On Thursday, the Central government said it had approved a Rs 15,000 crore emergency response package for handling the novel coronavirus epidemic in the country and that orders had been placed for a large number of ventilators and personal protective equipment (PPEs) for medical staff.
The announcement came on the 16th day of the 21-day nationwide lockdown declared by Prime Minister Narendra Modi on March 24.
Modi’s declaration could be a step to prevent more of India from sliding from Stage 2 (local transmission) to Stage 3 (community transmission). Some cities – such as Mumbai – have already said they are in Stage 3. Modi has called India’s movement against COVID-19 a “citizens’ war,” which has to be undertaken despite hardships.
Those hardships we saw immediately.
Scores of informal sector workers, stranded without work or shelter, began to migrate en masse to their home districts across India until the Union home ministry ordered the police to stop their movement at the state borders. Over the past 16 days, the poor in rural India have struggled to make ends meet as uncertainty looms. Lakhs of people have been left jobless in towns and cities, while thousands of micro, small and medium enterprises have been hit particularly hard. According to CMIE data, the unemployment rate has hit an unprecedented 23% because of the lockdown.
As in India, governments across the world – not without reason – have prioritised the health emergency over the economy, as lockdowns are seen as the single-most effective way to “flatten the curve” of growth in new infections.
However, with COVID-19 cases continuing to grow exponentially in India and the Union government now planning to extend the lockdown beyond April 14, experts are once again debating whether a pan-India lockdown is an effective means of containing the spread of the coronavirus.
At the same time, the opacity with which the government has operated in the last few days doesn’t bode well for the nation’s confidence. Health reporters have found it difficult to ask pertinent questions at the daily press briefings by the Union health ministry.
The government itself has been reticent in revealing adequate data through which independent experts can map the scale of the problem. Even when numbers are provided, as in the press conference on April 9, the detailing through which official claims may be validated is missing.
In such a scenario, questions regarding the government’s preparedness, its achievements in the last fortnight, and its planning to tackle socio-economic tensions on ground are bound to be asked, as India enters its 16th day of lockdown.
1) How does the Union government plan to ascertain the extent of the virus’s spread in the country? How many days would it take for it to procure testing kits according to the requirements of various states?
India is the only large country to have instituted a nationwide lockdown to slow the local spread of the new coronavirus. Countries that have instituted regional lockdowns, notably South Korea, have also conducted tests en masse to completely ascertain the extent to which the virus has spread.
India, however, is woefully short of testing kits. For instance, the Union government could provide only 250 kits to Bihar against its demand of 10,000; 5,000 to Jharkhand’s demand of 75,000. In light of this reality, the government has to undertake alternate testing strategies with clear, transparent communication.
2) The government has, until recently, denied community transmission, even as it is clear that this phenomenon is emerging in localised pockets in India.
But community transmission is too vague a term to guide policy decisions. Given the vagueness of the term, any country with growing local transmission still must test as widely as possible. Is India doing this?
The WHO has defined community transmission as a situation in which a large number of positive COVID-19 cases do not have any travel history, or links with people with travel history. However, the WHO doesn’t define the term “large”.
This vagueness makes the term community transmission meaningless from the point of view of public policy. This is evidenced by the fact that one of the worst hit countries in the world today, Italy, is still classified as being in “local transmission” by the WHO. So, even if India is technically not in the community transmission phase, as the health ministry has been saying, it is time for the country to start acting like it is, given the fast rise in cases. The denial of community transmission by the government may, therefore, be a red herring.
Second, the ICMR recently began testing all people hospitalised with severe acute respiratory infections (SARI) to look for evidence of community transmission. However, the health ministry has been irregular in sharing the number of SARI cases tested, and the number of positives among them, making it difficult for independent experts to assess if community-based testing is adequate.
Third, ICMR has not advanced any particular logic for the slow rate at which it has been expanding testing despite claiming at one point that India could test 6,000-8,000 samples per day.
3) Given India’s poor health infrastructure, has the government planned anything to revamp the existing medical facilities to handle COVID-19 cases at a mass level? And as existing public hospitals focus on COVID-19, what steps are being taken to ensure the regular flow of sick people is also attended to?
Other countries have sought to build new hospitals, notably China and even the United Kingdom with its ‘Nightingale’ facilities. The Railways has stepped forward to provide coaches for use as isolation wards but India has a large number of private hospitals, which the Central and state governments (barring some exceptions among the latter) have not moved to commandeer as they are no doubt empowered to do.
India is also very short on the requisite number of hospital beds per lakh population, nurses and personnel trained to handle devices like ventilators. The government now says 49,000 ventilators have been ordered but when they will be received is not known.
4) Frontline health workers have risked their lives to treat COVID-19 cases without personal protective equipment (PPE). What plans does the government have to provide protective gear to anyone who needs it?
