Social Distancing Poses Unique Challenges in a Country Like India

On March 17, while Italy reported 3,526 new cases and 345 new deaths and Spain and France were under a lockdown resembling war time conditions, life in Delhi appeared to be carrying on as before.

Granted, India was still at Stage 2 of the coronavirus pandemic, at which if a person gets infected with the coronavirus we can trace the source of their infection and the persons they might have exposed themselves to. And yes, the WHO had lauded us for our early and robust response – which included suspending travel from Europe and other affected countries, in addition to closing schools and colleges and banning gatherings of over 50. 

But still, I wondered, how much of our personal behaviour had truly changed to reflect this new and unpredictable world into which we were all entering? How ready were we as a nation for what was to come?

On my street, at the local temple there was still a line of people, pressed up against each other. The crowd was less than before perhaps, but not by much; and even though a few people had flimsily thrown on a mask, nobody was attempting to keep a physical distance from the person next in line. Farther ahead, a passerby coughed up a blob of spit which he released onto the street with an air of practice.

In normal times, I wouldn’t have noticed any of this, but nowadays nothing about the world is normal. From the radio and TV, to social media and chatter among friends, warnings about the coronavirus pandemic are ubiquitous. And while most people understand that COVID-19, primarily transmitted through virus in respiratory droplets, is a disease that disproportionately affects the old and the weak, I seriously wondered whether we as a people appreciated the severity of the situation.

Did we really comprehend transmission risks and what social distancing entails? How are we to maintain physical distance from one another in a country where personal space is the luxury of but a select few? Moreover, how do you make people change inveterate habits of resorting to quackery into a trust only in hard scientific facts?  If my WhatsApp was anything to go by – chockfull as it is with cures ranging from turmeric and lemon to reciting the Hanuman Chalisa and abstaining from chicken – our collective sense of preparedness looked dangerously bleak.

I spoke with Dr. Giridhar R Babu, Professor and Head, Lifecourse Epidemiology, Public Health Foundation of India (PHFI), Bengaluru by phone about some of these concerns. 

“The cultural setting in India is such that people have their own understanding about how their health should be”, he said. “60% of people go to private consultants outside the government system. And this is not just in urban settings. So how do you make them change? You can’t.  You can ensure you give enough information to every household. And that people get tested and learn how to isolate themselves. These are the messages which must be disseminated, fast. Advertisements to wash your hands, though important, sometimes simplify a complex exercise into a ‘product’ so that people can understand it and for this I don’t really blame the government. But testing and isolation is of paramount importance. And it is just not happening. 

Disaster Response Force worker sprays disinfectant as a precaution against a coronavirus outbreak at public places, in Hyderabad, March 20, 2020. Photo: PTI Photo

“We as a culture cannot fully understand isolation and quarantine. It is not how we live”, he continued. “While people in the upper socio-economic brackets might be able to follow this, they too will also be constrained by what happens in society at large. The majority of Indians, and especially those living in crowded settings like slums in Mumbai and Delhi where lakhs live in close proximity – for them separating themselves beyond a space of 1 meter is just not feasible. And that’s just the physical aspect of it. By social distancing – which means you should not attend meetings and parties – people may start viewing each other with suspicion. The rich might look suspiciously at their drivers or maids. What if they contract the disease? And this in a way also absolves the government of its own responsibility, somewhat. They can say, we have told people and if they are not careful what can we do?  

“At least if people have symptoms then they can be isolated and the government can come up with space for this purpose. Space that is hygienic and orderly. Such community areas need to be identified and built. It requires a mobilisation of resources and a sense of collective responsibility. Where we are right now, this is the only way forward. Because to me it seems that entering Stage 3 of the epidemic is inevitable and we are just not prepared for it”. 

