The Asia-Pacific Journal | Japan Focus Volume 18 | Issue 15 | Number 11 | Article ID 5445 | Aug 01 2020

1

Image Management over COVID-19 Management

Samrat Choudhury

Abstract Till March 13 th 2020 Indiarsquosgovernment was assuring citizens that thecoronavirus disease was not a healthemergency Preparations soon provedinadequate Bigotry superstition and poorgovernance worsened an increasingly badsituation in which government efforts tosuppress unfavorable news censoredinformation that would have been useful incontaining the disease A lockdown imposedwithout warning crashed the economy andcaused immense suffering to millions Poorinternal migrant workers were worst affectedMany died trying to walk home hundreds ofmiles away in the punishing heat of Indiarsquossummer The lockdown was lifted with theCOVID-19 curve heading sharply upward

Indiarsquos first case of the new novel coronaviruswas reported from the southern state of Keralaon January 30 2020 The news was announcedby the Indian governmentrsquos Press InformationBureau in a release that contained three briefsentences of Indian bureaucratese ldquoOnepositive case of Novel Coronavirus patient of astudent studying in Wuhan University has beenreported in Keralardquo it said ldquoThe patient hastested positive for Novel Coronavirus and is inisolation in the hospital The patient is stableand is being closely monitoredrdquo The news didnot cause any great excitement or alarm thecountry was then in the throes of the biggestprotests it had seen since the early 1990s overa contentious new modification to the countryrsquoscitizenship laws by the ruling Hindu nationalist

government that promised Indian citizenshipon relatively easier terms to Hindu BuddhistSikh Jain Parsi and Christian immigrants fromAfghanistan Pakistan and Bangladesh OnJanuary 30 news headlines were dominated byimages of a young Hindu fundamentalist armedwith a handgun opening fire on unarmedmostly Muslim students protesting against theCitizenship Amendment Act in Delhirsquos JamiaMilia Islamia university while a long line ofpolicemen in uniform stood behind him lookingon The single case of the invisible COVID-19then still restricted mainly to China was faraway in the public imagination

It was probably distant and remote even in thepolitical leadershiprsquos imagination

On January 31 a day after the first case wasreported the countryrsquos Directorate General ofForeign Trade passed an order banning theexport of masks and PPEs On February 8 theban was lifted The original notification wasldquoamended to the extent that items such assurgical masksdisposable masks and all glovesexcept NBR gloves are allowed freely forexportrsquorsquo said the DGFT in its new orderNewspapers reported that the decision wastaken to help China combat the coronavirusSince India and China do not enjoy the mostfraternal of relations the overturning of theDGFT decision was decidedly odd

On February 10 the news agency Press Trustof India reported from Beijing that ldquoIndia hascleared some consignments of medical gearplaced by China to combat the deadlycoronavirus after setting aside export bans onall kinds of personal protection equipmentIndian Ambassador to China Vikram Misri said

APJ | JF 18 | 15 | 11

2

here Monday The decision came a day afterPrime Minister Narendra Modi wrote a letter toPresident Xi Jinping offering solidarity andassistance to deal with the coronavirusoutbreak in China that has claimed over 900livesrdquo (PTI 2020)

The export of millions of pieces of PPEs andmasks from India worth vast sums of moneyresumed and continued apace Meanwhile thecountry and its media remained preoccupiedwith the bitter and vicious battle centred on thecitizenship law the no less controversialNational Register of Citizens and a lockdownin Kashmir where following abrogation of thespecial law governing the place and an internalredrawing of maps the entire political classincluding former Chief Ministers and UnionMinisters had been placed under house arrestOnly the planned visit to India by US PresidentDonald Trump his first to the country afterwinning the presidential elections created aflutter even amidst the raging countrywideprotests Mr Trump who visited on February24 told a campaign rally in Colorado threedays before his arrival that he had heard therewere going to be between six and ten millionpeople lining the streets to greet him on hisway to his joint public rally with Prime MinisterModi in a cricket stadium in Ahmedabad inModi rsquos home state of Gujarat S inceAhmedabad has a population of around 7million this expectation was difficult to meetbut the Modi government put in an effort todrum up the numbers and put on a big showfor which eventually more than 100000 peoplewere brought in By then COVID-19 cases hadalready been reported from 28 countries apartfrom China

The following day Trump and Modi were inDelhi for a scheduled summit meeting whencommunal riots erupted in the city wheresporadic violence had begun earlier over theprotests against the Citizenship AmendmentAct Hindu and Muslim mobs clashed withDelhi Police who report to Modirsquos closest aide

Home Minister Amit Shah allegedly providingcover and support to the Hindu rioters inseveral places The rioting claimed 53 lives

It was therefore only after Trumprsquos departureand the end of the rioting that the focus beganto shift towards the coronavirus response OnMarch 13 senior officials of the Health Homeand Civil Aviation ministries held a pressconference in Delhi to say that COVID-19 wasldquonot a health emergencyrdquo (Srinivasan 2020)PPE exports were finally banned again onMarch 19 By then the disease had spread to160 countries with 191127 cases according toWorld Health Organisation data

ldquoWhile other countries took measures to notonly ban export of PPE products but also rawmaterials it did not occur to India to do that till19 Marchrdquo Sanjiv Kumar the chairman of thePreventive Wear Manufacturers Association ofIndia told The Caravan magazine ldquoIn themeantime Indian companies continuedcatering to foreign governments which werestockpiling We also repeatedly raised the needfor creating stockpiles of protective gear whichwere ignoredhellip We are now facing a crisiswhich is of our own makingrdquo (Krishnan 2020)

In many places doctors and nurses in hospitalswere forced to improvise PPEs Photos andreports began coming in from around thecountry of frontline medical workers inhospitals dealing with novel coronavirus caseshaving nothing better than raincoats andmotorcycle helmets as protection On April 6the Resident Doctorsrsquo Association of the AllIndia Institute of Medical Sciences thecountryrsquos premier public sector hospital wrotean open letter to Prime Minister Modi to sayldquoOur frontline healthcare workers - doctorsnurses and other supportive staff - have comeforward with their problems and issues relatedto the availability of PPE COVID-19 testingequipment and quarantine facilities on socialmedia The officials should view these inputsconstructively Instead of appreciating their

APJ | JF 18 | 15 | 11

3

efforts towards the welfare of their peers andpatients they have received a harsh backlashrdquo(The Wire 2020) The letter also called for ldquoallpunishments to be withdrawnrdquo Medical staffwho had publicly complained of the lack ofPPEs had evidently been dealt with sternly DrSrinivas Rajkumar the RDArsquos generalsecretary told India Today TV the associationreceived complaints every day about medicalstaff being harassed by the management oftheir respective hospitals for raising legitimateconcerns (Pandey 2020)

After previously exporting PPEs to China Indiahad already switched to importing PPEs fromthere by this time On April 5 a consignment of170000 PPE kits arrived from China Howeveraround 50000 of these kits failed quality testsYet the exporters and importers who are oftenthe same people managed some good businessboth ways

The bad news surrounding PPEs was eventuallywashed away by a sudden flood of good news inearly May ldquoFrom zero India now producesaround 2 lakh PPE kits per dayrdquo news agencyAsia News International reported on May 5This statement was repeated by Modi himself inan address to the nation a week later ldquoWhenthe crisis began not a single PPE was beingmanufactured in India N-95 masks were beingmanufactured in negligible quantity Today thesituation is such that India is manufacturing 2lakh PPE kits and N95 masks each per day Weare able to do so because India has turned acrisis into an opportunity Indiarsquos vision toconvert this crisis into an opportunity is goingto prove influential as we become more self-reliantrdquo the PM said (Verma 2020)

Such dreams of national glory would not helppeople like Heera Lal senior sanitationsupervisor of AIIMS who died on May 25 ldquoItrsquosnot the virus that we are worried about Itrsquos theapathy of the government and the AIIMSadministration that worries us If thiscontinues we will be short of healthcare

workers to treat patients Since March we havebeen writing and fighting for the safety ofhostel premises poor sanitation lack of properquarantine protocol and need for adequatetestingrdquo Dr Rajkumar the AIIMS ResidentDoctors Association General Secretary toldNews18 after Lalrsquos death The reportmentioned that the number of healthcareworkers at the institute who had been infectedby then was around 195 (News18com 2020) Aday after the article was published the RDAissued a notice expelling Dr Rajkumar from thebody The article was subsequently modified todeny that healthcare staff were being infectedat work and its headline changed to reflect theofficial version that all was well

By June India was facing a shortage ofhealthcare workers to treat patients as DrRajkumar had predicted

