Opinions are questioning India’s ‘over reaction’ to Covid-19 outbreak. Their logic is based on the different trajectory of the virus in India. But there are ominous facts which should not be ignored. This virus has an RO (R naught) of 2.5, ie 2.5 persons are infected by one infected person. This is much more than the seasonal influenza virus which has a RO of 1.1 to 1.3, the SARS virus whose RO is 1.6, the H1N1 with a RO of 1.4 to 1.6 and the 1918 influenza virus which had an RO of 1.4 to 2.8. RO of under 1 means the disease will die out, 1 means it will stay alive and more than 1 means it will multiply. The Corona virus spreads much faster than others. The impact of this on our society could be really dreadful. Depending on the preventive measures, the RO of spread can change. So just because the trajectory has not been same in India, does not take away the importance of precautionary measures to slow the pace of spread.
The rapid rate of transfer of this virus has another importance also. That is, do what you will, it will spread and will spread fast. That the trajectory been slow so far is well documented by ICMR figures of infection rates of around only 2.5% amongst the suspectable contacts (not general population, which India is not testing yet). These figures appear correct as daily test data reports are difficult to manipulate in any big way. But all epidemiology experience points to the fact that the spread will occur, sooner rather than later. The impact of India’s lockdown on the spread of Corona will only be known now, after 8 to 14 days of its implementation and also in comparison to data from Pakistan and Bangladesh which have mostly implemented only advisories.
Why the trajectory has been slow in India has several factors. But the most important one is that the virus has been sourced from outside and in India has mostly been contained in social groups limited to the upper class and air travellers, ruling class politicians and the like. Countries that have delayed containment measures, most of Europe and US are paying the price. What failures led to rapid transmission in Italy, Spain and USA, we have still to know.
In India the spread and its impact is a definite threat and we must ensure that nothing is done to throw caution to the wind. It will be too early and seriously unscientific to rely on hypothetical conjectures floating that our genetic make up provides better resistance, the virus strain in India is less virulent, we have cross immunity due to wide malaria infestation, heat and humidity limits the virus, etc.
What we must remember is that India is a very poor country, with very poor health and nutritional security and a very huge population to take care off. This must never be lost sight of in any calamity, least of all this which can spread so easily and be so lethal. We must remember our losses during earlier similar disease out breaks have been huge. A report on the Spanish flue of 1918 states “the influenza killed between 17 and 18 million Indians, more than all the casualties in World War One. India bore a considerable burden of death – it lost 6% of its people. More women – relatively undernourished, cooped up in unhygienic and ill-ventilated dwellings, and nursing the sick – died than men. The pandemic is believed to have infected a third of the world’s population and claimed between 50 and 100 million lives”. We have faced several epidemic tragedies, cholera, typhoid, Smallpox, AIDS, Measles, etc and have been found woefully wanting in dealing with each of them. Possibly, and hopefully not, the outcome may be worse this time.
That is why we say our reaction has been ‘Irrational’, ‘Delayed’ and is an ‘Under’ Reaction.
Why Delayed?
Because we ought to have started acting, testing and quarantining well before this lockdown done on March 22 or 24, as you please, in January end or Feb itself. WHO had announced the danger in early January itself.
Why irrational?
Because our govt, our services infrastructure, particularly food and health security and our society with its inherent ‘social distancing’ and ‘medieval outlook’ are not geared to deal with a crisis of this magnitude. The govt has failed to address these factors.
Of the readily treatable and preventable disease in India, in 2018, 15 lac people died due to Tuberculosis and there were 20 lac Malaria cases and 1000 deaths. Of the 10.4 lac deaths of under fives in 2017, more than 7 lacs were attributed to malnutrition. The Global Nutrition Report states that India has the world’s largest number of stunted (46.6 million) and wasted children (25.5 million). Forty four percent of all under five children in India are malnourished, a very important factor in the spread of diseases, including viral diseases and their control. Nearly 1.6 lac children die every year due to diarrhoea.
The already emaciated health services have been virtually paralysed since the lockdown. Patients are unable to reach them. Govt facility rarely serves even emergencies that reach, as everyone is Corona geared. Most patients are turned back. And almost the entire private sector is closed, both due to fear of creating rush and fear of the medical staff getting infected. Each disposable PPE gown costs Rs 2200 and is supposed to be used only for 6 hours. Which medical team can afford it? There is no govt supply. One team of doctors working in a charitable set up had this to say, “We are working with ordinary precautions and high risk, because each time we see a patient we have to decide whether our lives are meant for our own safety or the patient’s”.
This is the toll that privatization of health care has taken on the society, both infrastructure and attitude. As reports reflect, privatization has taken a big toll in Italy, Spain and US also. Corona pandemic cries out loud for improvement of public health care as the only way out.
Regarding food supply, there are announcements and the Good Samaritans, who are unlikely to last long and who in anyway can play only a very peripheral role in such a big crisis. The officials have clearly announced to the village pradhans that there is no extra supply of rations, only regular supply is there. Only the Antyodaya card holders, those registered under Mnregs and with the Labour department will be given free food and there is no supply for those without cards. Pradhans will be responsible for shortfall.
Then there is the serious crises of 8 to 10 crore migrants, stuck far away from home, mostly left high and dry, sitting in slums with ‘ill-ventilated rooms’ which can become fertile nests for the virus to thrive. They are being beaten and pushed on the way, quarantined without facility, being scorned at and even sprayed with insecticides. They have suddenly been reduced to destitution.
What rational was employed to close down a country with these many problems? “Only a one day curfew” was appealed for, for March 22, all trains and buses were stopped suddenly on night of March 21 and the complete shut down for 3 weeks was declared on March 23, threatening to be extended. A deprived population left high and dry, instantly, when the govt woke up, without time to prepare and with the govt not interested.
Why Under Reaction?
Because the only govt institution which is reacting is the police. The rest is simply paralysed, almost in Quarantine. The officials implementing the shut down move without masks, mostly in ‘clusters’. The UP Chief Minister, galavanting in a Helicopter, never has a mask on his face. For poor and underdeveloped countries, physical distancing, face masks and hand washes are the most important measures and the political and administrative machinery itself is setting a bad example.
But still there is time. We can still improve if there is a will. If the lockdown is made sensible with precautions, the young and healthy are mobilized to take care of society’s needs – the old, the sick, the destitute. And if the lock out is equipped with facility for emergency movement, not just for the haves (car passes), but for all, as in several countries.
Dr. Ashish Mital
General Secretary
All India Kisan Mazdoor Sabha, AIKMS
Formerly, Resident Doctor in Deptt of Community Medicine, AIIMS