India has been under a lockdown to stem the spread of the coronavirus for two months. On March 25, the first day of the lockdown, India had 618 confirmed cases and 13 deaths.
As India is easing the lockdown now, it has more than 151,000 cases and more than 4,300 deaths — a much smaller number compared with the fatalities in the United States and various European countries, with a much smaller population. The cases rose from 100 to 100,000 in the United States in 25 days, in Britain in 42 days.
In India, which had the longest and strictest lockdown, the rise in cases from 100 to 100,000 took 64 days.
It may suggest the success of the Indian government’s strategy, but the almost similar trajectory of spread of the virus and fatality rates in Bangladesh and Pakistan suggests that other factors have had a considerable role to play.
Of the 30 countries that have registered more than 25,000 coronavirus cases, India, Pakistan and Bangladesh are among the countries with the lowest levels of testing per million people, which raises questions about whether statistics on the slow spread of the pandemic in South Asia are a result only of the lack of testing.
But the low fatality rates in South Asia seem to be real because no evidence has surfaced of large-scale underreporting of deaths across India, Pakistan and Bangladesh. It seems that a major factor explaining the lower fatality rates in South Asia is demographics. The median age in India is 29 years, 23 in Pakistan and 27 in Bangladesh, while the median age is 38 in the United States, 40.5 in Britain and 45 in Italy.
Data from New York City indicates that 73 percent of all coronavirus deaths have occurred among patients who were age 65 or older. Only 5 percent of the Indian population falls in this age group, as opposed to 16 percent of the American population.
The rate of hospitalization and death has been lower than in Europe and the United States. In Britain and Italy, the percentage of deaths among coronavirus patients has been 14.4 percent and 14 percent, while it has been 3.3 percent in India and 2.2 percent in Pakistan, where the median age is 22.8 years.
The most significant question now is whether the government has made adequate use of the time the long lockdown bought it to prepare for the problems that lie ahead. The number of cases is rising steadily and is expected to continue to rise as the lockdown is now being lifted in the face of increasing pressure on the economy.
India’s health minister has claimed that India has 31,250 intensive-care unit beds, which is up from 9,500 at the beginning of the lockdown. The health ministry said earlier that 4.8 percent of Covid-19 patients have required the intensive-care unit beds. It suggests that coronavirus cases would have to increase fivefold for India to run out of beds to treat patients requiring critical care. But aggregate data does not take into account the fact that the infections are not evenly spread across the country.
A staggering 60 percent of the coronavirus cases in India have been reported from five cities — Mumbai, Delhi, Ahmedabad, Chennai and Pune. India’s commercial capital, Mumbai, and Pune are already running out of hospital beds for critical patients. Mumbai is the worst hit and accounts for more than 20 percent of all cases, and the rise in cases is outpacing the ability of the city to ramp up its health infrastructure.
In the western state of Gujarat, Mr. Modi’s home state, the situation is equally grim. By mid-May public hospitals were already full and certain privately run hospitals were trying to exploit the pandemic by charging exorbitant fees to patients. The Gujarat High Court intervened and remarked that “an ordinary man will never be able to afford to avail adequate treatment from a private hospital,” given the fee being charged.
The high court pointed out that the most glaring problem with Mr. Modi’s badly planned lockdown was the crisis of hunger it had unleashed among India’s migrant workers and the poor. “They are not worried about the virus,” the court remarked. “They are worried about food.”
The starkest failure of Mr. Modi’s coronavirus strategy has been the devastation and misery it imposed on India’s informal sector workers, mostly people from impoverished villages, who work in Indian cities, without a safety net.
Hundreds of thousands of migrant workers were left without wages after the lockdown imposed with a four-hour notice closed factories and businesses. They couldn’t pay rent; they didn’t have enough to eat. They looked toward their villages, where they could find shelter and food by relying on extended family.
With the public transport suspended, the workers set out on foot, walking hundreds of miles in temperatures as high as 100 degrees Fahrenheit. In May alone more than 150 migrant workers walking back home have been killed in road or train accidents.
As the lockdown is being partially eased, the migrant workers are now making the same journey they could have made two months ago when the cases in India numbered fewer than 1,000. Since some of the workers are serving as unwitting carriers of the virus to areas of low prevalence, they are greeted with alarm and apprehension in their villages.
Demographics offered the Indian government considerable breathing room, but India now faces two challenges at the same time — a medical infrastructure already under strain in the very places where cases are rising most alarmingly and a population stretched to the limit by economic hardship, with many facing the threat of malnutrition and hunger.
Mr. Modi has a history of announcing sweeping measures with great fanfare and little administrative preparation or follow-up. He and his government will have to move beyond their focus on managing public perception.
The lockdown was observed with ease by the middle and upper classes, who can afford to do so. But the coronavirus cases are spreading fast in dense urban clusters of the poor, who can’t afford the luxury of social distancing. It is India’s poor who are and will be affected the most by a rising number of infections and economic hardship.
There is an Indian phrase for such a situation, a phrase that was already on the lips of every migrant workers leaving the pitiless cities for their villages under a punishing sun: “Bhagwan Bharose” (“With faith in God”). It is not an expression of faith in the rule of heaven, but an expression of a lack of faith in their rulers on earth.
Hartosh Singh Bal is the political editor of The Caravan magazine in New Delhi and the author of Waters Close Over Us: A Journey Along the Narmada.