Coronavirus, Lockdown and Alternative
Dinesh Abrol
Introduction
After the completion of forty (40) days of lockdown on the morning of May 5, 2020 the emerging COVID-19 situation due to mismanagement by the Modi government is becoming a cause for concern on several counts for everyone[1]. Today is the second day of lockdown 3.0 that is expected to end on May 17, 2020. and has recorded the biggest single-day jump in the number of coronavirus patients and deaths linked to COVID-19. Three thousand nine hundred (3,900) new cases have so far been reported. 195 COVID-19 patients died in the last 24 hours. This 4th highest spike takes the total to 46,433 COVID-19 cases, including 1,568 deaths. The average daily rate of infection, now below 4% can rise fast.The states that are the biggest cause for worry, both as a source of infection and spread include Maharashtra (high infection rate of about 10.78%, way above the national average), Delhi (almost all districts are affected, with an infection rate of 7.78%), Madhya Pradesh ( 6.4%), West Bengal (testing low, infection rate of over 6%), Gujarat (infection rate of 6.6%) and Uttar Pradesh (testing smaller, with an infection rate of 6.6% and increasing numbers over the past week). There is no information on the number of people who may have succumbed to non-COVID-19 medical conditions and a live dashboard for those numbers, which could well be higher[2].
Lockdown is not the way ahead
Today the Indian Express (Tuesday, May 5, 2020) carried an interview with Dr. Randeep Guleria, Director, All India Institute of Medical Sciences (AIIMS). Among the issues expressed was an honest admission for the first time that “the curve has not shown a downward trend”. He also claimed that the lockdown helped in flattening the curve and provided a buffer for the country to upgrade its medical infrastructure, and also added that “the next four to six weeks will be very important because the lockdown cannot be there forever”. Even while admitting that “the ideal dream would be to have zero cases (the criteria for area to be declared as green zone with no local hotspot areas)”, he also added “that is not happening” soon because “the number of cases is increasing every day”. Of course, as he wanted to sound hopeful, he also claimed that “the rise in the curve is not so sharp and can be handled”.
When he talked about the way ahead, the pathway was clear that “the solution is to identify the areas where the maximum number of cases are coming, and focus on containment to bring down the number of cases, and convert the districts to orange and green zones. To mitigate the economic impact of the lockdown, the reclassification strategy should be more granular, with focus on local hotspot areas rather than an entire district labelled as a red zone”, he suggested while adding that the most important data point to watch out for, ahead of May 17, would be the cases reported in the hotspots and reclassification zones. Recalling the lesson from history of India’s experience with the Spanish Flu, he added that most of the 7 million deaths happened in the second wave after the lifting of lockdown. He underlined that while India’s case count and mortality will remain relatively low, and added that “we will have to learn to live with COVID-19 for quite some time. We will have to have strategies which will work with COVID-19 being around”.
Creating spaces for alternate strategy
With this scenario of rising COVID-19 positive cases the shut door to politics is opening now. Yesterday the media and the Chief Minister (CM) of Delhi too picked up the required courage to say that the lockdown cannot be forever and we need to learn to live with coronavirus”[3]. In the latest statement of JSA-AIPSN, the collaborating networks of peoples’ science movements (PSMs) and of peoples’ health movements (PHMs) released more than 28 joint statements in India since March 25th. The challenge is clearly brought out that how India took 10 days to go from 5000 to 15,000 cases but it has taken only 5 to 6 days to go from 25,000 to 35000 cases (JSA-AIPSN, May 3, 2020, see aipsn.net for news, background papers and statements).
The steps recommended in the JSA-AIPSN statement are clear that the central government should “adopt a framework of cooperative governance for determination of criteria for the identification of hotspot areas and of restriction of movements and activities, guidelines for implementation of relief measures and allocation of resources, deliberate, make the guidelines part of a legal framework which would also mandate functional consultative mechanisms that would have to involve public health expertise, healthcare providers and organizations of working people who all would be affected, and mandate watchdog bodies that ensure that the sweeping powers given under the Disaster Management Act are not misused and that the cooperative framework is maintained.
The JSA-AIPSN statement advocates as a part of the strategy to strengthen the disease surveillance mechanism, with appropriate design for collection, flow and analysis of information to inform decision making at national, state and local levels, not make “Zero case reporting” the exit criteria for lockdowns or the basis for zoning and shun the coercive measures and treat the public in a humane manner and to follow complete transparency in policy making and decision making processes. A strategy of safe human distancing, social solidarity and neighborhood preparedness, involving the practice of door to door volunteer support for motivating the people to learn and live a “Safe and Healthy Life” in the times of corona is advocated. Of course, high risk cases will have to be managed by the governments in ramped up healthcare facilities at the sub district / district level. Low / mild risk residents / workers will have to be supported through the publicly funded efforts with the solidarity committees formed with grassroot volunteers taking charge of the containment, relief, rehabilitation and reconstruction work.
Open, transparent and accountable tools
Screening, monitoring and testing of the residents of these densely populated clusters must be practiced on a regular basis to give courage and confidence to the society as a whole to get on with the normal life. The key to moving forward is, smart and innovative disease monitoring tools and apps provides for the ethical evaluation of the algorithms in use to monitor the movements of targeted publics. The use of digital tools should be governed and supported by appropriate legislation with the privacy considerations taken care of fully before these tools are put into wider use or made mandatory.
Safe sample collection and testing (which should include targeted, opportunistic and rapid testing) would have to be practiced. Humanitarian approach to the quarantine, diagnostic and treatment needs to be rolled out for the management of COVID and co-morbidities. The government needs to promote and champion “voluntary and early disclosure of symptoms with acceptable diagnostic drives and community / neighborhood led quarantine measures in the urban slums and densely populated low-income urban areas. The government must establish integrated neighborhood settlement / contiguous area-based centres for “clinical diagnosis, monitoring and surveillance.