Table 1

Date Cases DeathsFeb 1 1 0

March 1 3 0April 1 1636 38May 1 35043 1147June 1 190535 5394

Source World Health Organisationfigures are cumulative totals

The PPE story contains in microcosm theprincipal elements that have characterisedIndiarsquos COVID-19 response Apart frommismanagement an important element of theresponse has been suppression of newsunfavourable to or critical of the governmentand attempts at fixing the blame on Muslims

APJ | JF 18 | 15 | 11

4

owing to the detection of a cluster of COVID-19cases among those who attended a gathering ofthe Tablighi Jamaat in Delhi in the daysimmediately preceding the lockdown This wassupplemented by a public relations pitch whosethrust from the start was to try and turn thecountryrsquos COVID-19 response into some sort ofpublic event involving the whole country ThisPR pitch was led by Modi himself through aseries of televised addresses to the nation

The first of these addresses was on March 19In that address Mr Modi called upon thepeople of India to observe a daylong ldquopubliccurfewrdquo on March 22 advising socialdistancing and staying home and requestingeveryone to go to their balconies doors orwindows at 5 PM to clap beat plates and ringbells as a mark of gratitude to those hospitaland airline staff who were working in the midstof the pandemic At 5 around the countryenthusiastic Modi supporters emerged out oftheir homes clapping and clanging pots andpans In several cities there were alsoprocessions of hundreds riding motorcycles orsimply walking and dancing through thestreets Photos and videos showed thatprocessions in at least two places in Indiarsquosmost populous state Uttar Pradesh were ledby the local district magistrate and seniorpolice officials

Scientism

Many people banging pots and pans had beenconvinced by a viral WhatsApp post that thesound would produce vibrations that kill thecoronavirus The notion was evidently sharedby prominent persons including the actorAmitabh Bachchan who tweeted on March 22to his 405 million followers that clapping andldquoshankh vibrationsrdquo meaning the vibrationsproduced by b lowing conch she l l s ldquoreducedestroy virus potencyrdquo Mr Bachchanrsquosapproach to driving away the virus was actuallymore sophisticated than that of his fellow

Mumbai resident Indiarsquos Minister of State forSocial Justice and Empowerment RamdasAthawale who earlier in the month had led arally at the Gateway of India where in thecompany of Chinarsquos Consul General in MumbaiTang Guocai he raised slogans of ldquoCorona GoGo Coronardquo

Indians also tried other innovative methods todrive away the virus A group called the AkhilBharat Hindu Mahasabha led by a man namedSwami Chakrapani organised a cow urineparty in Delhi where true believers were givensmall earthen cups of cow urine to drink Thecow urine therapy was not restricted to alunatic fringe Similar events were organised atvarious places around the country by membersof the ruling BJP In Kolkata which is ruled byan opposition party a BJP party workerNarayan Chatterjee was arrested after a manwho consumed the cow urine fell ill The partyrsquoslocal leaders including its West Bengal unitpresident Dilip Ghosh made statementsagainst the arrest and attested to themiraculous properties of cow urine which isheld to be holy by orthodox Hindus The beliefis backed by Ayurveda an ancient Hindusystem of medicine in which cow urine anddung are two among five constituents of a toniccalled Panchgavya ndash cow milk butter and gheeor clarified butter are the other three ndash whichhas also been touted as a cure for thecoronavirus Dr Vallabh Kathiria Chairman ofRashtriya Kamdhenu Aayog a governmentorganisation launched by the Modi governmentin 2019 told the Ahmedabad Mirror thatclinical trials of the wonder drug would beconducted in 10 hospitals in India starting withthe government-run Civil Hospital in Rajkot inGujarat the constituency of the statersquos chiefminister (Sanghavi 2020) Other ayurvediccures for coronavirus promoted by Patanjali acompany founded by a yoga guru turnedindustrialist with close ties to the ruling partyBaba Ramdev were also allowed clinical trialsin Jaipur and Indore although the permissionin Indore was later withdrawn following

APJ | JF 18 | 15 | 11

5

protests The trials in Jaipur met withmiraculous success according to Patanjali and100 percent of patients barring those on lifesupport were completely cured within sevendays of treatment with their herbal medicineswhich they offered for sale as part of a ldquodivyacorona kitrdquo meaning ldquodivine corona kitrdquo ofthree medicines for an affordable Rs 545($720) (Kumar 2020)

However the cheapest and most freelyavailable of all the unorthodox cures the waterof the river Ganga which is also held to be holyby orthodox Hindus failed to progress to theclinical trials stage after the Indian Council ofMedical Research turned down proposalsforwarded by the National Mission for CleanGanga ndash a Union government body whose job itis to clean up the highly-polluted river ndash to treatCOVID-19 patients with Ganga water

One controversial cure that did win the ICMRrsquosfull backing was hydroxychloroquine (HCQ) anant i -malar ia medicat ion that ICMRrecommended on March 22 as prophylaxis forasymptomatic healthcare workers treatingconfirmed and suspected COVID-19 patientsand family members of such patients The useof the drug was subsequently expanded on May22 to include frontline workers such as thepolice (Saikia 2020) After President Trumptouted it as potentially ldquoone of the biggestgame-changers in the history of medicinerdquo in atweet on March 21 ndash a day before ICMRrecommended its prophylactic use in India ndashdemand for the drug skyrocketed India is theworldrsquos main producer of HCQ and accountsfor 70 percent of global production of the drugExports were banned by the DirectorateGeneral of Foreign Trade on April 4 The banwas lifted on April 7 following a call fromPresident Trump to Prime Minister Modi Indiawent on to export HCQ to 97 countries over thenext month

The countryrsquos well-developed pharmaceuticalindustry might have been expected to profit

from this situation but even companiesmanufacturing HCQ struggled to keep theirproduction lines going at normal capacity Thesector as a whole saw an overall slump inproduction and sales ldquoSales have dropped tohalf At present we have reached just 60 percent of the routine sales for May targetrdquo RajivSinghal secretary general of All IndiaOrganisation of Chemists and Druggists(AIOCD) a body representing 85 lakh chemistsacross India told The Print (Chandna 2020)New product launches fell from 349 in April2 0 1 9 t o 4 i n A p r i l 2 0 2 0 D o m e s t i cpharmaceutical companies were barely able tomaintain the flow of their regular products andwere operating at 40 to 50 percent of theirtotal capacity The main reasons cited bymanufacturers for this slump were a severeshortage of workers and a disruption of supplychains

Lockdown

On March 24 two days after the daylongldquopublic curfewrdquo that had concluded incacophonous festivities and processions PrimeMinister Modi addressed the nation once againin a televised address Speaking at 8 PM heannounced that the whole country of 13 billionpeople would go into a complete lockdown for21 days starting at midnight People were leftwith four hours in which to prepare for thelockdown as best as they could Movement oftrucks soon ground to a halt Separating theones carrying essential goods from thosecarrying other items was a mammoth taskMoreover there was no clarity at ground levelon what exactly was considered essential orwhat was to be done about empty trucks Withthe cheap highway restaurants known in Indiaas lsquodhabasrsquo being shut down there was noplace for truckers to eat Many didnrsquot evenhave water to drink ldquoDrivers have startedabandoning trucks and hiking back home evenif these places are 200-300 km from where they

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

2

here Monday The decision came a day afterPrime Minister Narendra Modi wrote a letter toPresident Xi Jinping offering solidarity andassistance to deal with the coronavirusoutbreak in China that has claimed over 900livesrdquo (PTI 2020)

The export of millions of pieces of PPEs andmasks from India worth vast sums of moneyresumed and continued apace Meanwhile thecountry and its media remained preoccupiedwith the bitter and vicious battle centred on thecitizenship law the no less controversialNational Register of Citizens and a lockdownin Kashmir where following abrogation of thespecial law governing the place and an internalredrawing of maps the entire political classincluding former Chief Ministers and UnionMinisters had been placed under house arrestOnly the planned visit to India by US PresidentDonald Trump his first to the country afterwinning the presidential elections created aflutter even amidst the raging countrywideprotests Mr Trump who visited on February24 told a campaign rally in Colorado threedays before his arrival that he had heard therewere going to be between six and ten millionpeople lining the streets to greet him on hisway to his joint public rally with Prime MinisterModi in a cricket stadium in Ahmedabad inModi rsquos home state of Gujarat S inceAhmedabad has a population of around 7million this expectation was difficult to meetbut the Modi government put in an effort todrum up the numbers and put on a big showfor which eventually more than 100000 peoplewere brought in By then COVID-19 cases hadalready been reported from 28 countries apartfrom China

