If US and UK, with far superior medical infrastructure through public spends at 16.9% (US), and 10% (UK) of GDP, and far less population than India’s, failed at containing Covid-19 could India have done significantly better?
“The number of patients inside the hospital will be significantly less than last year and mortality will be less because of better preparedness and vaccination. We will never see a third wave!” This is not from a Modi bhakt, but it is from one of India’s most brilliant minds, a superstar highly respected doctor’s predictions in March 2021. He is a fine honourable gentleman doing yeoman service who said the above in good faith based on the data he had in front of him, then. The abiding lesson is that it’s a mission impossible to predict a pandemic, much less combat it, with seven decades of middling, decaying, crumbling medical infrastructure.
First, United States (US) even after 1 year, has bodies lying in freezer vans, without a decent burial; Japan’s world-class healthcare is buckling and patients are dying at home due to lack of hospital beds; German healthcare system was on the verge of complete collapse; and doctors bemoaned the catastrophic collapse in UK. Scott Galloway, the celebrated New York University don observed: “US and UK have demonstrated a level of incompetence that is staggering (when it comes to Covid)…with 5% of the world’s population and 25% of its deaths and infections, Americans have to take a hard look in the mirror and ask how a country that spends most on healthcare, prides itself on being an innovator, how we could have gotten this so wrong and had such an absolutely incompetent response to the virus”.
If US and UK, with far superior medical infrastructure through public spends at 16.9% (US), and 10% (UK) of GDP, and far less population than India’s, failed at containing Covid-19 could India really have done significantly better? Every life lost is a humungous un-compensable tragedy, and this essay is not an excuse nor a defence but yet what does the data say? As per Statistica, US and UK deaths/million are 1,778 and 1,906 respectively vs 213 for India as on 23 May 2021. (China was at a surprisingly low 3.47, which makes for many uncomfortable questions to be asked about the origins, including the probable funding of the “gain-of-function” research, or increasing the severity or weaponizing a virus) by Dr Anthony Fauci’s institution and others and the eventual escape or the spread of the virus. By the way, Dr Fauci has done a U-turn and is now saying Covid probably did not occur naturally.
Second, India is facing its greatest national tragedy since 1947 and every day for most of us, including me, is spent finding beds, ICUs, oxygen (and cremation grounds) for absolute complete strangers. My waking hours are spent reaching out to friends to check on their well-being and having lost a few loved ones to Covid, the sadness and helplessness are all-enveloping. Pain and with it anger, no matter how excruciating they are, should not obfuscate the clear stream of reason.
By all means, criticize the Government for valid reasons, but not without basis or knowing full facts. There are so many people going around with their eyes wide shut, showing “willful blindness” by comprehensively, nay deliberately, ignoring facts and data. India’s Covid surge has puzzled the topmost scientific minds in the world. Two epidemiologists, including those previously critical of India’s Covid situation, argued that the worst was behind us with the peak having been crossed in January itself. Nature is globally respected and is not the RSS’ mouthpiece “Panchajanya” nor is it part of the so-called “godi-media” nor are the epidemiologists cited there from Baba Ramdev’s outfit—just for the record. It has been an authentic and devastating “unknown unknown” and has left every response to it, inadequate—both in India and around the world.
Indeed, we have all made mistakes everyone, everywhere: governments, politicians, citizens, media, courts, healthcare and various other systems. But to be fair, we are facing something of a magnitude and severity none of us—citizens or governments—have witnessed in our lifetimes. Let us not forget that exactly 100 years ago, the Spanish flu killed about 40 million people and about 500 million people or one-third of the world’s population became infected with this virus. India alone had about 20 million deaths in just 4 months in its second wave. What is even more astonishing is that there is no cure for it, till date, a hundred years later. So, pandemics happen and then catastrophe follows. Chinmay Tumbe in “The Age of Pandemics” reports the inevitability of collapse during a pandemic:
Third, let us look at India’s health expenditure as a percentage of revenue expenditure (and as percentage of State GDP). Delhi 16.7% (1%) and Assam 8.8% (2.2%) are the top two, while Punjab 4.6% (0.8%) and Maharashtra 4.8% (0.6%) are the bottom two. Total health expenditure by Centre and States put together was about 0.9% of GDP in 2015 and is now up to 1.3% of GDP in 2019-20. India’s total healthcare spending (out-of-pocket and public) is 3.6% of GDP and is way lower than that of other countries. (OECD average is 8.8%). India spends the least among BRICS countries: Brazil spends the most (9.2%), followed by South Africa (8.1%), Russia (5.3%), China (5%).
