Death is no longer something that happens to people far away. Increasingly, the dead include people we know.
India is now among the four countries with the highest Covid-19 cases. The new virus has already claimed the lives of over 8,000 Indians.
It’s hard not to be depressed as deaths rise, and desperate cries of people running from pillar to post to get a hospital bed for a loved one flood the social media. It’s equally sad to find at times like these that many among those on the frontline doctors and health workers are being deprived of basics.
Doctors at Kasturba Hospital, run by the North Delhi Municipal Corporation, say they haven’t got salaries for the past three months. At a webinar hosted by the Indian chapter of Women in Global Health, an Asha worker from Haryana spoke movingly about the harsh realities of those at the forefront of India’s response to Covid-19.
“We are told the Asha work is an extension of every woman’s household work. Don’t we merit minimum wages or recognition? Our workload has doubled due to the coronavirus.”
Frontline workers in many states also say while they are being tasked to trace the contacts of those diagnosed Covid positive, they aren’t being given full protective gear. Who is keeping count of the doctors and health workers diagnosed Covid-19 positive?
Worryingly, as the country is grappling with the pandemic and acute economic distress following the lockdown, political slugfests continue. Now there’s a new phenomenon the “virtual rally”.
Home minister Amit Shah says his virtual rally for the people of Bihar is not related to the forthcoming polls. “It’s to boost the morale of the public against the Covid-19 pandemic.” Opposition parties don’t agree. The state is headed for Assembly elections.
The lack of trust between the Centre and Opposition-ruled states is a huge stumbling block in the way of a cohesive national response to the pandemic.
Arguably, there are people and places which are in a worse shape but try telling a mother who has just lost her son or a wife who has lost her husband to the new virus that India is doing far better than many other countries.
The official narrative pivots around India’s lower Covid-19 fatality rate compared to many countries.
The Indian Council of Medical Research (ICMR) insists there is still no “community transmission” of the virus in the country. ICMR’s recent sero-surveillance study says only 0.73 per cent of the sample population was exposed to the virus. According to a government statement, the study was conducted in 83 districts covering 26,400 individuals.
It says: “The measures taken during the lockdown have been successful in keeping the transmission low and in preventing rapid spread of Covid-19.” ICMR says compared to rural areas, the risk of the virus spreading is 1.09 times higher in urban areas and 1.89 times higher in urban slums.
Meanwhile, feedback from the ground point to many cases where the source of contagion isn’t known. Delhi health minister Satyendar Jain recently said the source of infection isn’t known in half the coronavirus cases in the city.
There’s a lot we don’t know about the new virus. However, what we do know about our context offers lessons.
India's young population is an advantage. Globally, deaths due to the coronavirus have been more among the elderly. That could be one reason why our fatality rate is lower, relative to ageing Western countries.
But it must be remembered everyone above 60 is at risk. Among older people, those with co-morbidities like cardiovascular diseases, diabetes, obesity and hypertension are at even greater risk.
Lifestyle ailments now afflict millions of Indians, including the not-so-old. Cardiovascular diseases, for example, hit Indians at a relatively young age. Much of this goes undiagnosed and therefore ignored, says Dr Giridhar R. Babu, professor and head of life course epidemiology at the Public Health Foundation of India.
One in three adult Indians suffers from hypertension, which would put a person at greater risk of Covid-19, says Dr Babu. What’s even more worrying is that roughly 50 per cent get diagnosed on time, and among them only half sustain treatment.
“People don’t know they are suffering from hypertension as very few undergo annual medical checkups. A nationwide study by Prof G.V.S. Murthy showed nearly 50 per cent were blind when they came to know they had Type-2 diabetes mellitus.”
What complicates this further is malnutrition. One in three of India's children suffer from malnutrition, which compromises immunity and puts a person at greater risk. The impact of childhood malnutrition extends to adult years.
Public health expert Anant Bhan says what we need most of all is a long-term, cohesive vision and solidarity between the Centre and states, within states, and different sections of society.
The pandemic has exposed the glaring gaps in India’s health system. It also provides an opportunity to fix the structural problems.
A lockdown, for example, will have little impact unless there are enough people who can carry out critical tasks like contact tracing, and healthcare infrastructure and staffing are built up to prepare for a surge of cases.
This means, as Dr Bhan points out, vacancies in various states for health workers must be filled up swiftly.
Will the various governments step up? A lockdown by itself is not a magic bullet. More testing, contact tracing and isolation, where necessary, are vital.