The following day Trump and Modi were inDelhi for a scheduled summit meeting whencommunal riots erupted in the city wheresporadic violence had begun earlier over theprotests against the Citizenship AmendmentAct Hindu and Muslim mobs clashed withDelhi Police who report to Modirsquos closest aide

Home Minister Amit Shah allegedly providingcover and support to the Hindu rioters inseveral places The rioting claimed 53 lives

It was therefore only after Trumprsquos departureand the end of the rioting that the focus beganto shift towards the coronavirus response OnMarch 13 senior officials of the Health Homeand Civil Aviation ministries held a pressconference in Delhi to say that COVID-19 wasldquonot a health emergencyrdquo (Srinivasan 2020)PPE exports were finally banned again onMarch 19 By then the disease had spread to160 countries with 191127 cases according toWorld Health Organisation data

ldquoWhile other countries took measures to notonly ban export of PPE products but also rawmaterials it did not occur to India to do that till19 Marchrdquo Sanjiv Kumar the chairman of thePreventive Wear Manufacturers Association ofIndia told The Caravan magazine ldquoIn themeantime Indian companies continuedcatering to foreign governments which werestockpiling We also repeatedly raised the needfor creating stockpiles of protective gear whichwere ignoredhellip We are now facing a crisiswhich is of our own makingrdquo (Krishnan 2020)

In many places doctors and nurses in hospitalswere forced to improvise PPEs Photos andreports began coming in from around thecountry of frontline medical workers inhospitals dealing with novel coronavirus caseshaving nothing better than raincoats andmotorcycle helmets as protection On April 6the Resident Doctorsrsquo Association of the AllIndia Institute of Medical Sciences thecountryrsquos premier public sector hospital wrotean open letter to Prime Minister Modi to sayldquoOur frontline healthcare workers - doctorsnurses and other supportive staff - have comeforward with their problems and issues relatedto the availability of PPE COVID-19 testingequipment and quarantine facilities on socialmedia The officials should view these inputsconstructively Instead of appreciating their

APJ | JF 18 | 15 | 11

3

efforts towards the welfare of their peers andpatients they have received a harsh backlashrdquo(The Wire 2020) The letter also called for ldquoallpunishments to be withdrawnrdquo Medical staffwho had publicly complained of the lack ofPPEs had evidently been dealt with sternly DrSrinivas Rajkumar the RDArsquos generalsecretary told India Today TV the associationreceived complaints every day about medicalstaff being harassed by the management oftheir respective hospitals for raising legitimateconcerns (Pandey 2020)

After previously exporting PPEs to China Indiahad already switched to importing PPEs fromthere by this time On April 5 a consignment of170000 PPE kits arrived from China Howeveraround 50000 of these kits failed quality testsYet the exporters and importers who are oftenthe same people managed some good businessboth ways

The bad news surrounding PPEs was eventuallywashed away by a sudden flood of good news inearly May ldquoFrom zero India now producesaround 2 lakh PPE kits per dayrdquo news agencyAsia News International reported on May 5This statement was repeated by Modi himself inan address to the nation a week later ldquoWhenthe crisis began not a single PPE was beingmanufactured in India N-95 masks were beingmanufactured in negligible quantity Today thesituation is such that India is manufacturing 2lakh PPE kits and N95 masks each per day Weare able to do so because India has turned acrisis into an opportunity Indiarsquos vision toconvert this crisis into an opportunity is goingto prove influential as we become more self-reliantrdquo the PM said (Verma 2020)

Such dreams of national glory would not helppeople like Heera Lal senior sanitationsupervisor of AIIMS who died on May 25 ldquoItrsquosnot the virus that we are worried about Itrsquos theapathy of the government and the AIIMSadministration that worries us If thiscontinues we will be short of healthcare

workers to treat patients Since March we havebeen writing and fighting for the safety ofhostel premises poor sanitation lack of properquarantine protocol and need for adequatetestingrdquo Dr Rajkumar the AIIMS ResidentDoctors Association General Secretary toldNews18 after Lalrsquos death The reportmentioned that the number of healthcareworkers at the institute who had been infectedby then was around 195 (News18com 2020) Aday after the article was published the RDAissued a notice expelling Dr Rajkumar from thebody The article was subsequently modified todeny that healthcare staff were being infectedat work and its headline changed to reflect theofficial version that all was well

By June India was facing a shortage ofhealthcare workers to treat patients as DrRajkumar had predicted

Table 1

Date Cases DeathsFeb 1 1 0

March 1 3 0April 1 1636 38May 1 35043 1147June 1 190535 5394

Source World Health Organisationfigures are cumulative totals

The PPE story contains in microcosm theprincipal elements that have characterisedIndiarsquos COVID-19 response Apart frommismanagement an important element of theresponse has been suppression of newsunfavourable to or critical of the governmentand attempts at fixing the blame on Muslims

APJ | JF 18 | 15 | 11

4

owing to the detection of a cluster of COVID-19cases among those who attended a gathering ofthe Tablighi Jamaat in Delhi in the daysimmediately preceding the lockdown This wassupplemented by a public relations pitch whosethrust from the start was to try and turn thecountryrsquos COVID-19 response into some sort ofpublic event involving the whole country ThisPR pitch was led by Modi himself through aseries of televised addresses to the nation

The first of these addresses was on March 19In that address Mr Modi called upon thepeople of India to observe a daylong ldquopubliccurfewrdquo on March 22 advising socialdistancing and staying home and requestingeveryone to go to their balconies doors orwindows at 5 PM to clap beat plates and ringbells as a mark of gratitude to those hospitaland airline staff who were working in the midstof the pandemic At 5 around the countryenthusiastic Modi supporters emerged out oftheir homes clapping and clanging pots andpans In several cities there were alsoprocessions of hundreds riding motorcycles orsimply walking and dancing through thestreets Photos and videos showed thatprocessions in at least two places in Indiarsquosmost populous state Uttar Pradesh were ledby the local district magistrate and seniorpolice officials

Scientism

Many people banging pots and pans had beenconvinced by a viral WhatsApp post that thesound would produce vibrations that kill thecoronavirus The notion was evidently sharedby prominent persons including the actorAmitabh Bachchan who tweeted on March 22to his 405 million followers that clapping andldquoshankh vibrationsrdquo meaning the vibrationsproduced by b lowing conch she l l s ldquoreducedestroy virus potencyrdquo Mr Bachchanrsquosapproach to driving away the virus was actuallymore sophisticated than that of his fellow

Mumbai resident Indiarsquos Minister of State forSocial Justice and Empowerment RamdasAthawale who earlier in the month had led arally at the Gateway of India where in thecompany of Chinarsquos Consul General in MumbaiTang Guocai he raised slogans of ldquoCorona GoGo Coronardquo

Indians also tried other innovative methods todrive away the virus A group called the AkhilBharat Hindu Mahasabha led by a man namedSwami Chakrapani organised a cow urineparty in Delhi where true believers were givensmall earthen cups of cow urine to drink Thecow urine therapy was not restricted to alunatic fringe Similar events were organised atvarious places around the country by membersof the ruling BJP In Kolkata which is ruled byan opposition party a BJP party workerNarayan Chatterjee was arrested after a manwho consumed the cow urine fell ill The partyrsquoslocal leaders including its West Bengal unitpresident Dilip Ghosh made statementsagainst the arrest and attested to themiraculous properties of cow urine which isheld to be holy by orthodox Hindus The beliefis backed by Ayurveda an ancient Hindusystem of medicine in which cow urine anddung are two among five constituents of a toniccalled Panchgavya ndash cow milk butter and gheeor clarified butter are the other three ndash whichhas also been touted as a cure for thecoronavirus Dr Vallabh Kathiria Chairman ofRashtriya Kamdhenu Aayog a governmentorganisation launched by the Modi governmentin 2019 told the Ahmedabad Mirror thatclinical trials of the wonder drug would beconducted in 10 hospitals in India starting withthe government-run Civil Hospital in Rajkot inGujarat the constituency of the statersquos chiefminister (Sanghavi 2020) Other ayurvediccures for coronavirus promoted by Patanjali acompany founded by a yoga guru turnedindustrialist with close ties to the ruling partyBaba Ramdev were also allowed clinical trialsin Jaipur and Indore although the permissionin Indore was later withdrawn following

APJ | JF 18 | 15 | 11

5

protests The trials in Jaipur met withmiraculous success according to Patanjali and100 percent of patients barring those on lifesupport were completely cured within sevendays of treatment with their herbal medicineswhich they offered for sale as part of a ldquodivyacorona kitrdquo meaning ldquodivine corona kitrdquo ofthree medicines for an affordable Rs 545($720) (Kumar 2020)

