Coronavirus Tsunami in India - what are the challenges? - Seeker's Thoughts

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Coronavirus Tsunami in India - what are the challenges?


India has asked 1.3 billion people to stay at home for three weeks to slow the spread of the coronavirus. It's an unprecedented lockdown in the country that has reported an increasing number in cases. 


However, the Indian government is clearly bracing for the worst. Experts say India could be dealing with about 300 million cases, of which four to five million could be severe.


Why India require a “hard” lockdown to fight the virus?

India is one of the crowded and densely packed countries. Both it's public and private spaces are crowded. The population density and a large number of poor people make it more vulnerable to the easy spread of such an easily transmissible disease.

With 450 people per square kilometer, some of the poor northern Indian states like Bihar, Uttar Pradesh have almost twice as many people per sq. km.

Indian households typically have between 4.5 to 5 people per family, compared with an average of 2.5 people in an average American household. 

40% of Indian families are non-nuclear or joint families. Most of these families will have one person above 60 years of age, one below 18 and two others aged somewhere in between.


Three generations often live together. One infected person in a family means the chance of widespread household spread- which is one of the fastest modes of transmission of infection is very high. Locking up the entire family to save the elderly who are the most vulnerable possibly makes sense.

Some 75% of Indian households – or 900 million Indians – with an average size of five members live in two rooms or fewer. Three people living in a single room in poor households are common.

picture credits - Shibal Bhartiya and vision unlimited

Then there’s public transport. Between 85% and 90% of the people who use India’s busy railway network travel in overcrowded second-class coaches. Passengers mostly belong to the lower middle class and the poor.

Shutting down the railways, which the government has already done, is the only way to prevent infection. 

Moreover. The practice of religion in India is mainly a community exercise manifested through prayers, congregations, and religious musical functions. That’s why the government has expressly closed all places of worship and said: “no religious congregations will be permitted, without exception”.                                                                          

     Also Read - What is a virus? Learn About All Deadly Viruses

How Lock down in the country puts the poor at risk?

The lockdown has already disproportionately hurt marginalized communities due to loss of livelihood and lack of food, shelter, and health and other basic needs. 

The government does have a responsibility to protect the health and wellbeing of the population, but some of these steps have left tens of thousands of out of work migrant workers stranded, with rail and bus services shut down.


The blanker closing of state borders has caused disruption in the supply of essential goods, leading to inflation and fear of shortage.

Thousands of homeless people are in need of protection. Police actions to punish those violating orders have reportedly resulted in abuses against people in need.

                                        

The central government announced a relief package of 1.7 trillion rupees to provide free food and cash transfer to the poor and vulnerable populations, and health insurance for healthcare workers, among other things.

Human Rights Watch is increasingly concerned about the stigmatization of individuals and a rise in vigilante violence. Police in several states, including Punjab, Rajasthan, Haryana, Uttar Pradesh, Maharashtra, and Andhra Pradesh have arbitrarily punished and beaten people publicly and shamed them.

In several states, health workers and airline staff faced discrimination from their neighbors and landlords threatened to evict them, fearing they could be carriers if COVID-19. People who have been quarantined have also been stigmatized and threatened with eviction.


What India can learn from the deadly 1918 flu?

Influenza killed between 17 and million Indians, more than all the causalities 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.

To be sure, the medical realities are vastly different now. Although there’s still no cure, scientists have mapped the genetic material of the coronavirus, and there’s the promise of anti-viral drugs and vaccines. 

The 1918 flu happened in the pre-antibiotic era. And there were simply not enough medical equipment to provide to the critically ill. Also, western medicines weren’t widely accepted in India then and most people relied on indigenous medication.

Yet there appear to be some striking similarities between the two pandemics separated by a century. And possibly there are some relevant lessons to learn from the flu and the bungled response to it.

       How to increase immunity to fight against virus?

Can India ramp up its health infrastructure swiftly to contain this pandemic?

India, which has a population of 1.3 billion wants to prevent such a situation from developing. Its fragile healthcare infrastructure will not be able to cope with such an outbreak.

Every Indian state today has similar priorities: add new beds, increase the capacity of intensive care units, requisition portions of private hospitals, order lifesaving ventilators, recruit medical practitioners o contract, weigh in on extending services of retiring doctors and nurses and earmark select government hospitals for Covid-19 patients.

In India, as in most nations, not all available ventilators can be plugged out from the ICU’s. So, the number of equipment that can be made available for Covid-19 interventions is far too less.


It appears the central and the state agencies have worked in tandem to add new health assets. Something that is indispensable to minimize the impact of a potential catastrophe but the key problem is that India’s health facility indicators are below par in any global parameter.


Sample this – Italy has 4.1 doctors and 3.4 hospital beds per 1,000 persons. Yet its infrastructure appears to be crumbling today. In comparison, India has only 0.8 doctors and 0.7 hospital beds for 1,000 persons.

According to the World Bank report collating global healthcare indices between 2011 and 2017. South Korea has 11.4 hospital beds per thousand, the report indicates. The US, which saw a dramatic spike infection last week, has 2.6 doctors and 2.9 hospital beds per 1,000 persons.

All these indices lead to a simple conclusion: if the situation in India exacerbates, the defense forces are bound to be deployed. And the forces could possibly do more than just convert a portion of their 133 hospitals for Covid-19 patients.



A way forward

“Hard” lockdown like the one India has embarked on requiring sharp planning to ensure the supply lines to deliver essential supplies to more than a billion people are not disrupted, and that there no panic and social unrest. In a largely informal economy, such lockdowns mean income losses for tens of millions of people.

It’s a huge and unprecedented challenge for the Indian government. If the costs are too high, people will break the lockdown and suffer badly. India needs to include rights protections.

Authorities should recognize that malnourishment and untreated illness will exacerbate problems and should ensure that the most marginalized don’t bear an unfair burden from lack of essential supplies.

The government should ensure that those at heightened risk, including sanitation workers, community health staff, early childhood caregivers, and people such as midday meal workers – often poorly paid public service officials – who are at the front lines during this crisis, are provided protective equipment, medical benefits, and timely wages.



The government should take urgent to get stranded migrants workers to safety, state governments across the country should immediately set up shelters and community kitchens for those most at need, taking measures to ensure physical distancing.

The government should not use Aadhaar (identity card)-based biometric authentication for the distribution of free food grains to the poor, Human Rights Watch said.

Even in normal circumstances, the failure of Aadhar has led to the denial of essential services and benefits. 

“The authorities in India should take all necessary steps to ensure that everyone has access to food and medical care and that the poor and marginalized are not mistreated or stigmatized,” .

The Indian government’s responsibility to protect its people from the outbreak should not come at the cost of human rights violations.
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