Covid-19: What you need to know today
On May 30, Hindustan Times published a news report about more babies being delivered at home in villages and towns in India’s hinterland during the lockdown that ended on May 31. There are still some restrictions on movement and activities but things are very different from how they were during the lockdown and the government itself likes to refer to this phase as Unlock 1.0.
The data on deliveries provided by some of the states bears out what anecdotes have been suggesting for some time — the lockdown, and the focus of the health care system and frontline health care workers on Covid-19, meant that a lot of routine health care work had come to a halt. There’s nothing as routine as births (India’s big success at reducing maternal and infant mortality has come on the back of its years-long effort to make sure more children are delivered in health care centres and hospitals, not homes). And there is nothing quite as routine as immunisation. HT’S health editor Sanchita Sharma tells me that there is little data available on immunisation activity over the past three months — the states seem to have stopped collecting and uploading it. Anecdotally, at least, there are suggestions that like many other things in health care not connected to the coronavirus disease, immunisations have ground to a halt (see page 6).
That could be disastrous. And its impact could play out over years, affecting the health, development, intellectual abilities, even economic prospects of an entire generation.
This shouldn’t surprise anyone. India has consistently underinvested in health care. It was only in 2018 that the government thought a nationwide health insurance scheme was needed. The country’s health infrastructure is inadequate and creaking; and there is a huge shortage of health care workers — doctors, nurses, epidemiologists and technicians. Indeed, this could prove to be the weak link in the huge exercise the Union and Delhi governments have undertaken to make more hospital beds available to Covid-19 patients in the Capital, which is seeing a surge of cases (42,829 cases; 30% of its total number of cases as of Monday night were added in the past week). Star hotels, banquet halls, railway coaches, even large prayer halls (one in South Delhi can accommodate around 10,000 people) are being converted into temporary hospitals. The important question is: where will the doctors and nurses come from?
The state of India’s health infrastructure — to their credit, the country’s health care workers have stepped up, and worked tirelessly, often at great risk to themselves over the past three months — may well be one reason why the numbers of cases and deaths continue to increase in India. The country ended Monday with 342,902 cases, of which 152,898 are active, and 9,915 deaths.
A recent article in The Wall Street Journal described the situation in Peru (where the number of cases is falling), which still has over 100,000 active cases (for comparison, India has over 150,000) and which, like India, was quick to impose a hard lockdown. Peru announced its lockdown in the middle of March. Yet, it has seen around 230,000 cases of Covid-19 and close to 6,700 deaths. The actual number of dead could be higher by a few tens of thousands, WSJ reports.
Peru’s per capita national income is around $7,000, compared to India’s $2000. Both are countries with thriving informal economies, poor health care systems, and inadequate social safety nets for the most vulnerable. Inequality is high in both countries.
The conclusion is inescapable: perhaps India’s hard lockdown would have worked better if the country had a better health care system and a wider and generously cushioned safety net. That’s a question for policy-makers to ponder when they sit down to discuss their post-covid priorities.