COVID-19: Let’s not paper over this time

As India restarts the economy, its top agenda should be public infrastructure and health services

By Sunita Narain
Published: Monday 10 August 2020
COVID-19: Let's not paper over this time. Illustration: Ritika Bohra

Deaths in the United States because of the novel coronavirus disease (COVID-19) pandemic are not so high, asserted President Donald Trump. This, he said, the day his country crossed 160,000 deaths because of the virus. But, however preposterous, Trump was right. If you take, as he did, deaths in the US as a proportion of the total cases — case fatality rate — the US is doing better than most countries.

In the US, the case fatality rate is some 3.3 per cent; in comparison, it is over 14 per cent in the United Kingdom and Italy and about 4 per cent in Germany. So, he is right and totally wrong. In the US, the contagion is out of control — for a country with 4 per cent of the world’s population, it accounts for 22 per cent of total deaths. But then, it’s all about the data points you choose and the sums you highlight.

This is why the Indian government continues to say we are not doing so badly. In our case, not only is the case fatality rate low — 2.1 per cent — it is even lower than the US. So, while our infection rate may be high, people are not dying.

Then, the government says we are a big country and so, the numbers will be bigger. That is why, even though we are adding some 60,000 new cases per day, the numbers in terms of cases per million population are 1,400 — still in control — or at least lower than the other parts of the world. The US has 14,500 cases per million; the UK has 4,500 and even Singapore has 9,200 per million,

But our case load could be low also because our tests, however ramped up, are still miniscule in terms of the total population. India, till August 6, 2020, did some 16 tests per thousand people; the US has done 178. Clearly, given the size of the country and our economic abilities, it would be impossible to match the US testing rate. But then, why do we compare ourselves with the US to argue that we are doing okay?

The question is what went wrong and what do we do next. This is where, I believe, India has done better than the US — our leadership has not discounted the contagion or sent out mixed signals about the need to wear masks. It has tried hard to follow all the safety prescriptions that worked in other parts of the world.

India called for a hard lockdown in the last week of March, which has come at a huge economic cost and led to massive livelihood losses and disruptions in the lives of the very poor. We did what we could. But it is a fact that the virus has won — or at least is winning today. This is what we need to recognise and not paper over by changing the subject.

This means we need to rework our strategy — restart the economy and put cash in the hands of a vast number of people. There is widespread distress in the country; there is hunger; there is joblessness; and there is destitution. This also cannot be papered over.

The top agenda is to address the issue of the lack of public infrastructure and, most importantly, health services. These are poor, even in our best cities. Otherwise, why would all our high-ranking officials, including our home minister, select private care when the going gets tough.

The message is clear: We cannot trust our government systems when it comes to our health, even though we run them. What’s even more worrying, health infrastructure is virtually non-existent in the states, districts and villages where the contagion is growing now.

It is also a fact that public systems are vastly stretched and fatigued. This is the real reason why the virus is winning. Doctors, nurses, cleaners, municipal officials, laboratory technicians, the police are all working day and night, day after day, month after month. They need reinforcements today and not tomorrow.

This agenda of investment in public infrastructure cannot wait. But this also means that for once and all, the government must accept the importance of these agencies and institutions. We cannot discount public health in favour of the private systems and then expect these to function as they must.

This then has to be our strategy going forward. We need investment — big time — in public health systems and in municipal governance. This has to be articulated and done.

Our current rate of spending on public health is miniscule — roughly 1.28 per cent of our gross domestic product (GDP). In comparison, China spends roughly 3 per cent of its vastly bigger GDP on public health and has been doing so for many years now.

We can no longer ignore this agenda. COVID-19 means putting health first. It means putting our money where it matters the most. It also means that we will have to do much more to prevent diseases — stop co-morbidity because of bad air, bad food or lack of water and sanitation. It’s about our health; our country.

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