For the poor, work has dried up entirely, and so those migrant workers who could sought to beat the lockdown by heading home in huge numbers. Since the restrictions came into force, buses and trains have stopped ferrying passengers across the country, leaving them to walk, often for days, with their families back to their towns and villages.
Again, the authorities’ callousness has been on display: In one heartbreaking video that went viral, police in the northern state of Uttar Pradesh force young boys to perform frog jumps as punishment for violating the curfew. Another video shows police waiting outside a mosque in the southern state of Karnataka, beating worshippers with a stick as they leave. Similar cases of police brutality have been reported around the country, and social media have filled with messages of people running out of food yet afraid to leave their dwellings, fearful of the police.
All of that is to say nothing of the medical disaster that may well await India, one I am familiar with—I have covered health care in India for 17 years, and was previously the health editor of The Hindu, one of the country’s biggest newspapers. As the government focused in recent months on passing the controversial anti-Muslim law, stoking protests and eventually communal violence, crucial time to prepare for this pandemic was lost. The World Health Organization warned on February 27 of a coming disruption in global supply chains, advising countries to create their own stockpiles of the personal protective equipment that medical workers would need. The Indian government waited until March 19, however, to finally issue an order prohibiting the export of domestically made PPE, and a further five days to ban the export of respiratory apparatuses. There are more such delays: Only last week did the government finally allow health-care workers treating patients suffering from COVID-19, the disease caused by the coronavirus, to be tested; it also only recently began testing those without a travel history, a long-overdue implicit admission that the virus was being transmitted locally; and it has just issued notices to private hospitals to submit tallies of the number of intensive-care beds and ventilators available and to cancel nonessential surgeries, and directed facilities nationwide to ensure those suffering COVID-19 are neither stigmatized nor turned away. Even the measures the authorities have taken have had unintended consequences. The lockdown, for example, bars factory workers from going to work, leading to a shutdown of the medical-device industry, and prevents truckers from transporting materials and stocks to hospitals.
There is, unfortunately, good reason to believe that all of this will not be enough. For one, India is still not testing enough people, having conducted the fewest number of tests of any country with confirmed cases of the coronavirus, at just 10.5 per million residents (South Korea, by contrast, has conducted more than 6,000 tests per million residents). That private laboratories are allowed to charge $60 per test—remember, just $7 a month has been offered as income support for some residents—means significant barriers to confirmation and treatment remain in place. (The government argues that because of the size of the population, widespread testing is not feasible.) The authorities are also not meticulously contact tracing, people are fleeing isolation centers, and measures such as self-quarantines and social distancing are impractical in a country where much of the population lives in dense clusters in overcrowded megacities. Whereas the WHO recommends a ratio of one doctor for every 1,000 patients, India has one government doctor for every 10,000, according to the 2019 National Health Profile. A 2016 Reuters report noted that India needed more than 50,000 critical-care specialists, but has just 8,350. In short, the country’s health-care system is in no position to cope with an avalanche of patients with a contagious respiratory infection in the manner that China and Italy have been doing—India’s continued inability to deal with the epidemic of tuberculosis speaks to that struggle.