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At the Café Coffee Day in Bengali Market in central Delhi many of the usuals were absent. The server, Neha, said to me giggling, “Since this corona-vorona news has come, business has dropped.” Yes, there was a hand sanitizer placed on the counter now, but it appeared that for many, the idea of social distancing was more amusing than pressing. And this lack of urgency was hardly the preserve of a certain age or socio-economic group either. My own parents, well-educated and both over 70 (and therefore at risk of developing severe disease if they became infected), had laughed away the idea of staying indoors. My mother said, “What will happen, will happen. When you’re 70, you’ve lived your life. I’m just relieved the virus is not seriously affecting young people like you”.  

The manager at a hair salon in South Delhi told me there had been a reduction of customers by 80% in this past week: “Even though we are sanitising the parlour the whole day and I have given my staff gloves and masks for their safety”. 

“I have also told them that if anybody feels ill, they are not to come, but there is so much fear around that if before we would get 35-40 customers a day, now it is only about 8 or 10”, he said.  

And he wasn’t the only one suffering a business setback. Everybody was. Noor Mohammed, a butcher in Delhi’s Gandhi Market told me that people had stopped buying chicken owing to rumours on WhatsApp that it was responsible for causing COVID-19. He was now forced to sell his produce at less than half price, at Rs. 80 a kilo. 

It was plain to see: if the disease hits the poor the hardest then, with the attendant epidemic-induced shrinkage of the economy, it would hit them doubly so. 

In a country where so many live a hand-to-mouth existence, should daily wage earners think first about their next source of bread or about keeping a physical distance from other people? And how would distancing even be possible when millions employed in the informal sector as maids, cleaners and workers, depended on jobs that required them to work in close proximity with others? 

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“At our stage in the epidemic”, Dr. Giridhar R Babu said, “a lockdown would anyway be a temporary measure and when it is lifted, the disease could rebound and then escalate. This is why the strategy should be to find the infected and stop the spread. And only testing will work. We are not testing and reporting enough”.

People board a train in Thane. Photo: PTI

“It’s a silent bomb and we are just not worrying enough. That Maharashtra has reported cases is actually a good thing. The public health system in Mumbai is really strong. But nobody is congratulating them. Why? Gujarat on the other hand has the highest per capita NRIs but they have not reported a single case. West Bengal also has no cases. This is very hard to believe. 

“Do we have a plan on how each state will manage the situation 10 days from now? I fear the way things are going everyone will get it. And it’s true, even if the severe cases are few, in India a ‘few’ means lakhs and lakhs of people. It is only a matter of time, and our health systems will not be able to cope. From Europe and China, we know that at least 5 percent will require critical care and this means having the requisite number of hospital beds available. In the US, they have 30 critical beds per 100,000 people. In China the number is 3.5. In India it is about 2.

“And we know that in the first 3 or 4 weeks, there is not much transmission. So right now, we are too early in the phase of outbreak. Maybe in another 10 days, we will know how things will unfold — if we do testing. If we do not change the case definition, then how will we really know? This is why declared cases will continue to be low. But community transmission is inevitable”.

He sighed. “In our country, people want convenient answers.”

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On March 18, there were more definite signs of the mood in the capital shifting to a somber rhythm. Every fourth person was wearing a mask, and markets, restaurants and shops were devoid of bustle. When a group of 10 men gathered around a street hawker, a house guard ran over and yelled at them to quickly disperse. But this was in a relatively affluent South Delhi neighbourhood. What was the situation elsewhere in the city and country? 

How do you change a collective psyche? 

I spoke to Dr. Pradeep Seth, former All India Institute of Medical Sciences (AIIMS) Virology HOD, and he gave me a more sanguine picture. 

“We are still in stage 2 right now. So there is no community transmission. But we have to be strict about preventing the country going into stage 3. We can request people not to go to restaurants and parties. And schools have also been closed. Like Korea, sanitisation of trains can also be done, and so on. But we have to take care of the daily needs of the people also”, he said.

“When you want to implement measures, the role of the community is very important. The community has to come forward. The government can’t police everything. We are not a dictatorship. That cannot happen in India. Educated people must step forward”. 

