A few days ago, the five-year-old daughter of a cook in our neighbourhood asked, “Toh hum sub mar jayenge? (So are all of us going to die?)” She must be frightened out of her wits, knowing that it is impossible for her family to do social distancing and observe all the niceties of hygiene and healthcare. In a society where more than 80% of families may be in that predicament, have any of our policy makers even considered what havoc we are causing to the health and psychology of those affected?
Brahmar Mukherjee and Debshree Ray, both professors in prestigious universities in the US, are reported to have remarked, “The collateral damage from Covid-19 interventions can easily exceed the damage from the virus itself but at this point there is no choice but to stop the virus transmission.” Terminology from war zones where thousands of innocent children are killed by drones and planes is useful when powerful nations want to justify pillage and murder. Is this the mindset – modellers and medical professionals like these – that our policy makers are listening to? Have the rich and powerful sunk to such inhuman reasoning?
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The coldblooded actions that have caused suffering of unimaginable magnitude to millions of human beings around us, and responses like experts and the little girl above, have set me thinking. Why is it that this time around the rich and powerful have suddenly become so concerned about public health and an infectious disease? It is not as if in this part of the world, we don’t experience millions of deaths and serious morbidity due to infectious diseases every year. Consider the following facts.
It is reported the number of deaths due to Seasonal Influenza (H1N1) in India for the years 2017, 2018, 2019 was 2,270, 1,128 and 1,218 respectively. If we assume a death rate of 1% then we would have to assume that there were 2.27, 1.13 and 1.22 lakh cases of H1N1 flu in those years. A study on causes of deaths In India was published in the Lancet Global Health in December last year. If we use the numbers from this study to estimate daily death rates, we find that number of Indians who could have died yesterday for different infectious disease is as shown in the table below.
| Respiratory Infections (not COVID-19) | 938 |
| Diarrhoea | 1,421 |
| Fever of unknown origin | 928 |
| Tuberculosis | 1,026 |
| Malaria | 508 |
If more than 4,000 persons are estimated to die every day from these diseases, why is it that none of us seems to care? If so many people experience these diseases every day, there should be hundreds of epidemiologists, virologists, public health planners, doctors and modellers in the country who are experts on how to study and deal with public medical emergencies.
Politicians and bureaucrats should be quite aware of what happens when such infections hit the poor. They should have informed us by now about the specific characteristics of the virus in India, the experience with infection rates form the past, the patterns of how the various flu viruses moved across the country, and India-specific measures for dealing with it. They could have given some intelligent reasons whether the draconian house arrests in India will work or not. Why is this only important now?
It appears that this health emergency is important because this time the rich are really scared as they never were before. The idea of social distancing and of blaming the victim suit the Indian elite because they have believed in this for centuries. A shadow falling on you could pollute you, many of us will not eat food prepared by the ‘wrong’ person, and millions are forced to live in separate enclaves all over the country because of their caste or religion. In this situation we needed a much more empathetic, thoughtful and carefully nuanced response to build solidarities and common action across communities.
It is quite obvious now that we are terribly short of real expertise across all sectors and we have to rely completely on all kinds of modellers and ideas from outside. Some of them are good, but many fly-by-night operators are now cashing in on a vacuum of original thinking and experience in India. We should have had useful and constructive debates on the right course of action for this crisis.
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All ‘experts’ on TV and most of print media have just been parroting what they hear from the US or WHO. There has hardly been any serious discussion in the public domain on alternative strategies. For instance, many countries like Sweden have imposed only a partial lockdown. Compulsory school and preschools in Sweden have not been closed because that would force parents of young children to stay home from work. Only public gatherings and events with more than 50 participants are prohibited. I have not come across reasoned arguments about different ways of dealing with a pandemic like this in a very poor country.
A very senior doctor informs me that doctors from private institutions don’t debate because their lucrative businesses may be threatened. Another head of a government research institution opined that they are not allowed to criticise government policies and employees have been threatened when they did so over the past few years. It is not surprising, then, that we as a society have not developed the confidence to do our own work and discuss different and original options constructively in order to hold our own in situations like this.
This is where we are. Hopefully, we’ll bumble through this and make do. It is not clear what the collateral damage might be at the end. What is clear is that the elite of India have taken azaadi from Bharat.
Dinesh Mohan does research on road safety.