On Tuesday, father and son and a small group of women from Khushwaha’s village who also work as laborers slept on the street, right in front of a bus stop where no buses are plying anymore.
I met Khushwaha this week, minutes before Prime Minister Narendra Modi announced that India’s 1.3 billion people will be in lockdown for 21 days, a hard but almost inevitable decision to fight the spread of covid-19. Khushwaha has also been asked to hunker down and “stay at home.” But Khushwaha, a migrant laborer from the central Indian province of Madhya Pradesh, gets paid by the hour and has nowhere to stay in Delhi and no way to get to his home state.
While many Indians like myself, middle- and upper-class, post memes on Instagram, complain about the lack of options on Netflix, binge-eat candy and tweet about out our angst, millions more — the 2011 Census counted 45 million transient migrant workers — fear that poverty will kill them before the coronavirus can.
Even with relatively few confirmed cases reported, the coronavirus is already exposing the deep fault lines in India’s society.
There’s our broken public health system. The virus has been ferried by India’s wealthy from countries visited in the past few months. But it is the poorest who will pay the harshest price, especially in a country where there is less than one doctor for every 1,000 citizens and only 2.3 critical care beds for every 100,000 patients. In 2019, India spent just 1.28 percent of its gross domestic product on health.
If the coronavirus spread turns out to be an exponential implosion like in Spain or Italy, India’s hospitals will simply not have enough beds, nurses or ventilators. In some states, sports stadiums are being readied as medical shelters; in others, officials are whispering about converting trains into mobile hospitals. (Railway services have been suspended as part of the lockdown.)
The Modi government was quicker than most in closing its borders. But the serious lapse has been a lack of sufficient testing, leaving us with no exact idea of the scale and spread of the virus. The tests were initially confined to those who had returned to India from one of the affected countries or to people who had come into contact with such travelers and were showing symptoms. “Virus detectives,” as they have come to be colloquially known, did an efficient job of hunting down those who may have come into contact with a covid-19 exposed individual.
But this is a giant country with a dense population and gaping inequities. Once the virus hits different communities, contact tracing may become impossible. According to the 2011 Census, 92 million households live in one-room homes and an additional 78 million in two-room houses. In many places, social distancing is a purely theoretical concept.
Without exact data, targeted lockdowns are an impossibility, and so the entire country has come to a halt, triggering worries of an economic emergency before the medical one. The absence of detailed testing data has also led to extreme variations in projected cases and fatalities. Ramanan Laxminarayan, a lecturer at Princeton University, used a simulation model to tell me in an interview that India should be preparing for an “avalanche.” He said without drastic intervention, India is likely looking at 300 million to 500 million cases by the end of July; at its peak, he said, 4 million of these would need intensive care, and half of these could end up being fatalities. The ruling BJP and its supporters dismissed his numbers as alarmist and headline-hunting.
Another study put the number at 100,000 cases by mid-May. Despite the wildly varying statistical models, the government is clearly aware, at least now, that there could be a catastrophe around the corner. As Laxminarayan said, “if the prime minister believed the official numbers, why would he have drawn a world war analogy in his national address?”
There are other existential challenges beside testing. Doctors at the front line in hospitals are already running short of personal protective equipment, or PPE. Manufacturers of medical devices say critical time has been lost in receiving official specifications. And so far, only two companies have been given the go ahead to make testing kits locally; many others are still awaiting approval.
The next 21 days could decide India’s next 21 years, as Modi himself conceded. During this extraordinary challenge, the prime minister should reach out to political rivals and make them part of the coronavirus response.
India’s poor will need the government’s urgent focus. The security guard at All India Institute of Medical Sciences, who has to walk two hours to the hospital; the municipal sweeper and rag pickers who will not get one day off; the migrant workers with no roof over their heads; and the small shopkeepers who are keeping supply lines going — they will all need significant economic assistance.
We cannot afford to forget the lessons of the past: The 1918 flu pandemic infected a third of the world’s population and killed about 17 million people in India, 6 percent of the population.
The first financial emergency package of $22.6 billion was announced on Thursday; there will be a special focus on cash transfers to daily wage laborers and the urban poor, along with insurance packages for all health workers. But in the months to come, more will be needed. The prime minister needs to put aside mindless spending, for instance the project to redesign the heart of Delhi, while the country confronts what could be an existential crisis.
Every single rupee must be devoted to the health-care system and fiscal stimulus for the economy. Or else, the moral question before India will be the one raised by Rajneesh Rajput, a contract worker I met as he began a 247-kilometer walk to his village. “Are only the poor going to die?”