21 days for each other

By the time I post this, India would’ve started day 1 of a 21 day curfew. It’s an insane idea which will not just inconvenience a lot of people but also throw lives into disarray. The economics of it is of course terrible but the human costs are much more severe. Lots of people will be out of jobs, out of their homes, hungry and unable to access basic resources. We will hear heartbreaking stories about people who are beaten up by the cops for no real reason. We will hear about the ridiculous lack of capacity at government hospitals. There’s no denying that for the foreseeable future, we are going to hurt just as the rest of the world has. There is nothing “right” about this decision to confine people to their homes and, in many cases, to the streets.

And now imagine all those exact same consequences for all of those people but with the additional burden of a virus that, as of today, has no cure or vaccine.

India is an unenviable situation. But we’re at that stage in this pandemic where inaction is not an option. A lot needs to be done. But the first step is to ensure that this is a crisis we can handle and the only way to do that, is to stop the spread. Two weeks ago, New York City where I live had 21 confirmed cases of Coronavirus. Today, 14 days later there are in excess of 14,000 confirmed cases (with more to follow). There are all sorts of statistical disclaimers which need to go with that but one thing is absolutely clear – left unabated, this virus will spread and do so quickly. For sake of transparency, I should add that the death rate in NYC is far, far less than that in Italy (where a majority of those who died where older people). But that is neither comforting nor the point.

The point is simply this: Our hospitals in India are desperately and depressingly under-resourced. The All India Institute of Medical Sciences in Delhi is the premier government medical institution in the country. Wait times for critical procedures at AIIMS is so high, people often have to camp outside for weeks to get in. AIIMS is no outlier. According to the World Bank, Italy has 3.4 hospital beds per 1000 people in the country. The United States has 3. India? India has 0.5 hospital beds per 1000 people.

Image result for aiims people waiting
Patients camped outside AIIMS waiting for their turn (for weeks).
Source: https://timesofindia.indiatimes.com/blogs/no-filter/waiting-for-doctors-appointment-spends-cold-nights-on-pavements-bus-stops-and-subway/

A 2017 study in Madhya Pradesh, found that there were only 2.5 critical care beds per 100,000 people in the state (and 75% were in private hospitals) and only 13% had a round-the-clock intensivist. These shortages of infrastructure and personnel are not unique to India but they’re especially acute given that a majority of our population rely on government hospitals.

All of that lack of capacity, is on a normal, business-as-usual day. But we don’t live in normal times.

There are people with life-threatening disease OTHER THAN coronavirus who aren’t able to access critical care in India. Now, imagine you add even a small number of “critical” coronavirus patients on a list to be on ventilators. You might save some coronavirus patients but you’ll almost certainly kill the others. And THAT, is the point. An overwhelmed healthcare system will collapse if we add strain to it and while statistically the coronavirus’ death rate maybe low, all the other life-threatening illnesses haven’t been put on pause.

What makes coronavirus special? Why shutdown the country because of coronavirus and not, say, because of Tuberculosis? GREAT QUESTION. India’s “contribution” to global TB cases is, a slightly terrifying 20%. But TB is, in theory, with the right treatment protocol curable. But the fact that drug-resistant versions of TB have emerged and we’re too under-resourced, too untrained and overall still struggling to deal with it is all the more reason to take the coronavirus seriously. In 2019, Prime Minister announced at the United Nations that India will aim to eradicate TB by 2025. A laudable mission and one that we must absolutely win. But in the meantime, we cannot afford another disease outbreak.

We cannot afford another disease outbreak

That’s the point. That is the only point. It isn’t whether coronavirus will kill us all. It probably won’t. But you only have to turn to China, Italy, the UK, the US or any other country to see what kind of strain it puts on the system. The system is put under strain when people who are vulnerable (the “at risk” population – people with underlying chronic medical issues or old people) need to get critical care. Even if you asked them to stay at home, people around them might be infected and, in turn, infect them. So it is beyond urgent to make sure that we reduce the number of carriers and spreaders of this disease.

