War on Corona Can Linger
Preparedness Should Not

Bibekananda Ray

Not only to India, the Corona pandemic was a bolt from the blue to the entire world; therefore, a flawless preparedness is too much to expect. As it was ‘novel’, mankind did not know enough about it. The WHO admitted as much and circulated data of prevention and cure from its experience of treating SARS victims in 2002. Naturally, it has exposed certain fault-lines in the global medical system that needs to be removed before it’s another wave, or of any other epidemic, strikes the world and catch us unprepared. Modern health infrastructures and additions cost a great deal; India’s GDP growth was sliding when it struck; in the last 50 days of nationwide lockdown, it has slid further and may bite the dust in next FY but with patience and planning, the fault-lines and flaws can be made up and preparedness against a fresh wave can be enhanced. Initially, India’s low incidence of infection and deaths etc. were deemed as just good luck but actually those were due to paucity of diagnostic kits and low detection. India clamped lockdown much later than Europe and the USA but even in seven weeks, it does not seem to have “broken the chain”. In daily outbreak of new cases, India is now second in the world, next to the USA although mortality is far less. US researchers have ruled out early death or disappearance of the deadly virus; even if vaccines and therapies are developed. China does not rule out another wave.

  As Dr. Amartya Sen bemoans, India’s health care leaves a lot to be desired; not only doctors and para-medical staff are numerically below WHO parameters, their qualifications and efficiency are not beyond cavil. Presently there are 23673 PHCs in India, generally single-physician clinics with facilities for minor surgeries. In 2005, the central government launched the National Rural Health Mission (NRHM), under which expenditure on it was proposed to be raised to 3% from 1% of the GDP but the ground reality belies this. India has approximately 641,000 inhabited villages, inhabited by more than 74 crore people; on an average, one sub-centre serves 5,000 persons, one PHC 30,000 people and one CHC 120,000 people in the plains. Each CHC has a physician, a surgeon, a gynecologist and a pediatrician who are assisted by 21 paramedical and other staff, 30 indoor beds, one operation theatre, X-ray unit and labour rooms and a laboratory. It provides emergency obstetrics care and specialist consultation but only 20% of patients, seeking OPD services and 45% seeking indoor treatment avail of them; the rest go for private facilities. Apart from old infrastructure and poor supply of drugs and equipment, public medical services are also crippled by rampant staff absenteeism. Many resident medical personnel run parallel private practice in their quarters, or in nearby towns. Though PHCs are supposed to be free, most of them charge a fee.

This is the first grassroots fault line that needs to be made up. City-educated doctors and para-medical staff refuse to serve in remote rural areas, not having good quarters, shops and bazaars, schools and colleges (for children) and other urban amenities. Even if posted and made to join, they serve by proxy, by paying local quacks and callow health workers. They have few equipment and almost no pharmacy, not to speak of diagnostic kits. Above a group of primary health centres are rural hospitals (RHC). Cheap nursing homes have sprouted even in block towns to fill this vacuum, where rural patients flock, spending a fortune.   Mysteriously, Corona epidemic appears to be an urban phenomenon; if it penetrates villages and slums and infects children, the fault-line will be wider.

The next sector where fault lines need to be removed are in the reporting of the sick. At present, unless a patient, or his kin, reports to the nearest health centre, or rings up a helpline, there is no means of knowing. Arogya Setu App is not available on basic or land phones. Government health centres seldom treat the infected and the suspects in the OPD with the meagre wherewithal; they refer them to city hospitals. This flaw can be made up, if a doctor or health worker is attached to a gram panchayet, who can report critical and suspicious cases to the BDO, or the PHC. Particularly, if a villager had gone elsewhere to work or for travel and returned with Corona symptoms, or has entertained somebody returned from abroad, or some other district or State, the Panchayet doctor or the worker should know and enquire about it.

One of the serious flaws in the Central government’s dealing with Corona epidemic was all students who had returned from Wuhan on vacation. If they were immediately quarantined or isolated the virus might not have spread so fast. Initially, like the WHO, the Central government did not give it much importance, occupied as it was with nationwide protests to CAA, NPR and NRC and outbreak of Delhi riots, later that month. The same is true of the Islamic Jamaat in Nizamuddin Darga in south Delhi, not very far from the PMO, or Health Ministry; it was a well-known hugely attended annual cross-country occurrence, held in middle of March’20. Muslims from other States and abroad could not return as lockdown was clamped from 24th March. When the NSA, Ajit Doval intervened, it was very late and many of the infected or suspects had dispersed. The government admitted that sudden rise in the number of infected thereafter were due to this unpardonable negligence. The Central government wasted two months when most other affected countries had adopted lockdown and other measures to contain the pandemic, alas, unsuccessfully.

Another fault line has been not taking into account the plight of lakhs of migrant workers, patients and their kin, students, tourists and pilgrims stuck up in many States  before the commencement of the lockdown. If Sonia Gandhi had not drawn the attention of Mr. Modi, the problem might have been pushed under the carpet. Her party, the Congress seems to have borne train fares of those who ran out of money. They should have been sent homes before clamping the lockdown.

