As more and more information about the COVID-19 pandemic comes to light, it is clear that adjectives like ‘devastating’, ‘deadly’ and ‘disastrous’ sound disproportionate to the damage caused by the virus itself. The need to slow its spread prompted governments to do different things, and that seems to have precipitated the most ruin.
The virus itself is a fast spreader and moderate killer (I imagine the fatality data is skewed by Italy’s tragic triaging policy and the very late institutional response in high-prevalence countries like the US and Brazil). Of those it infects, more than half don’t develop any symptoms. The Indian Council of Medical Research (ICMR) said a month ago that 80% of the cases in India until then had been asymptomatic, although this figure is likely to change as the results of the first seroprevalence surveys are published. A study published in February said the symptoms of over 80% of 72,000 patients researchers examined in China could be classified as ‘mild’.
The remainder develop severe symptoms and a fraction of them die. The size of this last set – of the people who die – is a shifting thing because it’s nearly impossible to deduce the true case fatality rate during an ongoing pandemic, more so if many of those who are infected aren’t tested (mostly because they’re asymptomatic). We do know that the overwhelming majority of those who die are elderly and/or have comorbidities known to heighten the risk of a serious infection.
These being the facts of the case, the novel coronavirus doesn’t seem as deadly as it’s often made out to be. I believe this perception of its ‘deadliness’ developed for three reasons: a) the virus is adept at spreading between humans, so the case-load is eye-poppingly higher than that of the SARS-CoV-1 virus, which caused the 2003 SARS pandemic; b) this pandemic is the first to happen in the unwavering, but often tinted, gaze of matured social media platforms; and c) the virus’s effects are often hard to distinguish from the state’s response to contain it.
In fact, the state’s response has often needlessly heightened the sense of panic. In Karnataka, for example, I’m told many companies require those of their employees who drive two-wheelers to wash their vehicles’ tyres when they enter the compound, and then park the bikes in a separate area. Such policies often complement municipal authorities’ tendencies to spray disinfectants on the road and on trees lining the road to give the impression that excessive caution is a virtue. However, such caution only suggests that the virus can infect roads and plants, and that unless they’re disinfected, it might be unsafe to step out, which is not so.
The main reason for us to remain focused on the role played by the state is because the data suggests once we correct for age and/or comorbidity, the virus would threaten those with subpar living conditions the most – those with poor healthcare and little or no social and financial security – as we know to be the case with most infectious diseases.
So continuing to ascribe ‘devastation’ and ‘disaster’ to the virus – instead of the socio-economic conditions that make it ‘deadly’ for some and not others – allows the state to escape blame for badly planned interventions.
Of course, it’s still important that governments, including that of India, quell the epidemic to manageable levels, if only to keep it from poaching resources already insufficient to treat other epidemics like tuberculosis and HIV/AIDS. In fact, an optimist might even hope the state’s earnestness on the count of this particular virus could be on display against other disease-causing pathogens in future.
But it’s also important to remember ‘test, trace, quarantine’ is only the part of the story that addresses the virus’s consequences. We need other measures that address the state’s potential to enable better outcomes, such as protection of workers’ rights, access to nutritious meals, supply of clean running water, good primary healthcare, etc., not to speak of transparent, data-based decision making rather than top-down, knee-jerk responses.
Against this wider background, yesterday’s New York Times is noteworthy. It listed on its front page the names of 1,000 people, plus a short yet evocative description, who died due to COVID-19 in the US, calling their passing an “incalculable loss”. According to a note published separately,
Putting 100,000 dots or stick figures on a page “doesn’t really tell you very much about who these people were, the lives that they lived, what it means for us as a country,” Simone Landon [assistant editor of the graphics desk] said. So, she came up with the idea of compiling obituaries and death notices of COVID-19 victims from newspapers large and small across the country, and culling vivid passages from them.
The outcome is a touching memorial for the people who lost their lives in the pandemic, and certainly something their friends and family will cherish. But it’s not clear whether this memorialisation of the disease draws attention to, or detracts from, the state’s mishandling.
Few would disagree with the fact that far fewer people would have died in the US if it weren’t for the Donald Trump administration’s delayed and then ham-fisted response, and the memorial should preserve our memory of such wilful negligence and incompetence. People died, of course, but they didn’t die in a vacuum. Unlike in Italy or Iran – and quite like in the UK, Brazil, Russia and China – some specific people are actually to blame for the situation becoming worse in specific ways.
India’s health ministry itself didn’t think of the pandemic as an emergency until mid-March – nearly 45 days after the WHO had declared the virus’s spread a public health emergency – and to this day continues to deny community transmission, thereby keeping its case definition narrow. In addition, the Indian government created a significant problem for itself when it made no plans for millions of migrant labourers who emerged from cities in droves after businesses shut down under the lockdown.
Now, when tens of thousands of these labourers crowd the Anand Vihar bus stand in Delhi, the Shivaji Terminus in Mumbai and Palace Grounds in Bangalore to register for seats on buses and trains home, what’s gut-wrenching is not that they’re violating physical distancing protocols but that this is how they’re treated, that this is what they need to do to find safe passage home instead of having to walk hundreds of kilometres like so many of their compatriots had to. The states of North India that now prepare to receive these train-loads need to find a way to accommodate them, feed them and treat them for any illnesses. This is a crisis brought on entirely by governments, not the virus.
A short essay by New York Times columnist Dan Barry accompanying the list of names only says,
Why has this happened in the United States of 2020? Why has the virus claimed a disproportionately large number of black and Latino victims? Why were nursing homes so devastated? These questions of why and how and whom will be asked for decades to come.
These questions can be translated to the Indian scene as well, with an additional one asking if the government’s request to support essential workers while simultaneously putting them in harm’s way – directly through ICMR’s hydroxychloroquine use policy and denying them proper support, indirectly by stymying the supply of PPE, qualifying faulty test-kits for field use and withholding crucial data about the government’s performance – isn’t just the government pinching the baby and rocking the cradle.
Perhaps an Indian newspaper could borrow Simone Landon’s wisdom and fill its front page with the names of those who continue to bear the brunt of the government’s failures, not the virus’s successes. They include migrant labourers who broke down on the roadside for want of any prospects, the hospital workers evicted from their homes, ASHA workers who haven’t been paid, the doctors refused a decent burial, the interns asked to attend to COVID-19 patients without PPE, the conservancy workers whose names were scrubbed from employment records when they got infected. And it will take several newspapers several days to record the names of these unrecorded victims of the Great Indian Epidemic of 2020.