However the cheapest and most freelyavailable of all the unorthodox cures the waterof the river Ganga which is also held to be holyby orthodox Hindus failed to progress to theclinical trials stage after the Indian Council ofMedical Research turned down proposalsforwarded by the National Mission for CleanGanga ndash a Union government body whose job itis to clean up the highly-polluted river ndash to treatCOVID-19 patients with Ganga water

One controversial cure that did win the ICMRrsquosfull backing was hydroxychloroquine (HCQ) anant i -malar ia medicat ion that ICMRrecommended on March 22 as prophylaxis forasymptomatic healthcare workers treatingconfirmed and suspected COVID-19 patientsand family members of such patients The useof the drug was subsequently expanded on May22 to include frontline workers such as thepolice (Saikia 2020) After President Trumptouted it as potentially ldquoone of the biggestgame-changers in the history of medicinerdquo in atweet on March 21 ndash a day before ICMRrecommended its prophylactic use in India ndashdemand for the drug skyrocketed India is theworldrsquos main producer of HCQ and accountsfor 70 percent of global production of the drugExports were banned by the DirectorateGeneral of Foreign Trade on April 4 The banwas lifted on April 7 following a call fromPresident Trump to Prime Minister Modi Indiawent on to export HCQ to 97 countries over thenext month

The countryrsquos well-developed pharmaceuticalindustry might have been expected to profit

from this situation but even companiesmanufacturing HCQ struggled to keep theirproduction lines going at normal capacity Thesector as a whole saw an overall slump inproduction and sales ldquoSales have dropped tohalf At present we have reached just 60 percent of the routine sales for May targetrdquo RajivSinghal secretary general of All IndiaOrganisation of Chemists and Druggists(AIOCD) a body representing 85 lakh chemistsacross India told The Print (Chandna 2020)New product launches fell from 349 in April2 0 1 9 t o 4 i n A p r i l 2 0 2 0 D o m e s t i cpharmaceutical companies were barely able tomaintain the flow of their regular products andwere operating at 40 to 50 percent of theirtotal capacity The main reasons cited bymanufacturers for this slump were a severeshortage of workers and a disruption of supplychains

Lockdown

On March 24 two days after the daylongldquopublic curfewrdquo that had concluded incacophonous festivities and processions PrimeMinister Modi addressed the nation once againin a televised address Speaking at 8 PM heannounced that the whole country of 13 billionpeople would go into a complete lockdown for21 days starting at midnight People were leftwith four hours in which to prepare for thelockdown as best as they could Movement oftrucks soon ground to a halt Separating theones carrying essential goods from thosecarrying other items was a mammoth taskMoreover there was no clarity at ground levelon what exactly was considered essential orwhat was to be done about empty trucks Withthe cheap highway restaurants known in Indiaas lsquodhabasrsquo being shut down there was noplace for truckers to eat Many didnrsquot evenhave water to drink ldquoDrivers have startedabandoning trucks and hiking back home evenif these places are 200-300 km from where they

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

3

efforts towards the welfare of their peers andpatients they have received a harsh backlashrdquo(The Wire 2020) The letter also called for ldquoallpunishments to be withdrawnrdquo Medical staffwho had publicly complained of the lack ofPPEs had evidently been dealt with sternly DrSrinivas Rajkumar the RDArsquos generalsecretary told India Today TV the associationreceived complaints every day about medicalstaff being harassed by the management oftheir respective hospitals for raising legitimateconcerns (Pandey 2020)

After previously exporting PPEs to China Indiahad already switched to importing PPEs fromthere by this time On April 5 a consignment of170000 PPE kits arrived from China Howeveraround 50000 of these kits failed quality testsYet the exporters and importers who are oftenthe same people managed some good businessboth ways

The bad news surrounding PPEs was eventuallywashed away by a sudden flood of good news inearly May ldquoFrom zero India now producesaround 2 lakh PPE kits per dayrdquo news agencyAsia News International reported on May 5This statement was repeated by Modi himself inan address to the nation a week later ldquoWhenthe crisis began not a single PPE was beingmanufactured in India N-95 masks were beingmanufactured in negligible quantity Today thesituation is such that India is manufacturing 2lakh PPE kits and N95 masks each per day Weare able to do so because India has turned acrisis into an opportunity Indiarsquos vision toconvert this crisis into an opportunity is goingto prove influential as we become more self-reliantrdquo the PM said (Verma 2020)

Such dreams of national glory would not helppeople like Heera Lal senior sanitationsupervisor of AIIMS who died on May 25 ldquoItrsquosnot the virus that we are worried about Itrsquos theapathy of the government and the AIIMSadministration that worries us If thiscontinues we will be short of healthcare

workers to treat patients Since March we havebeen writing and fighting for the safety ofhostel premises poor sanitation lack of properquarantine protocol and need for adequatetestingrdquo Dr Rajkumar the AIIMS ResidentDoctors Association General Secretary toldNews18 after Lalrsquos death The reportmentioned that the number of healthcareworkers at the institute who had been infectedby then was around 195 (News18com 2020) Aday after the article was published the RDAissued a notice expelling Dr Rajkumar from thebody The article was subsequently modified todeny that healthcare staff were being infectedat work and its headline changed to reflect theofficial version that all was well

By June India was facing a shortage ofhealthcare workers to treat patients as DrRajkumar had predicted

Table 1

Date Cases DeathsFeb 1 1 0

March 1 3 0April 1 1636 38May 1 35043 1147June 1 190535 5394

Source World Health Organisationfigures are cumulative totals

The PPE story contains in microcosm theprincipal elements that have characterisedIndiarsquos COVID-19 response Apart frommismanagement an important element of theresponse has been suppression of newsunfavourable to or critical of the governmentand attempts at fixing the blame on Muslims

APJ | JF 18 | 15 | 11

4

owing to the detection of a cluster of COVID-19cases among those who attended a gathering ofthe Tablighi Jamaat in Delhi in the daysimmediately preceding the lockdown This wassupplemented by a public relations pitch whosethrust from the start was to try and turn thecountryrsquos COVID-19 response into some sort ofpublic event involving the whole country ThisPR pitch was led by Modi himself through aseries of televised addresses to the nation

The first of these addresses was on March 19In that address Mr Modi called upon thepeople of India to observe a daylong ldquopubliccurfewrdquo on March 22 advising socialdistancing and staying home and requestingeveryone to go to their balconies doors orwindows at 5 PM to clap beat plates and ringbells as a mark of gratitude to those hospitaland airline staff who were working in the midstof the pandemic At 5 around the countryenthusiastic Modi supporters emerged out oftheir homes clapping and clanging pots andpans In several cities there were alsoprocessions of hundreds riding motorcycles orsimply walking and dancing through thestreets Photos and videos showed thatprocessions in at least two places in Indiarsquosmost populous state Uttar Pradesh were ledby the local district magistrate and seniorpolice officials

Scientism

Many people banging pots and pans had beenconvinced by a viral WhatsApp post that thesound would produce vibrations that kill thecoronavirus The notion was evidently sharedby prominent persons including the actorAmitabh Bachchan who tweeted on March 22to his 405 million followers that clapping andldquoshankh vibrationsrdquo meaning the vibrationsproduced by b lowing conch she l l s ldquoreducedestroy virus potencyrdquo Mr Bachchanrsquosapproach to driving away the virus was actuallymore sophisticated than that of his fellow

Mumbai resident Indiarsquos Minister of State forSocial Justice and Empowerment RamdasAthawale who earlier in the month had led arally at the Gateway of India where in thecompany of Chinarsquos Consul General in MumbaiTang Guocai he raised slogans of ldquoCorona GoGo Coronardquo

Indians also tried other innovative methods todrive away the virus A group called the AkhilBharat Hindu Mahasabha led by a man namedSwami Chakrapani organised a cow urineparty in Delhi where true believers were givensmall earthen cups of cow urine to drink Thecow urine therapy was not restricted to alunatic fringe Similar events were organised atvarious places around the country by membersof the ruling BJP In Kolkata which is ruled byan opposition party a BJP party workerNarayan Chatterjee was arrested after a manwho consumed the cow urine fell ill The partyrsquoslocal leaders including its West Bengal unitpresident Dilip Ghosh made statementsagainst the arrest and attested to themiraculous properties of cow urine which isheld to be holy by orthodox Hindus The beliefis backed by Ayurveda an ancient Hindusystem of medicine in which cow urine anddung are two among five constituents of a toniccalled Panchgavya ndash cow milk butter and gheeor clarified butter are the other three ndash whichhas also been touted as a cure for thecoronavirus Dr Vallabh Kathiria Chairman ofRashtriya Kamdhenu Aayog a governmentorganisation launched by the Modi governmentin 2019 told the Ahmedabad Mirror thatclinical trials of the wonder drug would beconducted in 10 hospitals in India starting withthe government-run Civil Hospital in Rajkot inGujarat the constituency of the statersquos chiefminister (Sanghavi 2020) Other ayurvediccures for coronavirus promoted by Patanjali acompany founded by a yoga guru turnedindustrialist with close ties to the ruling partyBaba Ramdev were also allowed clinical trialsin Jaipur and Indore although the permissionin Indore was later withdrawn following

