God is a virus

Written by- Dr Ruha Shadab

Let us assume good intention. Let us assume that the Government of India (GoI) is not fudging its numbers. Let us assume that GoI is not under-testing and instead assume that the most-at-risk are being tested. This means that a country of 1.3 billion has had only 1,300 cases of Corona virus with 35 deaths (at the time of written this article). With 15,000 tests conducted, the confirmed-to-tested ratio is similar to Malaysia’s.

India came down heavy and hard in its response. The Prime Minister (PM) is apologetic about the hardship the poorer have had to go through with the enforcement of a sudden 21-day lock down (enforced on March 24th). No policy is perfect, and public health asks for difficult trade-offs. Was there a smarter way of declaring a nationwide lock down in a country: a way that could lessen the blow on a population where two-thirds households have around Rs 9,000 (~$125) in savings?

The Union (= federal) government and numerous State governments in India, have come out with a plethora of supportive measures to tide over this crisis. As a welfarist economy, the focus has been on strengthening safety nets for the most vulnerable.

Union government/agency’s measures

The first few responses were to send advisories to students studying in the US. Circulars from the Consul General of New York encouraged students to not travel to India. These circulars were being generated on a daily basis, till they suddenly dried up. Indian students go to the US after collecting a lot of paperwork. The Ministry of External Affairs should compile an email address book of such students, for the future, to expedite communication with this group. Students, far from home and family, need to be assuaged by their country’s representative and simple circulars can be reassuring. A systematic way of having these messages passed on, and not instead solely relying on chatty WhatsApp groups should be one of the small revamps of our diaspora outreach. Especially, since things escalated to the point of international flights to India completely being canceled and visas of all non-nationals be rendered invalid.

On the Sunday prior to the start of the lockdown, the Prime Minister of India suggested a citizen’s curfew, meant to be voluntary, just for 14 hours, with an allotted time for citizens to clap for those on the front lines of working to control Coronavirus. A number of countries have had a “clap for essential services workers” moment, some are even doing it repeatedly. This could be seen as a primer for the announcement that would come in 48 hours: necessary preparation for a massive country.

After March 24th, the Finance Minister came armed with an arsenal of supportive measures, which leveraged existing schemes/yojanas: Free distribution of food grains and pulses to 800 million people (under PM Gareeb Kalyan Yojana); Rs 1,500 (~$20) to 200 million women’s accounts to help with running their households (Jan Dhan Yojana); A Rs 2,000 ($27) payment to 87 million farmers (under PM Kishan Yojana); Free cooking gas cylinders for 83 million below-poverty-line families (under Ujjawala scheme); A Rs20 ($0.30) increase in the daily wage under the country’s flagship employment guarantee scheme (MNREGA) which has 50 million workers; Up to Rs 2 million in collateral-free loans for 6.3 million Self-Help Groups (SHGs).

More ministries and agencies have chimed in: Hospitals meant for Railways’ employees have been opened up for other central government employees (the Indian railways, IR, employ 1.5 million people and as a public sector undertaking, have parallel social security services, such as a hospital network). IR has also doubled up some train coaches as isolation wards for Coronavirus patients.

NITI Aayog, the PM-chaired government think tank, is developing an App: CoWin-20. It is meant to inform users of possible contact with a Covid-19 patient.

“Start Up India”, a program run by the Ministry of Commerce, has created an innovation challenge to tackle a host of issues ranging from supply constraints of medical equipment to fake news detection.

The Self4Society, a platform hosted by the Ministry of Electronics and Information Technology, helps organize Initiatives for social work. Tackling Coronavirus has taken the lead in the plethora of work streams available. With over 90,000 individuals and 3800 organizations registered on this platform donating, volunteering, or contributing in four major areas: medical equipment, public awareness, logistics, and assisting local government, Self4Society has helped channelize the citizenry’s desire to help the nation with the pandemic.

State government’s measures

Health is in the list of “State subjects” in the Indian constitution, making it the prerogative of the State governments. There has been a robust response at this level, and even down to the level of municipalities. For instance, home-delivery of vegetables to residents of a municipality of Kalburgi, Karnataka; approval by Uttar Pradesh (UP), Punjab, Haryana and Chandigarh to designate spots for road-side vendors of perishables. UP has 12000 vendors approved.

This particular state, of 200 million, has a huge size of migrant workers who travel far and wide outside of the state to work. Tens of thousands, if not hundreds of thousands, were struggling to get back home under the lockdown (Why they didn’t stay put in their city of work? No money, no security, no safety net, no savings. These migrant workers are mostly ones that live off making meagre daily profits). The UP government deployed a thousand buses to help ferry these workers to their native districts in the state.

Down south, in Maharashtra, which receives a lot of migrants, announced that Covid-19 patients would get free treatment (under Mahatma Jyotiba Phule Jan Arogya Yojana).

Even further south, Kerala, which is the poster child of good public health programs and practices, beside checking all the right boxes on what to do in the time of a pandemic, has gone above and beyond to address collaterals, such as tasking local governments to take care of starving stray dogs and monkeys. Anticipating the impact of closure of alcohol shops during the lockdown, Kerala has strengthened its de-addiction centers.

While some of these measures should be permanently engrained in our governance structures, some measures taken, need to be critically reexamined for their propensity for misuse. While the Union government has encouraged States to use a precolonial law (Epidemic Act 1897) to enforce quarantine, a legal tool with a clear implementation and accountability framework should eventually replace it.

In a nation where religion is often one’s premier identity, only the wrath of god can lead to a reimagining of public health systems. A stagnated level of government expenditure on health (hovering around 1.1% of GDP for over a decade) has been a constant complaint of experts. The aforementioned financial support measures, by the Union government, come up to 1% of the GDP, as compared to the double digits seen else (Malaysia announced a

Dr Ruha Shadab

stimulus equal to 17% of its GDP). However, regardless of comparative figures, cushioning the blow of a lockdown and a lockdown itself, are not sustainable measures for the pandemic. The future needs a public health system in India that is dynamic, hyper-responsive, globally well-integrated, and optimally resourced. Maybe god is a virus, and Covid-19 will strengthen the one thing we all need: healthcare.

Dr Ruha Shadab
Public Service Fellow and Master Candidate, 2020
Harvard University, Kennedy School of Government
ruha_shadab@hks.harvard.edu

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