Abusaleh Shariff
US-India Policy Institute, Washington D. C and Centre for Research and Debates in Development Policy, New Delhi
It is about a month that the onset of Coronavirus or Covid-19 in India has become prominent. Described a rudimentary virus like any other normal cold, fever and chest congestion; its spread can be so fast and certain that the causalities both as sufferers and deaths can reach a very high proportion. Some projections suggest upto 30 per cent of the world’s population will get infected and with huge fatalities which are not quantified. So far Italy has recorded highest fatality rate of 10 per cent of those tested positive followed by Iran-7 percent. Read More
China (with negative to nil new additions) recorded just over 4 per cent fatality during the whole period of December to mid-March. Note that there are no robust estimations of the casefatality rates at all, although the above ones are indicative. Also, the doubling rates of the positive cases have over time declined from an average of 6 days to now just about 3 days which indeed is devastating and scary.
Indian finally has reached total Lockdown of the whole country through a stepwise geographic as well as temporal tests. This drastic policy emerged from the nation’s highest authority (first time invoked excepting during national elections) appear to have happened under international pressure. This is a delayed response, the first case in India was observed in January 2020 and lockdown on 25th March! There has already been precious time lost. Yet one finds only a marginal improvement in the number tests per million – only 18 test per million in India (total test only 25,144 as on 25th March), compared with 1280 per million in the USA, now as I write this article the ‘top corona-country of the world’ with 83,329 tested positive and 1222 confirmed deaths. On this date, India reports just about 700 positive and about 20 confirmed deaths!
Case Fatality Rate (percent death to total tested positive) calculated using data as on March 26th, 2020 EST (USA) – Italy 10.1; Iran 8.0; Spain 7.6; France 5.8; China 4.1; India 2.8; USA 1.5. Globally the coronavirus pandemic has sickened more than 519,300 people, according to official counts. As of Thursday evening (26th March 2020), at least 23,820 people have died, and the virus has been detected in at least 171 countries. (New York times: https://www.nytimes.com/interactive/2020/world/coronavirusmaps.html?action=click&module=Top%20Stories&pgtype=Homepage&action=cli ck&module=Spotlight&pgtype=Homepage
Do these numbers suggest India a successful nation or a nation with more opaque data and numbers than even China? Obviously not! Contagion Effects Experts’ understanding of how the virus spreads is still limited, but there are four factors that likely play a role: 1. how close one gets to another 2. how long one is near the other person 3. whether that person projects viral droplets on you, and 4. how much one touch own face Let us discuss a macro picture of the first and crucial factor – how close one gets to another? Distance is the factor and population density a major factor in determining a distance between one person and another. It is heartening to note that India is rather on the top, 19th of world nations in terms of population density of 414 persons per sq kilometer, next only to Bangladesh and South Korea; but note that India is a nation of over 1.36 billion people? Further ten of the top one hundred urban concentrations in the world is in India. Also, five Indian urban population density concentrations are on top of the world list with the highest 32,303 people per sq kilometer in Mumbai, followed by Kolkata (24,306), Gurugram, Howrah, and Ghaziabad. Therefore, India is characteristically in the high-risk category and it will not be easy to keep 4 to 6 feet distance between people, rather it will be difficult even to keep a two feet distance between two unknown individuals. Social Distance: The second dimension of population congestion is within the living quarters and type of living. India not only has small housing space per individual but also a higher incidence of joint family living and living in community-based quarters such as labour camps of unskilled manual laborers attached to factories and production sites. The chawl system in Mumbai is another example of an overpopulated living quarter in urban spaces. The Third dimension is of India’s distance within the community (urban ward, mohalla, and village) on the one hand and crowded goods and services markets on the other. These last two high population density spaces or distances act as multipliers to the first two. Lockdown has only shifted the markets into back allies which are streaming like fish markets and a swarm of customers, and authorities including police has turned a blind eye so far as the main roads are visually empty and quiet. India’s health-seeking behavior is unique. Culturally Indians are biased against women, children and the elderly especially in seeking timely and appropriate health care. It is observed that the elderly parents are pushed out of the main dwellings normally and definitely when sick due to multiple reasons – such as shortage of dwelling space, inability to provide safe and separate space for sick when others at home need spots for homework, entertainment and safe storage and so on. This behavior can supplement in boosting the fast spread of pandemic as the street level interaction of such elderly sick will increase many folds. Does India have what all it takes to contain this pandemic? India is basically caught between a ‘rock and a hard place’. It has no policy options which are sure to yield results. The murmurs that Indian has not yet recorded sickness from ‘domestic social’ sources appear either a lie or sheer ignorance. What is lacking in India is the data and its accuracy. The testing is so low one has no clue as to the measure of incidence and impact. Even on normal times, India’s health infrastructure is rather rudimentary and totally iniquitous. The doctor-population ratio is 1:1800 – and the doctors are accredited based on formal education including an allopathic and vast variety of indigenous protocols which constitute over fifty percent of total numbers. Similarity India records 1:500 ratio of nurses, but they are not the trained nurses that we find in hospitals, they are barely trained ASHA workers and auxiliary nurse midwives (ANMs). The weakest of all is the population-Hospital bed ratio which is one of the least in the word- only 0.7 beds per 1000 population which the international benchmark is 3 beds per thousand. Many romanticize a few India specific traits such as ‘have strong immunity’, tropical weather meaning high temperatures’ will kill the pandemic germs; pandemic is mostly urban occurrence and rural areas are safe and so on. These and similar explanations are but false expectations mostly promoting the fast spread of the pandemic. A centralized approach to address this pandemic is necessary but not adequate. It is not enough that some major hospitals in cities are earmarked to deal with this pandemic. Every local private physician, health workers, pharmacy and drug stores must be converted into a testing center. A referral system with this vast private and informal sector must be networked to identify, evaluate, undertake primary tests and act as the first point of referral. How can this be done soon must be discussed at the apex body of expert epidemiologists, civil society and of course the politicos together. The IT sector can play its part through some rudimentary but easy to use applications for selfchecks and diagnostics which can be geographically plotted on real time is a must. Millions of unorganized labour were made to flee mostly that their living spaces often provided by the companies in their back yards are now closed also due to police excesses. It was in fact much easy to oversee the emergence of virus if testing was arranged on those very sites. But now that labour initially was over the rooftops of trains and inter-state busses and now walking long on the roads with no food and water. This already is a calamity in the making progressing towards disease and death due to hunger and malnutrition sooner than later.