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Public Health Needs the Public, Modiji, but it Also Needs the Government

Public Health Needs the Public, Modiji, but it Also Needs the Government

Prime Minister Narendra Modi’s address to the nation today was a combination of sound if incomplete public health advice and dramatic appeals to civic consciousness, even as it lacked what many had hoped he would provide – an authoritative account of how the government intends to deal with the challenges of testing, treatment and tracing that the WHO says are as important as isolation.

It was a speech designed for the middle class, with Modi saying all the right things to ensure their cooperation in containing the spread of the new coronavirus, officially called SARS-CoV-2. But there was very little for others, especially the vast majority of Indians who cannot work from home.

Most of all, he said nothing about how his government is handling the situation today and how its response might evolve as the Indian Council of Medical Research’s deadline for stage 3 of the epidemic – marking the potential advent of community-transmitted cases – approaches. In the final analysis, he took no responsibility for what his government’s actions need to be and focused instead on what everyone else should do, as if aware that a closer look at the state’s response to the virus’s spread would immediately throw up problems.

Notable among Modi’s pronouncements were the appeal to salute members of the service sector (something people in Italy, Spain and Norway have been doing), to not crowd hospitals, to not hoard, and to understand the link between personal and public hygiene.

Thus far, 168 people in India have tested positive for COVID-19, the disease caused by the new coronavirus. And thus far, the ICMR, which has been spearheading the national response, has maintained that India is free of community transmissions (CT). Instead, according to the body, all 168 cases in India are the result of people having recently travelled abroad or people coming in contact with those who recently travelled abroad (called ‘imported cases’ and ‘local transmission’, respectively).

This claimed absence of CT cases is the difference between the thousands of cases being reported by high-risk countries like China, Italy, Iran and Spain and the minuscule number that the ICMR has reported out of India. Many experts and other observers have expressed the fear that India could simply be suppressing its count by manipulating the way it does, or doesn’t, check for CT cases. But the fact remains that the country – whether as a consequence of being in denial or not – is more apprehensive than panicked.

This is the context in which Modi delivered his speech. And he directed his words at the slice of society that is now more likely to cooperate – and whose cooperation could substantially ease the burden on a public healthcare system stretched thin.

Also read: Four Reasons It’s Hard to Believe India Doesn’t Have Community Transmission

His words on matters like giving the house-maid paid leave, not queueing up in hospitals for minor issues and, importantly at this hour, not hoarding essential supplies could very well make an important difference among those who have been reluctant to trust media reports on the same things. In fact, it was gratifying to hear Modi even touch upon something as uncommonly discussed as delaying elective surgery.

At the same time, some of these solutions are the proverbial band-aids in place of more drastic measures. For example, Modi asked people to get on their balconies and doorsteps for five minutes on March 22 and clap their hands and ring bells to express support for people who serve others instead of themselves, including hospital staff and sanitation workers. Leaving aside the risk of unnecessary social contact when people come to their doors, particularly in poorer neighbourhoods, the prime minister ought to devised – or at least promised – more direct forms of support for those on the frontlines of the battle. Many of these people regularly work in crowded places, often long hours, frequently lack personal protective equipment to keep them safe, don’t have institutional access to paid leave, can’t avail reimbursements for medical expenses, etc. Five minutes of public cheering is great, but what they need is an assurance of official support.

Other topics conspicuous by their absence included the need to keep the virus away from rural India, where access to – and quality of – healthcare is even poorer than in cities, and where social distancing is unlikely to work; a commitment to quickly expanding the availability of hospitals beds and isolation wards to accommodate a higher case-load; the absence of a national task force to front a multisectoral response to the epidemic; the absence of a national policy on stockpiling important medicines and equipment for public health emergencies, especially for medical workers – and getting his ministers in line so that they stop spreading dangerous myths and rumours. Just today, for example, the minister of state for health made the nonsensical claim that standing for 20 minutes in the Sun could kill the virus.

Apart from his call for applause for health workers, the other concrete step Modi announced was a voluntary lockdown – that he called a “janata curfew”. He exhorted everyone in India to remain at home from 7 am to 9 pm on Sunday March 22 and hinted that this exercise would prepare them for greater challenges to come. He could very well have meant longer curfews – janata or even official – to be imposed around the country in future.

Despite the frightening ease with which his government has resorted to dictatorial measures such as in Kashmir and against anti-CAA protestors, the COVID-19 epidemic in the country offers an arguably legitimate opportunity to demand that people keep off the streets. Perhaps Modi understood that if he had said outright that his government was actively considering an official lockdown, people might have had reason to be troubled by it.

The ‘janata curfew’ call is also a useful way of instilling confidence in the people that this government knows what it’s doing. Thus far, of course, the ICMR’s actions have been the only expression of the government’s strategy and they haven’t been inspiring confidence.

It is significant that Modi didn’t speak at all about what the health ministry, the National Centre for Disease Control and the ICMR have been up to – and that is because the speech was driven as much by political impulse as by public health concerns. Multiple public health experts have expressed worry that India may simply not be testing enough people so as to continue to maintain that the country doesn’t have any community transmissions. But when the heads of these bodies have been expected to provide answers, they have often offered confusing ones, contradictory ones or stayed silent. Modi’s silence on these issues was, therefore, not surprising,

If the government could just fix its communication strategy – or, better yet, acquire one – the people needn’t have had to wait with bated breath for the prime minister to give them the updates they desperately needed.

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