Unlock 1.0: How not to undo the gains of the lockdown
The threat to undoing the gains of lockdown is less from the spike in infection, but more from the mismanagement of Unlock1.0.
Charles de Gaulle, the legendary President of France is known to have said: “How can anyone govern a nation that has two hundred and forty-six different kinds of cheese?” If he was around today and in India, he would have probably empathised with Narendra Modi and said that managing a country of a billion opinions is far more difficult. The French may know their cheese but the complexities of India are often not understood even by Indians.
It is commonly said that many Indias reside within one India. However, this plurality was not always apparent to all. The Covid-19 crisis is unique because it brought to the surface multiple Indias, all at once. Most notable among them was the India of migrant workers, that had for long been below the radar for people and policymakers alike.
Fighting the pandemic while coping with domestic dynamics was confusion worse confounded. Everyone was (and, still is) clueless about the nature of the beast — Coronavirus. There were no historical precedents to go by. Experience of other countries, with their own demographic peculiarities, were of limited use. Mathematical modelling could not be blindly relied upon. Overnight, we became a nation of epidemiologists while the real experts remained divided on what should be the course of action.
The general consensus was to “act now” – even if that meant making some mistakes to be corrected along the way, rather than wait for the illusory right moment and perfect solution that never comes. So, the Prime Minister bit the bullet and declared a nationwide lockdown. At the time of taking the decision, he would surely have factored in the criticisms that would be heaped on him and the government, with the benefit of 20/20 hindsight. But, as the guardian of 1.3 billion people, that is a call he had to take.
The jury on the efficacy of the lockdown will be out for a long time, probably even after we put Covid-19 behind us. However, that is not the subject of the discussion. Here, we are concerned with the challenges before us today. The first, of course, is the continuing spike in the number of cases, on which there are snarky remarks about Narendra Modi having “flattened the wrong curve” – implying the economy, instead of Covid-19.
Without going into the wasteful exercise of ‘sanity check’ for those who expected the Covid-19 graph to have been on the descent after 10 weeks of lockdown or diving into the dictionary to find out the difference between “exponential” and “linear” growth, it would be better to concentrate on empirical data. It would be equally pointless to argue with people who are comparing statistics of countries like Spain and Italy, that have lesser population than some mid-sized Indian states such as Odisha and Gujarat.
As the Cornell Professor and former World Bank Economist, Kaushik Basu (who is generally critical of the present Indian government) has pointed out in a tweet, India has done remarkably well in terms of per-capita number of cases and deaths when compared with both developed and under-developed countries around the world.
A critical determinant of policymaking is how you cut, splice & look at data. In exiting lockdowns we must keep population size in mind & look at infection rate per capita (poorly measured in emerging economies) & mortality rate per capita (better measured). Here is a data slice. pic.twitter.com/o9tP7dXGSM
— Kaushik Basu (@kaushikcbasu) June 7, 2020
Inevitably, the question arises about the reliability of the data. Many public health experts have said that it is easy to fudge the number of cases reported but not deaths, even if the latter are classified under non-Covid-19 related causes. Even a one per cent discrepancy in reported infections and fatalities would have been difficult to gloss over. Experts may well be right in predicting that Covid-19 is yet to reach its peak in India, but it is unlikely to balloon.
Another encouraging factor is that the returning migrants have not caused an explosion in social transmission in their home states. This may be attributed to the screening and isolation arrangements made at the destination and also greater awareness in the rural areas about contact risks and quarantine needs. Still, it may be too early to turn complacent.
Therefore, it is not surprising that there is already a clamour to get migrant workers back to the user states to kickstart economic activity. Some employers and contractors are showing a willingness to up the wage rates. But, whether that will be enough to entice them back is to be seen. The trauma they suffered in being left hanging between life and death in no man’s land for several weeks, cannot be easily healed. And, if they manage to find gainful employment at home – even with lower wages – they may well opt for being “safe rather than sorry”. Their families too may not want them to go back in a hurry. So the logic of “market forces” may not entirely prevail.
In this context, Yogi Adityanath’s comment that the “returning migrants are not liabilities, but assets” is telling. That the exercise of mapping skills of the labourers has started in both the states – Uttar Pradesh and Bihar – is interesting. The states have started taking advantage of the Centre’s schemes for MSMEs, small businesses and rural infrastructure. If jobs are created in the “BIMARU” states of UP and Bihar, then it can be a win-win for both.
The problem of the inadequate number of hospital beds is genuine. On this, neither the Centre or the state governments can be absolved of responsibility. 10 weeks of lockdown should have been enough of a window for them to ramp up capacity or at least have a plan. On both the counts, they have failed miserably. It is convenient to redirect the wrath at private hospitals for charging usurious rates. But the truth is that policy for co-opting private healthcare providers into the Covid-19 battle was never thought through.
This can have several ramifications. Indiscriminate enrolling of private facilities can jeopardise treatment for non-Covid-19 conditions, including infectious diseases like tuberculosis. Reserving sections of a hospital for Covid-19 patients increases the risk of the virus spreading to other parts of the facilities and also exposing a large number of medical and non-medical staff to Covid-19. Hospitals are already witnessing attrition of nursing staff, especially those who have come from other states.
The bigger question is commercial viability. Hospitals carry large overheads and fixed costs. Once converted to a Covid-19 facility, other departments have to be either shut down or run below capacity. Departments like surgery, diagnostics and radiology – which are major revenue earners for the hospitals – go into loss with expensive equipment (often, financed by loans) remaining idle. Many of these hospitals are run as trusts and do not have deep pockets to pay salaries or even buy consumables (such as PPE kits) required for Covid-19 treatment. With state governments issuing “Tughlaqi firmans” capping charges and insurance companies applying their own rules of reimbursement – who foots the bill?
These are far too important issues to be left at the discretion of whimsical satraps. It requires immediate intervention from the highest level of the government. Otherwise, it can lead to a total collapse of the healthcare system across the country in no time. The threat to undoing the gains of lockdown is less from the spike in the number of infected cases, but more from the mismanagement of Unlock1.0.