APJ | JF 18 | 15 | 11

5

protests The trials in Jaipur met withmiraculous success according to Patanjali and100 percent of patients barring those on lifesupport were completely cured within sevendays of treatment with their herbal medicineswhich they offered for sale as part of a ldquodivyacorona kitrdquo meaning ldquodivine corona kitrdquo ofthree medicines for an affordable Rs 545($720) (Kumar 2020)

However the cheapest and most freelyavailable of all the unorthodox cures the waterof the river Ganga which is also held to be holyby orthodox Hindus failed to progress to theclinical trials stage after the Indian Council ofMedical Research turned down proposalsforwarded by the National Mission for CleanGanga ndash a Union government body whose job itis to clean up the highly-polluted river ndash to treatCOVID-19 patients with Ganga water

One controversial cure that did win the ICMRrsquosfull backing was hydroxychloroquine (HCQ) anant i -malar ia medicat ion that ICMRrecommended on March 22 as prophylaxis forasymptomatic healthcare workers treatingconfirmed and suspected COVID-19 patientsand family members of such patients The useof the drug was subsequently expanded on May22 to include frontline workers such as thepolice (Saikia 2020) After President Trumptouted it as potentially ldquoone of the biggestgame-changers in the history of medicinerdquo in atweet on March 21 ndash a day before ICMRrecommended its prophylactic use in India ndashdemand for the drug skyrocketed India is theworldrsquos main producer of HCQ and accountsfor 70 percent of global production of the drugExports were banned by the DirectorateGeneral of Foreign Trade on April 4 The banwas lifted on April 7 following a call fromPresident Trump to Prime Minister Modi Indiawent on to export HCQ to 97 countries over thenext month

The countryrsquos well-developed pharmaceuticalindustry might have been expected to profit

from this situation but even companiesmanufacturing HCQ struggled to keep theirproduction lines going at normal capacity Thesector as a whole saw an overall slump inproduction and sales ldquoSales have dropped tohalf At present we have reached just 60 percent of the routine sales for May targetrdquo RajivSinghal secretary general of All IndiaOrganisation of Chemists and Druggists(AIOCD) a body representing 85 lakh chemistsacross India told The Print (Chandna 2020)New product launches fell from 349 in April2 0 1 9 t o 4 i n A p r i l 2 0 2 0 D o m e s t i cpharmaceutical companies were barely able tomaintain the flow of their regular products andwere operating at 40 to 50 percent of theirtotal capacity The main reasons cited bymanufacturers for this slump were a severeshortage of workers and a disruption of supplychains

Lockdown

On March 24 two days after the daylongldquopublic curfewrdquo that had concluded incacophonous festivities and processions PrimeMinister Modi addressed the nation once againin a televised address Speaking at 8 PM heannounced that the whole country of 13 billionpeople would go into a complete lockdown for21 days starting at midnight People were leftwith four hours in which to prepare for thelockdown as best as they could Movement oftrucks soon ground to a halt Separating theones carrying essential goods from thosecarrying other items was a mammoth taskMoreover there was no clarity at ground levelon what exactly was considered essential orwhat was to be done about empty trucks Withthe cheap highway restaurants known in Indiaas lsquodhabasrsquo being shut down there was noplace for truckers to eat Many didnrsquot evenhave water to drink ldquoDrivers have startedabandoning trucks and hiking back home evenif these places are 200-300 km from where they

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

4

owing to the detection of a cluster of COVID-19cases among those who attended a gathering ofthe Tablighi Jamaat in Delhi in the daysimmediately preceding the lockdown This wassupplemented by a public relations pitch whosethrust from the start was to try and turn thecountryrsquos COVID-19 response into some sort ofpublic event involving the whole country ThisPR pitch was led by Modi himself through aseries of televised addresses to the nation

The first of these addresses was on March 19In that address Mr Modi called upon thepeople of India to observe a daylong ldquopubliccurfewrdquo on March 22 advising socialdistancing and staying home and requestingeveryone to go to their balconies doors orwindows at 5 PM to clap beat plates and ringbells as a mark of gratitude to those hospitaland airline staff who were working in the midstof the pandemic At 5 around the countryenthusiastic Modi supporters emerged out oftheir homes clapping and clanging pots andpans In several cities there were alsoprocessions of hundreds riding motorcycles orsimply walking and dancing through thestreets Photos and videos showed thatprocessions in at least two places in Indiarsquosmost populous state Uttar Pradesh were ledby the local district magistrate and seniorpolice officials

Scientism

Many people banging pots and pans had beenconvinced by a viral WhatsApp post that thesound would produce vibrations that kill thecoronavirus The notion was evidently sharedby prominent persons including the actorAmitabh Bachchan who tweeted on March 22to his 405 million followers that clapping andldquoshankh vibrationsrdquo meaning the vibrationsproduced by b lowing conch she l l s ldquoreducedestroy virus potencyrdquo Mr Bachchanrsquosapproach to driving away the virus was actuallymore sophisticated than that of his fellow

Mumbai resident Indiarsquos Minister of State forSocial Justice and Empowerment RamdasAthawale who earlier in the month had led arally at the Gateway of India where in thecompany of Chinarsquos Consul General in MumbaiTang Guocai he raised slogans of ldquoCorona GoGo Coronardquo

Indians also tried other innovative methods todrive away the virus A group called the AkhilBharat Hindu Mahasabha led by a man namedSwami Chakrapani organised a cow urineparty in Delhi where true believers were givensmall earthen cups of cow urine to drink Thecow urine therapy was not restricted to alunatic fringe Similar events were organised atvarious places around the country by membersof the ruling BJP In Kolkata which is ruled byan opposition party a BJP party workerNarayan Chatterjee was arrested after a manwho consumed the cow urine fell ill The partyrsquoslocal leaders including its West Bengal unitpresident Dilip Ghosh made statementsagainst the arrest and attested to themiraculous properties of cow urine which isheld to be holy by orthodox Hindus The beliefis backed by Ayurveda an ancient Hindusystem of medicine in which cow urine anddung are two among five constituents of a toniccalled Panchgavya ndash cow milk butter and gheeor clarified butter are the other three ndash whichhas also been touted as a cure for thecoronavirus Dr Vallabh Kathiria Chairman ofRashtriya Kamdhenu Aayog a governmentorganisation launched by the Modi governmentin 2019 told the Ahmedabad Mirror thatclinical trials of the wonder drug would beconducted in 10 hospitals in India starting withthe government-run Civil Hospital in Rajkot inGujarat the constituency of the statersquos chiefminister (Sanghavi 2020) Other ayurvediccures for coronavirus promoted by Patanjali acompany founded by a yoga guru turnedindustrialist with close ties to the ruling partyBaba Ramdev were also allowed clinical trialsin Jaipur and Indore although the permissionin Indore was later withdrawn following

APJ | JF 18 | 15 | 11

5

protests The trials in Jaipur met withmiraculous success according to Patanjali and100 percent of patients barring those on lifesupport were completely cured within sevendays of treatment with their herbal medicineswhich they offered for sale as part of a ldquodivyacorona kitrdquo meaning ldquodivine corona kitrdquo ofthree medicines for an affordable Rs 545($720) (Kumar 2020)

However the cheapest and most freelyavailable of all the unorthodox cures the waterof the river Ganga which is also held to be holyby orthodox Hindus failed to progress to theclinical trials stage after the Indian Council ofMedical Research turned down proposalsforwarded by the National Mission for CleanGanga ndash a Union government body whose job itis to clean up the highly-polluted river ndash to treatCOVID-19 patients with Ganga water

One controversial cure that did win the ICMRrsquosfull backing was hydroxychloroquine (HCQ) anant i -malar ia medicat ion that ICMRrecommended on March 22 as prophylaxis forasymptomatic healthcare workers treatingconfirmed and suspected COVID-19 patientsand family members of such patients The useof the drug was subsequently expanded on May22 to include frontline workers such as thepolice (Saikia 2020) After President Trumptouted it as potentially ldquoone of the biggestgame-changers in the history of medicinerdquo in atweet on March 21 ndash a day before ICMRrecommended its prophylactic use in India ndashdemand for the drug skyrocketed India is theworldrsquos main producer of HCQ and accountsfor 70 percent of global production of the drugExports were banned by the DirectorateGeneral of Foreign Trade on April 4 The banwas lifted on April 7 following a call fromPresident Trump to Prime Minister Modi Indiawent on to export HCQ to 97 countries over thenext month