Testing and quarantining (institutional and locally organized) with clear Do’s and Don’ts regarding the principles to be followed by the centres formed at the ward level and not at the district level is the way forward. Dignified and safe facilities need to be provided for the management of low-risk (mild to moderate cases) in community quarantine / primary care facilities. High risk cases will have to be managed at identified secondary health facilities to minimize the number of adverse health outcomes from the densely populated urban areas.
The alternate strategy is an exercise in the adoption of a humanitarian, compassionate and benevolent, non-threatening approach, uncompromisingly safe, transparent and answerable (secure quarantine) support to the quarantined workers, motivation for disclosure through direct cash transfer to the family members of the quarantined workers in order to compensate them for the lost wages of the quarantined (incentivized and wage compensated quarantine). No naming and shaming of the quarantined and their family members would be acceptable.
Name the quarantines as places of community care and provide top class hygiene facilities. Essentials and food would have to be appropriately supplied to the people under quarantine and their family members out of quarantine run by NGOs / CBOs / CSOs. Employment guarantee to those left behind family members who can work to make a living and cash support for non-earning pivotal adult family members consumption is the way ahead.
Opening up of the space for democratic politics
During the lockdown period the political opposition to Modi demonstrated lack of confidence. The politics got suspended. The BJP did open politics. They chose to stigmatize corona virus. Modi has failed the country. Even the government’s experts have started speaking. The number of outbreaks and hotspot areas is growing. The authoritarian leadership is caught in a vicious cycle. The lockdown 3.0 is informed by the approach of there is no alternative (TINA syndrome which was used to implement the policy regime of economic liberalization, privatization and imperialist globalization). The problems with the choice of the pathway of total lockdown are becoming obvious.
The open politics on the part of forces opposed to Modi is getting started. Opening up of the space for democratic narrative on coronavirus containment is essential. The political opposition to Modi will have to change the fearful cognitive mindset inhibiting emergence of systemic thinking enabling a more fruitful and democratic response for the alternate strategy to materialize. Can we seize the moment? How to break the chain of thought which is fueling undemocratic and unsustainable approaches to the governance of pandemic locally in India is the moot point? The political opposition to Modi will have to criticize openly the approach of arbitrarily declaring the whole living or working space as hot spots and waiting for the areas to become COVID free zones. This approach is taking way the civil liberties of the people as a whole.
The authoritarian political narrative is squarely responsible for damaging the livelihoods of the poor. Participation of the neighborhood area / sector / mass and class organizations / social groups-based organizations in the governance with guidelines can help in bringing this virus under the control of people. Poor residents of densely populated areas need to be supported in housing and getting declared as safe green and healthy workers. The virus of social apartheid, stigma and prejudice associated with the threat will have to be contained by opening up the space for democratic politics.
The demand for legislation which will provide for the employers of domestic workers and work spaces employing informal workers to formalize and register contracts and the employers and government jointly taking the responsibility of providing the workers with social protection through the formation of labour welfare boards for all types of occupations and categories of workers. They should be given necessary support to get themselves declared as green workers capable of working in a safe manner in any kind of work place. Working people should be allowed to work with all the precautions and be provided with the appropriately chosen protective gear in the workplaces.
Democratize expertise
The authoritarian political narrative is misrepresenting the sources of crisis caused by coronavirus. With the poor choosing to come out on the street in several large cities are confused and uncertain. The cost of total lockdown for the economy is borne by the poor. They are now coming out on the streets. They are being sent them back to places where it is difficult to live safely. The democratic leadership required for corona governance needs open political spaces to bring down the fear, reduce uncertainty and organize the people for the demonstration of social solidarity beyond providing food for survival. Peoples’ participation in the proposed collaborative efforts required to be undertaken for the implementation of alternate strategy of containment of coronavirus should be encouraged. The people need to be organized through the peoples’ solidarity committees. Purposeful contestations need to be actively encouraged on the way forward on all the relevant fronts-be containment, relief, rehabilitation and reconstruction.
[1] The Communist party of India (Marxist) has reached out to other opposition parties to bring them on a common platform to deliberate on the adverse economic fallout of the lockdown imposed to contain the spread of the COVID-19 pandemic. CPI (M) general secretary Sitaram Yechury said the Union government was getting clueless, and so on (May 5, 2020, The Hindu, Delhi Edition).
[2] See the Edit Page for the write up by Pranab Dhal Samanta entitled “Lock Down on Viral Politics” by in the Economic Times (p 10), the write up by Jacob Koshy with headline “States with high swine flu rate record most COVID-19cases) that points out how the cases of swine flu are already emerging and the same five COVID-19 states also account for majority of H1N1 infections. As per the Ministry of Health and Family Welfare data, the H1N1 virus killed 981 people in 2009 and 1,763 in 2010. The mortality decreased in 2011 to 75 but claimed 405 lives in 2012 and 699 lives in 2013. In 2014, a total of 218 people died from the H1N1 flu. Event post the outbreak, the Ministry data reveals that due to swine flu, the country recorded 265 deaths in 2016, 2,270 in 2017, 1,128 in 2018, 1,218 in 2019 and 28 in 2020. The WHO has declared COVID 19 to be ten times more dangerous than H1N1.
[3] The first set of 6600 cases occurred in 70 days. The latest set happened in 4 days (Hindu, May 1, 2020). Arvind Kejriwal, the CM of Delhi also went ahead to state that the city needs to learn to live with COVID-19, and the space for alternate strategies needs to be opened up and we should be more granular, with focus on the strategy of local hotspot areas containment as the way ahead.
