With the nation in the midst of an extended lockdown to prevent the spread of COVID-19, the question of what to do next looms large. We are operating in a brave new world where modern governance has met an old-fashioned enemy. The Spanish flu epidemic of 1918 is believed to have killed more than 15 million Indians and COVID-19 is seen to be almost as virulent. At the same time, there are more weapons in our arsenal to deal with this enemy today than a century ago.
Worldwide, social distancing is seen as a way to reduce the spread of the disease until health systems are able to cope with it and a vaccine is developed. The challenge we face is between public health needs and the requirement to keep the wheels of the economy rolling. How has the lockdown affected the society? Should we continue it for a few more weeks? While there is no crystal ball to predict the future, a recently completed Delhi National Capital Region Coronavirus Telephone Survey (DCVTS) by the National Council of Applied Economic Research (NCAER) offers interesting insights into the present. The NCAER National Data Innovation Centre has carried out the Delhi Metropolitan Area Study (DMAS) since February 2019. It has surveyed over 5,000 urban and rural households in Delhi as well as in the surrounding districts of Uttar Pradesh, Haryana and Rajasthan via in-person interviews. Between April 3 and April 6, 2020, about 1,750 households from this larger study were surveyed in a telephone interview about their understanding of symptoms and transmission of the novel coronavirus as well as their experience of the lockdown.
The results are fascinating. The massive communications effort undertaken by the government ensured that every single person interviewed had heard of coronavirus and 95 per cent believed it to be very dangerous. When asked to identify symptoms of the infection, they could easily distinguish between coronavirus as a respiratory disease as opposed to a gastrointestinal disease. The next stage of communications messaging, however, will need to focus on helping people identify when to seek help. Only about 45 per cent of the respondents noted breathing difficulties as a key symptom and only 36 per cent correctly named all three — fever, cough and breathing difficulties — as major symptoms. Past rounds of DMAS have found that 11 per cent of individuals suffered from cold and flu like symptoms. If all of them try to get coronavirus tests, this will pose an overwhelming challenge for the health system. Thus, educating respondents about key symptoms and identifying conditions under which treatment must be sought will be a necessary part of future communications strategy.
Respondents reported that the lockdown resulted in substantial reduction in income in the preceding two weeks. About 55 per cent respondents said that their incomes had reduced “very much” while 30 per cent said it had reduced “somewhat”. Most of the income drop occurred in households that drew income from casual labour or petty business. Regular salaried workers were somewhat isolated, as were farmers. Among households where the primary source of income was casual labour, 75 per cent suffered large income loss compared to 47 per cent for regular salaried workers. The drop in income affected households in the bottom 20 per cent of the wealth distribution more than those in the top 20 per cent — 62 per cent in the bottom quintile reported a large decline in income compared to 42 per cent at the top. This lends strength to the urgency for ensuring income support to households below the poverty line.
When asked about the supply of essential goods such as food, cooking fuel and medicines, 29 per cent respondents reported shortages in accessing one of the above items. Disaggregated data shows that 21 per cent respondents mentioned experiencing shortage of vegetables and fruits (25 per cent in rural areas and 15 per cent in urban areas), followed by grains and cereals (14 per cent), medicine (9 per cent), cooking fuel (8 per cent), and milk (6 per cent). This suggests that supply chains need to be strengthened and efficient distribution, possibly via PDS shops, will have to be ensured.
Social distancing, one of the primary weapons in our arsenal, is understood by most households and people are making an effort to follow it. About 85 per cent of the respondents noted some form of social distancing as a way of preventing infection. When asked about how many people they had come in contact with outside the house over the preceding 24 hours, over 50 per cent responded that they had not come in contact with anyone. Most of the others noted only one or two contacts outside the house. However, a minority of individuals had a large number of contacts. Many were in occupations like shopkeeping that did not allow them to distance themselves. We will need to develop strategies, such as use of masks, that allows these individuals to continue to offer essential services while reducing spread of the disease.
In spite of the difficulties noted above, the support for the lockdown remains high. When asked, “in order to limit the spread of the coronavirus, if the lockdown phase is extended for another two weeks after April 14, would you support that or oppose that?”, 63 per cent strongly supported it, 24 per cent supported it, 4 per cent opposed it while 9 per cent were either neutral or responded that it depends on the situation. This willingness to continue the lockdown is striking considering the fact that while most respondents understood the danger posed by the virus, few saw it as being personally threatening. When asked about the chance that they themselves or their family members may contract the disease, 65 per cent reported no chance while another 22 per cent reported low chance of getting infected with the virus. These results suggest that there is tolerance for the lockdown, at least among the individuals who responded to DCVTS in the Delhi NCR region. However, we will need to focus on maintaining transportation arteries and ensure that both production and distribution of critical items, including food grains, continues as smoothly as possible.
An emergency, like the threat of coronavirus, brings out the best and the worst of ourselves. It has brought forth a civic response unlike any we have seen in the past outside of war times. Regardless of their personal situation, individuals stand ready to fight the virus. In spite of some missteps, it has also brought out the strength of the Indian bureaucracy in identifying the challenge and in mobilising strategies like social distancing before the virus had a chance to spread to rural India. At the same time, it has also amplified preexisting vulnerabilities where some segments of the society face greater challenges due to loss in incomes or are at a higher risk due to preexisting conditions such as diabetes or heart condition. The coronavirus threat also highlights the vulnerability of the Indian health system, forcing us to make difficult choices in who to test, whom to treat and when to treat as we try to deal with shortages in testing supplies and treatment facilities.
Desai is director and Pramanik deputy director at NCAER National Data Innovation Centre. Views are personal
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