When I asked him how we were to do this, he said: “Rumours are not spread by the common man on the street. He is too busy earning his daily bread. They start with educated people, and still 99% of WhatsApp and social media is all full of nonsense. Some people say, eating onion will protect you, some people say prayers will help you. As a person of science I say these are mere home remedies. If reading the Hanuman Chalisa or some other prayer gives you mental strength, then do it. But if the government says, do not party, then we should not. Why are there still congregations of people at marriages?  For some time, we should stop this. We must look at the bigger picture.”

Dr Seth said that his reading as a doctor was that “when a poor man has a cough he will go to the doctor first. At AIIMS there is a huge queue of common people, because it directly affects their livelihood. So it is important for privileged people to consider that if they may be able to quarantine themselves in their homes this step not only protects them, it also frees up resources for the less well-off. For example, health care workers may get time to spread awareness in low income, congested areas only if the educated people in this country cooperate and ease the overall burden”. 

How likely was the country to enter stage 3, in which local community transmission starts occurring like in Italy? Dr. Seth said that his gut feeling was that we would be able to contain the epidemic at stage 2. While the WHO has said that hot weather would make little difference, Dr. Seth was of the view that “there is a possibility that with the summer, the transmission rates will dip. Because the virus doesn’t do well in a hot and dry climate. But if the environment is wet with moisture around, it can survive. In cool and air conditioned spaces, the virus can survive. The climate in Europe and China is cold and this maybe working against them. But as you go towards the equator, the number of cases has reduced. We have to see what is the epidemiology in those countries”.

“Another thing to be hopeful about is that whenever a virus crosses over species, like this has come to humans from bats who are its natural host, it will have some change in genetic material. For example, the influenza virus comes from birds to pigs. And from pigs to humans. We have cells, and every cell has a receptor to which the virus attaches itself. Hardly any cases come directly from birds to humans, and when they do, sustained transmission doesn’t occur. Yes, the noel coronavirus is a different virus. But like SARS and MERS, also coronaviruses, the epidemic will eventually die down, I believe”. 

People buy protective masks in wake of coronavirus (COVID-19) pandemic, in Srinagar, Thursday, March 19, 2020. Photo: PTI

“What happened to Ebola and Nipah? They all jump species, cause an outbreak and then they eventually die down. Let’s hope for the best,” he said.

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On March 19, there was news of a 20-year-old man from Delhi with no travel history or contacts testing positive for the novel coronavirus in Chennai, raising the ominous possibility of local community transmission of the disease taking place in India.

Nevertheless, while countries both to India’s east and west are reeling from the pandemic with their hospitals overwhelmed and cities shuttered down, thus far we in India have been inexplicably untouched from its worst effects. 

Before I hung up the phone, I asked Dr. Giridhar Babu one last question: What are the things I could personally do to help contain the spread? 

“You could ensure you don’t expose more vulnerable family members to the disease by keeping a safe distance from them, for example”, he said.

“And you could use social media to spread awareness, information, facts.” 

I thought about what my mother had previously said to me. While her remark seemed careless at first, I realised it had actually come from a place of selflessness; from love and concern for her children and grandchildren rather than a sense of self-preservation. But would the privileged and healthy youth (the demographic least likely to be personally affected by the disease) rise to this occasion in selfless ways?

Epidemics we know are great, awful upheavals and it is our individual choices that can make all the difference. For every selfish story I was hearing (for example of people in the US buying guns.) there were many more ones about the courageous men and women all over the world putting their lives on the frontlines of this fight against the virus. 

While the world first blamed China (before going on to praise it), the Chinese were now blaming the US army for starting the epidemic; and while many Europeans (among others) were hurling racist slurs at the Chinese, they might very well find themselves the victims of reverse racism in places like India today. So much for prejudice and pettiness. 

But just as people are intractably people, so too is a virus just a virus. 

It doesn’t discriminate between class, caste or age, race, nationality or religion. The only thing it knows how to do is to attach to a human host and multiply. And the only thing that can stem its exponential multiplication is for us to rally together as one people, one country, one world, under the unified and determined leadership of our medical and scientific experts.

Today, we are all Wuhan, we are all Italy.

Siddharth Kapila is a lawyer-turned-writer at present working on a travel memoir on Hindu pilgrimage sites.

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