India’s Covid 19 Moment of Truth

Avinash Gavai

In an attempt to stem the spread of coronavirus in India, Prime Minister Modi on March 25 announced a nationwide lockdown for three weeks.

Modi’s hasty announcement of the unprecedented lockdown gave hundreds of millions of Indians less than four hours to prepare. In an address to the nation, he said “Forget about leaving home for the next 21 days. If you cross the threshold of your house, you will invite the virus home.”

It has thrown much of the country into chaos.

Modi assured Indians that essential services would continue, but was vague regarding how people would be able to buy food and other necessary items. As a result, people rushed to shops to stock up before the decree took effect. People were seen lining up outside stores late into the night and traffic congestion was reported from across the country.

But it was a necessary, if long overdue move.

It took India forty days to reach the first 50 cases, five more days to reach 100 cases, three more days to reach 150 cases and then just two more days to reach 200 cases. From here on, the juggernaut is going to roll fast.

The number of confirmed cases in India is now doubling in five days or less, down from six days earlier this month. This puts India in line with trajectories of countries across the world — in the United States, cases are now doubling every two days.

Experts warn India that an avalanche of cases is likely in the coming days. As the pandemic proves far beyond any normal crisis India has experienced in the past, it can, in the absence of timely and effective intervention, potentially overwhelm the country’s public health infrastructure.

Moreover, these are only confirmed cases; to ascertain the true number of cases, India will need to ramp up its conservative testing. The Modi government took one small step closer to that by expanding testing to those hospitalised with respiratory distress who did not have known contact with a person with foreign travel history.

According to a Print report: “at this rate of growth, and assuming the 3.4 per cent fatality rate relative to confirmed cases calculated by the World Health Organization, India is headed for nearly a million confirmed cases by the end of May and over 30,000 deaths.” These are conservative estimates. A team of bio-statisticians used predictive modelling and estimated that the number could be even higher, reaching nearly a million cases by 15 May instead.

Many people do not yet realise the severity of what lies ahead — these numbers are vital, particularly in the context of India where the majority of workers do not have job protections.

Cultural Factors for COVID 19

Beyond the over-stretched public healthcare apparatus, social practices, public attitudes and behaviors are factors that have a strong bearing on the spread of the virus and therefore require considerable attention in framing policy measures to tackle the crisis.

Unlike many countries that the virus has affected, the case of India presents unique concerns owing to its geographical vastness and the complexity of its cultural and religious diversity, beliefs, and practices coexisting with poor social indicators, such as lower life expectancy, higher fertility, and high child mortality. Wide illiteracy, poverty, poor sanitary conditions, open defecation and manual scavenging further add to its woes. These health and social indicators underscore the gravity of the situation that can worsen conditions in the face of a massive community outbreak. All of this demonstrates the glaring reality of a vulnerable population that can potentially worsen the situation, according to Mufsin P. P. and Muhsin P.  P., writing for The Diplomat.

“While globally there is health misinformation circulating rapidly across various social media platforms, India has its own culturally rooted and domestically-driven misinformation and misconceptions that are adding fuel to the fire. Unfortunately, some of this misinformation is being spread by public figures and government agencies, advanced in part by cultural and religious underpinnings that increase the traction of such misinformation,” they write.

Misguidance in the form of suggesting cow urine as a protection against the virus; religiously-oriented obligations that discourage social distancing; and mass disregard and refusal to adhere to rules restricting and in some cases prohibiting altogether cultural gatherings suggest that such behavior escapes the particularity of any one religious, cultural and geographic identity.

Home remedies and dubious advisories that are rapidly spreading through WhatsApp and other social media platforms also weaken the resolve for preventive behavior. Moreover, the Indian government’s Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), released an advisory on January 29 which carried shockingly serious medical misinformation at a time when COVID-19 cases were rapidly spreading in different parts of the world. The advisory made claims regarding the ability of traditional Indian medicinal practices like homeopathy, ayurveda, and unani in fighting the spread of the virus.

India’s strong cultural and religious tradition of communal celebrations as well as close interactions with extended family members and neighbors constitute major social and behavioral factors that pose serious challenges. Muslim congregational prayers, Sunday church services, and similar mass gatherings among different religious communities can further expose the country to the lethal virus and trigger community spread.

The Way Forward

In terms of what is coming and what to do in the coming months, the implementation gap has a number of important implications.

First even if the lockdown works and the “curve gets flattened”, and the overall spread of the disease remains contained, the disease will continue to widen its ambit, as unknowing carriers reach new populations

Second, there are places where stemming the spread of the disease will be very hard, once someone has it. Proper social distancing and complete lockdowns are just very hard to achieve, for example, in many urban slums.

Third, the fact that the lockdown started before the disease reached very many people, means that almost no one has immunity. This means that as long as the disease is not fully eliminated in the next three weeks (very unlikely), the disease will start to spread at an accelerating rate as soon as the curfew is lifted. That does not mean that the curfew was useless — for one, it probably bought us some time to put a plan in place and limit the number of infections in the next few weeks — but the problem will be there even after 21 days.

Even if you don’t agree with his policies, it must be acknowledged that Modi is one of the world’s most astute and cunning politicians, a man who has demonstrated time and again his ability to understand what appeals to the Id of his base.

But rest assured, if this pandemic is not contained, Modi’s seemingly hypnotic hold over a huge chunk of the population will begin to evaporate.

The success of this shutdown will depend upon the state’s capacity to monitor it. And India’s ability to survive in the remainder of these 21 days will depend upon the state’s ability to provide essential services to the large sections of the country that may not survive without them. In a country where migrant laborers might live a dozen to a room, a shutdown of this sort in fact asks unprecedented questions of the state. Will you shift these millions of people back home, risking the further spread of the virus? Will you hope that these crowded conditions don’t become hotbeds of transmission? And, most simply, how will you ensure that many members of India’s working class, who live off daily wages, will have enough to eat at the end of three weeks?

The Indian state will have to step up and be there for its people in ways it never has in history. Some parts of the country will do fine; state governments that took the lead in chasing down the virus will also probably manage world-class results when it comes to managing the lock-down. But others, particularly in poor and overpopulated northern India, may not do as well.

Modi may have felt he was left no choice, and his instincts are analogous that of a professional poker player’s—the willingness to bet big. Shutting down 1.3 billion people for 21 days is as big as it gets. Whether the gamble succeeds or doesn’t, the India that emerges at the other end of these three weeks will be irrevocably changed.