“Social distancing… You must be kidding me.” Earlier this week, three Indian doctors made a compelling case about how tone-deaf, insensitive and non-inclusive the measures put out by the government to tackle COVID-19 are. In an essay they put out on March 15, the doctors—Vijay Gopichandran, Sudharshini Subramaniam, Vinod H Krishnamoorthy—based their argument on an incident that recently took place at the rural clinic they work at.
Last week, they said, a 50-year-old patient came to them with COVID-19 symptoms of fever, cough and breathlessness she had had for a week. The doctors were alarmed, but keeping the testing restrictions in India in mind, they started treatment for a lung infection. She had no travel history anywhere beyond the closest town, nor any history of contact with someone who had travelled to coronavirus-hit countries. To be on the safer side, they advised the woman home isolation.
Then the woman’s daughter spoke. “Doctor, what you are saying is not practical,” she told them. “Our house is a little hut and all four of us live in the same room. We have enough room just to lie down and sleep. Keeping a 1-meter distance is impossible. Three of us are women and it is not safe for women to sleep outside the house. There is also the threat of scorpions and snakes outside.” They tried to convince the patient to at least confine her movements to home, but her daughter insisted, “Rain or shine, sick or healthy, she must go out to graze the goats.” Through the day, they had similar conversations with patients, friends and families, all of which were essentially “a slap on [their] face”.
“All that social media is abuzz with is a lot of armchair speculation…Most public health advisories that have been released in the past few weeks are highly urban upper and middle class centric,” they concluded in their essay. “The reality of the poor and marginalised is very different.”Over the last few weeks, most of us have been tuning into the constant buzz around the many, many measures recommended by official medical experts and organisations, to restrict the spread of COVID-19. “Social distancing”, “self-isolation”, or “stocking up” are just some of the keywords doing the rounds. So while some people are figuring out how to protect themselves from this novel strain of coronavirus, here’s one uncomfortable truth: Not everybody can.
Coronavirus is Making the Rich-Poor Divide Even Worse
With its population of over 1.3 billion people, India has 176 million estimated to be living in extreme poverty. In fact, an Oxfam report released earlier this year showed how shocking the rich-poor divide in India is. “73 percent of the wealth generated last year went to the richest one percent, while 67 crore Indians who comprise the poorest half of the population saw a one percent increase in their wealth,” states the report. So what happens when a global pandemic hits an already broken social system?
The virus, initially seen as a “great leveller”—on the basis of several prominent politicians, celebrities and rich folks being diagnosed with it—is actually going to come down harder for the other end of the social spectrum, where “the proportionate losses are far higher”. “[This is where] the impact of the virus is likely to be most keenly felt,” said Oxfam International in a statement titled Coronavirus and Inequality. “Living day to day, the poorest do not have the ability to take time off work, or to stockpile provisions. Sick pay is non-existent, and even in the richest countries, after years of attacks on labour rights and increases in self-employed precarious jobs, poor workers are simply not in an economic position to take time off.”
This is currently happening across the globe. The New York Times observes that coronavirus is “pushing many of the burdens onto the losers of today’s polarised economies and labour markets,” and that the lower economic demographic is “likelier” to catch the disease. “They are also more likely to die from it,” says the report. “And, even for those who remain healthy, they are likelier to suffer loss of income or health care as a result of quarantines and other measures, potentially on a sweeping scale.” So in a world already ravaged by racial animosity, religious conflict, wars and other pre-existing vulnerabilities like health and workplace risks, what can a pandemic do?
In India, the inequalities of our social structure are already quite conspicuous on a daily basis, but COVID-19 has made this glaring divide an even more unsettling reality to live with. Here, the low-income and marginalised strata is not only in rural pockets, but also in urban centres where they provide services (such as food delivery and domestic work), even during the times of crisis. “They are the most vulnerable,” Amitabh Behar, CEO of Oxfam India, told VICE. “They cannot afford to miss work because of the fear of an epidemic, or when they are borderline sick.”
Unlike the Rich, the Poor Have Nowhere to Hide
The latest data has shown that “millions” of homeless people and those living in informal settlements (like the slums) across Asia are at great risk of contracting the coronavirus because of their living conditions. In India, at least 4 million people are homeless in urban areas, with more than 70 million living in informal settlements. Some of the key issues in such housing arrangements range from sharing resources and having community access to sanitation and drinking water facilities, to having little or no access to protective measures like sanitisers, gloves and masks, which are expensive and scarce. “If the virus reaches densely populated areas with slum homes, it would impact thousands of poor who lack awareness about this pandemic, the need for getting themselves tested and also low access to good quality health centres,” Amitabh Behar, CEO of Oxfam India, told VICE.