Go back to the top of this article. Think about the consequences of the curfew for all those people who are likely to be affected by it. Now think again if, under that circumstance, someone in those families needed urgent critical care. We simply wouldn’t be able to give it to them.

A sign pasted on a security barricade is seen after the India Gate war memorial was closed for visitors amid measures for coronavirus prevention in New Delhi.   Source: Reuters

It might turn out that in a week’s time, after widespread testing, the virus hasn’t spread that much at all. If that happens, it is easy enough to roll back the 21 day curfew and “re-open” the country. Doing that backwards, is not an option. Three weeks ago, NYC was open to business. Day before yesterday, the governor imposed a state-wide shutdown but only after 10,000 cases were already confirmed. A shut down, as evidence shows, is inevitable. WHEN it happens, is a hard decision and one that I’m glad Modi took seriously.

Demonetization was a pea-brained idea and I roundly criticized it at the time and I continue to do so. I can count on the fingers of one hand, the things that I like about PM Modi: 1. The Swacch Bharat mission and 2. That hilarious troll video of him placing garbage on a beach. This curfew ranks highest on that list because it could literally save the country.

There’s one thing he still needs to do though. That is host a (virtual and unscripted) press conference where he and his covid response team takes questions about India’s preparedness and gives the people answers. It is mind boggling that in his 6 years, PM Modi has done exactly one press conference. The lack of accountability is astounding and that can’t be the case with this crisis. This “governance by diktat” where he shows up one evening, broadcasts a video and disappears is unsustainable.

If you don’t think coronavirus is serious enough to mandate a curfew, please critique the decision (from home). If you really like the decision, please celebrate it (from home). As I said in an earlier post, the Janata curfew was a test which a large portion of the country passed but we also saw exactly the stupid, irresponsible, illogical, irrational behaviour that we’ve come to expect from some people. The reason YOU should take it seriously is so that you can then convince others to do so too. There will absolutely be challenges in implementing this curfew. We have to figure out how to get food and money to the people who need it most for these 21 days. But that is a far, far easier problem to solve and its the kind of goal-oriented, mission-mode task that our colonial bureaucracy is optimized for. We have to figure out rules for allowing people to buy groceries and medication. That will be challenging too but if we’re not all collectively crazy, we can get through with it.

I haven’t thrown thoughts onto a page this incoherently in a long time but it is really hard to focus my thoughts on this subject. Please just follow up the rules. Please stay safe and stay at home. If you’re sick, you will most likely recover at home over time. Just make sure to stay away from other people especially those who have old and/or vulnerable people at home.

This is for all of us.

Of course this is all the government’s job. But the time for passing the buck is not in the middle of a crisis. Where we can help mitigate the damage this will cause for the poor and the disadvantaged, we must. This is for them. Got ideas? Share them! Lets try to find some support and do it! (Crowdfund a weekly PayTM deposit to your regular sabziwallah aunty or someone similar who you know personally who needs it?)

I can think of my neighbors, even those who refused to give us back the ball when we accidentally hit it into their balconies or those who ratted to your parents because they saw you with “some boy”. Those aunties and uncles may mean nothing to us but they’re someone’s parents and grandparents. This is for them.

There will be cops under scrutiny to keep the streets clear 24×7 even now instead of being with their families like the rest of us. Don’t add to their job. Thank them later. This is for them.

The grocery store employees who have to show up to work despite the risk of contracting the virus? Don’t be rude to them! Be nice. Keep a safe distance. Wear gloves. This is for them.

If you have a driver or a gardner or a domestic help, please pay them and ask them to stay at home. If you have a security guard in your housing society, ask them about their families and help them in meaningful financial ways. This is for them.

There are people working crazy hours, behind the scenes in some government office somewhere creating the policy response to this, creating the solutions to these problems and who have to take critical decisions by the second. This is for them.

The people who are going to be under most severe stress in the next few months are our doctors. I could hear your pots clanging and bells ringing all the way in NYC. Now don’t forget them. This is so that they can focus on their (already insane) stressful jobs. This is for them.

This is 21 days for all of us.

P.S: Don’t forget to wash your hands (and don’t touch your face).

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