Covid-19: India’s decades of deep-seated callousness to the poor is going to cost us all dearly

With at least 1,452,123 confirmed cases of Covid-19 worldwide as of April 8, including 83,454 deaths, the gravity of the unfolding crisis is undeniable. India was late to feel the impact, but with 5,360 reported cases – an exponential increase over the weeks – it has become clear that India is, at most, two weeks behind the disease’s grisly peak. This is when – as was seen in China, Italy, and the United States – hospitals will be overrun with patients and hundreds will die every day.

Covid-19 in India has been a nightmare waiting to happen, but the numbers will not show its true impact. With just 30 tests per million people, most people getting healthcare at under-resourced hospitals, and a government more concerned with posting low numbers, we will never know how many Covid-19 carriers were misdiagnosed or undiagnosed.

Worst of all, instead of using the precious time before peak spread to aggressively expand testing, experts used the slow onset of the disease and the shortage of testing to raise questions like “is there any community transmission in India?” or “why is India’s transmission rate so much lower than China’s and Italy’s?”

Why wouldn’t there be community transmission in India when it has happened in every other affected country. Why exactly would we have a lower transmission rate?

The only reason to even ask these questions is if we make the absurd assumption that India, despite having an abysmal healthcare system in the best of times, is uniquely resilient to pandemics like the coronavirus. In truth, India is in fact uniquely vulnerable to the worst effects of Covid-19, not only because of its broken healthcare system but because all things that have worked against the virus in other countries are missing from India.

Mitigation strategies

In South Korea, the country which has handled the outbreak most impressively, testing has formed the cornerstone of a mitigation strategy. With one in 200 citizens screened since January, the country has had one of the flattest Covid-19 curves.

Strikingly, this has been achieved without sweeping lockdowns or quarantines, largely relying on free and accessible testing, voluntary social distancing, and a public surveillance campaign under which patients’ precise movements – right down to which seat they occupied in a movie theater – were shared with the public.

Although 90% of South Korea’s medical system is not government-run, the state authorised the private sector to produce tests early on and regulated it so tests were available for free under the country’s universal health coverage. The country also released a $9.8-billion stimulus package, which funded medical care, wages for small and medium business workers, and childcare subsidies.

In China, meanwhile, the initial cover-up of the virus was followed by very different – and for the most part, very effective – strategies of aggressive containment. This included the dramatic lockdown of some 50 million people in Hubei province since January 23, strict mandatory quarantines in other hotspots, contact-tracing suspected carriers using mobile apps, postponing non-urgent medical care, and punishing hoarding, price gouging, and other forms of noncompliance.

In addition to containment measures, China also tried mitigation by building entire hospitals within days, providing free Covid-19 testing, and screenings at the country’s many fever clinics, and mobilising citizens’ voluntary labour to get essential jobs done.

Besides Southeast Asian countries like Taiwan, Singapore, and Hong Kong, which have borrowed from the South Korean model of mitigation, most other countries have followed the Chinese model of containment – but not always successfully. For example, in European countries like Italy and the United Kingdom, delays in implementing lockdowns, universalising testing, and educating the public have cost thousands of lives.

However, at least most European countries still have universal healthcare systems and a commitment to social safety nets. This means that once the seriousness of Covid-19 was realised, healthcare was largely accessible, quarantines could be supplemented with suspensions in mortgage, rent and utility payments, and at worst, the private medical sector could be nationalised if there weren’t enough hospital beds or ventilators.

India’s response

Meanwhile, for too long, India pursued neither containment nor mitigation, and its early piecemeal quarantines came too late for a country whose policy combines the weaknesses of all of the abovementioned approaches without any of their strengths. India combines a largely poor population with defunct public hospitals, an unaffordable private healthcare system, and no universal health insurance. The Indian state has demonstrated little to no capability or willingness to regulate the private sector’s production of tests, ventilators, or hospital beds.

As already noted, there are currently 30 tests per million people and even these are being underused. Testing mechanisms rely largely on symptoms for identifying the diseased, leaving out asymptomatic cases that can then spread the virus further. With no previous experience in pandemic mitigation, India does not know how to set up sanitary quarantines, deploy the police and military for medical emergencies, build new hospitals quickly, or isolate the infected.

As if this weren’t bad enough, India’s Bharatiya Janata Party regime is about as science-sceptical as they come. Following authoritarians everywhere from China to the United Kingdom and the United States, India’s government spent February and much of March insistently downplaying the seriousness of the virus and prioritising its political calculus over lifesaving action.

This took the absurd form of Bharatiya Janata Party members gathering in crowds to drink and promote cow-urine as a vaccine to Covid-19, and most recently, in Prime Minister Narendra Modi’s penchant for thali-banging, diya-lighting, minority-baiting street theater going viral across the country. We’ve seen little in the way of genuine economic relief, no word on universalising testing, and no mention of how healthcare will be made more affordable: just showmanship and bluster.

India’s early delay in containing the virus and its slowness in universalising proper testing is certainly going to cost lives, and Modi’s 21-day nationwide lockdown did not make up for his weeks of inaction. If anything, the lockdown has made things worse. In a majority poor country where most people live hand-to-mouth existences, enacting a sweeping curfew without robust redistributive provisions promises grim results.

Drying up the poor’s measly income streams without laying out an expansive, nationwide social safety net with provisions of food, shelter, electricity, water, and a basic income is a cure which will only worsen the ailment. Shutting off markets, trains, and entire cities without warning causes more crowding, not less.

Violently imposing lockdown without providing vast armies of migrant labourers any secure shelter in cities is a surefire way to both spread the infection and to exacerbate hunger and poverty-induced deaths. Even if migrants workers manage to leave cities and survive their grueling journeys home on foot, this will then put rural areas at risk where medical infrastructure is woefully inadequate.

Despite calls to practice social distancing, there hasn’t been any concerted mass education on what social distancing would look like or why it is helpful. Police and politicians alike are treating the Covid-19 curfew as a military rather than a public safety concern, more keen to imprison and discipline than to protect. Is it any wonder then that people are likewise keen to escape the constraints rather than embracing them?

Historical burden

The dramatic incompetence of the current government is only building on decades of structural unpreparedness. India lacks the redistributive quarantine policies of Scandinavia, the pandemic-mitigation experience of Sub Saharan Africa, the universal healthcare systems of Western Europe, the regulatory and surveillance capabilities of Southeast Asia and even the authoritarian brute force of China.

This crisis ideally calls for all of these strengths combined, but India doesn’t possess any of them. Even the United States, where the government’s alarming response to Covid-19 has been to ask whether rather than how to combat the pandemic and where a profit-oriented healthcare system led to over 50,000 preventable deaths per year even before the pandemic, the growing strength of democratic socialist voices has helped push for pro-people ideas like basic income, free testing and treatment, and a moratorium on utility bills, rents, debts, and loans.

In India, such voices are systematically excluded while Prime Minister Modi convenes with business lobbies to find them the most profitable path out of the pandemic.

Journalist P Sainath has prophetically called Covid-19 “a junction from where we decide which way to go” and while this moment might indeed open up new paths towards justice, India’s history of inequality ensures that those paths will almost certainly be lined with the bodies of thousands dying medically preventable but socially mandated deaths. The coronavirus pandemic is that unique moment when the entirety of society is only as healthy as its most vulnerable. As such, our country’s decades of deep-seated callousness to the poor is now going to cost us all dearly.