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India’s Health System Is Caught Between COVID-19 and the Monsoons

India’s Health System Is Caught Between COVID-19 and the Monsoons

The onset of the southwest monsoons in India from June 1 will also mark the onset of a new set of issues for the Centre and state governments to deal with. Perhaps the most important among them are water- and vector-borne diseases. Every year, India prepares to receive the monsoons’ rains but every year, a substantial number of people die due to infrastructural damage and loss of livelihoods. This year, the monsoons are likely to be the hammer slamming into India, against the anvil of the novel coronavirus outbreak.

In all states barring Jharkhand and Mizoram, diarrhoea is the most common disease during the monsoons, followed closely by typhoid and viral hepatitis1. Dengue, visceral leishmaniasis (kala azar), chikungunya and swine flu are the other more common ones in decreasing order of severity.

The health capacity index – which indicates the status of a state’s medical infrastructure and human resources available to deal with patients – vis-à-vis the annual burden of monsoon diseases brings to light a cluster of states that could be in particular trouble once the rains arrive. These states include Andhra Pradesh, Odisha, West Bengal, Karnataka, Telangana, Rajasthan, Gujarat and Chhattisgarh.

What’s more disturbing is that most states in this cluster have also recorded a large burden of active COVID-19 cases, with a high growth rate in the last few days. In addition, the low burden of monsoon diseases in states like Bihar, Uttar Pradesh and Jharkhand, whose health systems are widely known to be beset with quantitative and qualitative issues, could be the result of under-reporting and testing. Their low literacy rates also suggest that their people are likelier to resort to unproven ‘traditional’ medicines and therapies as well as over-the-counter drugs, instead of consulting a doctor or getting themselves tested at a hospital.


India’s COVID-19 case-load curve is expected to peak around mid-July, i.e. during the monsoon season, according to one model. Even if we assumed that the rains, winds, etc. won’t materially affect the spread and severity of COVID-19 in India, the combined disease burden will still be high. Further, the symptoms of many of these diseases are similar to those of COVID-19, which could spawn gratuitous consternation in some and complacence in others. The resulting panic, stigma and exclusion can be devastating for a country already dealing with many epidemics.

One quick fix is of course large-scale testing. This will require sizeable infrastructure, skilled and efficient medical personnel and money for the testing kits. But in their absence, India’s hospitals are likelier than not to become overcrowded (Mumbai has already run out of hospital beds), endangering the health of other patients admitted for other ailments.

So as such, the Government of India is stuck between the devil and the deep sea, and may even have to brace for a surge in its COVID-19 case-load.

Going ahead, private hospitals, district and sub-district hospitals could be tasked with tackling coronavirus cases, freeing up small private clinics, and primary and community health centres, to treat monsoon-related illnesses as well as attend to general healthcare issues (including maternal and child care). Second, the government should ensure those already on the margins of society, such as families below the poverty line, have food security and access to affordable, good-quality healthcare.

Next, water-borne diseases are more prevalent than vector-borne diseases during the monsoon season. So it’s important to prevent water from stagnating in densely populated areas and to chlorinate water bodies before the monsoons arrive. Physical-distancing norms should be redrafted for conditions in which people may have to come together, such as in storm shelters and for relief efforts. At no point should the people have to forsake heathy food habits and personal hygiene, so in addition to disinfecting public spaces, governments should ensure masks and sanitising products are easily available.

Monsoon weather in Kerala, June 2011. Photo: kamaljith/Flickr, CC BY 2.0

Even more broadly, it’s important for the state to decentralise its powers and empower more local governments, including district officials, to make context-specific decisions at the block level. Their responsibilities should be properly separated and defined to keep any issues from falling between the cracks.

There should be a special focus on areas that have a high incidence of monsoon morbidities as they may also turn out to be hotspots for coronavirus cases. Finally, governments need to invest more in R&D projects that investigate the meteorological conditions that give rise to and help spread monsoon diseases, that can help predict the onset and spread of infectious diseases, and that can respond in an agile way with prophylactic, curative and convalescent therapies.

Pankaj Kumar Patel, Nand Lal Mishra, Akancha Singh and Mahadev Bramhankar are research graduates from the International Institute for Population Sciences, Mumbai.

  1. In Jharkhand and Mizoram, the disease-in-chief is malaria.

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