The countryrsquos well-developed pharmaceuticalindustry might have been expected to profit

from this situation but even companiesmanufacturing HCQ struggled to keep theirproduction lines going at normal capacity Thesector as a whole saw an overall slump inproduction and sales ldquoSales have dropped tohalf At present we have reached just 60 percent of the routine sales for May targetrdquo RajivSinghal secretary general of All IndiaOrganisation of Chemists and Druggists(AIOCD) a body representing 85 lakh chemistsacross India told The Print (Chandna 2020)New product launches fell from 349 in April2 0 1 9 t o 4 i n A p r i l 2 0 2 0 D o m e s t i cpharmaceutical companies were barely able tomaintain the flow of their regular products andwere operating at 40 to 50 percent of theirtotal capacity The main reasons cited bymanufacturers for this slump were a severeshortage of workers and a disruption of supplychains

Lockdown

On March 24 two days after the daylongldquopublic curfewrdquo that had concluded incacophonous festivities and processions PrimeMinister Modi addressed the nation once againin a televised address Speaking at 8 PM heannounced that the whole country of 13 billionpeople would go into a complete lockdown for21 days starting at midnight People were leftwith four hours in which to prepare for thelockdown as best as they could Movement oftrucks soon ground to a halt Separating theones carrying essential goods from thosecarrying other items was a mammoth taskMoreover there was no clarity at ground levelon what exactly was considered essential orwhat was to be done about empty trucks Withthe cheap highway restaurants known in Indiaas lsquodhabasrsquo being shut down there was noplace for truckers to eat Many didnrsquot evenhave water to drink ldquoDrivers have startedabandoning trucks and hiking back home evenif these places are 200-300 km from where they

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

5

protests The trials in Jaipur met withmiraculous success according to Patanjali and100 percent of patients barring those on lifesupport were completely cured within sevendays of treatment with their herbal medicineswhich they offered for sale as part of a ldquodivyacorona kitrdquo meaning ldquodivine corona kitrdquo ofthree medicines for an affordable Rs 545($720) (Kumar 2020)

However the cheapest and most freelyavailable of all the unorthodox cures the waterof the river Ganga which is also held to be holyby orthodox Hindus failed to progress to theclinical trials stage after the Indian Council ofMedical Research turned down proposalsforwarded by the National Mission for CleanGanga ndash a Union government body whose job itis to clean up the highly-polluted river ndash to treatCOVID-19 patients with Ganga water

One controversial cure that did win the ICMRrsquosfull backing was hydroxychloroquine (HCQ) anant i -malar ia medicat ion that ICMRrecommended on March 22 as prophylaxis forasymptomatic healthcare workers treatingconfirmed and suspected COVID-19 patientsand family members of such patients The useof the drug was subsequently expanded on May22 to include frontline workers such as thepolice (Saikia 2020) After President Trumptouted it as potentially ldquoone of the biggestgame-changers in the history of medicinerdquo in atweet on March 21 ndash a day before ICMRrecommended its prophylactic use in India ndashdemand for the drug skyrocketed India is theworldrsquos main producer of HCQ and accountsfor 70 percent of global production of the drugExports were banned by the DirectorateGeneral of Foreign Trade on April 4 The banwas lifted on April 7 following a call fromPresident Trump to Prime Minister Modi Indiawent on to export HCQ to 97 countries over thenext month

The countryrsquos well-developed pharmaceuticalindustry might have been expected to profit

from this situation but even companiesmanufacturing HCQ struggled to keep theirproduction lines going at normal capacity Thesector as a whole saw an overall slump inproduction and sales ldquoSales have dropped tohalf At present we have reached just 60 percent of the routine sales for May targetrdquo RajivSinghal secretary general of All IndiaOrganisation of Chemists and Druggists(AIOCD) a body representing 85 lakh chemistsacross India told The Print (Chandna 2020)New product launches fell from 349 in April2 0 1 9 t o 4 i n A p r i l 2 0 2 0 D o m e s t i cpharmaceutical companies were barely able tomaintain the flow of their regular products andwere operating at 40 to 50 percent of theirtotal capacity The main reasons cited bymanufacturers for this slump were a severeshortage of workers and a disruption of supplychains

Lockdown

On March 24 two days after the daylongldquopublic curfewrdquo that had concluded incacophonous festivities and processions PrimeMinister Modi addressed the nation once againin a televised address Speaking at 8 PM heannounced that the whole country of 13 billionpeople would go into a complete lockdown for21 days starting at midnight People were leftwith four hours in which to prepare for thelockdown as best as they could Movement oftrucks soon ground to a halt Separating theones carrying essential goods from thosecarrying other items was a mammoth taskMoreover there was no clarity at ground levelon what exactly was considered essential orwhat was to be done about empty trucks Withthe cheap highway restaurants known in Indiaas lsquodhabasrsquo being shut down there was noplace for truckers to eat Many didnrsquot evenhave water to drink ldquoDrivers have startedabandoning trucks and hiking back home evenif these places are 200-300 km from where they

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

6

arerdquo Bal Malkit Singh chairman of the AllIndia Motor Transport Congress told The Timesof India two days later (TNN 2020) By April 7transportation of goods in India had almostground to a halt The daily movement of truckshad by then fallen to less than 10 percent ofnormal levels according to the All India MotorTransport Congress the umbrella body ofgoods vehicle operators in the country (Sundria2020)

The human cost of the lockdown revealed itselfbefore the economic cost It was visible in thelines of migrant workers trekking home overhundreds of kilometres More than 90 percentof Indiarsquos workforce is in the unorganisedsector There are an estimated 100 millioninternal migrant workers who constitute thebackbone of the labour force in numeroussectors When the sudden lockdown kicked inmillions of daily wagers all over the countryespecially in its metropolises were immediatelyleft without a source of income ldquoWhere will weget some foodrdquo Bhole Kumar a mason at aconstruction site who earned Rs 500 ($655) aday asked The Wire ldquoHunger will kill usbefore the coronavirusrdquo (Agarwal 2020) Hewas one of a group of five men walking 170 kmfrom their workplace in Noida near Delhi toNajibabad in Uttar Pradesh

Internal migrant workers leaving Mumbaion foot This particular group was

photographed in Dombivili on the outskirtsof the city on their way to Solapur 400 kmaway Source Debasish Dey

Over the next two months similar reports andpictures poured in from everywhere At first itwas only men but by and by entire familieswith women and babies and scant belongingsbegan the long march home to their villages inthe punishing heat of the Indian summer inscenes reminiscent of Partition They did not allmake it On May 17 The Hindu ran a reporttitled ldquoUP migrant walking home dies oflsquohungerrsquordquo with the word lsquohungerrsquo in singlequotations as though it were somehow animpossibility whose reality could not beadmitted Two days later the Press Trust ofIndia reported a different case this time fromMaharashtra in the countryrsquos west of alabourer whose partially decomposed body hadbeen found in a remote village He had been onhis way home on foot from Pune Officials citedstarvation as the likely cause of death FromAndhra Pradesh in the countryrsquos south therewas a report published in The New IndianExpress on May 22 of a worker from WestBengal who had died of sunstroke trying towalk home from Chennai in the punishing heatof the Indian summer The distance fromChennai to Kolkata is 1670 km (Express NewsService 2020)

The total number of migrant workers who diedtrying to walk home during the lockdown isdifficult to gauge as reporting from thecountryrsquos interiors is patchy even at the best oftimes An NGO called SaveLIFE (Dutta 2020)compiled a report according to which 198migrant workers died in road accidentsbetween March 25 and May 31 An additionalsixteen migrant workers died when they wererun over by a goods train in Maharashtra onMay 8 They had been walking along the trackspossibly to avoid detection by the police ndash whoin most places were beating up arresting

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

7

detaining or otherwise harassing those tryingto walk home for violating the lockdown ndash andhad gone to sleep exhausted on the woodensleepers of the tracks secure in the belief thattrains were not running

On April 14 Modi announced extension of thelockdown until May 3 ldquoIf we look at corona-related figures in the worldrsquos big powerfulcountries India today is in a very well-managedpositionrdquo he said ldquoIt is clearly evident from theexperience of the past few days that we havechosen the correct pathrdquo The number of casesin India then was approaching 11000 still farbelow the numbers in countries such as ItalySpain and USA

