It’s now over 4 months into the Covid-19 global pandemic with
cases in India touching 117000 and over 3500 deaths (as on 21st May
2020) and there seems to be no light at the end of the tunnel. This is because
of the tunnel vision of our governments, policy makers and a wide variety of
experts. What was essentially a public health crises has been converted into an
economic and humanitarian crises.
We have had similar pandemics in the past like SARS in 2003,
H1N1 in 2009 and later years etc. They were all dealt with as a public health
crises and managed by each country within the context of their healthcare
system capacities. Infact in 2019 India saw 28798 reported cases of H1N1 with
1218 deaths, a case fatality rate similar to Covid-19 and we have forgotten
about it. There was no lockdown for this and neither in 2017 and 2015 when H1N1
cases were 38817 with 2270 deaths and 42592 and deaths 2990, respectively, with
case fatality higher at 6 and 7 percent was there any lockdown. H1N1 is here to
stay like tuberculosis, malaria, chikungunya, leptospirosis, encephalitis, pneumonia
and many other diseases. We have probably developed some level of herd immunity
to it. So what seemed to have changed that a complete lockdown over a prolonged
period became the main solution to tackle covid-19?
Generating a psychosis of fear amongst people so that they
become obedient subjects of the state and those in power, especially the right
wing regimes, can control their thinking, actions and behaviour. Events like
clapping and banging thalis, lighting lamps and torches and showering petals
from aircraft are mechanisms to test such obedience and build a false sense of
solidarity instead of focusing on the problem at hand which is the public
health crises and the lack of capacity to handle it due to the gross deficits from
which the public health system suffers. This fear psychosis is daily
perpetuated by debates and discussions on news channels wherein government
representatives and various experts are issuing advisories to people as to how
they should behave and face the crises but in terms of services which people
need there is not much being done to meet the demands and needs of people. So
this perpetuates further fear. As the infection spreads to poorer clusters like
slums and the poor communities and Dalits, social discrimination is clearly
visible where increasingly people are being denied access to medical attention not
only for covid-19 but also non-covid cases. For example tuberculosis detection
has fallen drastically as has access to treatment for existing patients where
drug supplies and nutrition supplements have been drastically affected. Or
people with other medical emergencies are being sent away from hospitals and
such denials have resulted in unnecessary deaths as reported widely in the
media.
If we had invested in a robust comprehensive primary
healthcare system and that was in place when covid-19 hit us the healthcare
system would have been better placed to respond to it effectively and such a
complete lockdown would not have been necessary – perhaps highly infected
clusters could have been identified for containment and locked down with
appropriate planning and support for testing, contact tracing and treatment,
and access to essential supplies. Kerala is clearly an outstanding example
where the well-developed primary healthcare system and coordinated efforts of
various government agencies helped to contain the spread of infections.
Similarly Goa, Puducherry, Sikkim, Mizoram and other Northeastern states (except
Assam) have controlled and contained the covid-19 attack because of their
well-developed primary healthcare systems. There is clearly something for other
states to learn from these states – but most importantly that these states
spend more than twice the national per capita average public health
expenditure. And consequently have robust public health systems.
The total lockdown for over 8 weeks now has created havoc
across the country and transformed what was essentially a public health crises
into an economic and humanitarian crises. With the lockdown businesses and
establishments shut down and given that over 80% of the workforce in India is
daily wage dependent and a large proportion of them migrate to large cities
across the country for employment, this workforce lost their means of
livelihood, were displaced and made completely insecure and pushed into a humanitarian
disaster. The migrants without work could not continue to sustain themselves in
the place of their calling and had no choice but to go back to their origin
states. The states response was very weak in dealing with the lakhs of such
stranded people despite sitting on millions of tonnes of food grains and vast
amounts collected in PM Cares and CM relief funds. State agencies completely
failed the people and created a humanitarian crises of unprecedented
proportions. The civil society response – peoples movements and collectives,
trade unions, NGOs, religious groups, community groups, afew corporate
foundations and even individuals and resident groups all pitched in with
collecting food and rations, cooked meals and other essentials like soaps and
masks and distributed them widely and prevented catastrophic hunger deaths. The
Union government and most state governments failed in their humanitarian
response and were only making announcements and proposals of schemes which as
yet have not been seen working on the ground in any significant way. Tax resources from the Centre have not
reached states and with states’ own taxes like alcohol excise duties, VAT and
fuel taxes, amongst others reduced substantially due to the shut down of the
economy the states are running into a fiscal crises and many may not be able to
pay salaries in the coming months let alone providing benefits to those
economically battered.
The Atmanirbhar Bharat Abhiyaan announced by the PM and
explained by the FM has no direct benefits to severely affected people – those
who have lost jobs/livelihoods, migrants, homeless and those living in
conditions which do not allow physical distancing. No social wages, food
security and social security measures beyond what already exist under the
targeted schemes for the vulnerable groups. Even MGNREGA is largely
non-functional and there is nothing of similar equivalence for urban
populations. So the vast majority’s survival is threatened and all the
government responds with is sorting out liquidity matters for businesses and
financial markets and calls for self-reliance. If each one of us must become
self-reliant then why do we need to pay taxes or for that matter why do we need
the various economic and social sector departments of government?
The gradual exodus of migrants who were treading hundreds of
kilometres is now moving towards a huge exodus with many states in a hugely
delayed decision allowing transportation of migrants to their home states and
making some arrangements for that. But on the other hand the opening up of the
lockdown in the green and orange zones wherein many categories of industry and
services are being allowed to reopen their businesses has put the migrant
workforce and the businesses in a quandary. Where will the workforce come from
if the exodus continues? For example Panjab has 8.5 lakh migrant workers and if
they all leave what will happen to the current crop season and the forthcoming
kharif season and large number of MSMEs. A similar situation will be in play in
states like Maharashtra, Tamil Nadu, Karnataka etc.. which have even larger
number of migrants. Again Kerala stands
out as they did provide adequate support to the migrants which has prevented a
large scale exodus from Kerala. And when many of these migrants experiencing a
humanitarian and economic crises reach their home states there is a public
health disaster of unimaginable proportions waiting to happen as most of these
“home states” have very poor public healthcare systems and don’t have the
capacity to cope with such a health crises. Odisha, Bihar and UP have already
started to feel the impact of returning migrants. When well endowed cities like
Mumbai and Delhi which have highest number of cases and deaths attributable to
covid-19 are not able to manage this crisis effectively the other states would
just collapse under the burden.
