown’ debate
  1. Vandana Prasad1,
  2. B Subha Sri2,
  3. Rakhal Gaitonde3
  1. 1Public Health Resource Network, New Delhi, India
  2. 2CommonHealth, Thiruvananthapuram, India
  3. 3Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, India
  1. Correspondence to Dr Rakhal Gaitonde; rakhal.gaitonde{at}

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Summary box

  • The current approach to assessing risks and defining interventions in the COVID-19 pandemic takes a narrow medical/epidemiological view.

  • A false dichotomy between saving lives and saving livelihoods has dominated the decision-making on responses to the pandemic.

  • A comprehensive public health approach is needed that would address social determinants and medical requirements simultaneously, with equity as an overarching principle.

  • A framework, including the major elements of COVID-19-related factors, health systems preparedness, non-COVID-19 medical conditions, social determinants and social protection, is proposed, with an illustration of its practical application.

  • By taking the lived reality of the poor and marginalised into account, this framework provides communities with more agency than one-size-fits-all approaches to COVID-19 control.


As the world grapples with the public health emergency brought on by the COVID-19 pandemic, various control strategies have been attempted across the globe resulting in a growing body of evidence.1 Thus, we see a wide range of ‘lockdowns’, from the extremely tight Wuhan style,2 to the more measured Rwandan3 and more open Swedish model,4 and a range of testing protocols5 6 and quarantine durations.7 8 These variations stem from differing interpretations of epidemiology and contextual factors, including the strength of a country’s health system, its political orientation and its ability to support citizens, medically and socially, during periods of lockdown.9 India stands apart in terms of the stringent application of a national ‘lockdown’ as its primary and first-line approach to ‘flatten the curve’ and buy time for health systems preparedness. By ‘lockdown’, we mean a complete shutting down of all economic activity except those deemed most essential, along with stringent travel bans and stay-at-home orders, with punitive action for any violation.

Predictably, one of the immediate outcomes in India of the lockdown announced with around 4 hours’ notice was an extreme …

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