Let us also remember that our tax to GDP ratio is also far lower than most of these countries. On top of it our per capita income is much lower than developed countries, so we have a smaller pie to share. The combined effect of lower GDP and lower health spending can be seen in this metric: critical-care beds/100,000 population: US tops at 34.7, Germany at 29.2; UK is 6.6, China 3.6 and India is 2.3. We cannot have a first world health care infrastructure with a third world tax/GDP ratio and the attendant middling health infrastructure. Expectations from Governments need to be tempered with these facts. These are plain facts. To expect India to counter a once in a 100-year pandemic with this kind of infrastructure, is asking for not just the moon, but it’s like asking for the whole galaxy.
Fourth, Government of India’s (GOI’s) Covid Modelling Committee comprising top scientists, predicted on 2 April that between 15-22 May there would be a second wave of about 1.2 lakh cases a day, as did several other experts. Immediately, GOI repurposed its long-term effort to take more immediate steps to counter it. Instead, the second wave with 4 lakh cases a day, came weeks ahead of what some of the best statistical and epidemogical minds and models had predicted. The second wave in Germany, Italy and Spain lasted between 60-140 days, despite their far superior AI-based predictions.
Fifth, the spread has happened in difficult-to-predict ways. Neelkanth Mishra of Credit Suisse argues that despite Delhi being seropositive, the virus evaded antibodies in Delhi, but not in Mumbai, which is another puzzle. Could the Government have done anything to stop a virus that evades antibodies? Kumbh could have been avoided, but the global evidence is extremely mixed on the causality of crowded outdoor events and spread of the pandemic. (Indeed, there is evidence that being outdoors is relatively much safer). Thus, it could have happened without it too. Don’t forget Maharashtra and Chhattisgarh second wave surges happened much before these events and UP’s panchayat polls were ordered by the courts.
The protesting farmers are violating both the Delhi and Haryana lockdowns. Are they an essential service? Can’t they be superspreaders too? The “so-called communal election rallies” in Bengal were unnecessary but weren’t the “so-called secular election rallies” of Tamil Nadu, also unnecessary? Incidentally, we Indians are not alone—Germans too behaved in this way and before Easter the churches refused to go into lockdown forcing Angela Merkel to change her policy. Can we as a nation remain socially undisciplined and complacent, not change our community behaviour, not follow Covid protocols, and yet expect Covid not to ravage us?
Lastly, the most vaccinated country in the world, Seychelles, which has jabbed over 70% of its population is seeing a Covid surge, or similarly Chile which too has vaccinated almost half its population. Is there any causality between mass vaccination, herd immunity and a Covid surge? If this wasn’t enough, another puzzle is that the evidence regarding lockdown preventing any Covid surge is extremely mixed—the vaccine has appeared to stop, as well as not stop the spread of Covid, with cases of death even after both doses.
Anything, anyone does anywhere—be it a SpaceX launch or a country fighting an “unknown unknown” pandemic—can, with hindsight, have been done better. The inadequacies of the vaccine strategy, the deep initial vaccine hesitancy, the badly broken oxygen and essential drugs supply chain (even though oxygen supply was increased manifold in the last few months), the large-scale black marketing in oxygen and medical supplies, the fudging of data—all could have been at least controlled. Not just doctors and nurses but many others—IAS/IPS/IRS officers, policemen, sanitary workers, accounting people processing bills for medical supplies, etc.—are working very hard (and not from home) and doing so while also being under risk of catching the disease.
In every Government of every political complexion, most officials are very hard at work in the face of heavy odds and personal risks—there has been virtually no “work from home” for most of them, most of the time. Yes, they can perhaps do more and do better—but this is not the time to demotivate them by haranguing them. It will only lead to a complete demotivation and surrender—people will stop whatever fight they are putting up, in the face of all odds, against Covid. The least we can do is to stop fighting amongst ourselves for political scores (or because we hate an individual or some ideology right or left or centre or perhaps some set of officers).
In sum, Covid’s second wave led to an unsurprising, inevitable collapse in India and around the world, and ignoring many of the facts and data by being willfully blind, only points to our own hypocrisy. Hindustan doob jayega—it’s all over for India; economy doob gaya hai, sub kuch doob gaya hai—everything is over. While a country is at war, the least, the very least, any citizenry can do is to come together, not keep handwringing, stay united and face the enemy, which in this case is both invisible and unpredictable. Don’t throw stones at the fire brigade, while they are fighting the fire. (If you hate them so much, do it after the fire is put out, not while the firefighting is on). Instead of cursing the darkness, light a candle to dispel it. This too shall pass.
Dr Srivatsa Krishna is an IAS officer. Views are personal. @srivatsakrishna