The ultrastructural morphology exhibited by the 2019 novel coronavirus. Photo: Alissa Eckert, MS; Dan Higgins, MAM/CDC/Handout via Reuters.
Earlier this month, the WHO designated the coronavirus outbreak a pandemic. The Government of India government subsequently declared it a “notified disaster”, allowing the state-level disaster relief funds to be used to care for quarantined people. The Union health ministry has also undertaken social media campaigns and issues messages about measures like hand-washing and social-distancing in English and Hindi. Health minister Harsh Vardhan also took to Twitter to share these messages
Such efforts are commendable considering hand-hygiene prevents most infections, including such as tuberculosis and the flu. However, merely sending such messaging is not enough. These campaigns have to be backed by resources for the poor and the marginalised. For one, the messages emphasise the widespread use of hand sanitisers but sanitisers don’t come cheap. The Indian government has invoked the Disaster Management Act to regulate the price of sanitisers, gloves and surgical and non-surgical masks to ensure they’re not sold above the MRP. However, the MRP itself isn’t low enough to begin with for many of these products.
A 100-ml bottle of hand-rub costs Rs 230-300. If used regularly, it will likely last 8-10 days for a family of five. According to calculations by economist Surajit Das, of the Jawaharlal Nehru University, based on the periodic labour force survey 2017-2018, the average monthly income of Indian workers is Rs 9,874. So spending Rs 750 or more just on hand sanitisers is not affordable for most Indians. Adding soap to the picture only makes it bleaker, not brighter.
Similarly, while washing hands multiple times a day looks easy, few households in India can really do so. According to the census, only 43.5% households in 2011 had tap water inside the house. So when more than 50% of households in the country don’t have taps at home, how can the government expect everyone to regularly wash their hands? And these figures don’t include people who live on the streets and in shelter homes but are equally exposed to the virus.
Social-distancing as a message has a similar class bias. Most poor people, especially in urban slums, stay in highly cramped spaces. According to the 69th round of National Sample Survey, 8.8 million households in urban areas exist inside slums in India. While there is no authentic data about the population density in slums, it is common knowledge that in most cases, five or five people occupy a room which that also includes space for a small kitchen. The houses are also built close to each other. In these conditions, residents of slums cannot practice social distancing effectively.
As cinemas, universities, schools, restaurants, etc. shut in cities, we are heading towards a virtual lockdown in many parts of the country. Most offices in big cities have issued mandatory work-from-home notices. Cities like Raipur have also shut down businesses in crowded places. Many parts of the country currently restrict the number of people who can gather in a public place at any given time. A lot of daily-wage earners associated with them stand to lose work for weeks to come.
Effectively, the health ministry’s advisories will work only for those who have financial stability and proper housing. And while better housing and tap water can’t be provided overnight, consumables such as hand sanitisers and soaps should be provided for free or at least at subsidised rates. This will go a long way in avoiding community transmission.
Taking cognisance of this aspect, the Delhi government recently started setting up wash-basins at different locations around the city. Similar policy measures need to be adopted by other governments, including the Centre.
Organisations working on public health and among women are already demanding for food security for the poor. A statement issued by the Jan Swasthya Abhiyan and the All India People’s Science Network acknowledged economic hardships faced by the poor to ask for greater social and food security from the government.
Labourers in the unorganised sector and daily-wage earners, a large number of whom are women, are finding it hard to put food on the plate at home. Under-nutrition will only lower their immunity and render them more susceptible to being infected by the new coronavirus. The All India Democratic Women’s Association has asked the Centre to release the 7.5 tonnes of food grain stock to states and ensure that the grains reach the vulnerable populations free of cost.
Kerala remains the only state thus far to have responded to such a fundamental need. It has ensured that underprivileged children continue to have access to midday meals by delivering rice, wheat, beans, oil and snacks to their houses through the Integrated Child Development Services programme. It is also providing additional support for children younger than 3, lactating mothers and pregnant women.
Finally, the Centre has also failed to address the issue of populations at risk. Most efforts thus far have been focused on stopping transmission by testing and following up with people who recently travelled abroad. However, people with low immunity such as those living with HIV, need more support as they are more likely to be affected by COVID-19. The WHO has also said people with diabetes, asthma and heart disease are more at risk of becoming severely ill if they contract the coronavirus. Similarly, people using wheelchairs have a unique problem as the wheelchairs has many surfaces that are regularly touched by different people. There is a need to map such vulnerable groups, reach out to them and provide services and consumables designed specifically for their circumstances.
Jyotsna Singh is a Delhi-based health writer.