COVID-19: I Think We Fucked Up

I think we fucked up. But also got lucky. We will also have tremendous collateral damage.

Am talking about India’s COVID-19 response and below are my non-data based inferences and a retrospective view of the last 3 months.

Let’s start with why India entered a lockdown

We are unarguably the world’s largest third world country. Some parts may look like the first world and even have those benefits, but never be fooled. We aren’t even second world. And even the most deluded of governments cannot make the mistake of thinking so. Thankfully, ours didn’t.

The lockdowns were needed and have done what I think they needed to do. That was to buy time. Everyone in the bureaucracy and the governments across the state and centre knew exactly what our state of healthcare is. We weren’t prepared for a pandemic. The example of Kerala and Nipah virus experience notwithstanding, the rest of our country had no delusions about our inadequacy. We needed time to prepare, time to think, time to learn, time to upgrade testing abilities, time to understand what models to follow, time to prepare hospitals, protocols etc.

Always remember, the number of people India has, is a huge factor. No modelling prepares for our population.

Add to that our dismal investment in rural and public health and it’s a no brainer that we needed to be locked down, shut down, put behind bars, in cages of our own making (I have run out of metaphors) to let the government do what it hadn’t done in years.

Had transport remained open, had people been given more time to travel across, the virus would have spread a lot sooner and completely overwhelmed our country.

A long winded way of saying, we needed to shut down. We needed to buy time.

When should we have exited?

No one knows. That is the straight answer. Any date, timeline, any predictions couldn’t have given us an answer. In the absence of that, every country has chosen their own methods, their own models.

I have heard a lot about Jacinda Arden’s leadership of New Zealand. I have great respect for her. A first time Prime Minister, she has managed a volcanic eruption, a terrorist attack, motherhood and a pandemic with aplomb. While taking nothing away from her, it is important to keep the population realities in mind.

If at all we need role models, maybe look at Angela Merkel. Germany has a much bigger population (83 million as against 5 million in New Zealand), a more heterogenized demographic, and a state that is so federated that regions in Germany have their own “Minister Presidents“. In that environment, what Madame Merkel and Germany have achieved is extraordinary.

However, even they couldn’t predict why they were hit by a virus strain less virulent than what hit Spain or Italy. Neither can we predict why the Asian countries have experienced lesser mortality rates compared to the western world.

What am trying to say is that no one has clear answers. Even Venki Ramakrishnan the president of the Royal Society says it is too soon to predict how the virus will behave, and hence expecting science or governments to get it right at first go, is silly.

 The lockdown was used by some states to beef up their medical systems, to prepare for an outbreak. Some just sat on their heels to see what the Government did next.

Hindsight a.k.a. what did we get wrong?

Testing

Why did it take us so long to begin extensive testing? If the current upward rise in numbers is any indication, the virus had already spread much wider than what we believed it to be. Testing would have identified that faster.

Recognising our poor

Where to start with that. We got a lot of it wrong. Like literally the whole of it.

Building public safety nets

This is a complicated statement but had we managed some kind of a safety net for our poor (people who earn less than 1 Lakh a year, living in urban slums etc) provided them income for a 3 to 6 month period, paid companies to retain them (and also found a way to police it) our current reality could have been much different.

Chronically under invested in public health

Just over 1% of GDP invested in rural and public health? (Source: LiveMint) For a country with ~70% living in rural areas (~800 million), it means that any outbreak needs cities and central government to manage, coordinate and provide funds.

Where are we today

1. Millions have left the big cities and, the whole trickle-down effect, super important for a vibrant economy, will see a big hit. Our cities, which are engines of growth, which bring prosperity to many and also a chance to rise the wellbeing ladder for others, will suffer for a long time to come.

Most governments implemented similar lockdown measures. And the people in the lowest economic strata have struggled everywhere.

Our numbers are screwed because of our population. 65 million interstate migrant population would challenge absolutely any country. Let alone one that hasn’t invested in rural or urban poor health effectively. The current government took big steps to cover the immunization of pregnant women and children up to two years of age but overall made no progress in strengthening health systems. That had to come to bite us.

2. The impact on tax collections. As various news articles testify, government incomes have come to a virtual standstill (GST Collection down 70% in April). Apart from income tax, which is central government collection, states have lost a lot of money as businesses have come to a stop. While opening up the lockdowns will restart the cycle, it will take a long time to reach pre lockdown levels. What this will do is create further issues with expanding public health services.

3. There is another big damage that cannot be calculated for at this moment and that is the cost of delay in the provision of support to the marginalized. As lockdowns intensified, regular medical protection, school-based meals, TB and AIDS cover etc all took a big hit. The health cost of this will only become apparent in some time. All the global aid organisations, Gates Foundation, WHO etc have been raising the alarm over essential health care services (HIV, TB, Malaria programs) suffering because there are no people to provide them, and no money to run them.

The Good News a.k.a. why the virus has been about economics and public health

The strain of the virus that hit us is either a lot more benign or our own genetics provide us with more immunity (if mortality data is correct). Also, herd immunity is possible and most people will develop it in some time.

In hindsight today had we known back in March that we probably (fingers crossed that I am not jinxing us) have been hit by a viral strain that is not deadly, we may not have even shut India down. What Sweden has done, or UK contemplated as a strategy, India could have gone that route as well.

The last word

This is political commentary. Forgive me for this.

Right-wing ideologies do not believe every life is precious. That trickles down into economics and politics in the form of “if I have money, I am protected and more powerful and have more rights than others”. Right-wing also believe in survival of the fittest/ adaptable. In human species, physical fitness or adaptability has been supplanted by the presence or absence of money. A long-winded way of saying that all life is not equal in their eyes. They are also a lot more okay about collateral damage.

Hence the lockdown project didn’t take our poor into account. Now it’s the poor who have taken over all news.