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Combating Coronavirus: How Inclusive Is India’s Response?

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This post is a part of YKA’s dedicated coverage of the novel coronavirus outbreak and aims to present factual, reliable information. Read more.

70 kilometres from a city, in an interior remote village, the sole earner in the family had to slash and bury their poultry (the only source of livelihood) because of a WhatsApp text on Coronavirus and pressurised by neighbours to kill the ‘source of Coronavirus.’

An ANM squatting in the anganwadi premises sighs and shares, “‘Coronaraj’ is here.” A Union Minister with a flock of followers holds a rally sloganeering, “Go away, Corona.” Groups of urban youths in Delhi shrug away the alerts because they do not wish to care.

Amidst all forms of information and reactions, on March 11, 2020, the World Health Organisation declared the spread of Coronavirus as a pandemic:

“We are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction.” 

The spread of the virus across different countries has for sure generated an alarm on global health. The bourgeoning incidence of cases of COVID-19 has pushed countries to take up stringent containment measures almost at the cost of jeopardizing economic stability. However, the three words: ‘spread’, ‘severity’ and ‘inaction’ are tearing apart the systematic approach to tackling this novel form of pandemic.

This pandemic surely is one of its kind and its frantic spread is both alarming and concerning. India’s current figure of the identified disease is 82 and still on the rise. It is therefore implicit that a country with one of lowest public health expenditure (1.2% of GDP)  and huge disparities in access to healthcare, will be in havoc if the spread is not contained at the earliest.

However, the response to the outbreak of COVID-19 has been fragmented. Information asymmetry and behaviours shaped by one’s cultural, economic, education and social dispositions have randomised the individual responses to the outbreak culminating into hysteria.

From sheer ignorance to sheer arrogance, fear psychology has created another form of response which is panic. At the same time, given the socio-economic diversity and geopolitical spread, the response has neither been inclusive nor equitable nor all-encompassing.

To begin with, the total number of cases are figures from passive case finding, meaning these are patients with symptoms who had sought doctor’s consultation or who could afford a doctor’s consultation or perhaps who were detected with the virus through PCR testing in few of those airports undertaking the exercise.

This only implies the actual numbers are probably much higher and cross-cuts gender and class. The question then is who are those missed out? What happens about them? It seems almost as though the ‘invisible communities’ in urban India, rural and remote India are insulated from the illness.

One may argue that they have not come in contact with an infected person, but how sufficient is the justification? With active case-finding efforts undertaken only at a select few airports (or seemingly so), the response has been clearly selective.

The other transiting population that has not been under the health system’s surveillance is the entire migrant poor in the unorganised sector that is highly mobile, undernourished and at high risk.

A young woman wears a face mask in public. (Photo: Sanchit Khanna via Getty Images)

Information Education and Communication (IEC), a much-touted term in development and public health lexicons is seen as a critical requirement for awareness. Social media has been a powerful medium of communication penetrating even the last mile communities with the influx of low-cost android phones.

With the outbreak, there has been a parallel outbreak of several kinds of messages pertaining to COVID-19. Messages on ‘antiviral foods to be consumed,’ banning meat and dairy products to religious propaganda around which gesture between assalam-u-alaikum and namaskar is more ‘hygienic’ and ‘non-infectious’ are being proliferated.

For those who can read and write, there are reliable sources one can rely on but for that massive segment of the population for whom the mobile phone is the only means of communication and who has always relied on word-of-mouth from the neighbour or family, what happens? For the segment who cannot read or write, what happens?

The automated message from the Health Ministry on the virus (in English and Hindi only) caters only to a select population of certain regions and instead of intentions being met, it has fed to dark humour and cynicism.

It is striking the way the response to the disease is centering around a certain privileged section of the society. Masks are being promoted and sold at the most abysmal prices ranging from ₹300 till ₹800. Surgical masks which are a dire requirement across health facilities are being priced higher and stocked out.

While the effectiveness of masks in preventing the penetration of the virus is still questionable, the need of the hour is more for individuals with symptoms of cough to cover their mouths (masks or no masks) and ensuring they spit appropriately. The (casual) use and re-use of masks by the ones who can afford to so but have no symptoms as yet of the illness only speaks of hysteria than being responsible.

The best and simplest protection against Coronavirus: washing hands.

Washing hands has been an important part of self-care and hygiene and clearly prevents against several diseases. However, there are families in rural pockets who do not have access to a bar of soap ‘that kills germs.’

