The Callousness of India’s COVID-19 Response

The government is showing how not to handle a pandemic.

Health workers wearing facemasks amid concerns over the spread of the COVID-19 novel coronavirus, stand as they wait to spray disinfectant at the corporation office in Chennai on March 20, 2020.
Health workers wearing facemasks amid concerns over the spread of the COVID-19 novel coronavirus, stand as they wait to spray disinfectant at the corporation office in Chennai on March 20, 2020. (Arun Sankar / AFP / Getty)

By now, the global timeline of the coronavirus’s development has been well established: The first case reportedly appeared in mid-November; in December, the Chinese government was still attributing hospitalizations to a peculiar form of pneumonia; through January and February, the outbreak began spreading around the world; and its epicenter is today firmly in Europe and the United States.

Throughout, another set of events were occurring here in India. Late last year, Prime Minister Narendra Modi’s Hindu-nationalist government introduced and passed a controversial new law, ostensibly in support of minorities in neighboring countries, that in fact openly discriminated against Muslims and undermined India’s secular foundations. Then, early this year, protests over that new law snowballed into a pogrom in which dozens of people—mostly Muslims—have been killed.

Yet even as India was gripped by demonstrations and violence, the coronavirus was making inroads into society here. The country reported its first case on January 30, but authorities steadfastly insisted that cases were one-offs and no local transmission was taking place. In recent weeks, though, India has seen exponential growth in the number of cases. Today, we are three days into a three-week nationwide lockdown, a heavy restriction on a nation of 1.3 billion people that Modi and his government have insisted will help defeat the virus.

In fact, it may well be too late. This lockdown is, in keeping with many of this government’s policies, a headline-grabbing initiative announced with little warning, but one that will do little to address the myriad problems India faces in dealing with the coronavirus. It puts responsibility for containing the outbreak on citizens, instead of instituting a robust official support system. It is needlessly punishing for the most vulnerable in society. It does nothing to solve this country’s problems with public health and safety. And everything that is wrong with India’s response flows from that period late last year through the early parts of this year, in which the government set the tone for what is undoubtedly the world’s harshest lockdown with police brutality, a lack of transparency, and a shortage of compassion.

The restrictions themselves are onerous: Indians should not be leaving their homes, all businesses were ordered to close, and no transport—via plane, train, or bus—would be allowed. The prime minister called for social distancing, urged his compatriots to avoid spreading rumors, and pledged financial support to strengthen the health-care system. Yet the announcement of the lockdown was remarkable not just for its scope, but for its timing. Modi made his speech at 8:00 p.m. on March 24, saying the restrictions would come into force just after midnight and be in place for three weeks. By the time he spoke, shops had closed for the day, catching off guard people who had been repeatedly told not to panic-buy. The next morning, nothing was open in Goa, the state where I live. Elsewhere, such as in Britain, France, and Italy, grocery stores and pharmacies have remained open to provide essential services, but here, they are closed. While most wealthy and middle-class Indians will make it through these three weeks unscathed, able to hunker down, work from home, and access some modicum of entertainment, the country’s poor and its huge number of transient migrant workers (there are no official figures, but the most often cited number is 100 million) will struggle to survive.

The government is offering little in the way of a safety net. Only after the lockdown came into force, and amid growing outrage, did the finance minister finally announce an aid package. Yet its $22 billion value is a pitiful amount compared with what governments elsewhere have provided: Whereas governments in Britain, Spain, and Germany have offered stimulus plans of up to 20 percent of GDP, India’s amounts to less than 1 percent of its GDP. It provides no help for day laborers or other workers in similar unorganized sectors. It contains no measures for migrant workers. The actual amounts of support—five kilograms of rice or wheat, and one kilogram of legumes, per person for the next three months, coupled with cash transfers, in some cases of 500 rupees, or $7, a month—have infuriated voters. Here in Goa, a lawyer has petitioned the high court to direct the state government to provide essential goods to the people, especially those who are living below the poverty line.

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.

An added issue is the Modi government’s willingness to tolerate unscientific thinking. The prime minister and his colleagues have held intellectuals and experts in disdain, and promoted traditional medicine in the past, undermining the health ministry’s efforts to combat misinformation by endorsing homeopathic prophylactic treatment.

India now has several hundred confirmed cases of the coronavirus, and has seen at least 17 deaths—both highly conservative figures. Thus far, the spread of infections has matched that of a textbook epidemic, yet the government’s response has been anything but. The lockdown may help “flatten the curve” and buy the authorities some time, but that means little if they do not take advantage by aggressively testing, isolating confirmed cases, and performing contact tracing. Absent these measures, the lockdown will merely create concentrated pockets of outbreaks that will then expand rapidly once the restrictions are eventually lifted.

During his first televised address to the nation on the pandemic—unlike leaders in other democratic countries, he has not given regular press conferences—Modi compared the effort to contain COVID-19 to the Great Wars, and asked citizens to perform their duties, without explaining what his government was doing.

Ramanan Laxminarayan, an epidemiologist and lecturer at Princeton University, used a different analogy. “Imagine that you’re standing on the shore and you’re watching the tsunami come in,” he told the BBC. “If you are going to just stand there, and watch the tsunami, you are finished. If you can run as fast as you can, you have a better chance.”

India is not running fast enough.