By this time distress had turned intodesperation for many A crowd of thousandsgathered at Bandra station in Mumbaidemanding trains be run so they could gethome They were dispersed by police who beatthem with sticks In Surat in Gujarat migrantworkers blocked roads and staged a protest Agroup of around 150 migrant workers inHyderabad that set off on foot on hearing of thelockdown extension was stopped by policeHowever the lines of those walking home didnot stop

Their suffering was only the tip of an iceberg ofwoes The Center for Monitoring the IndianEconomy a private think-tank estimated that122 million people from informal as well asformal sectors were rendered jobless in Aprilon account of the stringent lockdown Thejobless rate for the week ending March 3 stoodat 271 percent ldquoA massive 91 million lost theirlivelihood in just about a month This is not justa mind-boggling number It is a human tragedybecause these are perhaps the mostvulnerable parts of societyrdquo CMIE chiefexecutive Mahesh Vyas wrote (Vyas 2020)

The lockdown sent the Indian economy into atailspin Global research firm Fitch Ratings inan update to its Global Economic Outlook onMay 26 forecast a 5 percent decline in the

countryrsquos Gross Domestic Product for thecurrent financial year The same day theIndian analytical firm CRISIL released a reporttitled ldquoMinus fiverdquo making a similar predictionstating that ldquoIndiarsquos fourth recession sinceIndependence first since liberalisation andperhaps the worst to date is hererdquo (CRISIL2020) Two days later global ratings firmStandard amp Poorrsquos of which CRISIL is asubsidiary also forecast a 5 percentcontraction of the Indian economy for thefinancial year

With the economy crumbling Modi appearedonce again on TV on May 12 This time heannounced an economic relief and stimuluspackage of Rs 20 lakh crores amounting toalmost 10 percent of Indiarsquos GDP He also madethe remarks mentioned previously on Indiahaving turned crisis into opportunity throughthe manufacture of PPEs and masks issuing acall for lsquoAtmanirbhar Bharatrsquo or lsquoSelf-ReliantIndiarsquo and asking people to be ldquovocal for localrdquoOn closer examination of the details whichwere announced by the Finance Ministereconomists found the relief package wasactually closer to 2 percent of GDP since muchof the rest consisted of a repackaging of oldschemes to boost the headline figure HoweverModi did announce that day that people wouldhave to learn to live with the virus An easing ofthe lockdown began just when the coronaviruscurve had begun rising sharply

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

8

A few special trains named Shramik (meaninglabourer) expresses had begun running earlieron May 1 after the scale of the lockdowndisaster became apparent These increased infrequency On May 31 VKYadav theChairman of Indiarsquos Railway Board told newsagency ANI in a televised interview that therailways had ferried more than 54 millionworkers to their home states on 4050 trainssince the beginning of the month From May25 domestic flights resumed Another 200trains began to operate from June 1

Notions of social distancing are fanciful inIndia Millions of people often forced intocrowded spaces poured out of the cities withthe worst outbreaks of COVID-19 spreadingthe coronavirus into the far corners of thecountry When the lockdown was initiallyimposed on March 24 COVID-19 cases werestill being found only among those who hadarrived from abroad By June 1 when trainservices were restored India had the seventhmost COVID-19 cases in the world It wasreporting in excess of 190000 cases then ndash andthis number was almost certainly anunderestimate (see Table 1)

Despite having stopped international flightssince March 22 the countryrsquos authorities led byHealth Minister Harsh Vardhan continued toinsist even in mid-June that there was nocommunity transmission This made it verydifficult for people to get tested becauseaccording to the guidelines only those withfull-blown symptoms plus a history of foreigntravel and contact with a COVID-19 patientcould be tested if they had a doctorrsquosprescription recommending one The ostracismsuffered by COVID-19 patients ndash even funeralswere denied in at least three widely reportedcases ndash coupled with price-gouging by privatehospitals meant that there were seriousdisincentives to getting tested and littlechances of getting treated even if tests werepositive The Association of HealthcareProviders a body representing privatehospitals in India suggested a minimum fee ofRs 15000 per day for stay in general wardsThe Central Government Health Scheme aninsurance for central government employeesh a s a c e i l i n g o f R s 1 0 0 0 a d a y f o rreimbursements on general ward stays Inmany cases reported from across the countrypatients staying in hospitals for treatment ofCOVID-19 or other diseases were additionallybilled thousands of rupees for exorbitantlypriced PPEs In a country where the per capitamonthly income was Rs 11254 before theeconomy tanked private hospitals were out ofreach of the vast majority even after a couple ofstate governments belatedly imposed pricecaps

As of mid-June 2020 the numbers are mountingrapidly despite relatively limited per capitatesting Reports from Delhi and Mumbaisuggest a shortage of hospital beds Patientsare dying without treatment after being ferriedfrom hospital to hospital and denied admissionThe Chief Minister of Delhi Arvind Kejriwalhas reacted to these reports by accusinghospital administrators of black-marketdealings in hospital beds and trying to reserve10000 hospital beds for residents of Delhi ndash a

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

9

move shot down by the Lieutenant GovernorAccording to the Economic Survey of Delhi2019-20 the national capital region has a totalof 57709 hospital beds The statersquos populationwas 168 million in the 2011 census and iscurrently estimated at over 19 million(Planning Department Government of NCT ofDelhi 2020)

A shortage of doctors and nurses has alsobegun to bite The country has long had wellbelow WHO recommended numbers of doctorsand nurses per thousand population The levelof training of those who work in the sector wasalso a matter of some concern For instance aWHO study on healthcare workers in Indiafound that only 427 percent of allopathicdoctors in India actually had a medicalqualification (Anand and Fan 2016) Some ofthe most highly trained of these healthcareworkers are at AIIMS in Delhi There by June4 more than 480 workers including 19 doctorsand 38 nurses apart from attendantssanitation staff lab technicians and securitystaff had tested positive for the virus and then u r s e s h a d b e g u n t o h o l d p r o t e s tdemonstrations (Shukla 2020) They werehaving difficulty working in airtight PPEs forsix hour shifts without air conditioning in theheat of the Delhi summer where maximumtemperatures exceeded 47 degrees celsiusMumbairsquos King Edward Memorial Hospital atreatment facility for COVID-19 patients alsosaw a brief strike by nurses protesting workconditions on June 1 In Hyderabad around300 doctors working at the Gandhi Hospitalthe main COVID-19 treatment facility in thecity went on strike on June 10 after one ofthem was assaulted by relatives of a patientwho died

Implications

As of June 11 2020 India rose to number fourin the global ranking of the pandemic outbreakand the number of cases is still rising with a

peak expected sometime in July or AugustThere are clear signs that Indiarsquos overstretchedhealthcare facilities are beginning to collapseunder the pressure It is also evident that a lotof people are going to die in India before this isover The case fatality ratio in India has beenlower than the global average at 28 percentagainst 58 percent worldwide The reasons forthis low figure are unknown Even if the figureis taken at face value it implies that India isfacing a considerable disaster Withcontainment measures having failed and theeconomy in far too much trouble to allow arepeat of a full lockdown the only wayCOVID-19 can be checked at present ndash novaccine is in sight ndash is if the populationapproaches herd immunity The minimumpercentage of the population that would haveto recover from the disease for this to happenis still not clear but estimates range from50-70 (DrsquoSouza and Dowdy 2020) SinceIndiarsquos population is 13 billion that wouldmean 19 million deaths It is evident from thecurrent situation that many of the deaths willnot be recorded as COVID-19 deaths becausepatients will simply not be tested or treated

This grim situation will influence approachingelections in two large battlefield states Biharand West Bengal The treatment endured bymigrant workers from these states is already apolitical issue The growing economic distressand burden of illness will also increasinglybecome electoral issues The ruling BJP at thecentre has tried and will probably continue totry to use all means at its disposal includingits indirect control of large sections of theIndian media to shift the blame elsewhere Inthe early days of the outbreak in India theirefforts were aimed at blaming Muslims for thespread of the disease after the detection of theTablighi Jamaat cluster of cases BJP ChiefMinisters of four states ndash Gujarat UttarPradesh Madhya Pradesh and Uttarakhand ndashmade public statements ascribing the rise ofCOVID-19 numbers in their states to theTablighis It is probable that social fault-lines in

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

10

India between Hindus and Muslims will deepenfurther as a result of the politics of COVID-19scapegoating

