India Enters Covid Top-10; What Should Spook Us Is Not Headline Number, But Staying Ahead Of Curve

On Monday (25 May), Indian skies opened up to domestic flights, signalling the steady return to “normal” activities. Almost as if on cue, India entered the top 10 list of countries in terms of confirmed positive cases of Covid-19. It is entirely “normal” for infections to rise as economic activity picks up.

According to data compiled by John Hopkins University, India, with 138,845 confirmed cases, replaced Iran with 135,701 cases at No 10. There is no reason why by end-June or mid-July we will not be in the Top 3. No 3 right now is Brazil with 363,211.

We should be concerned, but not spooked. It is “normal” for a country with the second largest population in the world, and soon to become No 1 (China is just 60 million people ahead of us), to have high absolute numbers in Covid-19.

Instead, what we have currently is about 2.5 per cent of the world’s cases, when we have 17 per cent of the population. One can quibble and point out that we are testing too little (but we are nearing three million tests), or that asymptomatic cases are four times as many as the symptomatic ones. But even if you assume that our actual infection levels are five times the current number, we would still be doing okay compared to our size.

What should spook us is our alarmism. The rising headline number of infections matters less than our preparedness to handle those numbers.

We should expect a big spike in the coming weeks for three reasons: the decision to revive economic activity bit by bit; the steady stream of migrants now returning to their regional homes; and lockdown fatigue, which makes us more willing to take risks with the preventive safeguards prescribed.

The abandonment of caution is our biggest risk as we open up and leave our homes. The hand-washing, mask-wearing and physical distancing routines that we have tried to maintain so far will become unsustainable as we return to normality and go back to our workplaces, travel by bus, train and air, bring back domestic help to our homes, and start jogging in the park.

Keeping 1.38 billion people cooped up in their homes was always going to be an impossible task after the initial weeks of novelty. At the beginning of Lockdown 4.0 this is more than apparent. Every time a migrant train is announced, physical distancing goes out of the window as thousands push and pull to get a ticket. There is no kirana shop, liquor vendor, departmental store or food distribution camp where social distancing is maintained consistently. Masks are also coming off, and hand-washing routines are reducing as excess washing dries up the skin.

This implies that we have to consistently drill the message that caution is even more important as people start moving about. Physical distancing may be tough to maintain for the poor and we Indians anyway follow what is called the “elbow push factor”, where any queue where the physical space between one person and another is more than an elbow’s length will quickly be narrowed. This is because people behind us will press forward to force us to close the gap, or someone will cut into the queue thinking there isn’t one. “Do gaz ki doori” is a pipe dream, and possible only in public parks and underpopulated villages.

The next priority should be a constant escalation of healthcare facilities for the next one year, as the Covid-19 numbers keep soaring before a vaccine is found. We have to make up for 70 years of underinvestment in public health, and this should be seen as an opportunity to refocus public and private investment towards low-cost healthcare. As long as our ability to handle Covid-19 and also the other diseases (tuberculosis, diabetes, heart disease, etc) stays ahead of our infections rate, we are fine.

What should also worry us is that our cities are grossly underprepared to deal with a health crisis. Clearly, the business of eliminating slums and providing alternate housing for the poor in cities must take top priority, as also an expansion of public transport so that minimal physical distancing is maintained. Right now, public transport is packed to the gills.

The rising numbers should not matter too much. What matters is whether we are ahead of those numbers in terms of our ability to handle the sick and infected. And have begun work to improve public housing and transport.