If you live in a city, you cannot not see this divide play out around you. Take the current Work-From-Home (WFH) protocol for a white-collar job, for instance, where you have the luxury to work remotely, but your domestic worker doesn’t. VICE spoke to Manisha Kadam, a 49-year-old domestic worker from Mumbai, who takes the massively packed local train at 8 a.m from her Ghansoli house to Chembur (a 22-odd kilometre distance), and works all seven days, across five houses, up until 6 p.m, because she has to support a family of five. "I tried looking for masks in my area but none of [the chemists] had any,” she told VICE.
When the news of coronavirus broke, Kadam, who lives paycheck-to-paycheck, decided to do her bit, like avoiding touching anyone in packed morning Mumbai locals, covering her face with her dupatta, washing hands frequently, and steering clear of coughing or sneezing fellow commuters. “I finally got a mask from one of my employers the day before but it's still scary. I live with my two sons, daughter-in-law and a four-year-old granddaughter, in a one-room-kitchen apartment. If any of us start showing symptoms, I don't know how we will avoid contact with each other,” she said. Another domestic worker, Asha Govinde, 46, told VICE that her employers have given her all amenities to stay clean, but “none of them have asked me to stay at home.” “They want me to keep coming, even though they think it’s risky to be outside,” she said.
This is where the concept of “social distancing” is lost on experts, especially with these realities staring back in the face. “The way the government and the general media is talking about [these measures], it’s clear that they don’t recognise the reality of what the people in India face, especially the poor,” Jayati Ghosh, professor at the Centre for Economic Studies and Planning at Jawaharlal Nehru University in New Delhi, told VICE. “If you look at the slums, social distancing is not an option for them. They’re living cheek-by-jowl, sleeping two or three in a bed, they are huddled together at work and in life. So what do you even mean by social distancing?”
The Deplorable Public Health System Will Make Things Worse
It’s also important to see where the poor and marginalised are placed in the whole scheme of COVID-19 treatment in India right now. As of now, there are 152 reported cases, out of which three have died. But many have pointed out that the current testing protocol—which only applies to those with travel or contact histories—along with the fact that there are only 51 labs (in a country with 732 districts) equipped to conduct COVID-19 confirmatory tests, gives a rather incomplete picture of the actual spread of the virus. So in a country where the public health system is already in shambles (which is also leading to some people running away from quarantines) and failing the poor on a daily basis, what will the current situation lead to?
Some experts are not hopeful, especially since we live in societies where the game is already rigged in favour of the one percent. “The further you are down the ladder, the worse off you are,” Blake Poland, a professor at the University of Toronto who specialises in health and community resilience, said in a VICE article titled ‘The Rich Will Win at Coronavirus Because Of Course They Will’. In India, this hits home hard. “The testing and screening are not even trickling down to the middle-class people,” said Ghosh. “My daughter has been self-isolating because her co-worker is displaying all the symptoms of COVID-19. Her doctor has told her she should get tested, but no hospital wants to test her because she doesn’t have any evidence of foreign travel or meeting someone who has had foreign travel. All her co-workers are clearly exposed. If this is the state among the middle class, imagine the poor.”
As we collectively witness Europe and the USA, with their much better health system and draconian system of isolation, knuckle under the impact of COVID-19, the deplorable public health system in India, and our reliance on it for its virus-testing just evokes more despair. “In India, states with robust government-funded healthcare systems have the potential to ensure that the poorest are able to access healthcare and treatment, especially in remote, rural areas,” said Behar. “Unfortunately, many states still lack essential health infrastructure and access to the poor is largely based on the patient's ability to pay or reach a health facility, rather than their need.”.
There’s Still More to Come
Lastly, the growing pandemic has hit the country as it burns from political and social unrest over the controversial Citizenship Amendment Act. Will it make things worse for the disenfranchised and marginalised, who are already caught in violence and conflict? “My fear is that [the pandemic] will exacerbate all the concerns of our society and not just the current unrest,” said Ghosh. “During the period of a pandemic, people become very self-oriented and develop self-preservation instincts for themselves and their family. They develop anger against anybody else outside their ambit. This can easily take a vicious turn.”
This “vicious turn” was recently seen in Italy, where terrified inmates in the country’s overcrowded prisons and detention centres, started a riot and burned down a prison facility. In more popular instances, countries are running out of basic amenities like toilet paper. In India, there are only fears of shortages right now. “We haven’t got to the stage of scarcity yet, but when that happens, there will be fights over who gets what, and this is where all the social divisions come to the fore,” said Ghosh. “It’s not just Hindu-Muslim but also caste, men versus women, etc. I’m sorry to sound so dystopian but this is already happening in other countries.”
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