Similarly, a sanitiser is still a product that is foreign to them which is being prolifically used and overused by the ones who prefer and can access them. This disbalance between the two segments clearly reeks of the class divide and how responses are being commodified for a particular class and in dire shortage for another.

Airports and hotels are currently the hot-beds of the spread of this virus and clearly with individuals from different pockets of the globe, transiting in and out, these would be so. A glance at the airport and one sees masks on many faces. The only individual whose face wears a smile instead of a mask despite being under high risk, is the air hostess.

The gendered profession discourages the use of mask carrying the potential of demolishing the customer experience vested on the appearance, gestures, and attitude of the air hostess – the face of the aircraft. This selective response of who gets to wear masks and who doesn’t, clearly outlines how one’s position can deprive a basic necessity and in this case the essential need for protection – the right to cover one’s mouth.

While several institutions, congregational points have shut down as precautionary containment measures rest assured that work from home would suffice, the question then is what happens to the entire labour and wage dependent community?

Similarly, the process of quarantine (at least 15 days) brings to fore the question of loss of wages, especially for marginalised families. The hysteria around the disease has fed into stigmas to levels of denials against symptoms, resistance towards screening and fear of being quarantined. In this light, with an already severe shortage of screenings across the country, we are undermining several cases that could lead to prompt and early detection.

There has been a clear class divide in terms of access to information, appropriate healthcare, access to screening and access to protection of oneself. While highlighting the factors that increase the risk of contracting the virus, malnutrition as a factor has not been recognised on official papers.

One of the biggest reasons for poor immunity is malnutrition – a problem as real as the fact that India still has 36% of children undernourished which is higher (38%) in rural areas. There has been a rise in the percentage of children who are wasted from 19.8% (2005-06) to 21% (2015-16) during this period.

Similarly, as part of advocacy, the importance of timely access to responsive primary healthcare for all, the need for strengthening public health has not echoed strong enough, especially in times like this. More importantly , bringing in private providers within the entire surveillance exercise through standards is a daunting and yet critical exercise that seems to be missing.

The government’s exclusive undertaking of the screening exercise is, therefore, yielding to chaos in the light of shortage of staff and the need to act on an entire population across geography and swiftly.

It is undeniable that there needs to be a strong collective response, but it has to be inclusive. Inclusivity would imply cross-cutting gender, caste, class, religion and without getting tainted under political propaganda, an appropriate response will have to be responsibly taken up.

Inclusivity will ensure equitable access to information, access to products for prevention, access to diagnosis and care-seeking and access to guaranteed economic security in the face of a public health crisis. This inclusive, equitable response is the need of the hour that can only happen through shared responsibility (from providers, the government, the different sectors and from the communities), a recognition of the intersections of class, gender, caste, poverty in health, recognition of the gaps in health system that need to be plugged in and pushing for prioritising healthcare for all in the country.

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  1. Anil Mishra

    Hi Manisha, I have gone through your article on youthkiawaaz. It’s well-written and you have highlighted the weakness our public health system has. However, the approach in epidemic response is slightly different. All categories of countries, irrespective of their GDP share spent on health, have suffered in this epidemic (a pandemic). The countries which are considered to have an excellent public health system were also not spared by this nasty virus. The approach of response in such epidemics is based on making the best possible use of available resources. Such outbreaks which specifically point towards the import of virus (travelers coming from affected areas) or individuals having a history of contact with active cases as the cause of transmission will require the actions to be primarily addressed on this risk group. There can not be a universalized approach like screening everyone in every village or across every social class at this stage. By doing so we would be exhausting our resources at a stage that is too early. Assuming there is a large number of subclinical cases then also screening everyone is not possible. Had there been an effective vaccine available we couldn’t have thought of vaccinating everyone. The strategy in such fast-spreading epidemics is always targeting those ‘at risk’.

    There is no doubt that our public health system needs reinforcement, malnutrition rates are to be brought down but can we do it in a short time? this epidemic response is a quick reaction, using whatever resources we have. If we see the rate of doubling of the numbers and also the total numbers, India, at this point, is much better placed than many other nations of the developed world. Projecting a dark picture may accentuate the panic at this stage. A lot of actions at this stage depend on the individuals, communities and societies, namely, social distancing, personal hygiene, reporting travel histories, going to a health facility in case of a suspected history of contact, home quarantine. I think the health system would be able to adequately respond if we do our bit.
    Best regards,
    Anil Mishra

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