The Lockdown: India's Cure For The Covid-19 Problem

India has been progressively shutting down in response to the global Covid-19 pandemic since March 13, 2020. Offices, schools and colleges have been closed, and since last Sunday’s Janata Curfew, India’s 1.38 billion people have been faced with an unprecedented lockdown.

The panic that we feel is palpable. One of the main arguments put forward to underpin this panic is a straight-line comparison drawn with Italy’s experience with Covid-19. It goes like this: if a tiny country like Italy can have 63,927 confirmed coronavirus cases and 6,077 deaths (as of March 24, 2020), then India is staring at numbers 20 times greater.

Seems compelling? Let’s break down the facts.

• As of March 24, globally there were 272,168 current cases of Covid-19 infections (current cases exclude those who have recovered or have succumbed). 96% of current infected cases have mild flu-like symptoms with the remaining 4% having severe disease. As of March 24, India had 510 confirmed cases of this coronavirus.
• Covid-19 disproportionately kills the older population. According to the Italian National Health Institute, the median average age of those who died of Covid-19 in Italy is 80.5 years old. The percentage of India’s population aged 80 years and above is 0.9%.
• There are approximately 600,000 deaths globally (WHO estimates) from seasonal influenza every year. According to CDC, there were up to 54 million people with flu illnesses resulting in up to 59,000 flu related deaths (usually respiratory disease) in the United States this winter alone (between October 1, 2019 and March 14, 2020). In comparison, as of March 24, 2020, there were 46,158 Covid-19 infections and 582 deaths in the United States.
• Annual deaths in India (2017 data) from respiratory infections and fevers were 681,000. As of March 24, there were 10 deaths in total relating to Covid-19 in India in the eight weeks since India reported its first confirmed Covid-19 case.
• The overwhelming majority of active COVID-19 cases today are in regions where temperatures are below 15 degrees Celsius.

India is facing real and serious health problems that deserve our attention. Some of us have become prosperous to the point of rarely having to deal with severe disease or death from infectious diseases. We are oblivious to the reality that India is being ravaged by infectious diseases far deadlier than Covid-19. According to a study by Lancet, commissioned by the Government of India’s Ministry of Health and Family Welfare, in addition to deaths from Respiratory Infections and Fevers, deaths to Tuberculosis, Malaria, Dengue, Swine Flu and other infectious diseases result in approximately 1.5 million deaths in India every year to infectious diseases.

This brings us to the wisdom of imposing extreme social distancing measures in India. The science behind social distancing is sound: slow down the inevitable spread of the virus so that a nation’s healthcare system is not overwhelmed beyond its capacity. The foundational assumption is that India has a healthcare system that will be adequate to deal with the pandemic should the Covid-19 curve be flattened enough. This is a fallacy.

The healthcare system in India is so woefully inadequate that it is unable to deal with the deadly infectious diseases already prevalent in India, resulting in 1.5 million deaths a year. Covid-19, in order of priority, may need to cue up behind deadlier infectious diseases such as Tuberculosis, Malaria, Swine Flu, and Dengue. Flattening the curve of Covid-19 is therefore completely inapplicable to the Indian context.

And here is the unkindest cut. Some of us can work from home, watch Netflix or take online classes for the next 21 days. While we stay indoors and contemplate the potential dangers of Covid-19, let us remember that 37.1% of Indian households have only one-room with an average of 5 persons living in them, and that 53.1% of Indian households do not have toilets inside them. They will need to be indoors too.

And finally, 80% of India’s workforce of 519 million people is in the informal sector, and many of them rely on daily work to provide for themselves and their families. And unlike the countries we are aping in imposing social distancing measures, India does not have the resources to compensate this workforce for depriving them of their livelihoods, prevent evictions because they cannot pay rent, or defer their monthly loan repayments. The United States is in the process of legislating a US$2 Trillion stimulus to their already strong economy to buffer the effects of Covid-19. That stimulus alone is more than two-thirds the size of India’s overall economy. India on the other hand risks pushing an entire generation back into abject poverty, and a spate of suicides. You can read a detailed report of the lockdown's impact on India's informal sector by clicking here.

The fight to minimize the impact of Covid-19 must go on with all fervor, adopting the critical and life-saving impact of personal hygiene measures, strengthening Swachh Bharath initiatives, urgently upgrading our critical care facilities, procuring Personal Protection Equipment (PPE) for our healthcare providers and, where possible, having people work remotely or from home. But we must do so without jeopardizing the lives and livelihoods of hundreds of millions of our workers. Waiting 21 days to lift the lockdown may be too late.

The better approach to deal with Covid-19 in India will be to follow the UK’s lead in socially shielding the most vulnerable group. Those in the most vulnerable group who cannot be effectively isolated and shielded at home can be moved to facilities that are set up for this purpose. Social shielding occurs before people get infected, and will therefore not require ventilators or other sophisticated medical equipment. Implementing social shielding for a group that constitutes less than one percent of India's population will be far more effective, practicable, compassionate and beneficial to the economy than locking down an entire nation of 1.38 billion people.

The author is the founder of National School of Journalism and Public Discourse, Bengaluru (NSoJ), and a partner of a national law firm.