The first casualty has been the national economy. Normal economic activities came to a stop; domestic and cross-border trade was completely suspended. Non-salaried people bore the brunt, as they had to remain indoor, suspending their means of income. Surface air and road transportation of passengers and goods was completely grounded for over a month, incurring huge losses to the government and private operators. The precarious economy since 2014 had forced the Centre to utilize the hefty RBI surplus of 176000 crore which no government did since Independence; the apex bank used to transter 50,000 crore for some years. Mr. Modi announced cash doles and free ration to zero-balance account and ration-card holders to compensate for lockdown. When the Union Budget was presented on 29th February, Corona cases had not been so alarming but the Minister made no special provision. To make up for the fall in GST revenues and in direct and indirect taxes, , the government announced on 8th May  a borrowing of about 12 lakh crore rupees from the market, 54% more than estimated in the budget, taking the fiscal deficit for the FY to 5.5%, up from 3.5%, estimated. From 9th April to 8th May, this year, the government borrowed 1.06 lakh rupees from the market; it is considering to borrow 30,000 crore rupees more, every week, by auctioning its bonds between 11th May and 30th September. On 15th May, the World Bank announced a loan of one billion US dollars, i.e., 75000 crore rupees to India to help tide over the economic crisis. In the footsteps of the Centre, States severely affected by Corona may take resort to market borrowings and sale of bonds etc too.            

On 12th May, the Prime Minister announced a cumulative stimuli package of 20 lakh crore rupees (constituting 10% of the GDP) for building a ‘self-reliant’ India, largely unrelated to the Corona devastation. Giving the details on subsequent days, the Finance minister gave breaks-up, including some she had announced earlier. Mr. Modi diverted people’s attention from the untamed Corona, even after 50 days of continuous lockdown. He called for a pompous ‘self-reliance’ for the country, wrapped up in clichés and platitudes; it was like asking a lame patient to run on crutch. The package seeks to stimulate several sectors with outlays running to crores of rupees but very little to undo Corona-related damages, or to step up preparedness against a fresh wave. While going ga-ga on details of the self-reliance package, she did not specify, wherefrom this hefty amount will come, whether this would come from tweaking the current budget, or enhance total deficit by 20 lakh crore rupees. Economists had expected that she would ask the RBI to resort to deficit financing by printing more notes, float new bonds to be subscribed by banks, borrow from the market, or from international FIs. The Centre has frozen the DA of serving and retired government personnel up to July 2021, which will hit hard the vast mass of low salary and low pension people. As days go by, the economy will stare more in the face with its growth plunging to zero in 2021-‘22. No previous union Finance Minister has been so callow and clueless. She may be eyeing the revenues from sale of petroleum products whose prices crashed in other countries but not in India,

India is not alone in this economic meltdown; every other affected country is in the same boat but with better financial parameters, they may recover sooner than India. The fault line already existed before Corona struck in January; it has merely widened. A return by Corona or a fresh wave of another virus may render it irreparable. A three-phase lockdown for six weeks has been, economy-wise, a complete disaster.

Like many afflicted countries, India had no experience of treating previous Corona infected, or suspects, because its earlier incarnations eluded India. In November 2002 the SARS epidemic broke out in China’s Guangdong province and spread, by human transmission, to Toronto, Hong Kong China, Taipei, Singapore and Hanoi. Therefore, its performance in reining Corona might have been ad hoc but not too bad. In 50 days of uninterrupted lockdown, there has not been any improvement in infection and mortality, other restrictions remaining the same.  The Health Ministry is claiming, hypothetically, that if lockdown was not enforced, mortality might have exceeded a lakh. Almost every day, India is having record number of new cases, although one in three to four among the infected are claimed to be cured. Fortunately, in India, the severity is less; only 1.1% of the hospitalized needed ventilation, 3.3% needed oxygen and 4.8 needed to be shifted to ICU. Testing capacity has also increased- from 75000 to 95000 per day; cumulatively, over 13.57 lakh have been tested across the country so far. Out of 672 populated districts, 319 districts have been spared by Corona; cases are confined to 130 and 284 red and orange districts, respectively.   Initially, testing kits, PPEs, masks were in short supply but gradually it has been made up. Nobody foresaw such an emergency; the present acquisitions of testing kits, PPEs, masks etc. should be preserved to tackle another wave.  

Viruses seldom die; like millions of them that had afflicted mankind they can go weak, lose fangs, or mutate to another form- benign or malignant, like those causing small pox, malaria, dengue, chickengunia, plague, HIV and Ebola. Scientists say, like the HIV, NCOVID’19 could be immortal; it seemed to weaken in China, its epicentre but it returned even in patients who had tested negative. US scientists believe, it is going to stay with mankind for some more time until a vaccine or therapy reins it and the world has to remain prepared for a return or another wave. In number of new cases, India has soared to the second position in the world, next to the USA; its mortality rate is also rising, albeit at a slower rate. Nobody knows, where it will stop; even Prime Minister admits that India has to live with it for some more time. Meanwhile, the damage to the economy will take time to be undone, as Nobel laureate, Abhijit V Bannerjee predicts. As lockdown eases gradually and suspended services resume, they may demand compensation or incentives from governments. In the USA, the governments are paying the wages to home-bound employees in the private sector. If India is compelled to do this too, it will be the last straw on the economy. The State governments may also have to seek market or external loans on exorbitant interest; if they cannot repay, they will pass them on to the next governments. Overall, the picture is not rosy and if fault lines remain, another wave of Corona, or of other deadly virus will make it murkier, jeopardising the lives of some 138 crore people, united in fear and resolve to defeat Corona.

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Frontier
May 19, 2020