The Hindu-Muslim fault-line is hardly the onlyone in India Therersquos also a very visible rich-poor divide The poor blamed the coronaviruson the rich people traveling to and from foreigncountries and spreading it at home It has sincecaused untold miseries for the poor This mayfuel crime Additionally although leftist politicsin India have been pushed to the electoralmargins they are not completely extinct andhave gained fresh respectability in some placesduring this crisis Several state governmentswith the encouragement of the centre tried todilute the countryrsquos labour laws regulatingminimum wages and the length of the workingday as a response to economic difficultiesdrawing protests from trade unions and anexpression of concern from the InternationalLabour Organisation There is one state thatthe Communist Party of India (Marxist) stillrules That state is Kerala whose success incontaining COVID-19 has been notedworldwide but has earned no praise from Modior his government Political fault-lines havedeepened between opposition-ruled stategovernments and the ruling BJP not leastbecause the states have been at the forefront offighting the pandemic while the centre has notallocated them tax revenues they are owedPre-existing adversarial relationships betweenseveral states and the centre have acquired anew edge

Various kinds of politics ndash of religion languageand class ndash are being exacerbated by theCOVID-19 crisis The clashes between thesekinds of politics may sharpen as economicdistress mounts and the bodies pile up Theruling party has already shown its inclinationtowards democracy of the Russian variety

They will no doubt be tempted to go furtherdown that authoritarian path

References

Agarwal Kabir (2020) lsquoHunger can kill usbefore the virus Migrant workers on the marchd u r i n g l o c k d o w n(httpsthewirein20labourcoronavirus-lockdown-migrant-workers-walking-home)rsquo March27 Accessed June 5 2020

Anand Sudhir and Fan Victoria (2016) lsquoTheHealth Workforce in Indiarsquo World HealthOrganisation

Chandna Himani (2020) lsquoWhy India saw only 4pharma products launched in April its lowestc o u n t e v e r(httpstheprintin20healthwhy-india-saw-only-4-pharma-products-launched-in-april-its-lowest-count-ever426161)rsquo May 21 AccessedJune 4 2020

C R I S I L ( 2 0 2 0 ) lsquo M i n u s f i v e(httpswwwcrisilcomenhomeour-analysisreports202005minus-fivehtml)rsquo May 26Accessed June 15 2020

DrsquoSouza Gypsyamber and Dowdy David(2020) lsquoWhat is herd immunity and how can wea c h i e v e i t w i t h C o v i d - 1 9 (httpswwwjhspheducovid-19articlesachieving-herd-immunity-with-covid19html)rsquo April10 Accessed June 22 2020

Dutta Anisha (2020) lsquo198 migrant workersdied in road accidents since Mar 25 Report(httpswwwhindustantimescomindia-news198-migrant-workers-died-in-road-accidents-s i n c e - m a r - 2 5 - r e p o r t s t o r y -WnIIgmaHkO0nO7zAEJv1fIhtml)rsquo June 3Accessed June 22 2020

Express News Service (2020) lsquoWalking homemigrant worker dies of sunstroke in AndhraP r a d e s h(httpswww20newindianexpresscomcitiesvi jayawada2020may22walking-home-

APJ | JF 18 | 15 | 11

11

migrant-worker-dies-of-sunstroke-in-andhra-pradesh-2146527html)rsquo 22 May AccessedJune 18 2020

Krishnan Vidya (2020) lsquoIndia did not stockpileCovid protective equipment for health workersd e s p i t e c l e a r W H O g u i d e l i n e s(httpscaravanmagazineinhealthindia-did-not-stockpile-covid-protective-equipment-health-workers-despite-clear-who-guidelines)rsquo 22March Accessed June 17 2020

Kumar Ravi Prakash (2020) lsquoCoronavirustreatment Ramdevrsquos Patanjali launches Coronilk i t f o r R s 5 4 5(httpswwwlivemintcomnewsindiacoronavirus-vaccine-coronil-patanjali-baba-ramdev-press-c o n f e r e n c e - l i v e -updates-11592893304534html)rsquo 23 JuneAccessed June 24 2020

News18com (2020) lsquoNot worried about virusbut govt apathy Lack of PPE makes AIIMSh e a l t h c a r e s t a f f t a r g e t f o r C O V I D(httpsinnewsyahoocomsans-proper-protective-cover-healthcare-072600719html)rsquo 29 MayAccessed June 1 2020

Pandey Tanushree (2020) lsquoCorona warriorst h r e a t e n e d(httpswwwmagztercomarticleNewspaperMail-TodayCorona-Warriors-Threatened)rsquo 8April Accessed June 17 2020

Planning Department Government of NCT ofDelhi (2020) lsquoEconomic Survey of Delhi2 0 1 9 - 2 0(httpdelhiplanningnicincontenteconomic-survey-delhi-2019-20)rsquo March 21 Accessed June15 2020

Press Trust of India (PTI) (2020) lsquoIndia liftsban of personal protective gear to help Chinac o m b a t c o r o n a v i r u s(httpstheprintinindiaindia-lifts-ban-on-export-of-personal-protection-gear-to-help-china-combat-coronavirus362736)rsquo Feb 10Accessed June 22 2020

Saikia Arunabh (2020) lsquoCovid-19 India isrelying on flimsy evidence to expand use ofHCQ despite concerns about dangers(httpsscrollinarticle963071covid-19-india-is-relying-on-flimsy-evidence-to-expand-use-of-hcq-despite-concerns-about-dangers)rsquo May 27Accessed June 3 2020

Sanghavi Nischal (2020) lsquoGujarat plans to giveworld a wonder drug to battle corona(httpsahmedabadmirrorindiatimescom20ahmedabadcover-storygujarat-plans-to-give-w o r l d - a - w o n d e r - d r u g - t o - b a t t l e -coronaarticleshow76017951cms)rsquo 27 MayAccessed June 2 2020

Shukla Saurabh (2020) lsquo19 doctors 38 nursesamong 480 infected with coronavirus in AIIMS(httpswwwndtvcomdelhi-newscoronavirus-19-doctors-38-nurses-among-480-infected-in-aiims-2240563)rsquo June 4 Accessed June 8 2020

Srinivasan Chandrasekhar (2020) lsquo81coronavirus cases in India says healthm i n i s t r y a d d s ldquo n o t e m e r g e n c y rdquo(https20wwwndtvcomindia-newscoronavirus-in-india-81-coronavirus-cases-in-india-says-health-ministry-adds-not-emergency-2194552)rsquo13 March Accessed June 13 2020

Sundria Saket (2020) lsquoWorldrsquos biggestlockdown brings trucks to a standstill(httpseconomictimesindiatimescomindustry20transportationroadwaysworlds-biggest-l o c k d o w n - b r i n g s - t r u c k s - t o - a -standstillarticleshow75024266cmsfrom=mdr)rsquo April 7 2020 Accessed June 4 2020

The Wire (2020) lsquoAIIMS RDA writes to PM overlsquobacklashrsquo against doctors for lsquoraising genuinec o n c e r n s rsquo(httpsthewireinhealthaiims-rda-appeal-pm-targetting-doctors)rsquo 6 April Accessed June 172020

Times News Network (TNN) (2020) lsquoDay 2 oflockdown Truckers abandon vehicles deliveryb o y s f r e t a b o u t s a f e t y

APJ | JF 18 | 15 | 11

12

(httpstimesofindiaindiatimescom20indiaday-2-of-lockdown-truckers-abandon-vehicles-d e l i v e r y - b o y s - f r e t - a b o u t -safetyarticleshow74838109cms)rsquo May 27Accessed June 4 2020

Verma Kanika (2020) lsquoPrime minister Modiannounces mega economic package asC o v i d - 1 9 r e l i e f(httpswwwinvestindiagovinteam-india-blog

sprime-minister-modi-announces-mega-economic-package-covid-19-relief)rsquo 12 MayAccessed June 17 2020

Vyas Mahesh (2020) lsquoIndia has a jobsbloodbath as unemployment rate shoots up to2 7 1 (httpswwwbusinessstandardcom20articleo p i n i o n t h e - j o b s - b l o o d b a t h - o f -april-2020-120050400524_1html)rsquo May 4Accessed June 6 2020

This article is a part of the Special Issue Pandemic Asia Part II See the Table ofContents here (httpwwwapjjforg202015APJhtml)

See the Table of Contents for Part I (http00722814APJhtml)

Readers of this special may be also interested in another COVID-19 special VulnerablePopulations Under COVID-19 in Japan (httpsapjjforg202018ToChtml) edited byDavid H Slater

Samrat Choudhury is a columnist and author A former editor of newspapers in DelhiMumbai and Bengaluru he now lives in Kolkata where he writes a column for Firstpostcom(httpswwwfirstpostcom) He is the co-founder Partition Studies Quarterly(httpwwwpartitionstudiesquarterlyorg) an online journal that aims to document Partitioneffects in Northeast India and Editor of East Wind a magazine that focuses on NortheastIndia and its near-abroad His first book The Urban Jungle was published by Penguin in2011