Though the government has not shared any data, a critical shortage of PPE has been reported from across the country and PPE manufacturers have said it will take time before domestic production can be ramped up to meet the shortfall.
The breathing space provided by the lockdown ought to have led to the accelerated production and procurement of critical equipment but the government has not shared any details of what it has done so far on this front.
On April 9, the government in its daily press conference said orders had been placed for “1.7 crore PPEs” and that even now there was enough for what joint secretary Lav Agrawal called “rational use” but no details were given of what stage these orders are at or what the delivery schedule will be.
5) Within the space of two days, i.e. between April 4 and April 6, the Modi government went from a complete ban on the export of hydroxychloroquine to selective relaxation of the export ban. The only new development between those two dates was US President Donald Trump’s peremptory demand for the lifting of the ban.
ICMR has recommended healthcare workers use hydroxychloroquine, the antimalarial drug with scant evidence of effectiveness against COVID-19, as a prophylactic. The Union government says it has assessed India’s stocks,production capacity of the drug, and the potential domestic requirement. But it has not shared the rationale behind why the ban was imposed on April 4 and then relaxed two days later.
The government needs to share its data and projections with the public. And since Trump has imposed restrictions on the US export of PPE and other material that India has in short supply, the government needs to publicise whatever assurance it has received from the US that the latter will reciprocate.
6) A few clusters have been identified. News reports said state governments are looking for possible infections in these clusters. However, a few cases have also emerged from slums and dense colonies that can lead to rapid transmission.
Yet there have been negligible efforts at contact tracing, let alone testing, in such instances. If the lockdown is extended, what will the government do to handle such cases?
Considering only a small minority of those infected by COVID-19 need ICU care, the biggest ‘resource’ necessary to arrest the virus’s spread is the community of contact-tracers – the people responsible for tracking down all the contacts of a person who has tested positive for COVID-19, ensuring they are quarantined and checking in on them at periodic intervals to assess their health.
Thus far, there has been no indication that there is a shortage of contact-tracers, but this said, as new cases spring up in denser settlements, the demand for public health officials who will have to undertake these exercises will only skyrocket. The authorities in districts like Bhilwara have drawn praise for their effective monitoring but elsewhere, it is not clear how efficient the process has been.
Finally, once community transmission has begun in the right earnest, contact tracing would be infeasible and meaningless. So, it is important for India to recognise and accept when it happens in some regions.
7) Hotspots have been identified and sealed off in many states. States like UP and Delhi have promised home delivery of essential services in these areas. Tamil Nadu has started it. Is the government planning interventions to allay people’s fears if they are stuck in such hotspots?
A standard protocol to help people figure out where and in what circumstances they can purchase their food supplies and replenish medical prescriptions could go a long way in arresting panic and ensuring the sort of public cooperation necessary to make the lockdown successful. The government must also have an explicit stopping rule to decide when the lockdown will end.
8) PM CARES and PMNRF have received crores of rupees in donations. MPLADS funds have also been suspended for the next two years, the objective being that these funds would be diverted to ramp up the health infrastructure. Yet, the government has not released a detailed plan on how it will spend the money.
The Centre’s Rs 15,000 emergency response package for the states is to be implemented in three phases – from January to June 2020, July 2020 to March 2021 and April 2021 to March 2024.
Will the money for this be drawn from the prime minister’s relief funds? If not, where will the money going into PM CARES be deployed?
9) What is the Modi government planning to do to create a safety net for India’s poor? In some places, food distress and even hunger deaths have already been reported. Social tensions are brewing among people in a situation where most poor people have been rendered income-less.
Finance minister Nirmala Sitharaman rolled out a Rs 1.7-lakh crore ‘relief’ package that was aimed at India’s poorest in the last week of March, but it has been criticised for its relatively limited scope and some potential troubles with its implementation. Perhaps the biggest drawback of the package though was the lack of any relief directed to hundreds of thousands of migrant workers and daily wage labourers who need help.
Most social sector activists and public intellectuals reckon that many individual components of Sitharaman’s plan need to be doubled or tripled to provide immediate and effective help to those hit by the COVID-19 lockdown the hardest.
Commentators have also argued that the government needs to ensure that food is made available under the public distribution system to all those who need it and not just those with ration cards.
The Food Corporation of India (FCI) is holding a record 77 million tonnes of grains and is likely to add another 20 million tonnes in the rabi harvest. So, there is no shortage of food. But, as Amartya Sen has pointed out in his study of the Bengal famine, it was not shortage of food but lack of access to food that killed people.
10) Why does the health ministry briefing happen only in Hindi? And why is all official communication routed through institutions in Delhi?
Even though the national government’s efforts to contain the virus’s spread cover the whole country, journalists everywhere have to depend on communiqués issued by ministry officials and government institutions centred in Delhi, particularly through press conferences (which, of late, have been mostly only in Hindi and disallow the presence of cameras and mobile phones) and press releases.