India Caught in Coronavirus Surge

Health care system overwhelmed as millions flee virus in urban area

By: Neeta Lal

A massive surge in the number of Covid-19 cases across India has been linked to, among other things, an annual two-day convention of the Muslim sect Tablighi Jamaat on March 13, at which about 3,500 people congregated from all over the country and abroad in south Delhi’s Nizamuddin area. 

In the wake of the event, almost 2,000 stayed in the area for days. Doctors fear that the incident has turned the area into India’s coronavirus hotspot. It has also awakened long-simmering racial tensions between majority Hindus and minority Muslims. The national tally rose to 3,082 infections on April 5, with 86 deaths reported. Maharashtra leads with nearly 500 cases, followed by Tamil Nadu, Delhi and Kerala.

Making the problem worse across the country are millions of migrant workers – including my own domestic helper, who disappeared – who are fleeing shuttered cities and walking hundreds of kilometers (above) to their villages on highways turning into pedestrian walkways. The spread of infection is very high among these informal workers who are the backbone of the urban economy – construction workers, hotel/restaurant staff, domestic help, mine and quarry workers etc. But they have little choice. Without savings, food and shelter, and deprived of any social security net, they are escaping poverty in the cities.  

Yet, for a densely populated country of 1.3 billion people (455 people per square km according to World Bank data as against 148 in China, the world’s most populous nation), the number of cases is still relatively low compared to say Europe or the US. Medical experts pin this down to two reasons: low levels of testing, at 86 per million according to figures supplied by the World Health Organization, compared with approximately 10,000 per million in Spain, Italy and Germany. There is also little access to an already stretched healthcare system. 

Worse, the world’s second most populous country has large numbers of poor living in crowded, unsanitary conditions and weak public health infrastructure, with just 0.7 hospital beds per 1000 persons, compared with Italy’s 3.4 and the United States’ 2.9; India also has fewer than 50,000 ventilators.

Aggravating the crisis is that social stigma has kept hordes of people from reporting infections. Dozens of cases of residential colonies ostracizing corona victims and suspects have surfaced across the country. Doctors and other health workers and airline crews have been harrassed as well as Indians from the northeast region bordering China from where the pandemic originated. Houses under quarantine are being marked with “Do not visit” posters.

What’s disquieting is that only 47,951 tests had been performed by March 31 in just 51 government-approved testing centers across the country. “Ramping up testing is vital at this stage as a lockdown without testing will basically postpone the problem, not solve it,” said Dr. Rohilla Bhatia, a critical care physician at Fortis Hospital, NOIDA. 

A recent report, jointly published by three American universities and the Delhi School of Economics, claims that by mid-May India’s cases could balloon to as many as 1.3 million. Without control measures, 300 million to 500 million could be infected by July-end and 30 million to 50 million could have severe disease.

An abysmal outlay for health doesn’t help either. India’s budget for the 2020-21 fiscal year, presented and passed by the Parliament at a time when the virus had already gripped China, allocated just US$9.7 billion for health against a whopping US$66 billion for defense spending. India spends only about 1.3 percent of its GDP on public health, among the lowest in the world. 

The Organization for Economic Co-operation and Development, an intergovernmental economic body with 36 member countries, observed in its 2019 report that India's total public spending on health care is “alarming.” 

However, to support the poor, the Narendra Modi government announced an economic package of nearly US$23 billion on March 26. Provisions were made for rations of grains and pulses, free gas cooking cylinders to 83 million families, and cash transfers of $6.65 a month to about 200 million women for the next three months. Many schemes are also being run by state governments in synergy with local non-profits.  

A US$2 billion package is also aimed to buy protective gear for health care workers, expand testing facilities, and train health care workers across the country. India is also importing 10,000 ventilators from China and has ordered another 30,000 from domestic companies. Be that as it may, many feel the aid is too miserly given the magnitude of the pandemic, under 1 percent of India’s GDP. 

As the country hunkers down for what many fear could be a tsunami of coronavirus cases, a sense of alarm has also gripped healthcare professionals. Frontline medical staff are grappling with shortages of personal protective equipment as cases rise. Masks, gloves, and coveralls – basic ammunition for doctors in this war against a deadly and invisible enemy – is crippling their outreach. It is also forcing some to get inventive. Some doctors are using raincoats, medical equipment plastic wrappings and motorbike helmets to protect themselves according to Reuters.   

“We’re all at the mercy of God,” a doctor at a hospital in NOIDA district of Uttar Pradesh told me. “We’re working in close proximity with those infected without proper PPE.” 

Efforts are underway to ramp up capacity though. The country has recently allowed private labs to begin to test and approved 12 types of rapid-testing kits. Testing has also expanded from patients with an association with international travel to include patients with severe acute respiratory illness. 

Last week, Mylab Discovery, a company based in the city of Pune, became the first Indian firm to get full approval to make and sell testing kits, which have already shipped to labs in Pune, Mumbai, Delhi, Goa and Bangalore. Each Mylab kit can test 100 samples and costs about US$18.

Also raising hope is the country’s success rate in polio eradication, which also required innovation and coordination across multiple stakeholders at all levels of government, and community support. 

The Indian government has defended its handling of the coronavirus outbreak after a strict lockdown by saying it has done much better than many others. "Pre-emptive, pro-active and graded" is how it framed its response in the wake of the pandemic. Never mind if millions were given under four hours' notice of the three-week lockdown from March-April 14.

Currently, though the government’s approach to tackling the scourge is largely geared towards enforcing social distancing. But, as many have pointed out, social distancing is possible only if you have the luxury of space. More importantly, can there be social distancing without social security? How do you explain this ambiguous concept to the poor who are not sure where their next square meal will come from. Or to seven-member families who are packed in one tiny room? 

Good questions these. And ones that 1.3 billion Indians are also asking of their government.   

Neeta Lal is a Delhi-based editor and journalist and a longtime contributor to Asia Sentinel; Twitter: @Neeta_com